Tag: assisted dying

Categories
Death + the Economy Death + the Law Death Ethics Grief + Mourning

Frontline Documentary: Facing Death

Frontline: Facing Death
Miri Navasky and Karen O’Connor (November 23, 2010)

 

A Final Cocoon: Dying at Home
Joyce Wadler, New York Times (November 11, 2010)

Yet again, Frontline (the documentary film unit of America’s Public Broadcasting Service) delivers an unbelievably moving and intellectually engaged program. Frontline has won every major and minor documentary film award on the planet so it should come as no surprise that this new program Facing Death is so good.

Everyone needs to watch to this documentary. Everyone. Take the 55 minutes it requires and then watch it again.

Watch the full episode. See more FRONTLINE.

The documentary tackles one of the most pressing questions for any person with a terminal illness: when to stop heroic (potentially excessive) medical treatment and to then opt for palliative care in a hospice.

When Meg, Kim, and I started the Death Reference Desk we all agreed that End of Life issues would be fundamentally important to this entire project. I can honestly say that this Frontline documentary is one of the best programs that I have seen in a while on this very topic.

Critics of the American health care system (of which I am one) will lament the over medicalization of the patients in this film and I agree that the film really captures what aggressive, end of life medicalization becomes. The documentary also shows the medical staff and families involved in each case thinking through these bioethical quandaries.

What this film highlights, more than anything, is how impossibly difficult and heart wrenching all of these decisions become. None of this is ever simple or easy. My job is to think about death and dying all day, every day. I’m the son of a funeral director. I’ve watched my grandparents die.

These experiences are all valuable but they never fully prepare a person for that most difficult end of life decision: to die.

So watch this documentary and make your friends watch it. Then make sure that your end of life wishes are known to your next-of-kin and in writing.

The New York Times article at the top of the page is another side of the Frontline documentary, which is when people decide to stop the medical treatments and die at home. It’s a wonderful article about people choosing to die on their own terms in their own living spaces.

Categories
Death + the Law Death Ethics

When Medical Treatment is Worse than Death

Letting Go
What should medicine do when it can’t save your life?
Atul Gawande, The New Yorker (August 2, 2010)

 

Dr. Atul Gawande: Make End Of Life More Humane
Terry Gross, Fresh Air on WHHY (July 29, 2010)

A few weeks ago, Dr. Atul Gawande wrote a good piece on End of Life decision making for both patients and doctors. Gawande is a staff writer for the New Yorker and a surgeon at Brigham and Women’s Hospital and the Dana-Farber Cancer Institute. He was also interviewed by Terry Gross on Fresh Air about the same topic. Both the essay and interview are quite good and I would suggest that everyone (regardless of age) take some time to mull over when you no longer want medical treatment for a terminal condition.

This is an important question to think about since death is assured at the end of life.

But how you die and what quality of life you have during that process is a much broader question.

I would encourage everyone to spend at least one hour discussing these issues with next of kin. That’s more time spent discussing death than most people do in a lifetime.

Categories
Death + Crime Death + Popular Culture Death + the Law Death Ethics Suicide

Kevorkian Revisited

Independent Minds: Dr. Jack Kevorkian (Listen to the audio)

Heard an interesting public radio broadcast this evening. It’s a series titled “Independent Minds” and tonight’s profile featured Dr. Jack Kevorkian. The show illuminates, through interviews, audio clips and sound bites, the life of the controversial “Dr. Death” and attempts to separate and dissect the man and the myth.

Want more Jack? Check out trailers for the upcoming HBO film You Don’t Know Jack, starring Al Pacino as Kevorkian. Directed by Barry Levinson, it also stars Susan Sarandon, John Goodman and Brenda Vaccaro. I don’t have cable and it could be a while before it shows up on Netflix. So if anyone catches it, by all means let us know and share your thoughts!

Categories
Death + the Law Death Ethics Suicide

UK Children Not Charged with Assisting Parents to Die

No Assisted Suicide Charge for Son of Sir Edward Downes
BBC News (March 19, 2010)

My very first post for the Death Reference Desk occurred on July 15, 2009 and it discussed the deaths of Edward and Joan Downes. The Downes’ went to the Dignitas Clinic in Switzerland to die together, their’s is a common story in the UK. Indeed, the stories about UK residents going to the Dignitas clinic remain an almost weekly occurrence.

