Tag: Assisted Dying

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I’m glad my friend was able to make his own end-of-life decision

Cave of Coffins at Beit Shearim National Park in Israel is believed to be the final resting place of Judah Ha-Nasi, a talmudic sage whose maid assisted him in dying.

By Stewart Florsheim

[A] close friend passed away recently — no doubt among the first people to take advantage of California’s End of Life Option Act. Signed into law in 2015 and in effect as of June 9, 2016, the law gives terminally ill adults who have only six months to live the ability to request and obtain life-ending medication.

My friend had a virulent form of prostate cancer. He lived with it for a few years, but when the tumors began to invade almost every part of his body, he entered hospice and requested the drugs. He wasn’t sure he would take them, but when the pain kept getting worse and it became obvious that the end was near, he made his decision. He died peacefully with his family at his side.

Along with California, only Oregon, Washington, Vermont, Montana, Colorado and Washington, D.C., support medical aid in dying. Now, with the recent tide of conservatism, opponents of medical aid in dying are moving quickly to attack the option.

The law was challenged in Riverside in August, but a judge denied the request for an injunction filed by a group of anti-choice physicians. The Montana House of Representatives was considering a bill that would have allowed the state to execute doctors for prescribing end-of-life medication. The bill was narrowly defeated on March 1. The nominee to the Supreme Court, Judge Neil Gorsuch, wrote a book on how to defeat death-with-dignity bills, suggesting the option violates the Constitution.

I have always been a strong advocate of death with dignity. I first became involved in this issue several years ago, when my mother found out she had ALS, a devastating neurological disease. She was 77, a refugee from Hitler’s Germany, and knew what was in store. She asked me to help her.

I spoke to her doctor, who said he might be able to “put her under” if her distress became unbearable. We left it at that, until hospice became involved. When I told them about the agreement, they said they could not support it and would now monitor the amount of morphine in the house.

At a loss, I did research and found an organization called Compassion & Choices. They came to visit my mother and me, and told us what she could legally do to take control of her death in New York. She would have to acquire the appropriate life-ending medication, and take it while she was still functional. Like most patients in her situation, she was relieved to know what she could do, but ended up dying on her own.

All religions take a stand on this issue. There is no question that Jewish law and tradition reject suicide, prohibit murder and accept pain and suffering as a part of life. The tradition is less clear when it comes to a person who is already dying of a terminal illness.

The Talmud tells the story of the death of a great sage, Rabbi Judah Ha-Nasi. The rabbi is suffering greatly but his students are praying with fervor in the courtyard to keep him alive. Out of compassion for his suffering, his maidservant drops a jar from the rooftop, stunning the students into silence, at which point the rabbi dies.

This story has been used to justify the removal of life support, validating the patient’s right to a death with dignity, without pain and suffering. Judaism also usually considers palliative care an appropriate measure if someone is suffering at the end of life. But most Jewish traditions end there.

If we allow caregivers to remove life support, and to provide palliative care, why can’t we give the terminally ill the tools for a peaceful death? The states that support the legislation have very strict safeguards in place, and patients must take the life-ending medications themselves, after they have been prescribed by a physician for that purpose.

My friend found great comfort knowing he had the life-ending medication, even if he wasn’t sure he would take it. He told me it freed him from anxiety, so he could spend his last days focusing on what meant most to him — being with his family and his friends.

Complete Article HERE!

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The euthanasia debate is polarised, yet shared concerns unite all sides

People with opposing views on legalising the right to die agree palliative care is inadequate. We need to build on this common ground

Research funded by the Joseph Rowntree Foundation found that people were united in compassion for those with terminal illnesses.

By

[B]rigit Forsyth, the actor best know as Thelma in Whatever Happened to the Likely Lads? is currently playing a terminally ill musician on stage. Her character in Killing Time says she’s a “prime candidate for a one-way trip to Switzerland”. Forsyth has disclosed that her GP grandfather helped dying patients end their lives and that she is in favour of euthanasia. Her comments are the latest in a long line of opinions on legalised assisted dying reported in the press, which has a habit of oversimplifying the complex arguments for and against. And this seems to be damaging our ability to hold meaningful public debate on the subject.

