Category: Extraordinary Measures

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A ‘Code Death’ for Dying Patients

By JESSICA NUTIK ZITTER, M.D.

Sadly, but with conviction, I recently removed breathing tubes from three patients in intensive care.

As an I.C.U. doctor, I am trained to save lives. Yet the reality is that some of my patients are beyond saving. And while I can use the tricks of my trade to keep their bodies going, many will never return to a quality of life that they, or anyone else, would be willing to accept.

Code DeathI was trained to use highly sophisticated tools to rescue those even beyond the brink of death. But I was never trained how to unhook these tools. I never learned how to help my patients die. I committed the protocols of lifesaving to memory and get recertified every two years to handle a Code Blue, which alerts us to the need for immediate resuscitation. Yet a Code Blue is rarely successful. Very few patients ever leave the hospital afterward. Those that do rarely wake up again.

It has become clear to me in my years on this job that we need a Code Death.

Until the early 20th century, death was as natural a part of life as birth. It was expected, accepted and filled with ritual. No surprises, no denial, no panic. When its time came, the steps unfolded in a familiar pattern, everyone playing his part. The patients were kept clean and as comfortable as possible until they drew their last breath.

But in this age of technological wizardry, doctors have been taught that they must do everything possible to stave off death. We refuse to wait passively for a last breath, and instead pump air into dying bodies in our own ritual of life-prolongation. Like a midwife slapping life into a newborn baby, doctors now try to punch death out of a dying patient. There is neither acknowledgement of nor preparation for this vital existential moment, which arrives, often unexpected, always unaccepted, in a flurry of panicked activity and distress.

We physicians need to relearn the ancient art of dying. When planned for, death can be a peaceful, even transcendent experience. Just as a midwife devises a birth plan with her patient, one that prepares for the best and accommodates the worst, so we doctors must learn at least something about midwifing death.

For the modern doctor immersed in a culture of default lifesaving, there are two key elements to this skill. The first is acknowledgment that it is time to shift the course of care. The second is primarily technical.

For my three patients on breathing machines, I told their families the sad truth: their loved one had begun to die. There was the usual disbelief. “Can’t you do a surgery to fix it?” they asked. “Haven’t you seen a case like this where there was a miracle?”

I explained that at this point, the brains of their loved ones were so damaged that they would most likely never talk again, never eat again, never again hug or even recognize their families. I described how, if we continued breathing for them, they would almost definitely be dependent on others to wash, bathe and feed them, how their bodies would develop infection after infection, succumbing eventually while still on life support.

I have yet to meet a family that would choose this existence for their loved one. And so, in each case, the decision was made to take out the tubes.

Now comes the technical part. For each of the three dying patients, I prepped my team for a Code Death. I assigned the resident to manage the airway, and the intern to administer whatever medications might be needed to treat shortness of breath. The medical student collected chairs and Kleenex for the family.

I assigned myself the families. Like a Lamaze coach, I explained what death would look like, preparing them for any possible twist or turn of physiology, any potential movements or sounds from the patient, so that there would be no surprises.

Families were asked to wait outside the room while we prepared to remove the breathing tubes. The nurses cleaned the patients’ faces with warm, wet cloths, removing the I.C.U. soot of the previous days. The patients’ hair was smoothed back, their gowns tucked beneath the sheets, and catheters stowed neatly out of sight.

Then, the respiratory therapist cut the ties that secured the breathing tube around the patients’ neck. As soon as the tubes were removed and airways suctioned, families were invited back into the room. The chairs had been pulled up next to the bed for them and we fell back into an inconspicuous outer circle to provide whatever medical support might be needed.

I stood in the back of the room, using hand motions and quietly mouthing one-word instructions to my team as the scene unfolded — another shot of morphine when breathing worsened, a quick insertion of the suction catheter to clear secretions. We worked like the well-oiled machine of any Code Blue team.

Of those three Code Death patients, one died in the I.C.U. within an hour of the breathing tube’s removal. Another lived for several more days in the hospital, symptoms under watch and carefully managed. The third went home on hospice care and died there peacefully the next week, surrounded by family and friends.

