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Tuesday, October 28, 2008

Yes on I-1000

posted by on October 28 at 9:09 AM

I’ve received quite a few letters from people—from opponents of I-1000, from supporters of I-1000—assuring me that my mother was not in pain when she died of pulmonary fibrosis on March 31 of this year.

I’m a hospice nurse and have been with many people dying of pulmonary fibrosis. The way you describe your mom at the end, I want to reassure you she wasn’t in pain. If someone is short of oxygen but able to keep their eyes open calmly; not thrashing wildly in air hunger, their oxygen demands are waning. She did gasp for breath, but that is a reflex and she was not in distress. It’s called agonal breathing and people doing it are not aware of it. It is far worse for you to go through seeing it than it is for her to gasp like that. At that point, endorphins thrown off by the brain take over and the person undergoing this feels very light, very calm, regardless of what their body does. She had morphine in her system; between morphine and the natural endorphins, she was not feeling short of breath or panicked at the lack of air. Her body was shutting down and her consciousness was with you but separating from her body’s needs. She would have become more and more tired, a little sleepy and then when she was ready, her body would have let her go.

That’s some comfort. But even if my mother wasn’t in pain as she died—after the morphine was administered and the endorphins kicked in—her last fully conscious moments on this earth were dominated by her terror of dying in pain. I believe that, if she had had the choice, my mother would have been comforted by the control and finality of being able to administer, to herself, a fatal overdose of drugs that had been prescribed to her by her doctors. My family agrees. Either way, the choice should have been hers to make—and if I-1000 is approved by Washington state voters on November 4th, it will be ours.

But I want to thank this nurse and everyone else who wrote for your thoughtful notes, opponents of I-1000 and supporters alike. My mother was a lovely, vibrant, mordantly funny person; I miss her more with each passing day. And I will always regret that she wasn’t allowed to make a choice about how her final conscious moments would unfold. Would she die peacefully and in control, surrounded by family, after saying her goodbyes? Or would she go quietly panicking, tightly gripping her childrens’ hands, as she slipped into drug-induced semi-consciousness? My mother didn’t have a choice. She should have.

Approving I-1000 will allow other sons and husbands, daughters and aunts, and wives and mothers to make their own choices about their final moments. Please vote yes.

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what i don't think the opponents of I-1000 get is that this happens anyway.

when my aunt was in a hospice w/ severe heart, lung, stomach and brain cancer with only a few days of discomfort and unbearable pain left, she was given an open-ended morphine drop for the pain.

she took her own life, effectively OD'd on morphine, with the approval of her doctors. and family.

Posted by mike | October 28, 2008 9:29 AM

ayup. Also you die anyway, too. So if you are in pain or don't want fear of pain and two doctors agree you are terminal and if you are competent and if Oregon had a similar law with no problems WTF with telling people they have to live in pain for the last bit of their lives?

Why is the state trying to control your body? Who are these people who claim they can pass a law saying you can't control your own body?

The people who jumped out of WTC rather than burn to death we don't call them suicides. No one who would take advantage of death with dignity is going to live anyway, they are merely choosing the exact manner of their death when it is inevitable. If a spy can take a pill rather than be tortured and this is noble, why can't we all take a pill rather than be tortured with pain we have not chosen?

Making people suffer is barbaric.

Posted by PC | October 28, 2008 9:49 AM

I'm sorry for your loss, Dan. I've lost loved ones in pain as well, and it's hard.

I am still voting against I-1000, and am doing my best to convince other voters to join me.

Some reasons to vote no, in no particular order:

1. This bill contains no provisions to disallow insurance companies from covering suicide while refusing to cover treatment of the disease or palliative care for those who choose to live longer. I've been told by proponents that while this is terrible, still it's important to pass this bill even though it is vastly imperfect, because it's the bill we have in front of us. I will just point out that this kind of ends-justifying-means reasoning got us the PATRIOT act and some retroactive immunity for the telecoms.

2. This bill requires that doctors list the "underlying condition" as the cause of death on the death certificate. That means that we would be legislating falsification of medical records. That is unacceptable.

3. My sister, a disabled person who struggles with depression a chronic (and probably eventually terminal) disease, points out that it is inherently discriminatory for the state to say that SOME people are allowed (and potentially encouraged) to kill themselves, while "the rest of us are required to take our antidepressants and keep on suffering." Depending on how you look at it, it is enshrining in legislation either the government's value of some people's lives over others, or value of some people's right to "choice" over others.

4. When we look at history for examples of other industrialized societies that have passed similar laws, we are not really joining good company in a lot of ways, which should give us extra pause.