With this in mind, a study funded by the Joseph Rowntree Foundation sought the views of people with strongly opposed opinions on the matter. Participants in both groups included people with palliative care backgrounds, older and disabled people, those from organisations concerned with care and support and individuals from academic, social work and policy backgrounds.

What emerged is a surprising amount of common ground. People with apparently polarised views on legalising the right to die often shared areas of interest and concern. It is these areas that should form the basis for further public discussion, argues the report, Assisted Dying: Developing the Debate, which is published on Wednesday by the Shaping Our Lives network of user-led groups, service users and disabled people.

Shared concerns included clear agreement that palliative care for terminally ill people is inadequate. Whether for or against assisted dying, participants showed a willingness to discuss quality of life for terminally ill people, the value placed on good-quality care, and how to invest in and provide access to this care in the face of economic inequality.

Participants recognised that the debate on legalising assisted dying was taking place in an unequal society: we often place lower social value on older, sick, and disabled people. The research identified a willingness to discuss prevailing societal values, including the concept of “being a burden” on society; the value society placed on social care and support work; and our social attitudes towards death and dying. “How should assisted dying be funded?”, “Where should it be performed?”, and “What methods and means of self-administering a fatal dose should be used?”, were just some of the common questions raised.

Despite disagreement about the extent to which detailed processes and safeguards should be included in assisted dying legislation, participants from across the spectrum of opinion generally agreed that the “how” questions were not being discussed in enough depth.

Areas of shared understanding also emerged when respondents discussed ethical and existential ideas around death and dying, including the psychological aspects of pain and suffering, both for individuals and their loved ones. “All participants had a wish to find the best way forward with compassion for people who are terminally ill, regardless of being for or against legalising assisted dying,” the report concludes.

The study shows that the issues are far more complex than much of the public debate has so far allowed. Death and dying is a core issue for human beings, and public debate must reflect this. It is time to embrace the personal, social, policy and ethical issues that participants have highlighted.

Back in the theatre, Forsyth’s dying musician is visited by a young carer (Zoe Mills) who feels it is her duty to help put older people out of their misery. According to the reviews, she comes to realise that life and death is more nuanced.

Complete Article HERE!

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Northwest doctors rethink aid-in-dying drugs to avoid prolonged deaths

Doctors seeking to help terminally ill patients under state Death with Dignity laws have come up with a new drug mixture. It’s the latest alternative to one drug that suddenly got too expensive and a mixture that took too many hours to work.

Valium, also known by the name diazepam, is one drug used in a mixture of aid-in-dying medications.

[T]wo years after an abrupt price hike for a lethal drug used by terminally ill patients to end their lives, doctors in the Northwest are once again rethinking aid-in-dying medications — this time because they’re taking too long to work.

The concerned physicians say they’ve come up with yet another alternative to Seconal, the powerful sedative that was the drug of choice under Death with Dignity laws until prices charged by a Canadian company doubled to more than $3,000 per dose.

It’s the third drug mixture recommended by the doctors whose medication protocols help guide decisions for prescribers in the six U.S. states where aid-in-dying is allowed.

The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.

“[Twenty percent] of the cases were three hours or more before death, which we think is too long,” said Robert Wood, a retired HIV/AIDS researcher who volunteers with the advocacy group End of Life Washington, in an email. “The longest was 31 hours, the next longest 29 hours, the third longest 16 hours and some eight hours in length.”

Patients and families are told to expect sleep within 10 minutes and death within four hours. When it takes far longer, family members get worried, even distressed, said Dr. Carol Parrot, a retired anesthesiologist who has prescribed drugs for dozens of aid-in-dying patients in Washington.

The doctors say this can be addressed with larger doses of the three drugs they have been using — diazepam, often used to treat anxiety; digoxin, used to treat heart issues; and morphine, a narcotic pain reliever — plus another heart medication, propranolol, in a four-drug cocktail aimed at quickly inducing death, Wood said.

Parrot and Wood are part of a seven-member group of doctors in the Northwest who came up with the three-drug protocol after Valeant Pharmaceuticals Inc. acquired the rights to secobarbital, known as Seconal, in 2015 and raised the price sharply.