I would argue that a well-run Code Death is no less important than a Code Blue. It should become a protocol, aggressive and efficient. We need to teach it, practice it, and certify doctors every two years for it. Because helping patients die takes as much technique and expertise as saving lives.

Complete Article HERE!

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Poll finds Americans want to live longer, but not too much

* Survey finds Americans’ ideal age around 90
* Slight majority would refuse treatment to extend life
* Would living to 120 sap marriage, family, love of life?

 

By Tom Heneghan

How long would you like to live – 100 years? Maybe 120? Would extended life spans be good for society, the economy and the way people go through their lives?

With populations aging and medical science progressing, questions like these are moving from the science-fiction category to the realm of long-term issues that ethicists and policy makers are starting to consider.

Salustiano Sanchez, 112, the world’s oldest man according to Guinness World Records, resides in a retirement home on Grand Island, New York, July 30, 2013.
Salustiano Sanchez, 112, the world’s oldest man according to Guinness World Records, resides in a retirement home on Grand Island, New York, July 30, 2013.

The Pew Research Center, a Washington-based think tank known for its surveys into political and social trends, published a report on Tuesday exploring views about “radical life extension” and its effects in the United States.

Entitled “Living to 120 and Beyond”, the report said that “many Americans do not look happily on the prospect of living much longer lives”. Among the findings:

– The median ideal lifespan mentioned in the poll of 2,012 people was 90 years, about 11 years longer than the current average U.S. life expectancy of 78.7 years.

– Some 56 percent said they would refuse medical treatment to extend their lives, 38 percent would take it and the rest didn’t answer. But 68 percent thought that other people would seize the opportunity. Only 41 percent thought living to 120 would be good for society.

– Some 79 percent said life extension should be available to all, but 66 percent thought only the rich would have access to it and another 66 percent feared scientists would offer the treatment before fully understanding its health effects.

– Black and Hispanic Americans are more positive than whites about extending life, although the survey could not explain why. Religious views, gender and education did not seem to play a significant role in responses to the national survey.

ENDLESS LIFE “NO PARADISE”

Pew’s Forum on Religion and Public Life conducted the survey as part of its focus on emerging issues with religious and ethical implications, researcher Cary Funk told Reuters.

“Once we started talking to people whose job it is to think about ethical issues and the future, this came up over and over again,” said her fellow researcher David Masci.

The report stressed medical science is not yet able to offer radical life extension treatment and noted that three-quarters of those polled did not think average people in 2050 would be able to live to 120 or longer.

Only 10 percent said having more elderly in the population would be bad for U.S. society, although 53 percent thought it would not make the economy more productive.

The report said extending life spans would challenge the concept of life-long marriage and could confuse relations within families when “people may not look or act much older than their parents, grandparent or even great grandparents.”

It cited ethicists who asked whether postponing death until a distant future would make people appreciate life less.

While all faiths confront the issue of death, the report said none had yet taken a position on radical life extension.

But researcher Masci found that former Pope Benedict, who unexpectedly retired in February citing his old age, addressed the issue in a Holy Saturday sermon back in 2010.

Benedict, now 86, observed that modern medicine sought to delay death as much as possible and asked whether radical life extension would be a blessing.

“Humanity would become extraordinarily old, there would be no more room for youth,” he said at the Vatican. “Capacity for innovation would die and endless life would be no paradise. If anything (it would be) a condemnation.”

Complete Article HERE!

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ACLU says faith-based hospitals jeopardize reproductive, end-of-life care

By Aaron Corvin

Hospitals are supposed to be places of healing, but Washington’s hospitals are becoming places of conflict between religion and government over health care services.

faith-based hospitalsThe state’s American Civil Liberties Union is questioning whether health care regulatory agencies and public hospital districts should grant approval to faith-based hospitals — primarily Catholic — that don’t offer reproductive and end-of-life services that are widely available at secular hospitals. In some rural areas of the state, the ACLU says, hospital consolidations and mergers could leave communities only with Catholic hospitals which refuse, based on Catholic religious beliefs, to provide such services.