A lot of people present this as a case about "choice" and about some sort of presumed right to a death at the time and in the manner of our choosing. This is incorrect. It is always possible to choose to die; a large enough overdose of aspirin is fatal, among many other things. It is about the convenience of having a doctor use her expertise to prescribe the right dose and a pharmacist mix it up and give it to you in one easy-to-swallow pill.

This is a very strange thing for the Left to have climbed on the bandwagon for, and I'm not climbing the Bandwagon of Uncertain Structural Integrity and Destination just because someone named it Death With Dignity and told me it is all about choice.
I like dignity and choice, too, but I don't believe for a second that supporting dignity and choice requires me to support I-1000.

Posted by Thisbe | October 28, 2008 9:57 AM

@3... I have to take issue with your "it is always possible to die" statement. Someone who is truly in the end stages of a terminal illness will likely not be able to go out and pick up a bottle of aspirin from the pharmacy. Even if they are able to "push the button" or swallow the pills, they will probably not be able to procure the necessary medications. They will likely be bed-ridden, and as such, will need assistance if they decide to end their own life.

Your view that it's about "convenience" is also a little misguided. Sure, there are other methods of suicide, but why should a person near have to take the chance that their suicide will be a painful experience, or will not succeed? The point of opting for physician assisted suicide is that you are virtually guaranteed that it will work and be painless.

In my mind, this isn't about me being a liberal at all. This is about, if I were suffering and near death, what options would I want to have open to me? I can tell you that I would want a painless death, with no risk of any criminal charges for my family or my doctor.

Posted by Julie in Chicago | October 28, 2008 10:10 AM

** Depending on how you look at it, it is enshrining in legislation either the government's value of some people's lives over others, or value of some people's right to "choice" over others. **

#3, your whole post confused me - but this in particular. Seems to me that I-1000 has attempted to answer your concerns, by allowing the option of choosing death only when death is already eminant.

While I personally see depression as a debilitating disease that sufferers should have the option of ending, I can understand that others would disagree. And *usually*, the sufferer could take another path to death that doesn't require a doctor's help.

I have MS, and occasionally I am very depressed about it. If it gets bad enough, I'm capable of taking my own life. But Dan's mother was not. People with ALS are not - people with a myriad of other diseases are not.

For reasons I've never understood, suffering is somehow elevated to something we are 'supposed' to do, something that somehow makes us noble. I would never allow my animals to suffer like that. I've euthanized so many of my very beloved pets because I didn't want them to suffer. It's never an easy decision, but looking back, I've never regretted those decisions. I released them from suffering.

As I said before, I can't make sense of your comments - but damn, it makes me angry that you would make my own decison for myself even harder than it has been for my pets.

Yes, I could take so many aspirin that I bleed to death internally; I could starve myself to death - why can't I have that simple shot that eases me away?

Posted by Ayden/VA | October 28, 2008 10:25 AM

In addition to Julie's points, @3, your #2 point is pretty bogus. The underlying cause of death is always named on the death certificate, regardless of whether the deceased starved themselves to death (what a horrid way to go that would be), had the respirator removed, or had an open morphine drip.
As far as point #3, this is not about "disabled" or depressed people. It is not about "seriously ill" people. This is about people with *terminal* illness (verified by at least two doctors) who would MUCH rather live, if they had the chance. But they can't. Their death is imminent.

If they would prefer to live to the last possible moment, that's fine with me. It's their choice, not mine. But voting against Prop 1000 takes away somebody else's right to make their own decisions about when and how they will die, when they can no longer have a life at all.

Posted by lily | October 28, 2008 10:29 AM

I have to say that "agonal breathing" doesn't exactly sound painless. Agonal sounds like agony. Maybe it's just a poorly chosen way to describe what the terminally ill are going through, but to me it sounds horrible.

Posted by T | October 28, 2008 10:42 AM

I'm sorry that my attempt to express nuanced thought was confusing. The plain fact is that while I oppose government intervention in what I put in my body, this bill is not actually about that.

Nobody is taking away your right to make any choice for yourself. If you want to research a gently lethal combination of chemicals, make it yourself, figure out the correct dosage, and keep it around for the potential time when you would be faced with a protracted and painful death, no one is stopping you.
This law would simply facilitate your ability to have the thing you want with less effort on your part. That is a fine goal, but it does not rise to the level of an important right. Which means that the problems written into the bill are more than enough to keep me from voting for it this time around.

The fact is that when (for instance) a respirator is removed, the underlying cause of death IS the problem that keeps the patient from breathing normally on his own.

Perhaps I should have been more specific about my sister, who is disabled and has struggled with depression her whole life. She additionally has a chronic, incurable, physically and probably neurologically degenerative disease that will eventually result in her death.
She has well over six months to live (years or decades, probably), but is in frequent and increasing pain and distress and is afflicted with bouts of depression and suicidal tendencies. I would prefer that she not kill herself, and so, on her good days, would she. On her bad days, she would prefer to die. So I think that her perspective about incurably ill people and depression is valuable - she opposes so-called "death with dignity" bills because unless carefully crafted to avoid it (which this one is not), they enable people to make choices in relative haste that they might have lived to
repent at leisure.

