Photo by: JD Mason
Physician assisted suicide, aid in dying, death with dignity, end-of-life options or right to die…call it what you will but California has now become the fifth state to allow terminally ill individuals the right to end their lives legally. Governor Jerry Brown signed this monumental legislation on October 5, 2015 after reflecting on what he would want in the face of his own death. It felt great to be a Californian on that day!!
Undoubtedly, Brittany Maynard and the attention she brought to Death with Dignity played some type of role in this. The 29-year-old diagnosed with terminal brain cancer in 2014 passionately advocated for the right to die and shed much needed light on what it really means to have end-of-life options. With having a 6-month prognosis to live, she was adamant about how she would spend that time and die on her own terms. Unfortunately, that meant uprooting her life to move from California to Oregon where they’ve had legalized death with dignity for over two decades.
The End-of-life Option Act is just that. It gives those with a diagnosis of 6 months or less to live the choice to say when and where they die. It isn’t for everyone but for those that want to have the option, it’s comforting to know they now do. As a society, we commonly view euthanasia with our dying pets as humane and the honorable thing to do yet that hasn’t always carried over when considering human life. There does seem to be a movement and the fact that more states are putting these types of initiatives on the ballots shows a shift in public opinion and acceptance.
When end-of-life options are brought up, we hear a lot about “suffering” and it’s important to recognize that it isn’t only physical pain individuals go through but psychological anguish as well. Physicians in Oregon report the most common reasons for requests are “loss of independence, poor quality of life and a desire to control the circumstances of death” (Dunn, Reagan, Tolle & Foreman, 2008).
Many opponents believe that Physician Assisted Suicide (PAS) will dramatically increase and become a favored method for physicians and families to escape the “burden” of dying individuals. However, when you consider how its been utilized in Oregon, the statistics just don’t support this notion. In 2012, 115 people were written prescriptions for the lethal dose but only 67 of them resorted to using it. The Oregon Public Health Division reports annually on Death With Dignity Act (DWDA) prescriptions and subsequent deaths. As of 2012, a total of 1050 prescriptions have been written since legislation passed but only 673 patients have utilized them (Oregon.gov, 2013).
It’s also been feared that the gains hospice and palliative care have made will be superseded with PAS. However these routes for end-of-life care do not need to be mutually exclusive. A majority of individuals that request PAS are also receiving hospice care. In Oregon, 93% of those who carried out PAS from 2008-2010 were on hospice (Cambell & Cox, 2011). It’s also important to note that Oregon hospice utilization is among one of the highest in the nation. Perhaps all the attention that Oregon has received in light of legalizing PAS as well as the states program to record individuals’ wishes for Physician Order for Life Sustaining Treatment (POLST) have subsequently brought end-of-life concerns to the forefront.
While it might sound cold and callous to talk about the medical cost of a dying individual, there is a tremendous expense to end-of-life-care that needs to be considered especially with our aging society. Considering that “three-quarters of individuals that die each year are 65 and over, it accounts for 27% of Medicare spending” (Falls, 2008). The National Hospice and Palliative Care Organization believe that half of these costs are incurred in the last 2 months of a patient’s life when technology based procedures and drugs are used to prolong life (National Hospice and Palliative Care Organization, 2004).
Again, this does not mean that because someone is terminal that PAS should be sought to avoid the high medical costs, but it does mean that as our country ages and Baby Boomers get older, we need to take a serious look at death and maybe reevaluate how we approach it. While advancements in medicine and medical procedures have proven to extend human life, death is still very much a fact of life. It shouldn’t be a competition to see who can live the longest and how long doctors can prolong a terminal patient’s life. There is no consolation prize. Death will always be one of the most difficult topics to face and discuss. But for some, quality of life is more important than quantity of life.
It’s been over 20 years since the first state, Oregon, passed Death with Dignity and it seemed to be slow going for other states to follow. However, in recent years, more states have joined and it seems we are moving in the right direction. Nobody knows what they will do or not do when facing their own mortality but I can say I am truly grateful to live in a state where we have options and a say in the way we choose to live out our life….even if that means PAS.