“We’re very troubled by what’s going on,” said Sarah Dunne, legal director for the Seattle-based American Civil Liberties Union of Washington Foundation. The ACLU is pressing its case on several fronts, including the possibility of legal action. The group also is challenging proposed partnerships between Vancouver-based PeaceHealth and other health care providers.

PeaceHealth, a Catholic-sponsored health system, is pushing back. The nonprofit health care giant — Clark County’s top private employer — says its partnerships with public hospital districts and others are well within legal parameters. And the organization stands by its right to deny certain services based on its religious principles, officials say, as it continues a long history of improving health care in a variety of communities.

“All we have to point to is our record of service,” said Jenny Ulum, a PeaceHealth spokeswoman.

Later this year, the proposal by PeaceHealth and Colorado-based Catholic Health Initiatives to join forces will undergo a public review and decision by state health regulators. The companies are submitting paperwork, and critics say they plan to weigh in.

The controversy arises amid dizzying political and economic changes in health care. Consolidation has become a health care industry norm. And federal health care reform has heightened tension between the Obama administration and Catholic-based health providers over insurance coverage for contraception.

Not all religiously affiliated hospitals operate in the same way or with the same policies. In PeaceHealth’s case, the nonprofit is a church ministry authorized by the archbishops of Portland and Seattle, according to Ulum. “The church’s authority pertains to our Catholic identity,” she said, “which basically has oversight over faith and morals.” However, PeaceHealth also is a nonprofit corporation with its own governing board and bylaws, Ulum said. PeaceHealth owns its property and facilities, she said, and is responsible for business operations and its health care work.
Legal arguments clash

The ACLU cites data showing that several merger proposals this year would decrease secular hospital beds in the state, in some cases handing a monopoly on health care services to religiously affiliated institutions.

As a result, the ACLU in Washington has launched efforts to curb what it sees as an alarming trend. That includes opposing arrangements between PeaceHealth and taxpayer-funded public hospital districts in San Juan and Skagit counties. The group argues the tax dollars should not be used to subsidize health services limited by PeaceHealth’s religious policies.

It’s also urging public hospital officials to renegotiate their relationships with PeaceHealth in light of the nonprofit’s proposed partnership with Catholic Health Initiatives.

The ACLU argues CHI is even more restrictive in its policies than PeaceHealth. Partly because of its larger size and influence, they say, CHI will likely seek to impose its religious doctrines in communities served by PeaceHealth.

But PeaceHealth officials say the nonprofit and CHI already have agreed that neither of their respective patient-care ethical policies will change under their proposed affiliation, which will be structured as an equal partnership. What’s more, they say, their partnership is intended to boost the quality of care they provide and to strengthen their financial footing to serve growing populations.

The situation in San Juan County exemplifies the conflict. Under an arrangement with the San Juan County Public Hospital District No. 1, PeaceHealth built Peace Island Medical Center, which opened last year. The new facility was built for $30 million, with the community covering about a third of the cost using private funds and with PeaceHealth footing the rest of the construction bill. And PeaceHealth runs the hospital under a contract with the district, which uses its property-tax levy to partially subsidize PeaceHealth’s operations.

Ulum, the PeaceHealth spokeswoman, said the hospital district transferred about $1.2 million in annual property-tax revenue it had used to operate its previous clinic to PeaceHealth. Nearly all of those property-tax dollars enable PeaceHealth to cover the costs of providing charity care and of maintaining a 24-hour emergency department, Ulum said. There was no change in the tax rate, she added.

Lenore Bayuk, the San Juan Hospital District’s commission chairwoman, said PeaceHealth’s entry into the community, with modern facilities, was crucial. Previously, the district struggled to cover its costs at the old clinic, Bayuk said. With PeaceHealth, she said, the district is on sounder financial footing. “We have a cancer treatment center which we didn’t have before,” Bayuk added, noting many other improvements.

