Update on Death with Dignity in Washington State

Just a short piece in the Seattle Times giving some stats on what has happened under the first six months of Washington state's Death with Dignity Act. 

Twenty two people have received prescriptions for life-ending drugs, and it seems 16 of them have since died. The article cites sources that claim 11 are known to have died from using the medication, as opposed to natural causes. (The state will not release information on how exactly specific people have died because of patient confidentiality laws.)

That's about all the article says, except for a couple of quotes from groups on either side. But it's only a few quick paragraphs if you want to check it out. 

Is Assisted Suicide a Constitutional Right?

That's the question Montana's State Supreme Court will take up on Wednesday. 

It stems from the case of Robert Baxter, a 76-year-old retired trucker who died of lymphocytic leukemia. Baxter, while still alive, sought the right to die, and took his battle to the Montana court system. A lower court ruled in his favor, on the very day he died. The State of Montana appealed the decision and it has now reached the state's Supreme Court. 

According to the New York Times:

"The legal foundation for both sides is a free-spirited, libertarian-tinctured State Constitution written in 1972 at the height of a privacy-rights movement that swept through this part of the West in the aftermath of the 1960s. Echoes of a righteous era are reflected in language about keeping government at bay and maintaining individual autonomy and dignity."

It seems now, not only is the right to die being advocated for from some of the more liberally minded states (Washington and Oregon), but now we're seeing a movement come out of a more conservative, individualistic state. 

And we're seeing some different arguments because of the unique nature of Montana. For one, since so many people live in near isolation, opponents worry that the sick will be pushed into the law out of a lack of access to proper healthcare. Montana also already has one of the highest suicide rates in the nation, and some worry about enacting such a law in an area that already has problems with suicide. 

On the flip side, proponents state the need for individualism and autonomy in decision making—the rights of the individual to direct his or her own fate. 

This will be interesting to watch. And if the court does approve the assisted suicide, it will be interesting to see what type of law they come up with, since this move has not stemmed from a carefully drawn out initiative, the way Washington's and Oregon's laws did. Will they essentially copy Oregon's law, like Washington state did, or will they do entirely their own thing, which seems more in the character of Montana. 

Euthanasia

I wanted to share this with you all.

Hospice Physician in the comments section of last Friday's post, helped me clarify my paraphrased definition of euthanasia. 

"To address your quote below:

'when a medical practitioner directly brings about death by administering medicine to the patient'

This is true but to clarify even more, euthanasia is a deliberate act with the intention of causing death in a patient. There is an ethical principal called the "Rule of Double Effect" which states, a medical practitioner is not acting unethically by giving pain medication, for example, that may lead to death, if the intent is not to cause death but to relieve pain/shortness of breath or promote comfort."

I'm always a fan of further clarity. Thanks Hospice Physician!

Details, please

Newsweek has this piece that is supposedly debunking seven myths of the current healthcare debate. 

While debunking the myth that the House bill requires suicide counseling, this article states:

"Euthanasia, on the other hand, is legal in only three states, making it even more unlikely to be a major part of the federal health plan."

Pardon me, Newsweek, but euthanasia is not legal in any state. But death with dignity is legal in a handful of states.

The proper terminology makes a huge difference. Euthanasia in general means a mercy killing, but in practice usually refers to when a medical practitioner directly brings about death by administering medicine to the patient. Most people think of what vets do with their pets when they hear the word euthanize.

Death with dignity is a more specific phrase that refers exactly to the recently passed into law procedures in which the patient is prescribed medicine that they can take on their own to bring about their own death, on their own terms, at their own time, when they're comfortable doing so. And all along, the patient can decide not to go through with the practice. 

General euthanasia is not legal in any state. The specific act of death with dignity is legal in certain states. 

Besides which, since death with dignity is such a heated topic, and something that has the potential to make a revolutionary difference in the amount of choice and control people have over the way in which they approach death, they manner in which we speak about it is incredibly important. We need to be careful about what we're referring to and be clear about what we're talking about. I realize this was a side issue in this article, but a news magazine should be better at articulating the details. Simply calling it euthanasia is flippant, careless, and inaccurate.   

