How do you feel about legal medical assisted suicide?

I apologize for this long post, but I have personal experience with this to share.

I am strongly in favor of “end-of-life” choice. I respect anyone’s decision not to choose to end his or her own life, but I believe that doing so is a choice that everyone should be able to make for him or herself.

My mother took her own life five years ago under Oregon’s “Death with Dignity” act when her metastasized breast cancer caused her lungs to fill up with fluid so that she was literally gasping for every breath and drowning in her own body.

Here are important things my family learned while going through the process:

1) If you live in a state that gives you this option, do not make the mistake of thinking that going through the process of “qualifying” and obtaining the prescription means you have to use it. Even if you think you are unlikely to do so in the end, or are just not sure whether you will want to or not, it is better to make sure you will have the choice while you can.

We were told that 9 out of 10 people who go through the process of ensuring that they will be able to make the choice if/when the time comes – that is, who go through the process of qualifying for and then obtaining the prescription – do not actually use it in the end. My mother fully expected to be one of these people. We were very sad to realize that she would not be, but very glad that she had done what she needed to do to limit the worst of her suffering.

2) Just because you live in a state that offers you the right to end your life under these circumstances, do not assume that you might not experience difficulty fulfilling your choice. My parents lived in southern Oregon, which is a very conservative region. If you or your loved one is facing a terminal illness, you need to have a very frank conversation with your doctor NOW to find out if he or she will support your choice if you decide to end your life when you are within your “six months of death” prognosis. If not, NOW is the time to find another doctor ... not when you are really sick and frail and having trouble just getting in and out of the car.

My mother was terrified and desperate to find out how to exercise her legal right to end her life if she decided she would need to. Her doctor -- who, it turned out, was religiously opposed to the idea of self-delivery -- basically mocked and bullied her for even daring to ask about it, and told her that hospice would be “enough” and that the process of death was ennobling both to the person who experienced it and those who witnessed it. After that “conversation,” my mother came home and just shook, for days. I moved heaven and earth to find her a different oncologist, and she never went back to that woman’s office. And then I scoured the Web until I found the organization that helped us.

3) Once you have your six-month prognosis, it is also vital that you not wait to go through the hoops you will need to clear to actually fill the prescription. In Oregon, you have to be seen by two doctors over a period of (if I’m remembering correctly?) a couple of weeks. Both have to agree with the six-month prognosis and that you are in a sound state of mind. Then you have to find a pharmacy that will fill the prescription. Just as doctors who are philosophically or religiously opposed to the law are not required to prescribe the prescription, pharmacies are not required to fill it. If you live in a conservative/religious area, you may need to drive some distance to fill the prescription. None of these requirements would be difficult for a healthy adult, but all of this activity is exhausting for a person who is seriously ill. It is far better to jump through these hoops while you are still feeling fairly strong -- that is, to get the prescription, fill it, and then put it in a desk drawer at home where you’ll have it if you ever decide to use it -- than to wait until you are feeling REALLY bad, but are now too weak to do what you are legally required to do to get the drugs.

In my mother’s case, we were unable to find a local doctor or pharmacy that would help. A national organization that advocates for patients’ end-of-life choices helped to put us in touch with a choice-respecting doctor about an hour away from my parents’ home, and one of their volunteers also helped to get the prescription filled in a city four hours away and drive it to my parents’ home. They charged us nothing for their help, time, or gas (for the 8-hour round trip). I have never loved complete strangers the way I loved those kind people for helping my mother the way they did. She regarded them as her saviors. So do I, to this day.

4) Whether you live in a state with end-of-life choice or not, if this is an issue that is important to you, you should check out the wealth of information online at Compassion and Choices (dot) org. This nonprofit organization advocates strongly for choice on both the national and state levels. They have volunteers and counselors who can help patients get the information and the help they need. In states without end-of-life choice, they work to get these measures on that ballot, and they also advocate strongly for palliative care and other patient rights. They are a truly amazing organization that does incredibly important work, and I cannot recommend highly enough that you find out more about them if you want to know more about this topic for yourself or for a loved one in need.

My Mom never expected to use her “final” prescription. She told me she wouldn’t do so unless things got “really bad.” Well ... things got really bad. Everyone’s cancer takes a different path. Hers caused respiratory problems, with regular build-ups of fluid in her chest so that she could barely breathe. She couldn’t lie down. She couldn’t stand up. All she could do was perch on the very edge of a chair, gasping miserably for air through her oxygen mask. They couldn’t give her morphine or other pain-killing meds because these had a further suppressive effect on her ability to breathe. By the time she elected to end her life, she was desperate to go. She hung on an extra day so that my husband and I could come up and be with her and Dad as she died.

