Death with Dignity

Thesis: Is the fear of living an incomplete and possibly painful life a reason to bring your life to an end? Does this fear give us the authority to be masters of our own fate and end our own life before we and the ones we love suffer? 1. The beginnings of physician assisted suicide.

a. Dr Kevorkian b. The first to use the method. c. The Death with Dignity National Center 2. Oregon state and Washington state legalizing the method. d. The legal way the process is suppose to be administered. e. The drugs that are prescribed. f. The law and physician requirements to fulfill the patients last request. 3. Montana and its different view point. g. The court’s ruling on physician assisted suicide. 4. Will Massachusetts be the next state to legalize the death with dignity method? h. The process of getting the bill passed. 5. The families’ perspective on the decision? i. Family members who objected. j. Family members who supported? k. How they live after the decision is made. 6. Insurance and their perspective. l. Will insurance pay for the drugs required to perform the suicide? m. Will insurance pay for the doctors who assist with the procedure? n. What is the cost of physician assisted suicide?

7. Conclusion

Choosing to Die with Dignity: Should it be Legal?

Thesis: Is the fear of living an undignified and possibly painful life a reason to bring your life to an end? Does this fear give us the authority to be masters of our own fate and end our own life before we and the ones we love suffer? There is a lot of controversy with the subject of euthanasia. I, for one, was not even aware of the depth of the subject until I started researching for this paper. It has been most enlightening and sometimes heart retching process to write this paper. There are actually 4 defined approaches to the method of euthanasia.

Derek Humphries defines them in his book The Final Exit as the following: (Humphrey) 1. Passive euthanasia is the “pulling the plug” process. 2. Self-deliverance is simply the act of taking your own life. 3. Assisted suicide is when a physician advices and supplies you with the drugs used to kill yourself. 4. Active euthanasia is the physician administering the drugs that cause death. With those definitions in mind we can look at the history of euthanasia. Hippocrates, also known as the Father of Medicine, is believed to have written the Hippocratic Oath around 400 BC.

The oath, which stated, “I will not give a lethal drug to anyone if I am asked nor will I advise such a plan,” was not followed faithfully back then. Infanticide, active euthanasia and suicide were tolerated. Ancient Greeks stressed the voluntary end of life as long as it was done for the right reasons. After the coming of Christ, euthanasia and suicide became against God, therefore became almost extinct. Suicide was made illegal and if someone took their own life all their assets would go to the government.

After the revolutionary war, suicide was decriminalized but any form of euthanasia was still not allowed. In the 1870’s Samuel Williams was the first individual who spoke out to allow pain killers such as morphine be used not only to ease the pain of terminal illnesses but also to speed the death. He was not a physician but his proposal was given attention in medical journals and scientific meetings. It did not change anything but now it is out in the open that maybe there is another option for death. Ohio was the first state on record that proposed a bill to legalize euthanasia. The bill wanted to legalize euthanasia of the terminally ill as well as the “hideously deformed or idiotic children”. (Manning) It was defeated.

Dr. Harry Haiselden made headlines in America in 1915 for allowing the eventual death of an infant, baby Bollinger, who was born badly deformed and without an anus. The infant would die of auto-intoxication if surgery was not performed immediately. He stated in a news conference that he was going to “merely stand by passively and let nature complete its bungled job.” (Dowbiggin) He also informed the press that “the Bollinger baby dies after six days or the nation is saddled with the cost of taking care of it and its offspring, none of whom would enjoy life anyway.” (Dowbiggin)

This was not his first or last infant he made that decision for. It was never determined how many died before this baby but he let at least 5 more die after this incident. This started, what in my mind, is a twisted characterization of the act of euthanasia. Madison Grant, an American lawyer, eugenicist and conservationist, made the comment “the elimination of defective infants was the welcome first step in the obliteration of the unfit.” (Dowbiggin) Haiselden also exploited the media attention with a movie he actually starred in. “The Black Stork” was a “eugenic dramatization” of the Bollinger case. (Dowbiggin)

The movie opened in 1916 and continued showing across America until 1928. The most surprising supporter, in my eyes, was Helen Keller who stated that “the definition of life, and that a right to life ought to be honored only when a potential for happiness, intelligence, and social usefulness existed. Tolerating “anomalies” such as the Bollinger baby tends to lessen the sacredness in which normal life is held.” (Dowbiggin) The term mercy killing was attached to this idea of euthanasia.