“We wanted the new drug regime to be safe, reliable and effective — and cost $500 or less,” said Parrot.

How long until death?

Since 1997, when Oregon’s Death with Dignity law became the first in the nation, doctors had relied on fast-acting, relatively inexpensive barbiturates — either secobarbital or pentobarbital — for patients with terminal diagnoses who sought aid in dying in Oregon, Washington, California, Colorado, Montana and Vermont. The practice also has been approved in Washington, D.C., but is being reviewed by Congress.

Pentobarbital became unavailable after drugmakers blocked its use in U.S. death-penalty executions.

Concerns about the overly long deaths surfaced last summer, Parrot said. Nearly all of the problems occurred in patients already taking high doses of opiates.

“We run into patients who are so tolerant or dependent on narcotics that even the astronomically high doses of oral narcotics in our prescription do not stop them from breathing,” she said.

If patients have diseases that slow or alter normal organ function, it can affect the speed and amount of drugs absorbed in the small intestine, metabolized in the liver and sent to the rest of the body. Very large patients, too, may require larger doses.

Deaths aren’t required to be supervised, and no doctor was present with the unidentified patient who took 31 hours to die, so doctors would only be speculating about the reason, Parrot said.

Not all patients — or doctors — experienced overly long deaths with the previous drug mixture. Dr. Lonny Shavelson, a Berkeley, California, physician who has supervised two dozen aid-in-dying deaths under California’s new law, said it worked fine.

“My personal experience is, I haven’t had long deaths with it,” Shavelson said.

And not all doctors think long deaths are a problem. In Oregon, even with fast-acting barbiturates, time to death has ranged from one minute to 104 hours during the 20 years the law has been in effect, state records show.

“I’ve heard stories where it took quite a number of hours to die, and it was fine,” said Dr. David Grube, an Oregon-based medical director for the advocacy group Compassion & Choices.

Scrabble, then lethal drugs in scotch

Scott and Amy Kreiter, of Wenatchee, didn’t know what to expect when Scott’s mother, Patricia Hansen, 69, decided to take the lethal drugs on Dec. 26, 2016. Hansen, a lively woman who once ran a gourmet ice-cream business, had endured frequent hospitalizations for end-stage kidney failure, congestive heart failure and other ailments.

“She said, ‘I want to listen to Willie Nelson, I want to play a game of Scrabble, I want to drink a Rob Roy or two, and then I want to be done,’ ” said Scott Kreiter, 47.

Hansen proceeded to “kick our butts” at Scrabble, her son said — including fulfilling a goal of getting a triple-word score with a dirty word. Then she mixed the drugs with scotch and drank the solution.

“She didn’t complain. She just took it,” her son recalled. “She said, ‘You thought I’d chicken out, didn’t you?’ ”

Within two minutes of downing the mixture, Hansen was asleep. Within 20 minutes, her breathing had stopped.

“We thought it would take one to two hours,” Amy Kreiter said. “It if had gone on for hours, we would have thought we did it wrong.”

Critics of aid-in-dying say growing reports of overly long deaths underscore their objections. Dr. David Stevens, CEO of Christian Medical & Dental Associations, which has tried to halt or reverse laws, said coming up with new drug protocols could eventually be a step toward Holland’s practice of allowing euthanasia by lethal injection “so the patient could be killed ‘humanely.’ ”

“We are heading down that same path,” Stevens said in an email.

But Parrot and other frequent prescribers of aid-in-dying drugs say they are looking for the best way to honor the wishes of patients in states where the practice is allowed. Doctors recently began using the newest drug mixture and will gather data about its effectiveness.

“We’re not experimenting,” Parrot said. “We are working with available drugs to provide dying patients a comfortable, peaceful death that is reliable and safe for them and comforting for their families as well.”

Complete Article HERE!

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Circle of life: Former Victoria maternity doctor now helps terminally ill people end their suffering

Dr. Stefanie Green in her Victoria office this week. Green, who started her career as a maternity doctor, has provided medical assistance in dying to 25 people over the past eight months, people who want to depart this life on their own terms in the face of painful and imminent death.