What is new about the Downes’ case is that the Director of Public Prosecutions in the UK (Keir Starmer) has decided to not charge either of the Downes’ children with assisting their parents to die. I have discussed at length how suicide in the UK is legal but assisting a person to die is not. The Death Ref section on the Death + The Law presents these cases. Today’s legal decision is also important because it is the first time that the new guidelines drawn up by Keir Starmer have found no public interest in prosecuting a family member who clearly acted on compassionate grounds.

I am including a news clip from last July about Joan and Edward Downes. It’s interesting to note what has and hasn’t changed since then.

Categories
Death + the Law Death Ethics Suicide

2009 Oregon Death with Dignity Numbers

2009 Summary of Oregon’s Death with Dignity Act
The Oregon Public Health Division (March 2010)

Report Finds 36 Died Under Assisted Suicide Law
William Yardley, The New York Times (March 04, 2010)

Earlier this month, the state of Oregon published its annual report on who used the 1997 Death with Dignity Act. I have discussed the ins and outs of the Oregon law before but I want to highlight the following sections of the 2009 report:

• As in prior years, most participants were between 55 and 84 years of age (78.0%), white (98.3%), well-educated (48.3% had at least a baccalaureate degree), and had cancer (79.7%). Patients who died in 2009 were slightly older (median age 76 years) than in previous years (median age 70 years).

• Most patients died at home (98.3%); and most were enrolled in hospice care (91.5%) at time of death.

• In 2009, 98.7% of patients had some form of health care insurance. Compared to previous years, the number of patients who had private insurance (84.7%) was much greater than in previous years (66.8%), and the number of patients who had only Medicare or Medicaid insurance was much less (13.6% compared to 32.0%).

What is really important to note about the individuals using the Oregon law is their age, ethnicity, access to hospice care, and health insurance status. In a nutshell, the vast majority of the individuals were in the middle to upper middle social classes and hardly the lowest rung of Oregonians. This is important to point out because it demonstrates that this particular Assisted Dying law is not killing off the weak, the poor, and the uneducated.

In short, the law is not being abused.

Categories
Death + the Law Death Ethics Suicide

Living in America and Dying with Dignity in Europe

Frontline: The Suicide Tourist
PBS (March 02, 2010)

Assisted Suicide Guidelines: Family Can Still Face Prosecution
Sandra Laville, The Guardian (February 25, 2010)

Frontline, the documentary film unit for the Public Broadcasting Service in America, just premiered a really important new program. The film follows an American, Craig Ewert, as he decides to end his life at the Dignitas Clinic in Switzerland. What is unique about this storyline is that it focuses on an American going to Dignitas, which isn’t that common. To date, thirteen US citizens have ended their lives at Dignitas (as opposed to 135 Brits and 563 Germans).

The cultural, political and social issues surrounding Dignitas have been an ongoing topic in the United Kingdom, which makes the timing of Frontline’s documentary all the more uncanny. Last week, the Director of Public Prosecutions for the UK (Keir Starmer) published new guidelines for assisted suicide. Over the years, many people have wondered if “assisting” someone commit suicide included, say, going to Dignitas with the person. So much confusion has surrounded this UK law that short of actually changing it (which will eventually happen) the guidelines were published to help define whom the law can and cannot prosecute.

I have written extensively about the assisted dying debates in the UK on Death Ref (indeed, my first post was on an assisted dying case) and you can find a plethora of information in the Assisted Suicide section and the Death + the Law section.

As a final point of interest, the state of Oregon has published its 2008 Summary of Oregon’s Death with Dignity Act and you can see how people have used the law there to die.

In the end, the law will be changed in the UK and it will resemble Oregon’s law.

Categories
Death + the Law Death Ethics Suicide

Give Terry Pratchett the Freedom to Die…

Sir Terry Pratchett Calls for Euthanasia Tribunals
Maev Kennedy, The Guardian (February 02, 2010)

Terry Pratchett: My Case for a Euthanasia Tribunal
Terry Pratchett, The Guardian (February 02, 2010)

Last week, the British writer Sir Terry Pratchett (he of Discworld fame) catapulted the ongoing UK discussion on Assisted Dying back into the news. This is a persistent topic in the UK and I have written about it quite a bit on Death Ref here.

