I promised to look into the Oregon Physician Assisted Suicide situation. I don't mean to complain but it seems like such a very small step forward in the direction of providing as much assistance as my dog, Archie, will be able to receive to help him with his terminal illness and pain. If somehow I attempt to take a lethal dose of oral medication, like Seconal, and I am unlucky enough to vomit too much of it and survive, there is no legal way in the U.S. for a physician or anyone else to start an IV and give me the lethal dose that I need to exit.
To benefit from the Oregon law, one must be 18 years of age, a citizen of the state, and have a documented terminal illness. The patient must be competent to make medical decisions. The patient must request assistance in writing. I'll just provide some of the information from the statute. The complete statute is here:
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx
127.805 s.2.01. Who may initiate a written request for medication.
(1) An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner in accordance with ORS 127.800 to 127.897.
127.810 s.2.02. Form of the written request.
(1) A valid request for medication under ORS 127.800 to 127.897 shall be in substantially the form described in ORS 127.897, signed and dated by the patient and witnessed by at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request.
(2) One of the witnesses shall be a person who is not:
(a) A relative of the patient by blood, marriage or adoption;
(b) A person who at the time the request is signed would be entitled to any portion of the estate of the qualified patient upon death under any will or by operation of law; or
(c) An owner, operator or employee of a health care facility where the qualified patient is receiving medical treatment or is a resident.
(3) The patient's attending physician at the time the request is signed shall not be a witness.
(4) If the patient is a patient in a long term care facility at the time the written request is made, one of the witnesses shall be an individual designated by the facility and having the qualifications specified by the Oregon Health Authority by rule. [1995 c.3 s.2.02]
127.815 s.3.01.Attending physician responsibilities.
(1) The attending physician shall:
(a) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;
(b) Request that the patient demonstrate Oregon residency pursuant to ORS 127.860;
(c) To ensure that the patient is making an informed decision, inform the patient of:
(A) His or her medical diagnosis;
(B) His or her prognosis;
(C) The potential risks associated with taking the medication to be prescribed;
(D) The probable result of taking the medication to be prescribed; and
(E) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control;
(d) Refer the patient to a consulting physician for medical confirmation of the diagnosis, and for a determination that the patient is capable and acting voluntarily;
(e) Refer the patient for counseling if appropriate pursuant to ORS 127.825;
(f) Recommend that the patient notify next of kin;
(g) Counsel the patient about the importance of having another person present when the patient takes the medication prescribed pursuant to ORS 127.800 to 127.897 and of not taking the medication in a public place;
(h) Inform the patient that he or she has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15 day waiting period pursuant to ORS 127.840;
(i) Verify, immediately prior to writing the prescription for medication under ORS 127.800 to 127.897, that the patient is making an informed decision;
(j) Fulfill the medical record documentation requirements of ORS 127.855;
(k) Ensure that all appropriate steps are carried out in accordance with ORS 127.800 to 127.897 prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified manner; and
(L)(A) Dispense medications directly, including ancillary medications intended to facilitate the desired effect to minimize the patient's discomfort, provided the attending physician is registered as a dispensing physician with the Board of Medical Examiners, has a current Drug Enforcement Administration certificate and complies with any applicable administrative rule; or
(B) With the patient's written consent:
(i) Contact a pharmacist and inform the pharmacist of the prescription; and
(ii) Deliver the written prescription personally or by mail to the pharmacist, who will dispense the medications to either the patient, the attending physician or an expressly identified agent of the patient.
(2) Notwithstanding any other provision of law, the attending physician may sign the patient's death certificate. [1995 c.3 s.3.01; 1999 c.423 s.3]
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Well, that was my promise to provide more info about Oregon. At the end of this process, you will receive a prescription for a lethal dose of a medication. It would be nice if there were a refill available in case you screw up and vomit the first try. The law does make it easy to receive other medications that will be of help--for anxiety and for nausea.
There is an ongoing, active, negative campaign by opponents of end-of-life rights as exemplified by this Fox News article: http://www.foxnews.com/story/0,2933,392962,00.html
For this particular case above, I would like to see the original letter that the patient received. To notify the poor patient of a rejection of insurance coverage and in the same communication to offer assisted suicide is poor form, to say the least.
The safeguards outlined in the Oregon statute appear reasonable when considering that we intend to end a human life. The capacity to make the decision must be established. Pain must have been addressed aggressively. Depression should be ruled out or treated vigorously. Second opinions are a minimum precaution. Stretching out the process over two or more weeks reduces the probability of an impulsive decision.
Hopefully these safeguards become the foundation of a system that provides more in the way of help. No matter how carefully an individual prepares for the moment of departure, there is the possibility of a misstep or error, in which case a backup of actual euthanasia administered by an experienced practitioner would be highly desirable. So--Oregon seems like a "start."
The safeguards outlined in the Oregon statute appear reasonable when considering that we intend to end a human life. The capacity to make the decision must be established. Pain must have been addressed aggressively. Depression should be ruled out or treated vigorously. Second opinions are a minimum precaution. Stretching out the process over two or more weeks reduces the probability of an impulsive decision.
Hopefully these safeguards become the foundation of a system that provides more in the way of help. No matter how carefully an individual prepares for the moment of departure, there is the possibility of a misstep or error, in which case a backup of actual euthanasia administered by an experienced practitioner would be highly desirable. So--Oregon seems like a "start."