Death with Dignity Panels

So, I've gone from thinking I wouldn't post anything on the healthcare-reform debate to posting on it twice in two days. 

The Senate has removed the portion of their bill that allows Medicare to pay doctors for counseling sessions with patients regarding advance care and end-of-life planning. (Right now, it's still in the House version of the bill.) 

Just to be clear, these counseling sessions are happening already. End-of-life planning often occurs when someone becomes terminal. Patients will sit down with their team to discuss their options for resuscitation, hospice care, pain management, comfort, etc. 

What this particular bill provision addresses is not the actual conversation but Medicare coverage of the conversation. By paying doctors for time they are now not getting paid for, they may be encouraged to hold even more end-of-life consults—thus allowing more people to openly discuss how to create the best death possible for themself, making this blogger very happy. 

And yet, proponents of it are pushing fear in our faces, speaking as though passage would magically make death come sooner. As though the government is going to be paying off doctors to tell patients it's time to go. 

The American Medical Association supports this provision. The National Hospice and Palliative Care Organization supports this provision. These are two highly reputable organizations. Plus, to insinuate that individual doctors would go against their ethical, sworn duty to "first do no harm" and actually give up on patients because they're given money from Medicare, is incredibly insulting. 

Sarah Palin has infamously gone so far as to call these "death panels," which is so absurd, I don't even know how to address the claim.

When I hear these arguments, I can't help but flash back to some of the anti–death with dignity arguments. 

One of the big arguments against death with dignity—one of the fallacy, weak arguments—is that insurance companies will use the legislation to push people into death so that they don't have to pay for continued treatment. (Remember the Martin Sheen ad?) 

Well, if you replace "insurance company" with "the government" and "death with dignity" with "healthcare reform," this is basically the same argument being paraphrased and reshot at us. 

It's inaccurate, and it's fear-based, and it's a shame that it looks like it might pull the public away from more information and better choices. 

Fran Johns has a new blog

A sign of how out of the loop I've been lately (due to a cross-country move), Fran Johns has a new blog, and it's taken me a month to notice. 

But enough about me: The blog is excellent. 

Fran focuses on issues facing the elderly, and Baby Boomers who have elderly parents. The current post shares the thoughts of a retired California physician on Death with Dignity now that he is facing his own mortality. It's amazing! 

Other posts address housing options for seniors and palliative care. 

The site doesn't load real well format-wise on my Mac computer, but it looks like the site is still in beta testing, and it's worth bearing with any format issues to get to the content. Fran is one of my favorite writers in the blogosphere, and I try to read every word she posts. Trust me; she's that good. 

First Death with Dignity in WA

Yesterday, Washington state had its first death under our new death with dignity law. It was a 66-year-old woman with stage four pancreatic cancer.

Here is an article about the case from The Seattle Times.

When it rains, it pours ...

Another piece of good news from our current administration.

From The New York Times:

"WASHINGTON — The Obama administration moved on Friday to undo a last-minute Bush administration rule granting broad protections to health workers who refuse to take part in abortions or provide other health care that goes against their consciences."

The article references issues related to women's rights and reproductive choice, but as I blogged earlier this week, Barbara Coombs Lee has been very vocal in getting the word out that this law would also affect people's access to death with dignity.

Death with Dignity Specifics Adopted

Washington state has adopted the specific guidelines that it will use to implement its new death with dignity law. The Seattle PI has this article about the guidelines.

Unfortunately, the article is not super informative and is actually pretty vague and confusing. (I think it tries to cover too much in one piece instead of just focusing on the most recent developments.) But I'm going to link to it anyway since it's one of the first mainstream pieces written about death with dignity in our area in a while.

I'm hoping, as the deadline approaches, some better, more specific information will come out.

The Conscience Rule

Barbara Coombs Lee of Compassion & Choices has recently been blogging at Huffington Post about the "conscience" rule.

This law went into effect on January 19 it allows medical workers to refuse to participate in care that goes against their moral beliefs. Obviously, one of the areas this can and will affect is death with dignity. And we already know some facilities in Washington state have decided not to participate in the newly passed law.