But critics say the situation isn’t so tidy. Those include Monica Harrington, a former Seattle technology executive who opposes PeaceHealth’s contract with the San Juan County public hospital district. She cited the fact that San Juan County health officials have agreed to review concerns raised by some residents about health care cost and access issues, including at Peace Island Medical Center.

“We effectively traded lower-priced unrestricted health care in an increasingly dilapidated building for much, much higher-priced, religiously restricted care in a beautiful, art-filled facility,” Harrington wrote in an email to The Columbian.

The ACLU acknowledges the improvements made under PeaceHealth’s arrangement with the San Juan Hospital District. But the organization argues the contract between PeaceHealth and the district violates the Washington Constitution and the state’s Reproductive Privacy Act. “As a government entity, the hospital district should not subsidize religious facilities that discriminate against women’s fundamental rights,” Kathleen Taylor, executive director of the ACLU’s operation in Seattle, wrote in a letter to district officials.

PeaceHealth says the ACLU is wrong in its legal interpretation. There’s nothing in the law prohibiting public-private partnerships between hospital districts and private health care providers that maintain religious affiliations, the nonprofit says. The purpose of PeaceHealth is to provide “important health care services, not the advancement of religion,” according to its legal analysis. “To suggest otherwise is inconsistent with more than a century of collaboration in Washington between the state and religiously affiliated charities, health providers and others.”

But the ACLU says its concerns go beyond PeaceHealth’s arrangements with local public hospital districts.

In her letter to the San Juan County Hospital District, Taylor takes umbrage with PeaceHealth’s proposed partnership with CHI, which operates in 17 states and includes 78 hospitals. The venture between PeaceHealth and CHI would combine seven Catholic Health Initiatives hospitals in Washington and Oregon with nine PeaceHealth hospitals in Washington, Oregon and Alaska.

Although PeaceHealth has argued it will maintain its own ethical policies in its relationship with CHI, Taylor wrote in her letter, “the lack of any legally binding document to that effect fails to protect against the possibility” of additional restrictions on access to reproductive and end-of-life services.

In their concern about how PeaceHealth and CHI will interact, the ACLU and other critics also cite Kentucky Democratic Gov. Steve Beshear’s effort last year to block a proposed merger between University of Louisville Hospital and Catholic Health Initiatives. Beshear opposed the merger in part out of concern that the deal would reduce access to reproductive services. But after further negotiations, the deal went through this month and included a provision that U of L Hospital will remain independent of the Catholic health directives followed by CHI.

Closer to home, PeaceHealth says the concern about its potential relationship with CHI is a nonstarter.

In a letter to the San Juan County hospital district, Sister Andrea Nenzel, chair of PeaceHealth’s board, wrote: “(Catholic Health Initiatives) and PeaceHealth have already agreed that our hospitals, including Peace Island Medical Center, will not change their ethical policies regarding patient care that have been in effect for as long as 40 years.”
Diverging from mainstream?

PeaceHealth officials emphasize the nonprofit’s health care mission is spiritual and expansive, serving the poor and caring for those who are unable to pay for services. Its faith foundation means that PeaceHealth also carries a set of ethical policies that govern the medical services it chooses to provide. Those include:

• It does not permit abortion except to save the life of the mother.

• Contraceptive decisions, including tubal ligations and vasectomies, are between the patient and the provider, and are based on medical necessity.

• Emergency contraception is provided to women who are victims of sexual assault. However, PeaceHealth requires a negative pregnancy test before it will dispense emergency contraception.

• RU-486, which induces abortion, is not dispensed at PeaceHealth.

• With respect to end-of-life care, the nonprofit honors advance directives.

• Physician-assisted suicide is prohibited — even in states, including Washington, where it is legal — on PeaceHealth time and in the nonprofit’s facilities or any facility leased from PeaceHealth.

“In the vast majority of cases,” said Ulum, the PeaceHealth spokeswoman, there’s no “dogmatic policy that supersedes” the decision-making that goes on between a doctor and a patient.

