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A Doctor’s View Of Death With Dignity

Hundreds of concerned citizens and patient advocates gathered at Temple Sholom in Chicago to learn about “Death with Dignity,” legislation that could allow physicians in Illinois the ability to prescribe life-ending medications to some terminally ill patients. Currently, only three states have “Death with Dignity” legislation– Oregon, Washington and Vermont; physicians in Montana may raise a defense of consent if charged with assisting in a suicide because of a 2009 trial court ruling.

Both the Oregon Death with Dignity Act (1994) and the Washington statute (2008) set safeguards to protect patients against coercion from physicians or family members. Each patient must be of sound mind when requesting the prescription for life-ending barbiturates; each patient must be informed of all other options including palliative medicine and hospice care; two doctors must confirm a diagnosis of terminal illness with no more than six months of life-expectancy; and any patient may change his or her mind at any time.

Doctors Jorge Del Castillo, NorthShore University Hospitals, Dan Fintel, Northwestern Memorial Hospital, and Daniel G. Samo, Northwestern University’s Feinberg School of Medicine, offered their perspectives about the controversial legislation.

“I think we really need to move forward and get our legislature involved in making some progress in this state, making some inroads,” Castillo said, telling a story of his 96-year-old aunt. “She was clear minded, sharp as a tack, but heart failure– she wasn’t getting around anymore, she just wasn’t enjoying life,” he said. When Castillo visited her in Miami last year, she asked him to kill her. “I said, ‘I can’t really do that. You’re still around, we’re still enjoying each other.’ But she died a week later, I think she willed herself to die. It was a heartbreaking situation to me, because I had the wherewithal to help her, but I could not.”

Samo urged the crowd to separate “Death with Dignity” laws from physician-assisted suicide. “The physician writes the prescription but does not administer the drug,” he said. “This is about a competent person who decides this is time and wants to go.”

Death W/ DignityAccording to Fintel, very few deaths in Oregon and Washington are a result of prescribed barbiturates– only about .1 to .2 percent (1 to 2 out of 1000) of recorded deaths. “This has not been an abused treatment,” he said. “This is not a wholesale reason for people to end their lives early because their medical bills were horrible, or because their families wanted to do them in.”

Samo stressed that the legislation bolsters patient autonomy. “Your religion or your beliefs say you shouldn’t do it? Great, you don’t have to,” he argued. Samo said he believes “Death with Dignity” does not reduce the sanctity of life and does not unfairly targets minority groups. He referred to Oregon as “a great social experiment.”

Other states have attempted to pass similar “Death with Dignity” laws, but they have had mixed results. In May 2013, Vermont passed the Patient Choice and Control at End of Life Act, a law based on the Oregon model. But in 2012, proponents of similar legislation in Massachusetts faced strong opposition from the Catholic Church and social conservatives, and residents narrowly voted against that measure. According to Compassion & Choices, a more than 100-year-old provision in Hawaii law does not prohibit doctors from providing aid in dying to their terminally ill patients. It is unclear when or if Illinois will approve similar right-to-die legislation.

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Loretta Downs, past president of the Chicago End-of-Life Care Coalition, said she appreciated the doctors’ enthusiasm, but she felt their knowledge about palliative medicine and hospice care was limited. “Listening to three highly prominent physicians speaking publicly in favor of physician-aid-in-dying was exhilarating,” she said. “While they supported the use of advance care planning and palliative care and hospice at the end of life, each of them made comments that showed a disappointing misunderstanding of the care those services provide,” Downs added. The panel did not discuss the new Illinois POLST form, which Downs called “the most empowering legal medical directive a person facing death has today.”

Peg Sandeen, executive director of the Death with Dignity National Center in Oregon, told Life Matters Media that Illinois may be 10 years away from passing some form of “Death with Dignity” legislation. “We just had our first law passed legislatively, ever, in Vermont– it took 10 years to get that project complete. It started as a local group, much like the local group that sponsored the event in Illinois,” she said.

One of the biggest impediments for the organization’s movement in Illinois is the lack of exposure to “Death with Dignity” legislation, Sandeen added. “Oregon is way out in the West, and our experience hasn’t trickled across the U.S., yet,” she said. “It’s not like there has been a lot of discussion about ‘Death with Dignity’ in Illinois before this.”

One Thought on “A Doctor’s View Of Death With Dignity”

  1. Clearly, the laws against murder are seldom appropriate when applied to medical decisions near the end of life. So each state should create a better approach to making life-ending decisions. The law suggested here (following Oregon’s model) grants permission for a doctor to prescribe a lethal chemical to bring the patient’s life to an end. A completely different approach would cover all life-ending decisions by banning the harm of causing premature death: http://www.tc.umn.edu/~parkx032/CY-2APP.html.

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