Terry Pratchett (who has been diagnosed with Alzheimer’s) is asking that a tribunal system be set up in England which then evaluates an individual’s request to die. The goal of setting up the tribunals is to make sure that any person making this request is of sound mind and not being coerced into the situation. Suicide has been legal in England since 1961 but helping another person commit suicide is against the law. So, a number of legal and political battles have dealt with the limits of what “assisting” another person means.

I have discussed these issues quite bit in the Death + The Law section.

In so many ways, this issue just keeps going and going and going. So much so, I’ve been collecting various articles for months because they appear daily and posting each one would be a full-time job.

Terry Pratchett’s request for a new UK system (or, at least, something for England… Wales and Scotland might be on their own) is another article for the group.

The problem, of course, is that all these issues and arguments are really interesting and important to discuss/think about/mull over.

But even I get Assisted Dying debate fatigue, and thinking about death is my job. The biggest dilemma, it seems to me, is that death is a human “problem” without terminus. At least in the twenty-first century West. England is certainly taking its time with any permanent changes to the law. It’s a slow process, to be sure, but it is a process. Terry Pratchett’s request will go a long ways in helping change UK law.

In the event you are a person doing research on Assisted Dying and the plethora of issues related to this topic, here are the articles that I have been recently collecting.

To wit:

The Guardian on the Dignitas clinic in Switzerland: ‘Death tourism’ leads Swiss to consider ban on assisted suicide

The Guardian on an elderly couple who committed suicide together: Couple wrote to BBC to tell of suicide decision

The Guardian on tour in the Dignitas clinic: Inside the Dignitas house

New York Times Magazine article on Brain Death and Organ Donation (which are related….): When Does Death Start?

New York Times on End of Life Care in California: Months to Live: Weighing Medical Costs of End-of-Life Care

New York Times on End of Life sedation: Months to Live: Hard Choice for a Comfortable Death: Sedation

BBC News on push in Scotland for a Terry Pratchett-like law: Most MSPs oppose end-of-life bill

Categories
Death + Crime Grief + Mourning Suicide

The Rest in Pieces

This American Life: How to Rest in Peace
originally aired November 2, 2007.

This episode of This American Life re-aired yesterday, providing me a driveway moment (well… a snow-deranged street parking moment). If you missed it then or in 2007, have a listen online to these three stories exploring how the rest — the living left behind — find peace or stay in pieces.

Examining the emotional impact of the right to die, the last story is particularly striking. A growing old but generally healthy woman prepares herself and her family for her suicide because she fears suffering (and making her family suffer) the dementia that consumed her own mother. Her son is left in the horrible position of wanting to comfort his mother and respect her wishes while being sick with shock and grief about her oncoming death.

Categories
Death + the Law Death Ethics Suicide

New Assisted Dying Guidelines in England

Director of Public Prosecutions Publishes Interim Policy on Prosecuting Assisted Suicide
The Crown Prosecution Service (September 23, 2009)

Last week in England, the Director of Public Prosecutions, Keir Starmer QC, released new guidelines on assisted dying. The goal of these new guidelines is to give family members a clearer understanding of what is acceptable before the law when assisting a loved one to die. As the law currently stands in England and Wales, assisting another person’s suicide is against the law. I discussed what caused these new guidelines here.

Here, then, are the guidelines (which are not laws) which will be used to evaluate whether or not compassion was the guiding principal behind the assistance:

The public interest factors against a prosecution include that:

  • The victim had a clear, settled and informed wish to commit suicide;
  • The victim indicated unequivocally to the suspect that he or she wished to commit suicide;
  • The victim asked personally on his or her own initiative for the assistance of the suspect;
  • The victim had a terminal illness or a severe and incurable physical disability or a severe degenerative physical condition from which there was no possibility of recovery;
  • The suspect was wholly motivated by compassion;
  • The suspect was the spouse, partner or a close relative or a close personal friend of the victim, within the context of a long-term and supportive relationship;
  • The actions of the suspect, although sufficient to come within the definition of the offence, were of only minor assistance or influence, or the assistance which the suspect provided was as a consequence of their usual lawful employment.