The first society was formed in 1935 by C. Killick Millard. The Voluntary Euthanasia Society was founded in England and put a bill before the House of Lords which was defeated in 1936. The first society formed in America was in 1938. Originally named the National Society for the Legalization of Euthanasia it changed its name to Euthanasia Society of America. It was funded by Mrs. R. L. Mitchell who partnered with Charles Francis Potter.

They were inspired by the first society formed in England. The society’s members were made of several eugenicists. Eugenics and euthanasia were blended together with the Euthanasia Society of America due to the members, but they are different in meaning and purpose. Eugenics concerns are birth control, social planning, preventive medicine, and the study of heredity. Euthanasia is the mercy killing of the terminally ill or life afflicted individual.

In 1937, Senator John Comstock of Nebraska, wrote the Voluntary Euthanasia Act. It received some notoriety at the time but was never voted on. Euthanasia hit a downward spiral during World War II. It became a dark cloud because of Hitler and lost the meaning of what euthanacist were trying to explain. Everyone was focusing on the Nazi mass euthanization of the mentally ill, the old, epileptics, schizophrenics, cripples, criminals, orphans, and the racially undesirable.

Hundreds of thousands of people were killed during the Aktion T-4 program or sent to the gas chambers. Some were just left to starve or were given lethal doses of medications. The end result euthanasia was now the worst possible thing to believe in. Americans believed that legalizing euthanasia would lead to Nazi barbarism. Religious leaders preached the moral issues were a threat to democracy. Then in 1950, The World Medical Association voted to have euthanasia condemned “under any circumstances.” (Dowbiggin)

The battle to legalize euthanasia quieted down for several years. Then in 1952 the English and the American Societies banded together to submit a petition to the United Nations on Human Rights which stated “the right of incurable sufferers to euthanasia or merciful death.” (Margorie Zucker) Eleanor Roosevelt was the Chairman of the Commission at the time and decided to never present the petition. Over the next couple of decades the Euthanasia Society of America kept pushing for the legalization of euthanasia. The society went through several presidents but it was not until Donald McKinney in 1965 when essential differences were made between passive euthanasia and active euthanasia.

This progress was significant in the society’s first major victory. Attorney Luis Kuter wrote the first Living Will in 1965, twenty years after the Euthanasia Society originally discussed the idea. The Euthanasia Educational Fund, a separate organization created by the Euthanasia Society of America, drafted a model living will in 1969 and printed 5,000 copies. It took only 6 months to distribute them. The living will was a huge success. It provided people with the assurance that there death would not be prolonged if they had a terminal condition.

The popular newspaper column Dear Abby helped to promote the Euthanasia Educational Fund and the living will. As popular as the living will was it still took over 10 years to make it a legal document. Harvard Medical School inadvertently helped with the next victory in 1968 by redefining permanent coma “as a criterion for death”. (Singer) A new meaning of death was essential because of the great burden that trying to revive permanent comatose patients has on the patients as well as the family.

A list of decisive factors has to be considered but if the comatose individual meets the minimal health limitations then they can be considered brain dead in an irreversible coma and as long as the body has been sustained then organs can be used for transplant. The Hastings Center, founded in 1969 by Daniel Callahan, was set up to study ethical problems in medicine and biology. It was influential in the advance of bioethics as a discipline. The original focus of the center was on death and dying, genetics, reproductive biology and, and behavior control. The US Senate Special Commission on Aging holds the first national hearing in 1972 on euthanasia entitled "Death with Dignity: An Inquiry into Related Public Issues.” (Dowbiggin)

The hearings proved to be an excellent chance for professionals and the general public to discuss a variety of issues related to aging, terminal illness, doctor-patient relationships and the difficulty about defining death itself. The hearings showed that Americans were becoming gradually unhappy about the “brutal irony of medical miracles,” (Dowbiggin) which only extended the dying process and reduced the patient’s dignity and quality of life. The American Hospital Association, in 1973, adopted the Patient's Bill of Rights which recognizes the right of patients to refuse treatment. The Euthanasia Society of America revived itself with the new name. The Society for the Right to Die marked a renewed dedication to pursuing the legalization of active euthanasia, a revitalized campaign to seek legalization of euthanasia.