By Randy Shore

For Stefanie Green, the transition from baby doctor to helping people die was completely natural, providing care at different ends of life’s continuum. 

“I (originally) chose maternity and I liked the fact that it was happy medicine, and really I can’t think of a better job on the planet than delivering babies,” she said. “I was in in my 20s when I started, so it felt (like) really familiar territory because I was also getting married and having kids.”

But helping people to die is not so different when the dominant emotion is not sadness, but gratitude.

Green has provided medical assistance in dying to 25 people over the past seven months, people who want to depart this life on their own terms in the face of painful and imminent death.

“The overwhelming emotion in the room when I provide this care is relief and gratitude,” said Green, a Victoria-based physician with 20 years experience in maternity care. “There is a release from suffering. The family is overwhelmingly grateful. The patient is overwhelmingly grateful.

“There is a real satisfaction on the part of the patient, who has made an empowering decision and been able to fulfill it after years of pain and hopelessness.”

Death review panel

About 200 people in British Columbia have opted for a medically assisted death since last June 17 when Bill C-14 created a legal environment for assisted dying. More than 740 Canadians died with medical assistance in 2016.

With six-plus months of data now in hand, the B.C. Coroner’s Service — with representatives of the health regions and the provincial government — plans a Death Review Panel for later this month to assess the new process. A report will be made public later this year.

As a young doctor, Green took careful note of celebrated B.C. right-to-die cases, including the 1994 death of Sue Rodriguez and, more recently, the 2012 B.C. Supreme Court decision that would have allowed Gloria Taylor the right to end her life. But it wasn’t until Green took a break from her maternity practice two years ago that she considered changing the focus of her career.

“When I realized that our laws were truly about to change and there was an opportunity to work in this new field I really began to educate myself,” she said.

There is a release from suffering. The family is overwhelmingly grateful. The patient is overwhelmingly grateful’ — Stefanie Green, provider of medical assistance in dying

After attending the 2016 conference of the World Federation of Right to Die Societies in Amsterdam, Green felt sure of her new course.

“Talking to people in the field, they were talking about choreographing the death,” she said. “Everything I heard sounded a lot like preparing for a birth. I really saw how those skills were going to be transferrable from one to the other.”

“There’s an art to making sure everything is going as smoothly and safely as possible during a delivery while still understanding you aren’t the most important person in the room,” she said. “I find that is the skill I take the most with me to end-of-life care.”

Public demand

The new law appears to have tapped public demand, as almost one person per day receives medical assistance in dying in B.C. 

“When people come to me they have made a decision that they want this service,” said Green. “People are decided, courageous and very determined. They’ve made the leap.”

But not everyone who wants a medically assisted death can get it.

The federal law includes a criterion not found in the B.C. Supreme Court ruling, namely that the patient’s natural death “has become reasonably foreseeable.”

“It’s not exactly clear what that means,” said Green. “For someone who can’t make a clear case, it’s a difficult box to tick. I’ve had to say no to people and it’s the hardest part of the job, but I need to work within the law.” 

The vast majority of Green’s patients are in the terminal stages of cancer and many of the others are in end-stage failure of the heart, liver or lungs. Most remain lucid right to the end, and importantly able to consent or decline the procedure to their final moments of life.

With some neurodegenerative diseases, the accelerating loss of mental capacity can muddy the waters.

“When people come too late in the course of their disease, it’s a problem,” she explained. “It may be that they are well enough to make the decision when I meet them, but they decline so quickly that they become confused and we have to stop the process.”

MAiD becoming normalized

Green is convinced many people will come to view medical assistance in dying — MAiD for short — as it becomes a normal part of medical care in a continuum that includes prenatal and preventative care, aggressive therapy for illness, hand-holding when treatments aren’t working and palliative care for those who seek comfort at the end of their lives.

She is adamant that the obligation to provide care does not stop five weeks or even five seconds before death.

“MAiD is just another part of that spectrum. Some people really need to fight to the last breath and some people really need to call the shot at the end,” she said. “The Canadian public understands very well what this care is and 87 per cent of them support it. I think that’s very humane.”