Rationing
In another post I have mentioned rationing. It has always existed in the delivery of health care and to begin a serious conversation about the future of health care costs without recognizing its presence dooms the discussion at the outset.
I like the thoughtful presentations of Daniel Callahan in Setting Limits. Throughout human history, survival of the family, group, and clan depended upon pooling of resources and, at times, decision-making about the distribution of resources, like available calories immediately available to the group. I believe that one of his vignettes depicted an Eskimo family in which the grandparents decide that they are too much of a burden to make the next "hop" in their hunting and they stay behind as the family leaves without them.
In our own society, how should health care resources be distributed? If we all agree that a heart transplant at age 40 is reasonable and that a heart transplant at 100 is not, what about the ages in between? Is there a magic age? As fewer of us pay for health care out of pocket, how will health insurers, including governments, make decisions about the distribution of benefits? We have 300 million different value systems to apply to such questions but serious discussion is hidden behind sloganeering.
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medical *
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My enrollment in hospice has been completed. In the past 5 days I must have gotten 25 phone calls from various disciplines in the hospice agency including nursing, social work, pastoral, administration, etc. Apparently Medicare requires that each offers me their services.
The hospital bed was delivered on Monday and set up in the middle of living room.
The picture is before sunrise. The sea is out there but I guess you are going to have to trust me. The most distressing symptom is severe shortness of breath when I change positions, like getting up out of a chair and walking to another room.
There is a lot of fluid and crud in the base of my left lung. It is lying on the diaphragm, the dome-shaped muscle that does a lot of the work of breathing. The diaphragm is a structure that migrates during the fetal period. The nerves that innervate the muscle come from the cervical spine, C3 and C4. The epaulet area of the shoulder is also innervated by C3 and C4, where I am sometimes experiencing breakthrough pain, like right now as I write.
Today Kirk and I were busy. He spent the morning editing a cooking show while I worked on refinancing and taxes again. Then we took the RV to the beach. I took in the sun while Kirk and Archie had a great walk. Then a lunch at a restaurant on the water. I wasn't hungry so I drank a beer and ate some sourdough (I am really living it up!). Then a drive to Los Osos to the pharmacy to pick up some supplies. Then to Autozone to get replacement bulbs for headlight and rear running light...then replacement of bulbs courtesy of Kirk...then a nap. A great day. Somewhere in there we bought a very expensive single malt whiskey.
This was a treasured day. I hope yours was as well.
I recently wrote about my increased interest in observing human faces--I noticed that I was smiling back in response to seeing smiles both in my environment and on television. When I mentioned it to David, a psychiatrist friend, he threw out a comment about mirror neurons. Such neurons might be a key to empathy and permit us to walk a mile in another's shoes without leaving our living rooms.
http://en.wikipedia.org/wiki/Mirror_neuron
I like the thoughtful presentations of Daniel Callahan in Setting Limits. Throughout human history, survival of the family, group, and clan depended upon pooling of resources and, at times, decision-making about the distribution of resources, like available calories immediately available to the group. I believe that one of his vignettes depicted an Eskimo family in which the grandparents decide that they are too much of a burden to make the next "hop" in their hunting and they stay behind as the family leaves without them.
In our own society, how should health care resources be distributed? If we all agree that a heart transplant at age 40 is reasonable and that a heart transplant at 100 is not, what about the ages in between? Is there a magic age? As fewer of us pay for health care out of pocket, how will health insurers, including governments, make decisions about the distribution of benefits? We have 300 million different value systems to apply to such questions but serious discussion is hidden behind sloganeering.
***************
medical *
***************
My enrollment in hospice has been completed. In the past 5 days I must have gotten 25 phone calls from various disciplines in the hospice agency including nursing, social work, pastoral, administration, etc. Apparently Medicare requires that each offers me their services.
The hospital bed was delivered on Monday and set up in the middle of living room.
 |
| View from the head of my bed |
There is a lot of fluid and crud in the base of my left lung. It is lying on the diaphragm, the dome-shaped muscle that does a lot of the work of breathing. The diaphragm is a structure that migrates during the fetal period. The nerves that innervate the muscle come from the cervical spine, C3 and C4. The epaulet area of the shoulder is also innervated by C3 and C4, where I am sometimes experiencing breakthrough pain, like right now as I write.
Today Kirk and I were busy. He spent the morning editing a cooking show while I worked on refinancing and taxes again. Then we took the RV to the beach. I took in the sun while Kirk and Archie had a great walk. Then a lunch at a restaurant on the water. I wasn't hungry so I drank a beer and ate some sourdough (I am really living it up!). Then a drive to Los Osos to the pharmacy to pick up some supplies. Then to Autozone to get replacement bulbs for headlight and rear running light...then replacement of bulbs courtesy of Kirk...then a nap. A great day. Somewhere in there we bought a very expensive single malt whiskey.
This was a treasured day. I hope yours was as well.
I recently wrote about my increased interest in observing human faces--I noticed that I was smiling back in response to seeing smiles both in my environment and on television. When I mentioned it to David, a psychiatrist friend, he threw out a comment about mirror neurons. Such neurons might be a key to empathy and permit us to walk a mile in another's shoes without leaving our living rooms.
http://en.wikipedia.org/wiki/Mirror_neuron
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