Tag: assisted dying

Categories
Death + Biology Death + the Law Death Ethics Suicide

Radiolab short on Medical Doctors and their End-of-Life Choices

The Bitter End
Radiolab short (January 15, 2013)
We turn to doctors to save our lives — to heal us, repair us, and keep us healthy. But when it comes to the critical question of what to do when death is at hand, there seems to be a gap between what we want doctors to do for us, and what doctors want done for themselves.

This past week, the WNYC’s Radiolab ran a really good short on death, dying, and end-of-life choices. The show, The Bitter End, focused on the fascinating Johns Hopkins Precursors Study which asks Medical Doctors the following:

What are your preferences “…for treatment given a scenario of irreversible brain injury without terminal illness.”

The study has found time and time again that Medical Doctors do not want most (if any) medical treatments that would prolong their lives in this given situation. This finding stands in contrast to members of the general public who generally do want aggressive, life-prolonging treatments. The Radiolab reporters do a good job discussing these medical options with all kinds of people. You should also read the Radiolab blog post, which covers the Precursors Study.

The show flagged up, once again, an issue that the Death Reference Desk has been asking readers since it started: How much and what kind of end-of-life care you want?

This is a question, as most people can see, that only individuals can answer themselves and we here at Death Ref would encourage everyone to have this conversation with their next-of-kin. The Radiolab story captures precisely this kind of conversation between host Jad Abumrad and his Medical Doctor father.

The radio short also mentions, albeit briefly, a form of Do Not Resuscitate tattoo. Regular Death Ref readers will of course remember the recent run of DNR tattoo posts: Do Not Resuscitate this Tattoo or the Person Attached to It and Do Not Resuscitate Tattoos Cannot be Stopped.

Coincidentally, the New York Times ran a blog post today entitled When the Patient Knows Best and it covers many of the points in the Radiolab story.

Many thanks to Radiolab for putting the programme together.

Categories
Death Ethics Suicide

Will Self on the Right to Die

Terminal Thoughts
Will Self, BBC Radio 4 (January 11, 2013)

UK Writer Will Self put together a very good BBC Radio essay on suicide and choosing to die. You can also find Self’s writings on end-of-life issues on his blog.

The radio essay is about 10 minutes long. It’s good. Give it a listen.

Categories
Death + the Law Death Ethics Suicide

The Right to Die in 2013

A Life Worth Ending
The era of medical miracles has created a new phase of aging, as far from living as it is from dying. A son’s plea to let his mother go.
Michael Wolff, New York Magazine (May 20, 2012)

 

The Suicide Plan
Frontline, WGBH Boston (November 2012)

If there is anything that the Death Reference Desk can safely predict for 2013, it is this: right to die and assisted dying cases will continue to both happen and capture public attention.

I was catching up on some 2012 reading during the holidays and finally read Michael Wolff’s article in New York Magazine about watching his mother die. It is an exceptionally well written piece and it truly captures the following biomedical paradox: preventing death at every turn often makes living unbearable– for both the individual and next-of-kin.

One of Wolff’s key points is that the current generation of aging adults watching their elderly parents decline will most certainly impact how these same aging adults want to die. He is absolutely correct, and I do not foresee that situation lessening to any degree.

It was after I read Wolff’s article that I finally got a chance to watch the Frontline documentary, The Suicide Plan. I never intended these back-to-back end-of-life activities but they absolutely complemented each other.

The Frontline documentary is worth watching, if for any reason, it is a sign of what is to come regarding individuals who want to end their lives because of terminal illness. Death Ref has covered these kinds of cases before and will continue to do so into the future. The key issue is less about the actual suicide and more about if another person assists in the death. What exactly constitutes “assisting” or “to assist” takes on all kinds of meanings. Frontline examines a number of assisted dying cases in just this way.

Both Wolff’s article and The Suicide Plan share an important argument: forcing terminally ill individuals to live when they want to die, requires both collective, national debates (i.e., as part of health care laws) and individual, personal conversations so that next-of-kin know (and can document) what kind of death a person wants.

Writing about these end-of-life items reminded me of Tony Nicklinson’s right to die case in the UK. Two good articles on Nicklinson here and here.

Death cannot ultimately be stopped. That’s the central dilemma confronted by both Frontline and Wolff (and the modern West writ large). Different kinds of researchers are certainly looking for a method to delay the aging process and dying by extension but those medical innovations (if actually desirable) are longer term possibilities.