Complete Article HERE!

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Trump’s Supreme Court pick is deeply opposed to assisted suicide

10th US Circuit Court of Appeals Judge Neil Gorsuch was nominated by President Trump Tuesday to fill the vacancy on the US Supreme Court.

By Lev Facher

[P]resident Trump’s Supreme Court nominee is a constitutional originalist who opposes all forms of assisted suicide and ruled twice against the Affordable Care Act’s contraception mandate but has never ruled on abortion.

Trump announced the nomination of Neil Gorsuch on Tuesday night, kicking off what Democrats have said will be a contentious confirmation process to fill the seat of the late Antonin Scalia. Gorsuch is currently serving on the 10th Circuit Court of Appeals, which holds jurisdiction over six western states

The 49-year-old Gorsuch holds a Harvard law degree and a PhD in legal philosophy from Oxford.

In 2009, he authored “The Future of Assisted Suicide and Euthanasia,” in which he argues against the practice from both a moral and legal standpoint.

“It is an argument premised on the idea that all human beings are intrinsically valuable and the intentional taking of human life by private persons is always wrong,” Gorsuch wrote in the opening pages of the book.

Federal rulings on physician-assisted suicide have been limited. Most recently, a 2006 Supreme Court ruling continued to defer to the states on the matter. In 2009, the Montana Supreme Court ruled against prosecuting doctors who provide aid in dying but made no ruling on the broader legality. But its opponents are still hankering for a fight: In a November op-ed, Wisconsin’s deputy solicitor general urged another legal battle over the issue and a change in conservative legal tactics.

In Hobby Lobby’s lawsuit challenging the Affordable Care Act’s contraception mandate, Gorsuch sided with the company in an initial circuit court ruling in 2013 as it sought a religious exemption to the mandate. The ensuing Supreme Court decision allowed privately owned for-profit companies to claim a religious objection to the mandate that they cover contraception for their employees.

In a later case also centered on the law’s contraception requirements, Gorsuch joined a dissent in a ruling that denied a motion by other opponents of the mandate claiming religious objections. The dissent blasted the majority for their “dangerous approach to religious liberty.”

With Trump’s recent executive order instructing federal agencies to “ease the burdens” of Obamacare, the contraception mandate could once again end up entangled in litigation.

On the landmark abortion case Roe v. Wade, however, Gorsuch’s appointment does not move the court in a different direction. Though he has never ruled on abortion before, Gorsuch is expected to vote as the deeply conservative Scalia did should the issue appear again before the justices.

The security of the 44-year-old Roe v. Wade ruling is among liberal groups’ chief concerns when it comes to Trump’s judicial nominees.

Trump said during the 2016 campaign that he is personally opposed to abortion, and that he would appoint judges who would overturn Roe v. Wade so that states could decide their positions on the issue individually.

Senate Republicans now face a procedural decision if Democrats try to block Gorsuch’s confirmation. Senate Majority Leader Mitch McConnell can employ the so-called “nuclear option” — which would allow Trump’s nominee to pass via simple majority rather than the usual 60-vote margin. But McConnell has in the past sounded reluctant to change the chamber’s rules.

Many Democrats, incensed that Senate Republicans never gave former Obama Supreme Court nominee Merrick Garland a hearing or vote after his nomination in March 2016, vowed to oppose Trump’s nominee even before Gorsuch was announced. It remains to be seen, however, if enough Democrats will unite to stop his nomination without a change in Senate rules.

When President George W. Bush appointed Gorsuch in 2006 to the 10th Circuit Court of Appeals, he was confirmed by the Senate with a voice vote.

Complete Article HERE!

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Death With Dignity

Longtime lobbyist John Radcliffe, 74, terminally ill with stage-four cancer, is working to change Hawaii’s laws that prohibit access to life-ending medication when suffering becomes unbearable

By Susan Kang Sunderland

[P]utting one’s life on the line for a cause is nothing new to lobbyist John Radcliffe. The deft negotiator made a career of it. But now he literally is doing so to awaken our community to an issue.

If he and supporters are successful, Hawaii will be among seven states to legalize medical aid in dying.

