‘Death With Dignity’ Gains Steam, Remains Divisive
Posted on Monday, June 29th, 2015 at 11:58 am by lifemediamatters
Support for physician-assisted suicide is proliferating in state legislatures across the nation as proponents contend the practice enhances patient freedom at the end of life and guarantees terminally ill adults a way out of pain and suffering.
Physician-assisted suicide is legal in only a handful of states including Oregon (the first state to legalize the practice in 1997), Washington (passed by ballot measure), Vermont (passed by state Legislature), New Mexico and Montana (allowed by the courts).
However, support for so-called “Death with Dignity” legislation has grown in recent years as advocates, including Compassion & Choices and the Death with Dignity National Center, work to turn the issue into a political and social movement. It seems to be working in California, the nation’s most populous state.
Senate Bill 128 (The End Of Life Option Act) by State Senators Bill Monning and Lois Wolk recently passed through the Senate 23 to 15. The legislation is now in the Assembly and will be voted on in early July.
“I’m cautiously optimistic that it will pass, but you never ever know for certain until the day of the vote,” George Eighmey, vice president of the Death With Dignity National Center, told Life Matters Media. “There are many people who are facing death who wish to have one more option in considering how their life is going to end, in addition to palliative care, hospice care, taking medicine or not taking medicine.”
On the East Coast, Maine’s “Death with Dignity” bill, LD 1270, was narrowly defeated by a single vote in the Senate in June. In 2012, voters in Massachusetts, one of nation’s most Catholic states, narrowly voted down a similar referendum.
Shortly after the Vermont legislation became law, Peg Sandeen, executive director of the Death with Dignity National Center in Oregon, told LMM she believes Midwestern states, including Illinois, may be 10 years away from passing some form of “Death with Dignity” legislation.
Mark Sheldon, distinguished senior lecturer in the Medical Humanities and Bioethics Program at Northwestern University, said he is evolving on the issue as he grows older.
“For a very long time I was very opposed to assisted death, but in the last decade or so I became a supporter of it under certain circumstances,” Sheldon said. He would support aid-in-dying for patients seeking a sense of control over their death and facing extreme pain.
“I’m aware of the arguments against it, and palliative (comfort) care is important, but there are instances when adequate pain control is not available,” he added. “Sometimes adequate pain control is very heavy sedation, and that’s something that makes me uncomfortable.”
Sheldon, who does not wish to be a financial burden to his family if he ever becomes seriously ill, told LMM that assisted-death is a viable option for him. He would rather save resources for his children.
Still, the public remains closely divided on the issue, with 47 percent in favor of laws that would allow doctor-assisted suicide for terminally ill patients and 49 percent opposed, according to PEW Research.
Despite calls for legalization from a growing number of proponents, the American Medical Association remains firmly opposed to such policy. The Chicago-based AMA is the nation’s largest organization of physicians, representing nearly 200,000 doctors, medical students and residents.
“It is understandable, though tragic, that some patients in extreme duress – such as those suffering from a terminal, painful, debilitating illness – may come to decide that death is preferable to life,” according to a statement sent to LMM. “However, allowing physicians to participate in assisted suicide would cause more harm than good.”
Many physicians, bioethicists and religious leaders caution that physician-assisted suicide is incompatible with physicians’ primary role as healer and would foster resentment towards sick people hoping to live as long as possible, no matter the costs.
Mark Kuczewski, director of the Neiswanger Bioethics Institute at Loyola University Chicago, is concerned that society and medical providers have become too focused on making dying patients “productive” and not content with just “being.” That mindset, Kuczewski added, leads some to view dying patients as unnecessary and even weak.
“Once we go down that road, it’s very hard for us to retain the alternate option: to help people live every moment of their remaining life with quality and dignity. There’s a tendency, once you institutionalize it, for the right-to-die to become the duty to die,” Kuczewski said. “Once you have a society that facilitates this, once you have that, it’s so easy the way that mixes with our culture, for it to be hard for anybody to be a healer in those situations or have an alternate point-of-view.”
Others point to advances in hospice and palliative medicine that can help to alleviate pain. But proponents of physician-assisted suicide, including Eighmey, say just knowing the option to end life is available can serve as a source of comfort.
The Brittany Maynard effect
Many right-to-die advocates credit the recent high-profile death of 29-year-old Brittany Maynard for raising awareness about the issue amongst so-called Millenials (adults 18 to 32).