Until that future arrives, many people will continue to choose death.

Watch The Suicide Plan on PBS. See more from FRONTLINE.

Categories
Death + the Law Death Ethics

New York Times Editorial on End of Life Care

Care at the End of Life
The New York Times (November 24, 2012)

Really good editorial in today’s New York Times on end-of-life decision making. The editorial sums up the issues and makes a clear and cogent case as to why advanced planning directives make sense.

Here’s to hoping the changes to American health insurance coverage eventually cover end-of-life discussions between patients and doctors.

Go go Gray Lady!

 

Photo by Chalmers Butterfield

Categories
Death + the Law Death Ethics

Assisted Dying Law on the Ballot in Massachusetts come Tuesday

Over My Dead Body: Helping the Terminally Ill to Die, Once Taboo, is Gaining Acceptance
The Economist (October 20th, 2012)

 

Assisted Suicide Goes To Vote In Massachusetts
Sacha Pfeiffer, National Public Radio (October 25, 2012)

A quick pre-election 2012 Death Reference Desk style(!) post about a proposed Assisted Dying law in Massachusetts (state motto: By the sword we seek peace, but peace only under liberty.)

Should a terminally ill patient with less than six months to live have the right to a doctor’s assistance with committing suicide? Massachusetts voters will decide on Tuesday. If so, Massachusetts will become the third state to do so after Oregon and Washington.

The proposed Massachusetts law is very similar to Oregon’s Death with Dignity Act, which is widely regarded as a model assisted dying law.

The National Public Radio print article and radio piece are quite good on giving the backstory to the Massachusetts vote.

The New York Times ran an op-ed by writer Ben Mattlin last week that presents Mattlin’s concerns about the ballot vote: Suicide by Choice? Not So Fast.

Not much else to say, other than we at the Death Reference Desk will keep an eye on Tuesday’s vote and report any developments.

Categories
Death + the Law Death Ethics Grief + Mourning

When People Choose to Die

When Prolonging Death Seems Worse Than Death
Fresh Air with Terry Gross, NPR (October 09, 2012)
Many of us think of death as the worst possible outcome for a terminally ill patient, but Judith Schwarz disagrees.

Fresh Air’s Terry Gross ran a really fantastic interview this week with Judith Schwarz from Compassion & Choices. I can go on and on about why people should organize their End-of-Life directives and wishes, but Judith Schwarz spells it out from A-Z during the interview.

I strongly suggest listening to the full interview.

Categories
Death + the Economy Death + the Law Death Ethics

The War On Death

Death and Budgets
David Brooks, New York Times (July 15, 2011)
Much of the budget mess may stem from a deep cultural antipathy toward recognizing our own mortality.

 

The Quagmire: How American Medicine is Destroying Itself
Daniel Callahan and Sherwin B. Nuland, The New Republic (July 15, 2011)

Since the American political system (read: mostly the Republican party) seems hell bent on watching the federal government go into default I thought that I would revisit a recent column by David Brooks in the New York Times. Earlier in July, Brooks wrote about spending on End-of-Life care and Medicare. For those who don’t understand the idiosyncrasies of the American health care system, Medicare is the medical insurance all US citizens receive at age 65. It’s a good program. Both my parents use it.

One of the financial issues that Medicare faces is that more and more people are living to be older than before. Well into their 80s. The extension of age, by itself, isn’t an issue. Where the problems begin are with medical costs soaring in the last few months of life.

The second article at the top, by Daniel Callahan and Sherwin B. Nuland (which Brooks references), explains the costs this way:

In a 2006 article, Harvard economist David Cutler and colleagues wrote, “Analyses focused on spending and on the increase in life expectancy beginning at 65 years of age showed that the incremental cost of an additional year of life rose from $46,800 in the 1970s to $145,000 in the 1990s. … If this trend continues in the elderly, the cost-effectiveness of medical care will continue to decrease at older ages.” Emory professor Kenneth Thorpe and colleagues, summing up some Medicare data, note that “more than half of beneficiaries are treated for five or more chronic conditions each year.” Among the elderly, the struggle against disease has begun to look like the trench warfare of World War I: little real progress in taking enemy territory but enormous economic and human cost in trying to do so.

One of the most important ways to address these cost issues is by talking about death and dying. The crux of David Brooks article is that:

…we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.