Before Vancouver-based Southwest Washington Medical Center became part of PeaceHealth’s system in 2010, the hospital had been secular since the late 1960s, according to Ken Cole, a PeaceHealth spokesman. Still, the secular hospital honored its Catholic heritage, which dates to the hospital’s founding in 1858 by Mother Joseph of the Sacred Heart.

None of the ethical policies that Southwest, as a secular institution, followed in providing medical services changed when the hospital joined the Catholic-sponsored PeaceHealth network, according to Cole. “We were already in alignment with the system,” he said.

Of course, both organizations have made numerous other changes to solidify their affiliation, Cole said, including updating their clinical procedures.
‘Our conscience’

But critics see more gaps, “don’t ask, don’t tell” situations and slippery slopes in the policies of PeaceHealth and other religiously based health care companies than they do comprehensive services. And they cite examples in Puget Sound and across the nation where they believe that religiously based policies have interfered with patient rights and needs, and modern medicine.

“Who wants their doctor worrying about what a bishop thinks in the middle of a medical emergency?” said Harrington, the critic of PeaceHealth’s contract with the San Juan County public hospital district.

Harrington leads the Coalition for Health Care Transparency and Equity — the group arguing against the arrangement in San Juan County. She’s also co-chair of Washington Women for Choice.

Harrington has weighed in on issues of choice and access in a variety of ways, including submitting op-ed columns in the San Juan Islander newspaper. In one column, she wrote that she’s had “dozens of conversations with people who’ve had terrible experiences because of religious doctrine — from the doctor whose career was threatened as she worked to honor the wishes of a dying patient to a woman who found herself feeling abandoned and alone at Swedish (Medical Center in Seattle) with a midterm pregnancy that needed to end for her health and safety. Rarely do people feel comfortable speaking publicly.” Swedish entered into an affiliation with Providence Health & Services last year.

Harrington grew up in a Catholic family but said she has left the Catholic Church. The church’s view of health care “is diverging from mainstream health care,” she said, “and the people who are most at risk are reproductive-age women and people at the end of life.”

When asked whether the ACLU was girding for a lawsuit, Dunne said the group is exploring all of its options. For now, it continues to research the issue, including asking patients and medical providers to take a confidential survey intended to pinpoint cases in which health services have been denied on religious grounds.

For its part, PeaceHealth says it’s focused on its mission to expand services and deliver improved care to the populations it serves. “I don’t think there’s a lot of disagreement over the positive contribution (the) hospital is making,” said Ulum, the PeaceHealth spokeswoman. And PeaceHealth’s policies against providing certain services, Ulum said, are based on “our conscience as an organization.”

Complete Article HERE!

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How we can change end-of-life medicine

A gift Americans owe to themselves and their country in 2013 is lessons on how to die.

our-livesDoctors know this. They don’t spend their final hours like the other 2.4 million Americans who die every year. They’ve seen patients hooked up to tubes in hospital beds, suffering unnecessary pain and indignity, while tens of thousands of dollars are spent on every medical option to extend lives that are clearly near the end. According to a Johns Hopkins study, most doctors have advance care directives, reject CPR and live their final days with dignity, at home and in hospice, surrounded by loved ones.

The Mercury News’ Lisa M. Krieger has spent the past year grappling with our approach to death in America. Her insightful, heartfelt series, “Cost of Dying,” concludes Sunday with a practical analysis of how to change end-of-life medicine. She encourages us to take charge of our own deaths, tell doctors what we want, reject treatments that we really know can’t help and — this is most important — consider suffering, not death, the enemy. Expanding access to hospice care is a key to all this.

Pain can be managed very well today. Most Americans could die in peace at home. But nearly 80 percent die in hospitals or nursing homes, even though surveys show these are the last places the vast majority wants to be. About 20 percent die connected to tubes in intensive care units, the least humane and most expensive end of life care.

We need a culture change in our approach to death. We need to focus more on dying with dignity and less on extending life to the last possible minute. This will be better for individuals, and it will be better for America: Our health care costs are killing our economy, and pointless end-of-life care is a big part of the reason.