In 2014, Maynard was diagnosed with an aggressive glioblastoma brain tumor and was later given six months to live. Maynard and her husband, Dan Diaz, moved from California to Oregon because that state did not allow terminally ill adults to end their lives with doctor-prescribed barbiturates.
Working with Compassion & Choices, Maynard used her story to raise awareness about the practice and inspire other terminally ill Americans to end their lives on similar terms. She ended her life later that year, sparking headlines across the world.
“I don’t wake up every day and look at it, I know it’s in a safe spot,” Maynard said in a Compassion & Choices-produced video about her life-ending drugs. That video has been viewed more than ten million times via YouTube. “I will pass peacefully with some music I like in the background.”
Like Eighmey, Compassion & Choices President Barbara Coombs Lee said Maynard “changed everything,” partly because she introduced Americans to the human side of the issue.
“She has single-handedly transformed our whole movement from from one organization working actively in the field to a broad movement where all kinds of people are introducing bills and filing lawsuits and becoming active,” she said last year in Chicago. “We will see bills advancing in many, many states. Her brazen visibility helped to increase momentum.”
Oregon POLST Adjusts To Digital Shift
Posted on Wednesday, June 17th, 2015 at 9:27 am by lifemediamatters
An Oregon medical order designed for patients nearing death is evolving to better complement the state’s shift towards electronic record keeping.
ePOLST is the fully integrated electronic version of Physicians Orders For Life-Sustaining Treatment, or POLST form. They are more detailed than conventional living wills or advance health care directives – these medical orders extend patients the freedom to indicate preferences regarding hospitalization, resuscitation, intravenous antibiotics and duration of feeding tubes.
In emergency situations, first responders are trained to look for the form in the patient’s home, purse or briefcase. Unfortunately, sometimes care providers are unable to locate the document or forget to ask for it. In hospitals, such forms are often illegible after being faxed.
ePOLST is designed to make sure no patient with a completed form ever receives unwanted treatments by more accurately recording and storing them. The initiative is a collaboration between Oregon POLST, Oregon Health & Science University and Silicon Valley startup, Vynca.
OHSU clinicians can now view a patient’s POLST at the top of his or her electronic health record. They will soon be able to electronically search the Oregon POLST Registry through ePOLST, which will hopefully make it easier to find forms from other health care systems.
Paper forms will still be honored, but the current statewide error rate for paper POLST forms submitted is nearly 20 percent, according to the Oregon POLST Registry.
“We want to ensure that patient wishes, to have or to limit treatment, are honored in every step of the process of transition from one setting to another,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care and chair of the Oregon POLST Task Force. “It’s imperative that these important orders be found quickly and available in every context.”
The program was developed in Oregon the 1990s to help ensure the wishes of terminally ill patients nearing death are followed by physicians and emergency responders. POLST programs have since been adopted or are in development in 43 states across the nation, as well as in five countries.
POLST is divided into basic sections – CPR, medical interventions and artificial nutrition. Medical providers are required to follow patients’ preferences as they are indicated on signed forms. Ideally, preparing a POLST should spark serious discussion about goals of care between terminally ill patients, their loved ones and medical providers.
“You want more, you get more. You want less, you get less,” Tolle added.
In Oregon, more than 250,000 POLST forms have been submitted to the registry since its inception in 2009, according to data compiled by Oregon POLST. More than 5,000 health care professionals have called the registry seeking forms.
A 2014 study co-authored by Tolle and published in the Journal of the American Geriatrics Society found that patients with POLST forms are highly likely to have their wishes honored.
Terminally Ill Cancer Patient Brittany Maynard Has Died
Posted on Sunday, November 2nd, 2014 at 9:07 pm by lifemediamatters
The woman who moved to Oregon to take advantage of the state’s controversial physician-assisted suicide law ingested lethal drugs prescribed by a doctor and died Sunday.
Brittany Maynard, 29, was diagnosed with a glioblastoma brain tumor in January and was later given six months to live. She and her husband moved from California because that state does not allow terminally ill patients to end their lives with drugs prescribed by a doctor, The Associated Press reports.
Putting Dying Wishes In Medical Record Helps Them Happen
Posted on Monday, June 9th, 2014 at 1:55 pm by lifemediamatters
This piece was first published in Reuters Health. LMM President Randi Belisomo is a contributor.