Lastly, I am not convinced that "six months to live" is a valid or useful criterion. I understand how statistical models work; it is true that most people who are told they have six months to live die within six months, but many do not. There are experimental and alternative treatments and the simple factor of the right-skewed probability distribution.
Moreover, the medical assessment of "time left to live" is not in any way verifiable in a situation of subsequent suicide.

If we really and truly believe that people have a right to die at the time and in the manner of their choosing, we need to legislatively protect that right for all people, not just the "terminally ill" who have the requisite two doctors who will give the opinion. If there is a right to lethal prescription, it needs to be protected equally under the law for all people. If it is not equally protected under the law, then the law is discriminatory.

I personally do not believe that there is a right to lethal prescription. Thus, though I-1000 is a nice idea, I find that the numerous problems with it prevent me from feeling like I can vote for it.

Posted by Thisbe | October 28, 2008 10:58 AM

@7, thanks for your highly scientific examination of what a word "sounds like" to you. 'cause words in English never have multiple meanings, right?

It's that sort of I-know-it-all disregard for relevant experience and actual expertise that has become the hallmark of creationists and dingbats who think Miss Congeniality == Presidential Material.

Posted by J | October 28, 2008 10:59 AM

In Response to 3:

#1 Nope. Doesn't work- two doctors have to confirm that the patient is terminal, with no other options... They are going to die no matter what. And besides, whats to keep an insurance company from denying coverage even without suicide as a second option?

#2 Personally I could give a flying fuck if my death certificate says "suicide by pills" or "cancer". In any case, it's reported to Public Health, so there will always be records.

#3 So your saying we should withhold these rights from all terminal patients because some depressed people can't choose to get a doctors note to kill themselves? That's truly moronic.

#4 Wow- could you be anymore vague? Better yet, are you out fighting against building stadiums and indoor plumbing because the fallen Roman Empire built them too?

Posted by mojo mojito | October 28, 2008 11:01 AM

Thisbe, let me pose a hypothetical question to you-

Your sister is suffering from a diabilitating illness that leaves her bedridden. (So we're ruling out depression, obviously) She's seen two independent doctors who confirm her illness is terminal in 6 months, and a psych evaluation has shown her to be of sound mind (again, all these are requirements of I-1000).

What do you do?

A) Let her suffer and/or dope her up on morphine for the remainder of her life, unaware if she's comfortable or just unable to express her agony to the outside world.

B) Get her the necessary drugs to end her own life (again, she's bedridden and unable to get them herself) and face going to prison for murder or manslaughter.

C) Receive medication from a trained medical professional that will quickly and painlessly help your sister end her suffering.

I think the choice is obvious. Vote for I-1000

Posted by UNPAID BLOGGER | October 28, 2008 11:12 AM

Thisbe, what is this bullshit about "convenience"? You think it's convenient to a) have a terminal illness diagnosed, b) to have less than 6 months to live, c) get it confirmed by two doctors, d) request the lethal prescription three times, two weeks apart, e) make the decision about when and where, and f) take it yourself--not hard for us, but I imagine it's a lot harder to swallow pills when dying of something like esophageal cancer.

That's hardly like hopping to the pharmacy to procure some magic pills.

As far as how long you have left to live, does it really matter if there is a possibility of 7 months instead of 6? The end is the same. Only the suffering is lengthened, and the person dying can probably tell better than you can whether they are hours away from death.

Posted by lily | October 28, 2008 11:12 AM

My main concern with I-1000 is that insurance companies will be covering assisted suicide, but reduce coverage for everything else. The sick and elderly would then be left with a choice: kill themselves, or leave their children with no inheritance and their spouse deeply in debt.

Posted by Gustopher | October 28, 2008 11:42 AM

** My main concern with I-1000 is that insurance companies will be covering assisted suicide, but reduce coverage for everything else. **

That is your main concern?

Seems to me you're really grasping for some reason to oppose this measure. Never gonna happen. Insurance companies need living sick people to buy their product.

Posted by Ayden/VA | October 28, 2008 12:36 PM


Anyone with a possibility of survival with other medical care wouldn't be eligible for I-1000 anyway; Two doctors have to verify that a patient is terminal, thus no other options available to them.

And besides, what keeps insurance companies from denying care now? The same guidelines and rules would still be in place after I-1000 passed.