This country spends nearly twice as much per capita on health care as any of its competitors in world markets, but by most measures, it achieves poorer results than European counterparts. A major reason is that the 5 percent of Medicare patients who die every year consume almost one-third of all Medicare expenditures. And one-third of those costs are incurred in the final month of life, when there is no chance of a real recovery.

The number of Americans 65 and older will double in the next 20 years, putting more pressure on our medical system. People understandably worry that treatments that could benefit them may be less accessible, but the enormous amount of money paid to extend suffering at the end of life benefits no one.

Today 75 percent of Americans could die comfortably at home with hospice care. But we have to make that choice personally, talk frankly with doctors and family — and work to change family and community attitudes.

All we need is the will.

Complete Article HERE!

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Let’s talk about dying

Lillian Rubin lives and works in San Francisco. She is an internationally known writer and lecturer, who has published twelve books over the last three decades. Last evening her latest essay appeared in Salon. It’s brilliant and a must read.  This courageous woman breaks open a discussion we are all literally dying to have. But so much in popular culture avoids and even prohibits this essential death talk. I commend Lillian for breaking this cultural taboo. Perhaps now others in the media will do likewise.

Lillian Rubin

Complete Article HERE!

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End-of-Life Care Should Be Universally Provided and Need-Based

By James Hamblin, MD

Dr. Ezekiel Emanuel, oncologist and chair of the Department of Bioethics at the National Institutes of Health (and, entirely incidentally, brother to Rahm and Ari Emanuel) has long been a champion of end-of-life care. He spoke today with Corby Kummer at The Atlantic’s Washington Ideas Forum, where he made succinct points about strategies for systematic improvements in our approach to caring for those nearest to death.

First, all doctors and nurses should be formally trained in end-of-life care and discussions. Walking into a room with a patient and their family to discuss a terminal diagnosis or prognosis is — especially at first — overwhelming, and impossible to just know how to do. Emanuel admits that facing those situations remains “scary,” even as a veteran clinician. He and most of his generation of physicians never received formal training in how to best discuss terminal illness with patients and offer palliative options, and some in training today still do not. Considering the large number of people who eventually face death, it is unreasonable that not all doctors and nurses are thoroughly prepared to help them as they do.

Emanuel also cited that more than 40 percent of hospitals in the U.S. do not offer access to palliative care, either within the hospital or after a patient has been discharged home. He believes that hospitals should be required to at least offer the option.

And finally, at present, eligibility for hospice care is predicated on having six months to live. Emanuel sees access to hospice as more aptly need-based, not calendar-based. Patients with symptoms warranting palliation, regardless of the estimated length of their remaining life, should be standardly offered care in that vein.

All of these changes would come as part of an ongoing shift in psychology and broader openness about death. Emanuel is quick to add the caveat that he is not talking about euthanasia or [shudder] … “death panels.” His inclination toward explicit clarification on that point stems from accusations that he and other leaders in the realm of end-of-life care have endured in the past. The fact that he still needs to make that clarification speaks to the persistent widespread misunderstanding surrounding quality end-of-life care. That mindset is and will remain the primary barrier to seeing these improvements out.

Complete Article HERE!

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Assisted suicide measure narrowly defeated; supporters concede defeat

By Carolyn Johnson

A divisive ballot initiative that would allow terminally ill patients to end their lives with medication prescribed by physicians was narrowly defeated.

The Death with Dignity Campaign conceded this morning, as unofficial results tallied by the Associated Press showed that, with 95 percent of precincts reporting, 51 percent of voters had opposed the measure, compared with 49 percent in favor.

“For the past year, the people of Massachusetts participated in an open and honest conversation about allowing terminally ill patients the choice to end their suffering,” the campaign said in a statement released at 6:30 a.m. “The Death with Dignity Act offered the terminally ill the right to make that decision for themselves, but regrettably, we fell short. Our grassroots campaign was fueled by thousands of people from across this state, but outspent five to one by groups opposed to individual choice.

“Even in defeat, the voters of Massachusetts have delivered a call to action that will continue and grow until the terminally ill have the right to end their suffering, because today dying people needlessly endure in our Commonwealth and do not have the right to control their most personal medical decision.”