When patients’ end-of-life preferences are entered as instructions in their medical record, their wishes are more likely to be honored, a new study suggests.
The study was done in Oregon, one of two states with an end-of-life planning program called POLST (Physician Orders for Life-Sustaining Treatment).
“POLST is not for everyone. Only patients with serious illness or frailty should have a POLST form,” the program’s website notes.
But for those patients, “POLST records and honors wishes in a way that (medical professionals understand) and can implement across settings of care,” said Dr. Susan Tolle, an internist at Oregon Health and Science University in Portland and the study’s senior author.
Bright pink POLST forms are medical orders signed by physicians, nurse practitioners or physician assistants after discussions with patients about preferred treatment plans.
Tolle’s team studied death records of 58,000 people who died of natural causes in 2010 and 2011. About 30 percent had copies of their POLST form in a state-wide registry. The researchers compared the location of death on death records to POLST patient preferences.
“Although it is probably more important how you die than where you die, where you die can strongly affect how you die,” they write in the Journal of the American Geriatrics Society.
POLST forms don’t let patients specify where they prefer to die. Instead, the forms include three order sets that could impact location. More than two thirds of patients with POLST forms had chosen the first option: “prefers no transfer to hospital for life-sustaining treatments . . . transfer if comfort needs cannot be met in current location.”
Slightly more than a quarter chose the second option: “transfer to hospital if indicated . . . generally avoid the intensive care unit.”
Only six percent chose full treatment: “transfer to hospital and/or intensive care unit if indicated.”
One limitation of the study is that for people who died without a POLST form in the registry, there was no way to know what their preferences would have been. Also, the results would have been more reliable if everyone had been randomly assigned to a POLST or no-POLST group.
Still, the researchers believe, their findings suggest POLST forms made it more likely that patients’ wishes would be carried out.
Belgium: Euthanasia For Children Nears Approval
Posted on Saturday, February 15th, 2014 at 6:37 am by lifemediamatters
The Belgian Parliament has adopted a controversial bill extending the right to euthanasia to terminally ill children, the Parliament announced Thursday via Twitter.
The bill easily passed the Belgian House of Representatives 86 to 44, following a vote by the country’s Senate in December in support of the measure. The bill is expected to be signed by King Philippe, making Belgium the first country in the world to remove age limits to the practice.
Under amendments to the country’s 2002 euthanasia law, a child of any age may be helped to die under strict conditions: the child must be terminally ill, close to death and suffering a great amount of pain. Counseling by doctors and a psychiatrist or psychologist is required, as is approval by parents or guardians. The child must possess the “capacity of discernment and be conscious” of requesting death.
Socialist Senator Philippe Mahoux, sponsor of the country’s 2002 “right to die” legislation, called for the law’s expansion because he said doctors have been illegally helping sick children die. Mahoux, a trained surgeon, called euthanasia “the ultimate gesture of humanity,” according to Agence France-Presse. “The scandal is illness and the death of children from disease.”
Opponents, including religious leaders and some medical professionals, argue that children are not capable of making such difficult decisions. “The law says adolescents cannot make important decisions on economic or emotional issues, but suddenly they’ve become able to decide that someone should make them die,” Brussels Archbishop Andre-Joseph Leonard said at a prayer vigil last week, according to the BBC.
On Wednesday, 160 pediatricians petitioned lawmakers to postpone the vote arguing the bill is unnecessary. “Pain can be eased nowadays; there’s been huge progress in palliative care,” Nadine Francotte, a cancer specialist in the city of Liege, told AFP.
In 2012, euthanasia accounted for 2 percent of all deaths in Belgium, up 25 percent to nearly 1,400 cases. A terminally ill person may drink a barbiturate-laden syrup, or a doctor can administer the drug through an intravenous tube to induce death.
Belgium is one of a handful of European countries where euthanasia is legal. The Netherlands legalized euthanasia in 2002, even allowing it in some cases for seriously ill minors 12 and older. Luxembourg allows euthanasia for adults; Switzerland allows doctors to help patients die in some circumstances.
Euthanasia is banned in the U.S., but physician-assisted suicide, or “Death with Dignity,” is legal in four states: Oregon, Washington, Vermont and Montana.
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