Radcliffe, 74, who is terminally ill with stage-four cancer, has been in the news a lot lately to express his wish to have access to life-ending medication should his suffering become unbearable. But currently in Hawaii that is a crime.

Through legislative and legal action, Radcliffe hopes to empower individuals to make life-ending decisions that do not subject doctors to prosecution in order to assist patients in that process.

Radcliffe’s family is in full support of his wish, but unless things change, this will not be among the options available to him when he suffers prolonged, debilitating pain.

Words matter in discussing this sensitive issue. So Radcliffe is quick to set parameters on what he is — and isn’t — talking about.

John Radcliffe says if the legal system is a barrier to quality of life, you change the law

“Aid in dying is a medical practice to treat adults who are terminally ill with six months or less to live,” Radcliffe explains. “They must be mentally capable of making their own decision to request a prescription for life-ending medication from their physician, which would be self-administered.”

Aid in dying, he emphasizes, is not assisted suicide or euthanasia.

“To a terminally ill person, the term ‘assisted suicide’ is offensive and hurtful,” the Makiki resident says. “I want to live, but my condition is incurable. There is no hope for a better outcome.

“Suicide is secretive and often impulsive, without involvement of family, friends or health care professionals,” he adds.

Medical aid in dying also is known as death with dignity.

“The issue is really about dignity, pain and unnecessary suffering,” Radcliffe says. “I come from the position that you should do as much as you can as well as you can for other people for as long as you can.

“I am in a unique situation to do that,” asserts the government relations expert.

Radcliffe was diagnosed with incurable colon cancer in 2014 that has metastasized to his liver. He’s been hospitalized three times, been in the emergency room 15 times and has had 42 chemotherapy treatments.

He took his 43rd chemo treatment Wednesday, Jan. 18, while seated next to state Sen. Rosalind Baker at the opening of the state Legislature.

That’s a bit dramatic, we say about his unorthodox tactic of persuasion.

“Nah,” Radcliffe says with a laugh. “No one even noticed. That’s why I have to make a point of it. When you talk to legislators about cancer, it tends to be theoretical. Well, this isn’t theoretical to me. This is real.”

As a union organizer and lobbyist for four decades, including 13 years as executive director of the Hawaii State Teachers Association, Radcliffe knows that addressing social problems with lawmakers is not easy.

His credibility is at stake. “The legislators know me,” says the co-founder and president emeritus of Capitol Consultants of Hawaii. “They trust me. They know I won’t lie to them or give them bad information.

“But I can’t imagine that with 80 percent of voters being in support that they would be opposed,” Radcliffe suggests.

A poll conducted last November by Anthology Research shows 80 percent of Hawaii voters across all demographics believe a medical aid in dying option should be legal. Strong support (55 percent) outweighs strong opposition (8 percent) by an almost seven-to-one margin, while 12 percent oppose the option.

“This is about the ability to have a choice when you’re suffering,” Radcliffe states. “It’s comforting to some people to know they have a choice, as it is to me.

“I want to be in control of my life, as I’ve always been. It’s about quality of life. If the legal system is a barrier, ‘you change the law.’”

That’s the second strategy he and the advocacy organization Compassion & Choice Hawaii will mount after years of failing to get legislation passed.

Radcliffe, retired oncologist Dr. Chuck Miller, and Compassion & Choices Hawaii are plaintiffs in a lawsuit against the state of Hawaii asserting that the Hawaii Constitution and existing state law allow the practice of medical aid in dying.

“Mr. Radcliffe can’t wait and see whether the courts or the Legislature will ultimately solve this question, but our hope is that this option will be made available to him as soon as possible. By filing litigation now, we have put the process in motion on all fronts,” says Mary Steiner, Compassion & Choices Hawaii campaign manager.

Aid in dying currently is permitted legally in Oregon, Washington, Montana, Vermont, California and Colorado.

In Hawaii, a Governor’s Blue Ribbon panel on living and dying with dignity in 1998 recommended changing existing laws, rules and practices to give wider choices in end-of-life decisions, including physician-assisted death.