She lay back in her favorite recliner at home. My Dad sat on one side of her and I sat on the other, holding her hand. The volunteers who had brought the prescription mixed it up, gave it to her, and took themselves discreetly away (but stayed close by in case we needed them). The law requires that the patient be able to administer the drug him or herself. My mother tipped back that glass without a single second of hesitation, and then she leaned back in the chair, gripping our hands. Over the next few minutes, she relaxed. Then her breathing just ... stopped. A few minutes later, my Dad checked her pulse and said that she was gone.

It was an incredibly gentle and peaceful death, after what had been a year and a half of painful, nauseating treatments, and at least four months of increasing agony and decreasing quality of life.

It was what I have been legally allowed to provide for every beloved animal in my life who has reached a point where suffering crowds out all else ... but which I am legally prohibited from choosing for myself, or from helping a loved one to provide for him or herself, in the state where I live.

It is what I want for myself, if and when I find myself in similar circumstances.

It is why I am terrified of developing a dementia, since that will likely prevent me from being able to exercise the right even if I live in a state that recognizes my “right to die."

It is what I grieve for my Dad not being able to choose, now that he has developed a progressive dementia (and is therefore, unlikely to be in a legally “sound state of mind” by the time he gets a prognosis of being within six months of death).

It is why I contribute to the work of Compassion and Choices ... why I support the fight to give every human being in every state the right to end his or her life when suffering becomes overwhelming ... and why I will move to a state that supports this choice if my husband or I become terminally ill.

On a final note, I strongly recommend the documentary film, “How to Die in Oregon.” It is an amazing account of the illness and self-delivery of one incredibly courageous Oregon woman who permitted her journey through this process to be documented. Aside from the fact that she lived in a progressive area and did not have difficulty finding a helpful doctor or pharmacist, her story rings very true to my family’s own experience -- and if you want an inside view of the overall decision-making process against the backdrop of family relationships and disease progress, I cannot think of a better film.

I hope this helps.

I think that the fact that 'assisted suicide' is gaining support is a sad commentary on modern medicine's treatment of the elderly. There's a very hungry and very profitable machine in place that feeds on a very long, very tortured dying process. Patients are being 'propped up' long past their ability to have any quality of life by pharmaceuticals and procedures. There are some astounding statistics out there about the number of cancer treatments and heart procedures performed on people who have a diagnosis of late state dementia and a host of other terminal health problems. In the future, it may be that 'assisted suicide' will be our only way to end the torture.
Nowadays, unless you are lucky enough to die in your sleep, every last ounce of your billable ailments are wrung out you before you're allowed to go.

I feel strongly enough about this that after reading this site for several months, I signed up in order to respond to this thread.

I absolutely support "end-of-life" choice. Currently, my mother is in hospice and is at the point that she cannot process nutrition, even through her feeding tube. She aspirates on anything given through the feeding tube. It is now day 20 since she was last able to be fed. That is no way for anyone to have to linger, slowly starving away. She is the kind of person who would have wanted a choice to go painlessly and peacefully, but that choice isn't available where we live. So she is instead drugged heavily and is still agitated and afraid. It's cruel, and modern medicine's good intentions have brought us to this point. We need to sit down and think about ethics that can make it possible to escape from modern medicine's good intentions, when that's appropriate.

The folks above who worry it will be abused may be right in some cases, and that may prevent it becoming available for those who are of sound mind and wish not to have to suffer the prolonged, painful twilights that our medical profession has brought to pass.

I don't really have an opinion. I wouldn't want to be one involved in the final decision for someone else. One thing I am concerned about is the assisted "livacide." There is a pill or procedure for almost anything that will get a few more months/years of life. Often the life is lived in misery and pain, which can be a fate worse than death for everyone involved. I often think about how lucky the people are who are taken suddenly when they get older. They don't have to face the indignity of being kept alive against the will of their bodies.

Some people say that assisted suicide is playing god. But really prolonging life through artificial means (pills, procedures) could also be called playing god. If a person is ready to die and wants to die, I think they should have the right to let go. Someone asked recently about when should they stop giving medications. I think the answer is that when a person is dying, the only things they should receive are medications for comfort. We never stop to think that the other medications or forced food supplements we are giving are just trying to squeeze a little more life out of the person. They would not choose them for themselves, so we are guilty of assisting them to live against their will. What egos we can have!