I agree. Callahan and Nuland also make a similar argument. Indeed, the Death Reference Desk ran a piece in August 2009 on exactly this issue: America and End-of-Life Care: Death, Dying, and Mortality.

 

In fact, most of the death with dignity posts on Death Ref deal with the question of death acceptance in one way or another.

So, what’s to be done. Until the US budget issues are sorted, not much. The first step, which isn’t easy by any means, is telling people that death is ok. Especially at the end of life, when compassionate care will go a long ways towards extending quality of life instead of fixating on the quantity of days.

Callahan and Nulland make a quick reference to the “…war against death” in their essay.

They are absolutely correct. A war is being fought against death, particularly in America.

And we modern humans will lose that war. Every single time.

Categories
Death + the Law Death Ethics Grief + Mourning Suicide

Terry Pratchett and Assisted Dying in England

Terry Pratchett: Choosing to Die
BBC iPlayer (only available until 9:59PM Monday, June 20, 2011)

 

Terry Pratchett’s BBC Documentary Reopens Debate on Assisted Dying
Fantasy writer’s film shows final moments of a man with motor neurone disease at Dignitas clinic in Switzerland
Esther Addley, The Guardian (June 07, 2011)

 

Terry Pratchett Defends Choosing to Die Documentary from Critics
Critics round on writer and BBC for promoting assisted dying in film that included footage of man’s death at Dignitas clinic
Haroon Siddique, The Guardian (June 14, 2011)

 

TV Review: Terry Pratchett: Choosing to Die
When life is finally squeezed of all its juice, Terry Pratchett finds there’s tea on tap
Sam Wollaston, The Guardian (June 13, 2011)

I cried and cried towards the end of Terry Pratchett’s documentary on Assisted Dying. My tears arrived not at the end of the documentary, where Pratchett watches UK citizen Peter Smedley die in Switzerland at the Dignitas Clinic. Rather, I began to cry when the various individuals involved in this documentary started traveling to Switzerland. I can only explain my emotional response as tears of respect for Peter Smedley and his wife as he chose death over a physical life increasingly controlled by motor neurone disease.

The documentary, Terry Pratchett: Choosing to Die, was shown on BBC 2 Monday night and it created a week’s worth of commentary. Most of it predictably either for or against everything in the documentary.

Terry PratchettI do not know what to say any longer about the UK’s debate on Assisted Dying. Indeed, the Death Reference Desk has a number of pieces on Assisted Dying debates in both the UK and the United States. You can review all of those previous posts here. It’s worth noting, I think, that when Death Ref started in July 2009 some of the first posts were on the UK’s Assisted Dying debates.

 

Some pieces of that debate have changed but not significantly. The only anti-Assisted Dying argument that I will flag up as incorrect is the assertion that the deaths which people choose somehow diminish the value of hospice care. That is not true. Many many people choose hospice care at the End-of-Life and I wholeheartedly support that choice. But hospice care and End-of-Life care are different than choosing an Assisted Death. These things are related but they are not co-terminus. Advocates for both hospice care and assisted death often find themselves in televised debates but these same individuals are involved in entirely different kinds of conversations.

Most importantly, neither ‘side’ will ever agree. They just won’t. The best that anyone can work towards, I think, is a well regulated, extremely stringent law which both increases funding for hospice care and allows Assisted Dying. The model law is Oregon’s Death with Dignity Act.

Every year, the state of Oregon publishes an array of statistics which explain how the law was used the previous year. Here is the 2010 statistic that I think most people would benefit from knowing:

Most (96.9%) patients died at home; and most (92.6%) were enrolled in hospice care at time of death.

In fact, you can read all of the 2010 statistics here.

If you are in the UK, then you can still watch the documentary until Monday night for free on the BBC iPlayer.

If you are in the United States then I would suggest that you watch the Frontline documentary The Suicide Tourist. I discussed that documentary earlier this year and it is extremely good. It also follows a person to Dignitas who chooses to die.

Barring either of these options, I have embedded a short clip from Terry Pratchett’s documentary.

Rest assured, these conversations about Assisted Dying in the UK will continue.

Categories
Death + Technology Death + the Law Death Ethics Suicide

The Kevorkian Generation

Life After Kevorkian
He fought for the right to assisted suicide. Now what should we do with it?
William Saletan, Slate (June 3, 2011)

I am a member of the Kevorkian generation. Those of us in our mid-to-late thirties and onwards into our forties are usually called Generation X (for those who still remember the 1990s…) but I really think that we are Kevorkian’s kids.