End-of-life options include declining treatment or avoiding unwanted medical treatment, palliative care (pain management) or VSED (voluntarily stopping eating and drinking).

Radcliffe’s is not the only story of a terminally ill person seeking end-of-life options. There are many stories of patients, families and friends who know the plight of long-suffering individuals.

There are heart-wrenching accounts of bewildered care-givers who experience the helplessness and difficulty of aiding agonized loved ones. They suffer in silence.

But proponents of legislation urge citizens to let their voices be heard, whether it’s by letters to legislators, testimonies to help educate the community, or joining forces to add representation to the cause.

“If this means anything to people, they must show up,” Radcliffe urges. “This is the year that this must happen.

“It’s too late for me. But it doesn’t have to be for others,” he implores.

Opponents cite spiritual, moral and modern medical advances to counter the need for more options. In fact, emotions run high when the dialogue is about death — the D word.

“Local people no like talk about dis kine stuff,” Radcliffe says.

Actually, all people don’t enjoy bringing up the subject. Talking about death is a social taboo. It’s just not done

in polite society. But with Hawaii’s aging population, it is an essential and timely topic for private and public discourse.

In Oregon, for instance, end-of-life care reportedly is improved since the law’s implementation in 1997. It is said to be thanks in large part to the dialogue the law encourages between people and their doctors.

Hospice use is high and referrals are up, as is other use of palliative care.

But what of the man to whom we address this living eulogy?

“I want to be remembered as a good, loyal friend and a decent human being,” he says.

“I hope this legislation passes without trouble,” he reflects, citing the move toward patient-directed care. “It would say something about us as a people. If we aren’t humane people, then who are we?”

As an inspired philanthropist once said, “There’s a lot of difference between human being and being human.”

Many will remember the contributions John Radcliffe has made to this community. He has spent his life fighting for causes. This will be his last and perhaps best fight.

As retired teacher Carol Sakamoto says in tribute, “Wish him well, and tell him that all the teachers will be praying for his success and thank him for his many years of service.”

That’s what living well and making a difference is all about.

Complete Article HERE!

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Legalizing Aid In Dying Doesn’t Mean Patients Have Access To It


Dr. Lonny Shavelson heads Bay Area End of Life Options, a Berkeley, Calif., medical practice that offers advice and services to patients seeking aid in dying under the state law enacted last June.

 

By JoNel Aleccia

[I]n the seven months since California’s aid-in-dying law took effect, Dr. Lonny Shavelson has helped nearly two dozen terminally ill people end their lives with lethal drugs — but only, he says, because too few others would.

Shavelson, director of a Berkeley, Calif., consulting clinic, said he has heard from more than 200 patients, including dozens who were stunned to learn that local health care providers have refused to participate in the state’s End of Life Options Act.

“Those are the ones who could find me,” says Shavelson, who heads Bay Area End of Life Options and is a longtime advocate of assisted suicide. “Lack of access is much more profound than anyone is talking about.”

Across California, and in the five other states where medical aid-in-dying is now allowed, access is not guaranteed, advocates say. Hospitals, health systems and individual doctors are not obligated to prescribe or dispense drugs to induce death, and many choose not to.

Most of the resistance comes from faith-based systems. The Catholic Church has long opposed aid-in-dying laws as a violation of church directives for ethical care. But some secular hospitals and other providers also have declined.

In Colorado, where the nation’s latest aid-in-dying law took effect in December, health systems covering nearly third of hospitals in the state, plus scores of clinics, are refusing to participate, according to a recent STAT report.

Even in Oregon, which enacted the first Death with Dignity law in 1997, parts of the state have no providers within 100 miles willing or able to dispense the lethal drugs, say officials with Compassion & Choices, a nonprofit group that backs aid-in-dying laws.

“That’s why we still have active access campaigns in Oregon, even after 20 years,” says Matt Whitaker, the group’s state director for California and Oregon. “It becomes a challenge that causes us to have to remain extremely vigilant.”

In Washington state, where the practice was legalized in 2009, a Seattle hospice patient with advanced brain cancer was denied access to willing providers, so he shot himself in the bathtub, according to a 2014 complaint filed with the state health department.