The ballot question has been the subject of a ferocious political battle. After a Boston Globe poll in September showed voters overwhelmingly supported the measure, support steadily eroded in the face of a last-minute effort by a diverse group of opponents, including religious leaders, anti-abortion activists, and conservatives who aired their message in aggressive television advertisements and at church services. The concerted opposition campaign, which also included a major physician’s group, raised more than three times as much money as proponents.

In a statement, Rosanne Bacon Meade, chairperson of the Committee Against Assisted Suicide, said that while some votes remain to be counted, the efforts to stop the measure had been successful. She added that she hoped the result would spark discussions about how to improve medical care at the end of life.

“We believe Question 2 was defeated because the voters came to see this as a flawed approach to end of life care, lacking in the most basic safeguards,” Meade said in the statement. “A broad coalition of medical professionals, religious leaders, elected officials and, voters from across the political spectrum made clear that these flaws were too troubling for a question of such consequence.”

“Tuesday’s vote demonstrates that the people of the Commonwealth recognize that the common good was best served in defeating Question 2,” Cardinal Sean O’Malley said in a statement.

Massachusetts would have followed Oregon and Washington, which have passed similar initiatives to allow terminally ill patients to seek life-ending drugs from physicians. Donations to opposition groups, which raised nearly $2.6 million, came from far-flung Catholic dioceses, fueled in part by fear of a domino effect if the measure were to gain a foothold in Massachusetts.

Proponents of the measure raised about $700,000.

Other efforts to legalize physician-assisted suicide in New England have failed. In 2000, a ballot initiative in Maine lost by a close margin. Legislative efforts to pass a similar bill in Vermont and New Hampshire have been defeated in recent years.

Voters said they formed their opinions about the controversial ballot initiative after careful consideration, informed by personal experiences with family members and by concerns about the safeguards written into the law.

North End resident Paul Santoro, 42, cast a vote against the initiative.

“I’m actually in favor of assisted suicide, but not how this is written,” Santoro said, citing concerns about the proposal’s lack of required psychiatric evaluations and family notification and the lack of tracking for any leftover pills.

Santoro, who works in sales, said he has five children and worries about young people getting access to dangerous, untracked medications.

Alex Coon, 37, voting at the Dante Club in Somerville, said he voted for assisted suicide for a very personal reason.

“My grandmother was Dutch, and she always said, ‘When I get sick, take me home to Holland, because they’ll let me die,’ ” he said.

The Massachusetts ballot measure was modeled after similar legislation passed by voters in Oregon in 1994. If it had passed, it would have allowed terminally ill patients with less than six months to live to request medications to end their lives. Patients would have had to request medication from physicians multiple times verbally and in writing, be deemed competent to make the decision, and administer the lethal dose themselves.

Critics had said the measure was sloppily written and contained insufficient protection for vulnerable patients. Objections ranged from the difficulty of assessing how much time a patient has left to the failure to require a mental health screening by a specialist. Others opposed the initiative for moral reasons, or because it was counter to the fundamental do-no-harm ethos that governs physicians.

The legislation would have required the state Department of Public Health to write rules by March 20, 2013, to require physicians to report when the drug was dispensed, file copies of prescriptions, and help facilitate the collection of other statistical information.

Statistics kept by Oregon and Washington are frequently cited by proponents as evidence that the law is not being abused and poses no large-scale societal threat. Those detailed statistics show that the fatal doses of medication are requested by a small number of patients and used by even fewer.

Oregon’s law was mired in legal challenges for several years, but since 1997 when it was enacted, 935 people have requested prescriptions, and 596 have used them to end their lives. In 2011 in Oregon, most of the 71 people who used the medication were white, well-educated, and suffering from cancer.

In Washington last year, 103 people requested the prescriptions, with 70 using them and 19 dying without taking the drugs. Of those who requested prescriptions and died, nearly half were married, three-quarters had some college education, and the overwhelming majority had cancer.

Complete Article HERE!