Particularly troublesome for me would be any physicians who would refuse treatment but also would not tell patients that the option is available for them. The post by Barbara Coombs Lee says most physicians who object to a treatment would let a patient know about a treatment but some would not—no figures are given though.

Whatever side you come down on, it is an important issue that is getting lost in the midst of economic worries. Check out the blog or Google the topic—but Google "conscience rule HHS," or you won't get decent results.

Death with Dignity Deadline Approaches in Washington

According to The Seattle Times, medical organizations throughout Washington state are struggling with whether to participate in Washington's new Death with Dignity Act.

And whether they decide to participate, they are frantically working to prepare for the March 5 deadline to be ready for implementation. Caregivers must be able to handle questions on the law, be set to refer patients, give out prescriptions if they and their organization are choosing to do so, know their policy on mental-health evaluations, etc.

Oregon, the only other state to legalize death with dignity, ended up with approximately three years to implement their law due to all of the legal challenges brought against it, as this New England Journal of Medicine article pointed out. Since their state's law was taken to the U.S. Supreme Court, we're unlikely to end up in a similar situation.

Let's hope for some patience and cool heads during this transition. It's a tight, tight deadline for Washington state. Only four months to put into place a very complicated and very controversial law.

Televised Assisted Suicide in the U.S.

In the comments below, Dethmama asks whether assisted suicide has ever been televised in the U.S., as they have just done in Britain.

This is by no means a comprehensive answer, but I was reminded of 60 Minutes' interview with Dr. Jack Kevorkian from 1998, during which they televised the euthanasia of a man with Lou Gehrig's disease. (It was an actual euthanasia; Dr. Kevorkian was responsible for the act of death.) 

The interview was what led to Kevorkian's imprisonment for second-degree murder. He served about nine years of a 10–25 year sentence. 

I can't find the actual clip of the first interview, but I found this clip from a follow-up interview that shows most of the original piece within it. However, CBS' site won't let me embed it, so you'll have to follow the link to view. 

There are some marked differences between the U.S. piece and the British piece:

*First, the U.S. piece is as much about Kevorkian as it is about assisted suicide. 

*Second, I'm really struck by how the British piece gives the dying man a voice. And I realize someone with advanced Lou Gehrig's disease cannot speak well ... but there are other things that could be done—talking more to family, photos of his past, stories, etc. 

*Third, the British piece showed us an assisted suicide done through legal channels, so we are well positioned to confront the issue. The shock value of breaking the law, doing things behind closed doors, with shady methodology, all of that is gone. Dr. Kevorkian lost his medical license in 1991. Thus, he didn't have access to the usual cocktail of barbituates used for assisted suicide. What we see in the U.S. piece are his makeshift means. In the British piece, the man's death feels peaceful; he says goodbye to his wife. I see a death with dignity. In the U.S. piece, I see a more haphazard way of ending suffering. 

Assisted Suicide in Britain

Controversy has flared up over assisted suicide in Britain this past week.

This catalyst was a televised assisted suicide—the suicide of Craig Ewert who was 59 and suffering from motor neuron disease.




Ewert took a fatal dose of barbiturates in a Zurich clinic in 2006, although the documentary covering his decision and final act was first shown just last week.

Assisted suicide is illegal in Britain. According to the NY Times, about 100 Britons have committed assisted suicide in the past decade or so—by traveling to Switzerland or other locations where assisted suicide is legal.

I'm really glad the show aired. You all know I support death with dignity and assisted suicide, but beyond that, even for people who are against this movement, discussions like this get us all thinking and talking about death. And the more it comes into the open, the less alien it becomes. And I hope, the less frightening it becomes.

Ewert's wife was quoted in the New York Times saying, “For Craig, my husband, allowing the cameras to film his last moments in Zurich was about facing the end honestly,” she wrote in The Independent, a British newspaper. “He was keen to have it shown because when death is hidden and private, people don’t face their fears about it.”

My thoughts exactly.

NEJM Piece on Death with Dignity

From the New England Journal of Medicine, a nice overview piece on the passage of the Death with Dignity Act in Washington state, how it compares to the law in Oregon, what the two laws have meant for palliative care, and what they might mean for the future of palliative care.

