Death With Dignity

Robert Warren died yesterday afternoon. 

He was 95, turning 96 in April. He died with dignity.

He was my friend for 29 years. He was ready to die and he welcomed it. I helped him navigate the process to make it happen.

July, 2022

In 1997 Oregon passed the Death With Dignity Act. It allows Oregon physicians to prescribe life-ending medications to patients who meet the criteria of being at the end of life, who have the cognitive capacity to understand their decision, and have the physical ability to take the dose on their own. There are waiting periods and hoops for both patients and health professionals.

In 2022 278 people chose this path and died from physician-prescribed medications.  There were 431 prescriptions written in 2022; 84 of those people died from other causes without having taken the prescription. There is no timetable or requirement to take life-ending medication.

I call the life-ending white powder "medicine." That is the term used through the hospice and "Death With Dignity" process. This wasn't "poison." Poison is a misuse of something. Drain cleaners and agricultural herbicides are poisons when ingested. The white powder that came in a pill bottle from a pharmacy was a kind of pain reliever. It worked as intended. It had the normal prescription-type words on it, along with instructions on how to mix it and consume it. The pharmacist gave a consultation. The hard part isn't for the patient, he said. For them it is quick and easy. The patient is totally unconscious and at peace. He warned that there will be some waiting, possibly hours. Death itself takes time. You need to be ready for that, he said.

Bob Warren said that 2:00 p.m. yesterday would be a good time to go. We coordinated that time so that the various hospice people could arrange their schedules to be there. Throughout the morning employees from the assisted-living facility that he lived in came to tell Bob what a joy he was to help and that he would be missed. They knew what Bob had planned. Bob greeted them warmly and thanked them. They stopped coming at 1:00 p.m. The word must have gone out: No visitors after 1:00. The facility was careful to have nothing whatever to do with the Bob's death. At 1:20 I gave Bob two anti-nausea pills. These are to make sure the life-ending medicine stayed in his stomach. 

Just before 2:00 p.m. I mixed the powder with apple juice, as instructed. The nurse and health care people stepped out of the room. They, too, are instructed not to participate in the act of Bob drinking the mixture. Two people from Oregon's Death With Dignity nonprofit asked him if he understood that he would be taking a life-ending drug. He said he certainly did. He sat on the edge of his bed, took the glass, drank it down. We sat there together, my arm around his shoulder. In two minutes he said he was sleepy and was ready to lie back. He sighed and closed his eyes. The room filled back up with hospice nurses, who helped to scoot him back onto the bed with his head on a pillow. The nurses and I held his hand and talked to him as he lay there quietly, sighing from time to time, unconscious and otherwise motionless. During that hour and 40 minutes the nurses monitored his heartbeat and breathing until his heart stopped.

Bob Warren made a living as a musician in Los Angeles. He was alert and opinionated to the end. We played Wordle together every day. He got yesterday morning's word, BREAD, in three guesses. He knew exactly what he was doing yesterday. He had made a decision. He had had enough. He knew the lyrics to hundreds of songs that were popular in the 1930s, 1940's, and 1950's. He recited the lyrics to a song made popular by Rosemary Clooney, "I Stayed Too Long at the Fair."

The merry-go-round is beginning to slow now
Have I stayed too long at the fair?
The music has stopped and the children must go now
Have I stayed too long at the fair?

He was ready to leave the fair.

The Oregon Health Authority keeps track of this program, including questions about why people choose to end their lives.

As in previous years, the three most frequently reported end-of-life concerns were decreasing ability to participate in activities that made life enjoyable (89%), loss of autonomy (86%), and loss of dignity (62%).

That was Bob. He had become essentially immobile. He needed help to get to the bathroom. He couldn't see well enough to read. He couldn't get to his computer or navigate its keyboard. People brought him food and he said he could barely taste anything. He wasn't suffering in agony, but he was generally uncomfortable. He was getting weaker. He knew what he had to look forward to was more of the same, only worse. Time to go now, while I still can make my own decisions and die with my dignity intact, he said. 

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