“Refusing to provide information or appropriate referrals directly led to the unnecessarily violent death of this patient,” said the complaint filed by an anonymous hospice nurse. “I strongly believe this constitutes patient abandonment.”

Lack of access was also an issue for Annette Schiller, 94, of Palm Desert, Calif., who was diagnosed with terminal thyroid and breast cancer and wanted lethal drugs.

“Almost all of her days were bad days,” recalled Linda Fitzgerald, Schiller’s daughter. “She said, ‘I want to do it.’ She was determined.”

Schiller’s hospice turned down her request, and she couldn’t find a local referral, forcing Linda Fitzgerald to scramble to fulfill her mother’s last wish.

“I thought it was going to be very simple and they would help us,” says Linda Fitzgerald. “Everything came up empty down here.”


Annette Schiller of Palm Desert, Calif., who was 94 and diagnosed with terminal thyroid and breast cancer, had trouble finding doctors to help her end her life under California’s new aid-in-dying law.

Opponents of aid in dying cite providers’ reluctance as evidence that the laws are flawed and the practice is repugnant to a profession trained to heal.

“People consider it a breaking of professional integrity,” says Dr. David Stevens, chief executive of Christian Medical & Dental Associations, which has worked to stop or overturn aid-in-dying laws in several states.

But those decisions can effectively isolate people in entire regions from a legal procedure approved by voters, advocates said.

In California’s Coachella Valley, where Annette Schiller lived, the three largest hospitals — Eisenhower Medical Center, Desert Regional Medical Center and John F. Kennedy Memorial Hospital — all opted out of the new state law. Affiliated doctors can’t use hospital premises, resources or systems in connection with aid in dying, hospital officials said.

“Eisenhower’s mission recognizes that death is a natural stage of the life journey and Eisenhower will not intentionally hasten it,” Dr. Alan Williamson, vice president of medical affairs of the non-profit hospital, said in a statement.

Doctors may provide information, refer patients to other sources or prescribe lethal drugs privately, Williamson said.

“All we have done is say it can’t be done in our facility,” he added.

In practice, however, that decision has had a chilling effect, says Dr. Howard Cohen, a Palm Springs hospice doctor whose firm also prohibits him from writing aid-in-dying prescriptions or serving as an attending physician.

“They may be free to write for it, but most of them work a full day. When and how are they going to write for it?” he said. “I don’t know of anyone here who is participating.”

Patients eligible for aid-in-dying laws include terminally ill adults with six months or less to live, who are mentally competent and can administer and ingest lethal medications themselves. Two doctors must verify that they meet the qualifications.

Many doctors in California remain reluctant to participate because of misunderstandings about what the law requires, says Dr. Jay W. Lee, past president of the California Academy of Family Physicians.

“I believe that there is still a strong taboo against talking about death openly in the medical community. It feels like a threat to what we are trained to do: preserve and extend life,” Lee says, adding that doctors have a moral obligation to address end-of-life concerns.

There’s no single list of doctors willing to prescribe life-ending drugs, though Compassion & Choices does offer a search tool to find participating health systems.

“They don’t want to be known as the ‘death docs,’ ” says Shavelson, who has supervised 22 deaths and accepted 18 other people who were eligible to use the law but died before they could, most within a required 15-day waiting period.

Officials with Compassion & Choices said past experience indicates that more providers will sign on as they become more familiar with the laws and their requirements.

At least one California provider, Huntington Hospital in Pasadena, originally said it wouldn’t participate in the law, but later changed its position.

Other health systems have opted to not only participate, but also to help patients navigate the rules. Kaiser Permanente, which operates in California and Colorado, has assisted several patients, including Annette Schiller, who switched her supplemental insurance to Kaiser to receive the care.

Within weeks, Schiller was examined by two doctors who confirmed that she was terminally ill and mentally competent. She received a prescription for the lethal drugs. On Aug. 17, she slowly ate a half-cup of applesauce mixed with Seconal, a powerful sedative.

“Within 20 seconds, she fell asleep,” her daughter recalled. “Within a really short time, she stopped breathing. It was amazingly peaceful.”

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