It's a lot to cover in such a short article, but Dr. Robert Steinbrook offers a succinct and logical take on the controversies and goings-on.

One interesting point: due to legal challenges, Oregon law makers and health workers had about three years to figure out how to implement their version of the law, while Washington state will only have four months. How will this change the shape of care?

Death with Dignity—Not a Trend

I must apologize for being a couple of weeks late catching this editorial. ...

It's from The Oregonian, and it argues that Washington State's recently passed Death with Dignity Act is not simply another fluke, like Oregon's, but the beginning of a larger national trend.

The author, Don Colburn, points out that the Death with Dignity Act captured 59% of the vote and won 33 of 39 counties in Washington. That means, it didn't fall into the typical, Seattle and other big cities vs. eastern Washington and other more rural areas—a fairly typical liberal/conservative divide in this state. The initiative also outdid our Democratic governor, who won reelection. And it outdid Obama, who won the state.

So yes, Washington state can be fairly progressive and fairly liberal, but Colburn shows us that it's not just progressive liberals supporting Death with Dignity. Compassion and Choices has mentioned many times their desire to spread this work to other parts of the country. We just have to keep pushing the dialogue forward.

Initiative 1000—Death with Dignity—Update

Officials in Olympia have begun drafting legislation for Washington state's new death with dignity law. According to The Seattle Times, they have four months to come up with the exact law ... because it goes into effect on March 4.

Ah, also, just found this. ... mynorthwest.com has an even better article with more information. Two points of note. The piece points out that any legal challenges to the law could be difficult since Oregon's law has been upheld by the Supreme Court. Also, it quotes Jennifer Hanscom, spokeswoman from the Washington State Medical Association, which opposed the initiative: "She said it will be looking closely at the initiative language to see if there's room for improvements, but 'we are not actively seeking any changes.'"

Both facts are good to hear, although I'll be surprised if implementation is not some sort of struggle, if for no other reason than Seattle and Washington state are famous for over-processing everything!

Death with Dignity Initiative Passes in Washington

The Seattle Times is projecting victory for Washington State's Death with Dignity Initiative, I-1000. I'm so grateful and proud of my home state. And score one for the initiative process!

This makes us only the second state in the country to pass such legislation.

If Oregon's history with the law is any indication, many legal battles are in the future for Washington's Death with Dignity legislation. But this is a big step forward. And any legal battle means more press, which means more discussion about the way we die.

"I'm not afraid of dying ... I'm just afraid of dying like this."

A quote from this piece in today's Seattle PI. The article covers some of what has happened over the 10 years Oregon's Death with Dignity law has been in place. I think it does a better job of providing a balanced overview than The Seattle Times piece did. (Less focus on exceptions, more compilation of overall statistics, although it's still a bit negative and fear-laden for my tastes.) The visual I include here is from the PI's article.

I hope this law passes. But right now, I'm so happy to see an article about the way we face death on the front page of Seattle's daily paper. This is definitely a step toward helping us all talk about death to the extent we should. Yay!

Also, I promise a thoughtful, non–I-1000 related post soon. It's just been in the news and on my mind a lot lately.

One Patient's Struggle with Death with Dignity

The Oregonian has this heart-wrenching site, which offers an amazing opportunity to see inside one woman's struggle with decisions related to Death with Dignity.

Lovelle Svart was a former employee of the paper diagnosed with stage IV lung cancer who had supported Death with Dignity in theory but now had to decide whether to actually apply it to herself.

I think anyone who is charged with the opportunity to vote on I-1000 in Washington state this November should see this as part of making an informed decision. And it would be illuminating for anyone. But I will warn you, it is not easy to watch, read, or listen to.

Here is a link to the general page. And here is a link to audio and video from Svart's last hours and minutes.

Death with Dignity in Oregon

The Seattle Times is running an article about Oregon's Death with Dignity law, focusing on some of the cases and trends that have come up over the roughly 10 years that it has been in effect. I wish the article focused more on the generalities and less on the exceptions, but nevertheless, it is an interesting read.