I posted on Friday about the assisted death of Robert Warren at age 95.
People asked me questions. Here are some answers.
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| Bob Warren, 2019, age 92 |
1. "How does one connect with the people who will advise one on 'Death with Dignity.'"
If the patient is in hospice, the many caring people within the hospice organization will refer you. If the patient is not in hospice, one can call End of Life Choices Oregon. They are a non-profit organization with local staff and volunteers. They will walk you through the process. My experience was that people were helpful and respectful. They know what to do.
2. "Start to finish, how long did it take to jump through the hoops to meet Oregon's process?"
At least a month, start to finish, if everything goes smoothly. Every situation will be different. Bob Warren was judged to be in hospice, which meant that he had already been medically determined to be near end of life. Getting that assessment is a hoop, and a patient might be too healthy for this. Or a patient might not be healthy enough to take the end-of-life medicine on his own, which is another hoop. The Death with Dignity legalities involve getting the patient to sign a form saying he or she understands what is being asked. Two witnesses sign saying the person is not under duress. If the patient's mental competence is in question, then again, this path may not be available. The patient then needs a sign-off from two physicians, with visits spaced more than 15 days apart. That takes some scheduling, because doctors are busy. The pharmacy needs a hard copy of the physician's prescription. In two days someone can pick it up.
The patient can decide whether or when to take the medicine. They can take it within days, or never. Their choice.
3. "Peter, Bob Warren didn't look all that sick in the photo you published. Was he really near end of life?"
The photo below was from nine months ago. Out of respect for him I wanted a photo preserving his dignity and showing him looking good. Very recent photos show the decline he experienced. I won't publish those.
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4. Was it expensive?
The end-of-life medicine was $600. There were no other costs beyond whatever the small co-pays there might be for the doctor visits.
5. What really happened after he drank the medicine? Was it terrible?
No. For Bob, it was easy. The medicine goes down in two or three swallows. Bob sat quietly and in two minutes said he felt sleepy. He slumped back with his head on a pillow, and began snoring. I saw no sign of conscious distress.
I won't sugar-coat this next part. This was new to me, and hard. In a "good death" like this one, the conscious patient is gone after that two minutes, but the patient's body may take hours to shut down. I spent the time holding Bob's hand, rubbing his shoulder, and whispering in his ear. Hospice nurses and End of Life Choices Oregon people were there, too, holding his other hand. His skin slowly went pale, his lips got blue. His breathing became occasional deep sighs, every fifteen seconds at first, and then every minute and finally two minutes. It can take one or two hours or more before the patient's heart stops. You might find it very uncomfortable to be part of this.
You don't need to be there for this. You can say goodbye before or after the patient drinks the medicine and know that your loved one is unconscious and on his way. Hospice and Death with Dignity people will be there to supervise the death. I stayed with him. I had come that far, so I was going to finish with him. Bodies shut down and die, one organ at a time, and I watched.
If this last part is too painful to contemplate, I understand. It is OK to let the professionals handle this. The patient is on a path. Our bodies know what to do. We were born knowing how to die.
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8 comments:
Thank you for the additional information.
One reality check: Most Americans live paycheck to paycheck or scrape by month to month on government assistance of one kind or another. So, $600 is expensive. I wonder if any groups provide financial assistance for poor and low income people. (Google "most Americans are broke" for more info.)
It is unreal to me how other people are so nosey, controlling and meddling. People should be allowed to die peacefully and painlessly whenever they want and at any age (except minors).
My only concern would be if someone else was trying to enrich themselves at the expense of the person who wants to permanently check out. The would-be criminal could influence or encourage the person so that he or she could cash in. Unfortunately, gold-diggers and morally corrupt people, including family members, are part of our world.
Thank you, Peter, for all you did for Bob.
Regarding access to Death with Dignity, the requirements are that a patient must be: 1) 18 years of age or older, 2) capable of making and communicating health care decisions for him/herself, and 3) diagnosed with a terminal illness that will lead to death within six months.
These requirements disqualify those with dementia – a notably undignified death – and other conditions that might make life seem intolerable, such as chronic pain and severe depression. I'm not saying those diagnoses should be included, but pointing out that they aren't. Ending life is inevitably fraught with ethical controversy.
There is an editorial in todays Sunday Oregonian from a clergyman suffering from a form of dementia asking the governor to consider the need for death with dignity options for dementia sufferers. Here's the link
https://enewsPO.oregonlive.com/data/32733/reader/reader.html?social#!preferred/0/package/32733/pub/53305/page/27/alb/1606955
I find the exclusion of patients with extreme dementia, including Alzheimers quite troubling. In those instances where a person in complete control of their faculties has executed an Advance Directive specifying no extreme measures, does that mean no feeding or water via a tube, as one example ?
I'm not afraid of dying; I am afraid of being shuffled into some kind of geriatric warehouse, after a stroke, or advanced dementia, and being spoonfed gruel by an everchanging slate of poorly paid "health care" workers, and me being unable to end my socalled "life". IMHO, just autonomic orders by our brains to keep breathing, hearts beating does not necessarily constitute "luving".
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When I say I find the exclusion of Dementia victims from the Death with Dugnity Act, I don't mean to imply that those conditions be made a part of what is included, but that a lot of discussion around a painful subject needs to be initiated, and solutions sought. This thread has alerted me to the fact that I need to have another sit down with my Dr. about just what my Advance Directive does, and more importantly, does not do.
Ed Cooper. I found out the hard way that an Advanced Directive is merely a suggestion to the medical professionals. It has NO legal authority. Please be sure you have a POLST. The doctors are legally required to follow it. So grateful we have the POLST available to us here in Oregon.
Ed, you’re spot on. We need to address the issues you’re concerned about. Have you filed an advance directive with your pcp? With the state??
Malcolm, I have done a PCP, but I'm convinced I need to restudy it, and perhaps make a few changes. I'm in reasonably good health, but I just turned 76, and that pushing the outer limits for the men on both sides of my parentage.
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