I too am a person of faith but I believe all of us should have a legal choice. I agree with Fitzgerald, in too many cases death is prolonged under the guise of giving what is described as sound medical care. I do not fear death. What I fear is getting ill and being kept alive for years on end while exhausting my bank account or Medicare or insurance, ripping the hearts out of my family, etc. I pray this doesn't happen. Im not above begging God.
I'd just like a choice of assistance if I find I can't or don't want to handle this horrible fate. When my father learned he had Alz, mom had to take the guns out of the house. I often wonder if she hadn't what my dad would have done. He clearly knew what was ahead of him, he was from a family plagued by Alz who he watched die from it. Witnessing your parent slowly die with this disease affects you mentally in addition to breaking your heart.

I know for certain my own mother would have opted for this choice. She was a huge supporter of Jack Kervorkian when she was younger and we had many an argument about this back in those days. In her later years she didn't suffer from pain, but her aging and health conditions severely affected the quality of her life. I knew she was unhappy and depressed and we were getting her treatment for that. I know she felt trapped and locked in her aging and deteriorating body and lost the independence which made her who she was. Then she had a stroke which robbed her of her ability to communicate. She could speak but was mostly unintelligible. The doctors told us in her mind, however, she was talking and making perfect sense. She could not understand why we weren't understanding her. I watched her be confused, frightened and then downright angry and frustrated. It was so hard. I loved talking to my mom and she was a great person to converse with. Fortunately, that was two weeks before she died. Her body was shutting down. She was ready (and had been ready) to go. We moved her from the hospital into a beautiful hospice facility with the most caring and wonderful workers. Mom was there less than 24 hours before she passed. Her last words to me were as clear as day, "I'm so very tired" she told me as I left. I told her "that's ok, Mom, just rest". Little did I realize she was wanting me to give her my approval to go. When I got to the hospice facility the next morning she had just passed. So like her, to go without a fuss and not having everyone standing around. She hated being the center of attention.

Well, all that being said and getting back to the original question (finally), I don't think I would be ok with this for myself or for others in my immediate family. I certainly wouldn't want to be the one to make the decision that "now is the time". I hate doing that for my pets...I can't imagine doing it for my loved ones or having someone do that for me. But that's JMHO.

In many cases, the protocols of our medical-pharmaceutical-insurance complex claim to prolong life, but are really only prolonging death.

For reasons as complicated and sometimes irrelevant as we are individual, we too often seek to delay the inevitable.

I can see how simply declining medical care can be construed as "assisted suicide."

I think that it is important for people still in their right minds to have choices. And I can see that various kinds of "assisted suicide" might be sane, even humane, choices. I would not like to be denied any of my options.

I say these things as a person of deep faith.

PaulaK, thank you so much for sharing. I got shivers reading it. The advice to bring this issue up with your doctor well in advance of need is excellent.

I was thinking that discussing a doctor's philosophy, and the nursing home's philosophy, on adequate pain relief, before the time comes when you need it, is something we should do as patients and caregivers. If they have a belief that suffering is noble or that dying people can become drug addicts, then make changes while you can.

I am for it. I lived in Oregon when the issue came before the people for vote, and I voted for it. There are so many safeguards in place that very few assisted suicides actually take place, but it is comforting for many to know that it is available. I would opt for it myself, mainly because I am allergic to narcotic pain killers. Having suffered through an extremely painful condition that lasted about 2 years (2005 - 2007), I can't see myself suffering long term with no hope of recovery. I barely made it through last time (I actually had a gun to my head at one point), but knew that the pain would eventually go away, but death would not, and the pain my family felt would not, so managed to pull myself away from the edge. Without the benefit of pain medication, life can become a living hell.

My ex-husband suffered from a horrible disease called scleroderma. It went into his internal organs, and even though he had a feeding tube, he was no longer digesting the food. We lived in Oregon at the time, but it was in the days before the death with dignity law. When the feeding tube was withdrawn, Jack asked the doctor how long he had. He was told anywhere from a few days to a few weeks. Jack asked his doctor to be kept unconscious during that time, because he didn't want to be anxious and afraid, so he said his goodbyes to everyone. The doctor wrote an order for morphine. When the nurse came in to administer the morphine, she looked at it twice and said, "My, that's a very.... generous.... order". Jack died that night. I believe that some doctors find ways to be humane.