The first hospice opened in New Haven, Connecticut in 1974. Hospice does not take a thin view of the complexities of patients with an irreversible illness. The control of physical pain is the primary concern for caregivers; it is not the main concern. The patient with an irreversible illness suffers from an array of emotional, spiritual, social and financial problems. The underlying standards for hospice care are that it is impossible for any one discipline to provide the variety of services required.

Hospice helps patients and families reach the best possible quality of life at the least likely time. Hospice care can be provided at the patient’s home or in a skilled facility. The case of Karen Quinlan, in 1983, marked the historical court ruling that the family could have her removed from her respirator. The story did not end there. The hospital did not obey the court order immediately. They reduced her respirator slowly to see if her body would learn to breathe on its own. They did this without informing the family. Their plan worked and Karen lived another 10 years without waking up. The family did not have the feeding tube removed. They thought it would be direct euthanasia. (Rebman)

The California Natural Death Act started a chain of developments. It was signed into law by Governor Edmund G. Brown Jr. in 1976. California became the first state to grant terminally ill persons the right to authorize withdrawal of life-sustaining medical treatment when death is believed to be imminent. Within the next year seven states, New Mexico, Arkansas, Nevada, Idaho, Oregon, North Carolina, and Texas followed California example. The World Federation of Right to Die Societies was founded in 1980. Its membership included dozens of organizations from countries around the world. Derek Humphrey made the next significant statement for the euthanasia movement into the 20th century.

The author of the true story, Jeans Way published in 1978, he was the first to tell his wife story with cancer and the part he played in her death. I read this book myself and the end was heartbreaking and heroic. It takes an incredible amount of courage and love to do what he did. It is truly a love story to the end. The last day of her life was the saddest and the most memorable of his life. Derek Humphrey did not write the book immediately. He waited 5 years and after he moved to the United States. In 1980 he formed the Hemlock Society in Los Angeles, Ca.

He has written several books on the subject. The Right to Die: Understanding Euthanasia was published in 1986. Final Exit: The practicalities of Self-deliverance and Assisted Suicide for the Dying were published in 1992 and have been updated 3 times. The book gives direction on different forms of euthanasia. He continues writing and publishing books and remains on the top sellers lists even today. His life and accomplishments have played a significant role in furthering the movement of euthanasia and the compassion behind the deed. During the 1980’s several events unfolded.

* Pope John Paul II issues the Declaration on Euthanasia, opposing mercy killing but permitting increased use of painkillers and a patient's refusal of extraordinary means for sustaining life.

* The American Medical Association publishes two reports, Withholding or Withdrawing Life-Prolonging Medical Treatment, and Withholding or Withdrawing Life-Prolonging Medical Treatment -- Patients' Preferences. The reports stated their formal position “that with informed consent, a physician can withhold or withdraw treatment from a patient who is close to death, and may also discontinue life support of a patient in a permanent coma.” (Association) * The California State Bar Conference passes a Resolution to become the first public organization to approve of physician assisted suicide. *

The Unitarian Universalist Association of Congregations passed a statement named The Right to Die with Dignity. The document expresses there agreement for physician assisted suicide for the terminally ill; they became the first religious body to announce a right to die statement. * The Journal of the American Medical Association published an anonymous article entitled "It's Over Debbie." (Unknown) The story was about a gynecology resident in a large private hospital had injected a patient suffering from painful ovarian cancer with an overdose of morphine. The article caused controversy and debate.

Dr Kevorkian, also known as Dr. Death, made history in the 1990’s. He assisted in many suicides around 130 was the last number and was taken before the courts several times. He was always acquitted or there was a mistrial. I read a lot of his biography and he had a misguided since of doing right. He was acting on the patients behalf. He designed a device which allowed the patients to administer the combination of drugs which would cause there death. The machine came to be known as the suicide machine.

