Book: Being Mortal

One of my book buddies recommended this meditation on modern medicine by Atul Gawande. In it he discusses the intersection -- no, the collision -- between length of life and quality of life.

Hospitals and specialists can often prolong the life of seriously ill patients, with a litany of increasingly invasive procedures. Increasingly expensive procedures. Quite often they do little to forestall the inevitable, and even more often they make the patient's final hours or days a living hell.

The author argues that when death is inevitable the patient must be told so, and allowed to decide for him- or herself how much intervention to endure.

The author, a surgeon, went through the very same situation with his own father, a urologist who knew exactly what his spinal cancer meant. It was painful and cathartic and an eye opener for somebody who had avoided having these discussions with his patients up until then.

Morbid, and grim, but germane to my last three years. Well written, humane, intelligent. Everybody should have a Medical Directive including a DNR.

I saw Gawande interviewed a while back.  Everything he said - some of which you have described - made perfect sense to me and maintained a reasonable moral stance.

You mentioned DNRs. I gave it some thought, and realized that everyone I have known who was in a shitty medical condition has requested a DNR. That certainly validates Gawande's position as far as I am concerned. In fact, I think other states should take a cue from Oregon and pass the equivalent of their Death With Dignity Act.

Yeah but Oregon's DWDA doesn't go far enough.

The patient has to have 6 months or less left to live as confirmed by two doctors -- but has to be capable enough to orally request DWD and sign forms. When my sister's chemotherapy options dried up and her tumors won, she had something like 3 weeks to live.  That wasn't enough time. She was not eligible to take a lethal cocktail, although I think she certainly would have preferred it.

Quote :

Q: How does a patient get a prescription from a participating physician?

A: The patient must meet certain criteria to be able to request to participate in the Act. Then, the following steps must be fulfilled: 1) the patient must make two oral requests to the attending physician, separated by at least 15 days; 2) the patient must provide a written request to the attending physician, signed in the presence of two witnesses, at least one of whom is not related to the patient; 3) the attending physician and a consulting physician must confirm the patient's diagnosis and prognosis; 4) the attending physician and a consulting physician must determine whether the patient is capable of making and communicating health care decisions for him/herself; 5) if either physician believes the patient's judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination; 6) the attending physician must inform the patient of feasible alternatives to the Act including comfort care, hospice care, and pain control; 7) the attending physician must request, but may not require, the patient to notify their next-of-kin of the prescription request. A patient can rescind a request at any time and in any manner. The attending physician will also offer the patient an opportunity to rescind his/her request at the end of the 15-day waiting period following the initial request to participate.

Similarly, my mother had to wait several weeks between her losing all muscular control of her larynx and when she finally starved to death.  We investigated getting her on some sort of DWD thing but by then she was too disabled to self-administer.

My feeling is, it should be easier to get and assuming you're not leaving any huge debts or unresolved issues, it should be perfectly legal for anyone.  Guns and poisons are SO untidy.

Quote :

Q: Are there any other states that have similar legislation?

A: Yes. On November 4, 2008, the State of Washington passed Initiative 1000, the state's Death with Dignity Act, which became law on March 5, 2009. Information about the Washington Death with Dignity Act can be found at http://www.doh.wa.gov/dwda

In 2009, the Montana Supreme Court ruled that physicians may assist patients in ending their lives by prescribing lethal medications (to be self-administered by the patient), citing the state’s Rights of the Terminally Ill Act. Information on the Montana Supreme Court decision can be found at http://searchcourts.mt.gov/getDocument?vid={88A87FE0-2501-438A-AC31-CCE62D37C894}

In 2013, the Vermont General Assembly passed Act 39, the state's Patient Choice and Control at End of Life Act, which was signed into law on May 20, 2013. Information about the Vermont Patient Choice and Control at End of Life Act can be found at
http://healthvermont.gov/family/end_of_life_care/patient_choice.aspx