Monday, November 11, 2013

Helping A Patient Die - Death with Dignity

Recently at a conference, I invited others to consider posting their stories on this blog about end of life issues.  The following story is from a physician who volunteers with Compassion and Choices in Washington State.  About 1 in 500 deaths in Washington state (0.2%) occur by utilizing Washington's Death with Dignity law - passed by a 59% margin several years ago.  Oregon's similar law was also passed by a voter initiative, and Vermont's legislature recently passed a similar law.  Here is this physician's story:

"As a Client Services Volunteer for Compassion and Choices of WA, (C&C) it is my privilege to help a dying person in choosing his/her way of dying.

A few years ago I helped an incredible woman, 64, end her life.  She had gotten the diagnosis of lung cancer, unrelated to smoking, 4 years earlier.  In the midst of an active and successful career as a consultant for large companies seeking more effective Human Resources, she was stunned by this news.  She had some surgery, which relieved her difficulty with breathlessness, followed by chemotherapy.  The bouts of chemo were hard to tolerate for her as an always healthy, exercising, normal weight person.  But she got through them and enjoyed a remission of 2 years. 

A year later, recurrence was found in her lung, brain and liver.  Radiation and more chemo seemed to shrink these lesions, but her mental acuity was slowly decreasing.  She and her husband decided to pursue, via the Death with Dignity Law, an option to end life if she needed to do that.

Because she had obtained a prognosis or 6 months or less from her physician, she was eligible for that choice in WA. I was called when they contacted C&C, so I met with them in their condo.  We began the process specified by the Law. After another physician confirmed her diagnosis and prognosis, she also was found to be non-depressed and mentally competent to decide.  She completed the Written Request form and the waiting period.  Finally, she obtained the prescription from her personal physician.

She continued to work past her initial 6-month prognosis.  Then her strength forbid the traveling and exertion required.  They took the trip to Antarctica she had always wanted.  However, she again used her strength of character to get there.  Predicted bad weather caused the captain of their small ship to turn back toward the Cape of Good Hope, but she rallied the other passengers to demand that the captain check and recheck the weather.  A better forecast allowed them to proceed to Antarctica. 

She decided to set a time for death when she was unable to go outside for walks with her husband and she was getting more short-term memory loss, to the extent that she could not read books.  They got a rental hospital bed for the living room.  They invited close family and arranged a time with me.  On a weekend morning, after a light snowfall near Christmas the family spent time sharing memories and she took anti-nausea medications.  I arrived and mixed the powder with warm water.

She expressed her love for each person and her gratitude to me.  Holding her husband closely, she drank the small amount of liquid.  She chased the bitter taste with a favorite juice.  Her family gathered near her and held each other.  She quickly slept and died."  Posted by an MD.

Comment: Years ago I had a similar case where I was pretty sure that a patient with end stage mesothelioma was squirreling away sedatives and contemplating ending his life of suffering with an overdose.  He was suffocating as his lungs were being progressively compressed by tumor masses.  I presented his case to our Ethics Committee and was surprised that the Ethics Committee supported his autonomy even though it appeared to violate the "Do No Harm" ethical principle (and was against the law at that time).  In reality I think it could be argued than harm was being forced on this man by not giving him the help he wished.  At any rate I think he may have ended his own life with medications.  How often is this quietly done?  Probably much less often now that Hospice is widely available and a Medicare benefit.  JdeM

1 comment:

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