Jack Kevorkian, who died last week, began assisting suicides in 1990. As soon as he started this work, debates began about the legality and ethics of assisted dying. I have distinct memories of these debates, which started during my high school years and carried on into college.

I and my peers came of age and entered adulthood surrounded by End-of-Life debates. Most people have mixed feelings about what Kevorkian did but at least he made people talk about death and dying. And those conversations have had an impact over the years.

Kevorkian-edit-021

So say what you will about Jack Kevorkian but he really contributed to a debate that informed an entire generation’s future. And as we all begin looking towards the End-of-Life for our own parents, I know that Jack Kevorkian’s influence will be felt.

The Slate article by William Saletan at the top is the best essay/article that I found after Kevorkian died.

Here is how Saletan concluded his piece and I wholeheartedly agreed with him point by point:

Kevorkian didn’t have the answers. But he raised the right questions. We can’t criticize his flaws, temper his ideas, and praise the hospice movement without acknowledging what he did. He forced an open conversation about the right to take your own life. Under what conditions, and within what limits, should that right be exercised? Even if it’s legal, is it moral? What do you do when a loved one wants to die? Kevorkian didn’t take those questions with him. He has left them to us.

The obituaries in both the Washington Post and the New York Times were also good.

What struck me most about Kevorkian’s death was how he died in the middle of a debate that he, alone, significantly pushed along.

This is also a debate that will most assuredly continue without him.

In mid-May, for example, large majorities of voters in Switzerland re-affirmed the right of individuals to choose an assisted death. The Swiss voters also (and more significantly) voted against proposals to ban citizens from other nations from using the Dignitas clinic, for example, to die.

Just this past week, the Personal Health columnist for the New York Times, Jane Brody, wrote a compelling column about New York Doctors who are not comfortable discussing End-of-Life decisions with their patients. Doctors in the state of New York are now required by law to discuss End-of-Life planning and some MD’s do not want to do it. The copy title for Brody’s column sums up the situation: Law on End-of-Life Care Rankles Doctors

And then last weekend, WNYC’s radio program On the Media ran a story on how the ‘Death Panels’ allegation used by opponents to President Obama’s health care law received press coverage which seemed to validate the absurdity of that claim.

I could go on and on with the examples. Indeed, a version of each of these stories has been previously covered by Meg, Kim, and myself since the Death Reference Desk began in 2009.

Here, then, is my point: Jack Kevorkian got an entire generation of young people, now in their mid-to-late thirties and soon to be in their late forties, thinking about dying, and in such a way that I can only hope it helps End-of-Life conversations with aging parents and elderly grandparents.

Jack Kevorkian didn’t inspire my generation, per se, but he played a much bigger role in our development than most people realize.

I will wrap everything up with a video obituary by the NewsHour on Public Television.

PBS NewsHour: Jack Kevorkian, Doctor who Brought Assisted Suicide to National Spotlight, Dies

Watch the full episode. See more PBS NewsHour.

Categories
Death + the Law Death Ethics

Suicide Tourism

The Suicide Tourist
Frontline (March 22, 2011)

On March 22, 2011, Frontline will re-broadcast its brilliant documentary The Suicide Tourist. This is an exceptionally well done documentary (even for Frontline) and it captures the end of one man’s life, Craig Ewert, with an unflinching gaze. I watched it last year. Unfortunately, the website version of the documentary is only available in America, which is too bad because everyone should watch this Frontline piece.

h_vid

The entire story is presented without sentimentality or moral judgement. It forthrightly and honestly follows Craig Ewert and his wife Mary as they travel to Dignitas in Switzerland. Many Death Reference Desk readers will have come across Dignitas either on Death Ref or in other situations. Dignitas was founded in 1998 by Ludwig Minelli and it remains one of the few places in the world that individuals can travel to, in order to end their life without hiding. Ludwig Minelli appears in the documentary and you can read a longer interview with him here.

The documentary speaks for itself, so I won’t drone on and on.

But watch it.

For those who are interested, the state of Oregon has now published its official 2010 Death with Dignity Act statistics. This is the annual report that Oregon files, as required by the DWDA, documenting how many individuals used the law and for what reasons.

These statistics are worth reading too.