Dr Kevorkian was very disappointed that his court cases did not result in jail time. When given the opportunity to assist in a suicide in which the patient was not able to complete the process himself, the Dr agreed to do it himself. Knowing that this would be against the law he wanted to make a statement. He videotaped the interview with the patient as well as the death. He then contacted 60-minutes and had it aired on television.

He was arrested and was later convicted of second-degree murder and the illegal delivery of a controlled substance on March 26, 1999. He received 25 years in prison with a possibility for parole. After 8 years he was released for good behavior. You don’t know Jack was the name of a movie made to tell his story. California was the first state to vote on a Death with Dignity bill in 1992. The bill would allow physician assisted suicide. It was defeated. Oregon was the second state to put the bill on the ballot. Oregon became the first state to pass the Death with Dignity Act. The act spells out very specific guidelines to be used before the physician can assist with the suicide. The information can be found on the website oregon.gov. I believe it is very detail oriented and allows for a clear decision to be made. The following is a list of guidelines: * Must be an adult of age 18

* Must be a resident of Oregon * proof is given with a drivers license, * registration to vote card, * proof the individual owns or leases property in Oregon, * filing the previous year’s tax return in Oregon. * Must be mentally capable to make medical decisions * Must have been diagnosed with a terminal illness with less than 6 months to live. Once a patient meets the above stipulations they must then follow additional guidelines. * The patient must make two oral requests to his or her physician, separated by at least 15 days.

* The patient must provide a written request to his or her physician, signed in the presence of two witnesses. * The prescribing physician and a consulting physician must confirm the diagnosis and prognosis. * The prescribing physician and a consulting physician must determine whether the patient is capable. * If either physician believes the patient's judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological examination.

* The prescribing physician must inform the patient of feasible alternatives to assisted suicide, including comfort care, hospice care, and pain control. * The prescribing physician must request, but may not require, the patient to notify his or her next-of-kin of the prescription request. (Manning) There are also forms that need to be filled out to confirm the above guidelines are followed by the patient as well as the physician. * Patient Request form

* Statement of what terminal illness the patient has * The formal request for their physician to administer a life ending medication * 2 witness signatures are required * Attending Physician Form * Patients information * Physician information * First verbal request checklist * Second verbal request after the 15 day waiting period. * The written request for the medication * Consulting Physician Form * The patient diagnose and mental health * The name of the psychiatrist * Psychiatrist form * The full psychiatric evaluation of the patient * Pharmacy Dispensing Record Form * A list of the medications physician ordered for the procedure These forms are sent to the Oregon Health Authority. The forms are reviewed by the Oregon Health Authority and after receiving the death certificate will contact the physician to confirm wither the patient died by lethal injection or terminal illness. The physician must then provide the medications given and the time it took for the patient to die. The Oregon Health Authority does not give permission for the procedure they just make sure that every step is taken before the death to assure it is the patient who is requesting it and they do not have any other medical options to take. The publish a yearly report on the deaths.

The state of Washington became the second state to pass the Death with Dignity Act in 2008. They follow the same strict guidelines as the state of Oregon does. The Washington Department of Health collects the same forms and reports all death in an annual report just like the state of Oregon.

As of current history there have been several states to put a bill up for vote. Hawaii introduced there bill in 2011 but has yet to be addressed. Massachusetts also submitted a bill in 2011 which has also not been addressed. It seems they are just pushing the bills under the rug and ignoring them. Massachusetts resubmitted the bill in 2012 but it is still being ignored. New York submitted the similar bill in February 2012. It was stricken on May 9, 2012.

Pennsylvania has presented their bill in February 2012 but it is still active. No decision has been made as of today’s date. Vermont submitted a bill in February 2012. It moved for to the Senate Committee on Judiciary on March 29, 2012. It was defeated but with the attention given was considered progress for the supporters of euthanasia.

