Death With Dignity
The State of Oregon leads the way as the only jurisdiction in the world with legal, regulated assisted dying. And as it does so, it has its very own Compassion in Dying affiliate to assist with information, consultation and supportive personal presence for patients and families.
Compassion will play a critical role in the responsible implementation and availability of the Act.
Oregon Death with Dignity and others provided the seed money to establish an office, bring in expert staff and develop a panel of mental health and end-of-life specialists to ensure that palliative needs are well met and decisions under the Act are voluntary, enduring and rational. The goal is to have Compassion counselors available throughout the state.
In January, the first month of operation. Compassion of Oregon received 26 general inquiries and 10 from patients asking how to access the Death with Dignity Act. Compassion arranged referrals and assisted with the transfer of care from physicians who declined to participate in the Act to physicians who will include it in the range of options they are willing to offer. We have assisted in improving comfort care and mental health services and recommended therapies for a number of patients. Even for those who would not qualify under the Act, we have continued to be involved and help improve the quality of life.
Task Force on Life Ending Medication
The Task Force on Life Ending Medication was a joint project of Physicians for Death with Dignity and Compassion in Dying Federation.
Composed of two physicians and two pharmacists, the task force prepared a report called "Life Ending Medication and the Oregon Death with Dignity Act," which includes information for physicians about medications to prescribe and instructions for patient self-administration.
The document is distributed exclusively to physicians and pharmacists who are responding to a patient request under the Act and will not be published or distributed generally. It appears that this protocol will be the only set of recommendations available to physicians in the state.
Pain ManagementOn January 12 Compassion in Dying Federation kept the heat on the medical community to improve end-of-life care with a well-publicized memorandum to each state medical disciplinary board and their association, the Federation of State Medical Boards.
Operating from the firm belief that no one should have to consider assisted dying because of inadequate pain medication. Compassion launched a national project to prompt professional consequences for physicians who fail to adequately treat pain and suffering in terminally ill patients.
Experience at the Bedside
Compassion often receives calls from families who are struggling to control the pain of a loved one who is dying at home or in an institution.
Families tell Compassion how hard it is to get adequate narcotics to relieve pain completely. They are told such things as "'Everyone must suffer some," or "We need to hold the line on narcotics because they are addictive." Ms. Lee told reporters that 'The truth is that the 'proper dose' is the dose that is effective, not a lower one. Experts agree but doctors in practice haven't gotten the message."
The memorandum called for actions to "help our country move beyond discussing improved end-of-life medical care and toward real and immediate changes that will be apparent at the bedside." The mission of Compassion in Dying is to improve care and expand options, including that of assisted dying. Recent research and our experience confirms that effective pain medication, delivered in the quantity and frequency to relieve pain in terminal illness, is frequently lacking.
Physicians perceive risk in prescribing narcotics, but rarely perceive risk in under-treating pain and allowing their patients to suffer. The memorandum calls upon medical boards to change this balance of perceived risk and suggests seven specific strategies.
Supreme Court Cases
This project grew out of the ruling of the Supreme Court in Compassion's two cases, Glucksberg v. Washington and Vacco v. Quill. Although declining to recognize a right to assisted dying, the Court did recognize a right to adequate pain medication, even in quantities that may hasten death. We believe that pressing ahead to make this right a reality will relieve much end-of-life suffering. It will also heighten public awareness of the many end-of-life options available, some of which hasten death as the unavoidable consequence of relieving suffering.
Since death frequently occurs as a result of treatment decisions, we believe that the patient himself or herself is the safest and most ethically defensible decision maker concerning whether suffering is tolerable and whether knowingly hastening death is acceptable.
This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.