Categories
Death + the Law Death Ethics

Discussing End-of-Life with Jane Brody

Personal Health: Keep Your Voice, Even at the End of Life
Jane E. Brody, The New York Times (January 18, 2011)

Here is a quick follow-on article to the recent post on End-of-Life discussions in the American medical system.

Jane Brody has been writing for some time about the importance of End-of-Life planning with a person’s doctor. Her most recent column is a response to the Obama administration’s back and forth on Medicare funding for End-of-Life discussions between patients and physicians. I wrote about that recent debacle (for lack of a better term) two weeks ago. Brody’s writings have appeared before on the Death Reference Desk. In August 2009 I wrote about her push for End-of-Life planning in the (then) proposed American health care reform bill. You read that here.

Brody’s commitment to this issue is partly personal and she has been extremely open about the recent, unexpected death of her husband. She makes the following case for End-of-Life planning in her most recent column:

For many more of us these days, the end does not come swiftly via a heart attack or fatal accident, but rather after weeks, months or years battling a chronic illness like cancer, congestive heart failure, emphysema or Alzheimer’s disease. When doctors do not know how you’d want to be treated if your heart stopped, or you were unable to breathe or eat and could not speak for yourself, they are likely (some would say obliged) to do everything in their power to try to keep you alive.

 

A year ago, my husband was given a diagnosis of Stage 4 cancer. As his designated health care proxy, I had agreed long before he became ill to abide by the instructions in his living will. If he was terminally ill and could not speak for himself, he wanted no extraordinary measures taken to try to keep him alive longer than nature intended.

 

Knowing this helped me and my family avoid agonizing decisions and discord. We were able to say meaningful goodbyes and spare him unnecessary physical and emotional distress in his final weeks of life.

Not much else to say, really.

Categories
Death + the Law Death Ethics

One Step Forward…Two Steps Back with End-Of-Life Discussions

Obama Returns to End-of-Life Plan That Caused Stir
Robert Pear, The New York Times (December 26, 2010)
Advance care planning, which touched off a political storm over “death panels,” will be covered under Medicare – a “quiet victory” that supporters have been urged not to crow about.

 

‘Death Panels’ Controversy: Is Obama Avoiding Congress?
The Obama administration is set to expand options for ‘end of life’ counseling for Medicare recipients. The White House says it’s practical. Sarah Palin says it’s akin to ‘death panels.’
Gail Russell Chaddock, The Christian Science Monitor (December 27, 2010)

 

‘Death Panels’ are Real — Brought on By Budget Pressures
Norman J. Ornstein, The Washington Post (December 31, 2010)
During the debate over health reform, Rep. Michele Bachmann (R-Minn.), Sarah Palin and others railed against the “death panels” that would result from the bill. Government bureaucrats, critics said, would decide who would die and when. The bill passed – and indeed there are death panels. But they do…

 

A Reversal for Medicare on Planning for Life’s End
Robert Pear, The New York Times (January 05, 2011)
The Obama administration will revise a Medicare regulation to delete references to end-of-life planning as part of the annual examinations covered under the new health care law, officials said.

 

End-of-Life Planning Dropped from Medicare Checkup Rules
Ricardo Alonso-Zaldivar, Associated Press (January 5, 2011)
Reversing a potentially controversial decision, the Obama administration will drop references to end-of-life counseling from the ground rules for Medicare’s new annual checkup, the White House said Wednesday.

While most people were enjoying the 2010 holiday season, a most peculiar series of American End-of-Life stories slid under the radar.

Right after Christmas, many news outlets reported that the American Medicare rules had been changed to allow Doctors and their patients to discuss End-of-Life planning as part of an annual medical exam. This was big news because the very idea of discussing End-of-Life issues almost derailed President Obama’s health care initiative. I wrote about that debacle in August 2009: America and End of Life Care: Death, Dying, and Mortality

Then, all of a sudden, there was a policy reversal and it looks like Medicare coverage won’t include End-of-Life discussions– as originally reported a few days earlier.

 

The whole situation is a little suspicious, and it suggests to me that if the post-Christmas stories had never run, then the End-of-Life rules might have remained.

Who knows.

I have compiled a group of the articles that I read through at the top of the page. They’re all good. Norm Ornstein’s piece is particularly smart.

More than anything, we’ll be back discussing Medicare funded End-of-Life issues in 2011. I guarantee it.