Montana does not have a specific bill which allows physician assisted suicide but it is not illegal. The states Supreme Court ruled on ruled on December 31, 2009 that “physicians should not fear prosecution when writing lethal prescriptions for mentally competent patients with a terminal illness”. (O'Reilly)

While America fights over the ethical issue of euthanasia there are some countries that currently have legal laws supporting Death with Dignity. Holland, Belgium and Luxembourg, and Switzerland were the first countries to rule for it. Argentina was the most recent to pass the law on May 9, 2012.

I previously mentioned the story Jeans Way. It is the true telling of a life which ended with a death with dignity process. It told the story of her life and when she got diagnosed with cancer. The years after with treatments like surgery and chemotherapy. It also told of the day she asked her husband to help her die and his process of accepting and finding the solution. They discussed the children and how much they should be told. The last day of her life was very moving and filled with love.

Today there is a group of people called Compassion and Choice. It is an organization which combined with the Hemlock Society in the 1980s. Their mission is to reach out and give end of life counseling, instructions on Advance Directives, as well as help with legal court battles and activating media attention if needed.

A daughter tells the story of how her father was diagnosed with glioblastoma, a form of cancer. She lived in Oregon but he lived in Massachusetts. He requested to move to Oregon so when the time came he could choose when he wanted to die. She agreed and he moved to Oregon where he was given all the treatment his doctors recommended. He was allowed to die with his family surrounding him and talk of happy times going on around him.

I was not able to find any documentation where families were against what their loved one was requesting. Of the stories I read the family members were supportive and understanding. They too were affected by their loved ones suffering. I would have to say that making this decision would be one of the hardest to make. It does release you from a life of pain and humiliation but it also means you are releasing your family of the responsibility of making the ultimate decisions at a later date. The modern day euthanasia is a more compassionate approach to death then history has provided us. The dark cloud that has hung over the subject for the last several hundred centuries is not as heavy.

The reasons and motivation for euthanasia have become more civilized and compassionate since the Greek era. I understand the ethical dilemma doctors might have with the Hippocratic Oath but I think it was broken a long time ago when abortion was made legal. It is probably time for someone to rewrite the oath and bring it up to modern terminology. There is a website dedicated to informing and updating the issues of death with dignity.

The Death with Dignity National center has been around for over 20 years and played a large role in passing the Oregon Death with Dignity Act. I have spent a lot of time on this site within the last few weeks and have found I agree with the process it supports. With the books I have read and the stories of what patients and families went through when deaths were prolonged I hope I would have the choice if the situation was to happen in my life. I included in the history the hospice origination. I believe that it is a caring and fundamental way for terminally ill patients to spend the last days but I also believe that they should be able to choose when to die. T

he idea of putting my family through the process of watching me deteriorate breaks my heart. I want them to remember me as a competent, strong individual who loved them beyond death. I do believe there is certain ethics to physician assisted suicide and if a physician chooses to participate in the process they certainly have a lot to decide. This should not be a decision made lightly by any physician. I would personally want to be given the option to choose my own destiny if the circumstances where to present itself.

Association, American Medical. American Medical Association. 12 1984. web. 2 9 2012. Death with Dignity National Center. n.d. web. 30 8 2012. Dowbiggin, Ian. A Merciful End. New York: Oxford University Press, 2003. Humphrey, Derek. Final Exit. New York: Dell, 1992. Print. Manning, Michael MD. ProCon.org.History of Euthanasia. 28 9 2010. web. 20 8 2012. Margorie Zucker, PhD. "The Right to Die Debate." Margorie Zucker, PhD. The Right to Die Debate. Westport CT: Greenwood Publishing Group Inc, 1999. book. O'Reilly, Kevin. ama-assn.org. 18 January 2010. web. 3 9 2012. Rebman, Renee. Euthanasia and the Right to die. Berkeley Heights: Enslow Publishing, 2002. book. Singer, Peter. Rethinking Life and Death. New York: St Martin Griffin, 1994. book. Uhlmann, Michael. Last Rights. Washington DC: Ethics and Public Policy Center, 1998. Book. Unknown. The Journal of American Medicine. April 1988. web. 3 9 2012.