It was interesting to read the different press reactions to the guidelines.

Washington Post: Britain To Clarify Policy on Euthanasia
Associated Press: Charges Unlikely for Helping Suicide in England
The Guardian: New assisted suicide guidelines to give ‘clear advice’ to relatives
Lesley Close (in The Guardian): Thank you, Keir Starmer
New York Times: Guidelines in England for Assisted Suicide
BBC News: Assisted suicide law ‘clarified’
Death with Dignity in Oregon
All of these articles point to one central point: these new guidelines are only a step towards changing the entire assisted dying/suicide law in England and Wales. This was only the first step.

The most interesting response to the decision from Timothy Egan at the New York Times. I highly recommend reading his piece The Way We Die Now.

Categories
Death + the Law Death Ethics Suicide

The Right to Die Free in Montana

Montana Court to Rule on Assisted Suicide Case
Kirk Johnson, New York Times (September 01, 2009)

Since July I have been posting stories on Right-to-Die cases in England. Those posts involved Edward and Joan Downes (who traveled together to the Dignitas Clinic in Switzerland to die) and Debbie Purdy who successfully fought a campaign to have England’s assisted suicide law changed.

Now it is America’s turn and in the great state of Montana no less. State motto: Oro y Plata…which means Gold and Silver in Spanish. I know.

I will let the Billings Gazette take the lead, with the August 29, 2009 article, State Appealing District Court Judge’s Ruling Favoring Assisted Suicide:

Robert Baxter, a 76-year-old former truck driver from Billings, spent his last months fighting for the right to hasten his own death.

Robert Baxter

Baxter was the Montana face and only named terminally ill patient in a legal case that sought to legalize physician-assisted suicide; he wanted doctors to prescribe him medication that would bring about his death and end his struggle with chronic leukemia.

Baxter died Dec. 5, 2008, the same day that Helena District Judge Dorothy McCarter ruled that the Montana Constitution protected the right of terminal patients like him to obtain lethal prescriptions from physicians.

This is an interesting case to watch because it involves the Montana State Supreme Court ruling on whether or not assisted suicide is legal. The other two American states with assisted dying laws, Oregon and Washington, both passed those laws by popular vote.

As always, I will keep my eyes on this case.

Categories
Death + the Economy Death + the Law Death Ethics Suicide

America and End of Life Care: Death, Dying, and Mortality

At the End, Offering Not a Cure but Comfort
Anemona Hartocollis, New York Times (August 19, 2009)

I started and re-started this post on American Health Care reform several times. To watch America’s current Health Care debate (such as it is…) makes me all the happier that I now live in the UK and am covered by the National Health Service. I have no problems with the NHS and I am glad that it exists.

Do Not Resuscitate Tattoo

One part of the NHS that impresses me most is its National End of Life Care Programme. The EOLC Programme’s mission statement provides a succinct mandate:

OUR AIM: To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

What I think is fundamentally important about this NHS program is that it acknowledges the obvious: people die. Indeed, the program was explicitly created to embrace death so that the dying process is made as comfortable as possible for UK residents.

Do No Resuscitate

Herein lies one of the key reasons that I think the American Health Care reform debate is failing: Serious discussions about death, dying, and mortality have been jettisoned. What America needs more than ever, right now, is a National Conversation about dying because until that occurs, health care reform will continue to ignore that one part of human biology that we all share: Death.

And yet, paradoxically, it would seem that this kind of conversation is going on all the time.

The New York Times article at the top offers a lengthy and important discussion on End of Life Care in American hospitals. And NYTimes Health columnist Jane Brody offered this recent piece: End-of-Life Issues Need to Be Addressed.

President Obama made it clear in May that he was interested in a National Conversation about End of Life Care in a lengthy New York Times Magazine interview about the economy.

It is a long(ish) interview, so if you click here you can skip to the bit on Obama’s Grandmother and how her death informed his own thinking about End of Life decisions.

Do Not Resuscitate Bracelet

The problem, of course, is that people rarely talk to their family members about death. To bring home this point, the August 7, 2005 New York Times Magazine featured this article: Will We Ever Arrive at the Good Death?

