Death With Dignity

By Accident: An Unexpected Outcome

The eighty-three-year-old patient was holding her stomach and groaning as I entered her bedroom. Pain wasn't a stranger to this woman; severe arthritis had made walking impossible for years, so she kept pretty much to her bed. Even there, she was more uncomfortable than her daughter and I liked to see. She limited her use of pain medications because of GI upset and bleeding. But this was new. This morning the stomach pain had come on abruptly, within seconds. I'd packed up my kit and driven to her house to see if could help. I could see right away the problem wasn't the usual hip and back pain. She was curled up, ignoring us, and moaning over and over.

Since the patient was fairly deaf, I went right to my physical exam. The possibilities included perforating ulcer, gastritis or other conditions, but what most concerned me was a dissecting aortic aneurysm. I called the surgeon. Yes, he could meet her at the hospital right away, and no, he wouldn't mind if I gave her a shot of Demerol for her pain. Usually, we are reluctant to give a pain-reliever to someone with abdominal pain, as it can mask the diagnosis. But with her agony, there seemed no alternative. I drew up a conservatively low dose of Demerol and injected it.

Over the next five minutes, she became quiet. Then she stopped breathing. Given the frailty of her bones, CPR would have been more of an assault than a life-saving measure. The woman's daughter insisted we accept nature's verdict, and we did. While I was about to jump out of my skin, having given the shot and watched the patient promptly expire, the daughter assured me, several times, that she was glad I had done it. "My mother's been in constant severe pain for years. I am so relieved she had a few moments of comfort. Now she's at peace."

The surgeon, too, seemed relieved. "Were her pain due to some surgical problem, she still wouldn't have had much chance of surviving surgery. You didn't have any option."

Whether the pain had been keeping her adrenalin levels so high that the stimulation was all that kept her alive, or she'd had an unusual response to Demerol, or I'd overestimated the proper dose, or an aneurysm or something else had killed her in those moments, we'll never know.

In any event, she was tired, exhausted, and in agony. Were I back in that situation again, I'd do the same thing.

On Purpose: Washington's Death with Dignity Act

This incident, which happened far away and long ago, today brings to mind Washington State's new Death with Dignity law.

You may remember the old adage: the doctor's job is "To cure sometimes, to relieve often, to comfort always." We physicians work very hard at our job, but we can't do everything. We humans age; we get sick; we die. Doctors try to relieve the pain of illness and old age. We can do a lot, but there are some trials even modern medicine cannot touch. Watch someone die from emphysema or amyotrophic lateral sclerosis. The former unfortunates suffocate to death. The latter choke. This suffering goes on for days, weeks, sometimes years, and there is little you or I can do about it. Opponents of the law repeat ad nauseum that we don't need this law because we can always relieve pain. Repetition doesn't make their claim true. Some suffering we cannot relieve.

If you are one of those who oppose this law for yourself, please know that you are not alone. In the state of Oregon (the only state with experience with such a law), 799 people out of 800 die without purposeful use of medication to hasten the process. The Gestapo knew in WWII that threats were the most effective way to get someone to talk. Once they actually started causing pain, the victims discovered they could bear a great deal more than they thought they could. That is what most people find with serious illness; they can tolerate suffering better than they imagined. The experience in Oregon shows that many people given a prescription for a fatal dose do not use it. Nonetheless, people find comfort in knowing they have some control, a way to escape.

Built-In Protections

Washington State's new Death with Dignity law provides many protections for you as well as constraints on physicians. In order to qualify for a life-ending prescription, you must have a terminal illness. You must have appropriate care, such as hospice. You must have requested help on three separate occasions over a specified period of time. You must not suffer from mental imbalance. Witnesses must observe your signed agreements. Even if you have granted a family member a healthcare power of attorney, that person cannot request aid in dying on your behalf. If you are unconscious and appear to be suffering, we will do our utmost to relieve that suffering but by law we cannot purposefully end your life.

If you have a living will you can set down your desires for treatment or for letting go. These will guide your physician should you, in an extreme circumstance, be unable to say what you want. Still, you can only specify what measures should or should not be used to prolong your life. In no case will anyone hasten your death with medication.

In the rare circumstance that someone is so ill and exhausted as to find comfort in the idea of shortening their suffering, they should know that I, as well as most other local physicians and the Jefferson County hospital district, stand ready to offer considered and compassionate help.

To find out more about this law, go to the Washington State Center for Health Statistics page on the Death with Dignity Act. For more information about choices in dying, please go to the Compassion & Choices of Washington page on the Death with Dignity Act.

Follow-up Department

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We figure that you shouldn't have to stick your neck out to refer a friend to a doctor. Just to remind, when you refer a friend to us, we will cheerfully refund their office fee if they are not pleased with our service.