Posted by UNPAID BLOGGER | October 28, 2008 12:36 PM

@7: They both come from the greek agonia meaning either struggle or anguish, depending on context. Although "agony" unmodified retains the sense of anguish, "death agony" derives from the other sense, and refers to involuntary movements (such as convulsions) preceding death, because the body seems to be struggling in vain to live. Thus "agonal respiration" refers to respiration that is part of the death agony, rather than respiration that is characterized by agony in the common sense of the term.

Posted by christopher | October 28, 2008 12:45 PM

I have long believed in the right to choose to die with dignity. I believe in it now. But to be honest, for a brief time about eight months ago, I did not believe in it.

At that time, my father was dying. It was, for cancer, a relatively brief illness -- he died six weeks to the day after doctors first found the tumour. It was a devastating, shocking diagnosis for me and my family, because my father had always been an extremely healthy man.

In the last two weeks of his life, my father repeatedly said he would like to have assisted suicide if that was an option. Doing it himself was not a realistic option as he couldn't swallow, had no access to weapons and not even enough strength to stand, never mind anything else.

At the time, I hated the idea and argued with my father about it -- in any case, a moot point, since it's as illegal in Canada as in the States. I argued he was well cared for in the hospice (and he was, most of the time), he wasn't in too much pain (with the drugs, though he did still have nausea and discomfort), and since he had so little time left, didn't he want to spent it with us, his family?

If at that point I'd had an opportunity to vote on something like I-1000, I would have voted against it because I wouldn't have wanted my father to end his life before I was ready.

Repeat: before *I* was ready.

Looking back on it, the way I felt was a knee-jerk reaction to shock and grief. It was a selfish reaction, not a loving one.

Looking at the situation more clearly now, I see that when my father started talking about suicide was when his quality of life had seriously declined to the point it was hardly worth living. Though the diagnosis clearly depressed him, he didn't mention suicide right away, because for the first month or so, while his quality of life was certainly reduced, he could still value time with his family.

In the last two weeks of his life, our time together was no longer quality time. It was dominated by my father's discomfort, fatigue, irritability and sense of humiliation due to his failing body. He was a proud, independent man and of course didn't want to spend his last days hooked up to catheters and oxygen and bags of fluid. But my selfish desire to hang onto him outweighed my compassion and understanding.

I wish I could have seen more compassionately back then. And I wish my father had in fact been able to end his life on his own terms. I hope others have the choice in the future. And remember, it's a CHOICE.

I'm many of those who oppose giving people the choice to die with dignity have felt the way I did -- they wanted to hang on to a loved one longer, even if just another day or week. I understand why they might feel that way. But I bet it they examine their feelings honestly, they'll realize they feel that way for their own sake, not for the sake of their loved one.

Posted by Karen in Canada | October 28, 2008 2:18 PM

Minor clarification in last paragraph:

I'm SURE many of those who oppose giving people the choice to die with dignity have felt the way I did.

Posted by Karen in Canada | October 28, 2008 2:21 PM

Well said, Karen. I take back everything I ever said about Canadians.

Posted by UNPAID BLOGGER | October 28, 2008 3:57 PM

To add to #17:

Almost two years ago, I lost my husband. Kidney disease, no transplant forthcoming, dialysis failure. They gave him two weeks. He was housebound and had to use a commode chair because he couldn't make the one three-inch step up to get into the bathroom.

We had hospice home care, and they sent us the drug kit that included Ativan, Haldol, morphine, etc. Five weeks later, he was still alive and suffering terribly.

On Monday of week 5, he asked me to help him end his life the next Sunday. I told him I would do whatever I could to help, even though to be found out would cost me my medical license.

Fortunately, he told his home hospice nurse about his plan, and she convinced him to go into inpatient hospice where he could be kept sedated and have food and water withheld until the end came. He accepted.

He was admitted and sedated via IV drip on a Friday. Eight days later, he died. I sat in his room every day, knowing that as power of attorney I could have stopped the process at any time. It tore holes in my soul that have yet to heal.

So to those of you who would vote no, I sincerely hope you get the chance to experience the cruelty and pain that he got to go through before being offered a humane option, and then I hope you get to deal with the eternal damage that going through this experience does to the loved ones left behind.

'Cause, you know, you deserve no less.

Posted by Young Widow | October 28, 2008 4:00 PM

I'm voting yes after watching 3 weeks of agonal breathing, hoping and praying for death to finally come each time the monitor began violently beeping and declaring apnea.

No legislation will ever be perfect. This deserves to pass. Now.

Posted by Dawgson | October 28, 2008 6:12 PM

I-1000 is an abomination and another example of our self centered culture. What does this say to our children, “When life’s pain is too great, just throw in the towel?” Having this legislation on the books condones actions that are clearly immoral and sets precedence that our actions only affect ourselves with no consequences to those within our sphere of influence. VOTE NO on I-1000

Posted by Concerned Parent | October 29, 2008 5:18 PM

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