Here is the key quote from that article:

As J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, said last April to the Senate Committee on Health, Education, Labor and Pensions, “Americans are more likely to talk to their children about safe sex and drugs than to their terminally ill parents about choices in care as they near life’s final stages.”

Let me be clear that I think that President Obama is delving into an extremely urgent topic but, ironically, he is not the first modern American president to discuss end of life decision making. Oh no. Not by a long shot.

Some of the first presidential statements on death involved Ronald Reagan. In the early 1980’s, President Reagan received a series of reports on death and dying from some totally forgotten (but important) bioethics commissions:

  • Defining Death: Medical, Legal and Ethical Issues in the Determination of Death (July 9, 1981)
  • Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions (March 21, 1983)

    • So, in a way, President Obama is attempting to carry out a project begun by President Reagan and is actually acting very Reaganesque. But I digress…

    For me, the key reason President Obama has seen his health care debate derailed is that he dared to embrace death. Or, at least, to suggest that end of life care is something that needs to be discussed (on the local and national level) since individuals need to be clear in their own heads about how they want to die.

    And since President Obama is involving himself in this debate, it means that the head of the nation is suddenly speaking out about death and dying. As a result, Obama is acknowledging a much more profound dilemma for modern America: the nation-state (as in America) usually ignores death at all costs.

    At a certain point, the nation can do absolutely nothing about death and instead it focuses on mortality. Death is utterly ignored by the nation because it represents that one, final act that an individual can choose and that beyond a certain point-in-time no life will return. President Obama isn’t anywhere near making statements about who lives and who dies. But he is making it clear that death is inevitable. (I am unfairly paraphrasing Michel Foucault’s comments from his Society Must Be Defended lectures, p. 248).

    That alone, I think, is causing some of the biggest problems.

    Do Not Resuscitate Logo

    All of this is to say, that American health care reform begins and ends with death. And until those discussions occur, America will continue with its current system.

    If you’re interested in making sure that your own end of life requests are followed, then use this information offered by Jane Brody of the New York Times.

    To help people make sound health care decisions and get the care they would want for themselves or their family members as life draws to a close, the National Institute on Aging has produced a comprehensive 68-page booklet, “End-of-Life: Helping With Comfort and Care.” Individual free copies can be obtained through the institute’s Web site, www.nia.nih.gov, or by calling 800-222-2225.

Categories
Death + Crime Death + the Law Death Ethics Suicide

Important Right-to-Die Court Decision in the UK

Debbie Purdy wins ‘significant legal victory’ on assisted suicide
Afua Hirsch, The Guardian (July 30, 2009)

An important turn today for UK Assisted Dying supporters (which is about 62% of the public…). Debbie Purdy successfully argued that it would be a violation of human rights for her to not know whether her husband would be prosecuted for accompanying her to the Swiss clinic Dignitas, where she wishes to die if her multiple sclerosis worsens.

Debbie Purdy and Omar Puente

The Purdy case is important and it will presumably force a change in UK law. As it currently stands, the UK’s 1961 Suicide Act decriminalizes suicide if you kill yourself. But any person whom:

aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.

What that aiding, abetting, counseling, and procuring entails is really ambiguous. It is all so unclear that UK Prosecutors have been declining to press charges against families that accompany, say, a loved one to die in the Dignitas Clinic.

For an extremely thorough history on the Assisted Dying debate in the UK, see the Guardian’s Assisted Suicide page.

I discussed much of this information a few weeks ago in a Death Reference Desk post about the recent deaths of Edward and Joan Downes.

Since the Downes’ deaths and that discussion, I came across the following article: ‘Romantic’ death may idealize suicide: critics. Maybe. But I’m not so convinced. If anything, what Edward and Joan Downes chose to do was die and to die together. It was an act of love, to be sure, but I’m not ready to call it romance.

They chose death over a biological life neither one of them wanted to live.

It is absolutely acceptable to choose death. And family members and/or friends who want to assist in that choice should be able to do so without fear of the law.

But LOOK OUT: Scotland might beat England to the punch. Scottish MPs are discussing a change to Scotland’s own assisted suicide laws.

And Scottish MP Margo MacDonald is leading a fierce charge.