Death Without Dignity in Oregon

Poster boyBig Pharma–profiting off disease and death

IMO, death is never dignified, but it can be made less ugly and painful. However, that’s not necessarily how Oregon’s law is carried out.

A bit of background: almost two months ago, Sylvia and I traveled to the home of an old friend in Florida. Marion is 86, is losing short-term memory, and is aware of it. She knew she couldn’t continue living alone. Our plan was to move her into assisted living near us, where we could visit frequently.

However, during the two weeks we spent packing up her apartment, Marion was diagnosed with metastatic throat cancer. Assisted living was no longer an option. After returning to Portland, we enrolled her in Kaiser. Then we began to look at her options.

The ENT surgeon—tops in his field—recommended removing part of her lower jaw, her lower front teeth, and her salivary glands, and reconstructing the jaw with titanium and a bone graft from her arm. This would take 12-14 hours in the OR, and 10+ days in the hospital during which she’d be fed through a tube. Radiation would follow, and weeks of speech therapy. She might easily die in the OR, or have a stroke, and even if she didn’t, the chances of success for this treatment are not great. Without treatment, though, Marion could expect the tumor to break through the floor of her mouth, which would be extremely painful and disgustingly malodorous. She would become unable to eat or talk.

Both alternatives—treatment, or no treatment—are unbearable to contemplate. Although it is becoming increasingly difficult for her to eat, Marion decided against the surgery. She is horrified at the idea of having a stroke and lying in a nursing home, unable to communicate her wishes. Yet we are all horrified at the thought of the hideous death she faces without the treatment.

We are now researching palliative care and, at her request, assisted suicide. Oregon’s assisted suicide law, the “Death with Dignity Act,” at first seemed by far the kindest alternative. However, it turns out that there are several interesting catches.

Catch #1: Two doctors have to agree that you will likely die within six months. This is always a guess, of course. You have to be of sound mind and not suffering from depression, and you must make two requests, the second at least 15 days after the first. Right now Marion is competent to make such a decision, but her memory is continuing to deteriorate. If her cognition declines sufficiently before the docs agree on their prognosis, she could cease to be considered of sound mind and so lose that window.

Catch #2: She must be able to swallow a lethal dose of Seconal (90 capsules emptied into a glass of juice) within 2-3 minutes—and keep it down. She is already finding it more and more difficult to eat. What if she loses the ability to swallow before she gets the opportunity? The social worker at Kaiser said that Marion could ask the doctors to put in a feeding tube. She would have to lie, to say she needs it to nourish herself and not for the lethal dose.

Catch #3: A neighbor told us that her husband was denied access to assisted suicide because he had a prior prescription for an antidepressant. With no other way out, he starved himself to death. Depression isn’t Marion’s problem, but many others might find themselves in this man’s situation, since having terminal cancer could easily lead to an emotional state that would result in a prescription for antidepressants.

Catch #4: The only drug prescribed for this purpose is Seconal, a tranquilizer that was patented in 1934. It used to cost just pennies a capsule. When it became the go-to drug for assisted suicide, Marathon Pharmaceuticals bought the rights to it. According to Kaiser, the lethal dose now costs $3,000-$4,000 here in Oregon. (In Canada, it is still only $64 US.) Medicare does not pay for it, and neither does Kaiser. If you’re on the Oregon Health Plan, that is, Medicaid, they will pay for assisted suicide. However, they won’t pay for expensive treatments to prolong life if their bean counters guess you aren’t likely to survive more than five years. What this means is that the Death with Dignity act serves only those poor enough to qualify for Medicaid, or those with enough money to pay the vultures at Marathon. If you’re somewhere in between, you can just suffer.

Meanwhile, we try to fill Marion’s last days with the food she loves, with good music, good literature, and visits from friends.

What do you think? I’d love to hear your stories and opinions on this issue.

8 Responses to Death Without Dignity in Oregon

  1. brian January 8, 2016 at 3:52 pm #

    that’s really sad. i would want to blow my head off with a shotgun wherever the workplace of the people who are responsible for these rules/prices is – right in front of them so they can see the results of their actions.

    • Martha Shelley January 8, 2016 at 3:59 pm #

      Brian, they wouldn’t care. They are greedy sociopaths. If I were in that situation and ambulatory enough to visit them with a shotgun, I’d consider blowing their heads off first. However, I don’t own any guns.

  2. anonymous January 8, 2016 at 5:03 pm #

    One of my loved ones died a couple years ago using the Death With Dignity law. I agree with most of what you’re saying, but his experience was different in some ways. He was given the option to have a compounding pharmacy (Pharmaca) make his dose (I’m not sure if it was Seconal or an equivalent) and through that method his dose cost a few hundred dollars. Which is still bad, but something like ten times less than the other method, which you mentioned. I know this for a fact because I had to pick the medicine up for him and paid in cash. I don’t remember the exact amount but am fairly certain it was less than $500. (I’m thinking somewhere between $200-$400.) My loved one did not have to lie to a doctor to get the dose through a food tube. He was shown how to do it himself. His Death With Dignity doctor who actually drove to our home on his own time and was present in case of any complications (which fortunately did not occur). My loved one injected the fluid into the tube with a syringe and died peacefully less than five minutes later. This doctor was exceptionally kind to do this, but he is with OHSU and not Kaiser. His name is Dr. Charles D. Blanke. Perhaps he can help in some way, if he cannot take over the case himself. I hope you can get some better treatment in this horrible time for your friend and those who care about her like yourself. I’m not giving my name here but will provide an email address I can be reached through in case you need any more information (though I probably gave all the information I have to offer on subject).

  3. dennis siple January 8, 2016 at 7:00 pm #

    Time to tweak the legislation. This just shouldn’t be happening this way. The idea was that compassion and dignity should be afforded the patient. Can the patient’s durable power of attorney for healthcare sign if the patient isn’t able to make the request, given that it’s on paper and legal?

    Assisted suicide became legal in CA on Jan 1. I think I should read up on the law, now.

  4. Martha Shelley January 8, 2016 at 9:56 pm #

    Dennis, the person who has power of attorney for health care can’t do that. If the patient isn’t mentally capable of making her wishes known, it would be considered homicide. What that person can do is make sure the advance directive is followed. Marion has signed an advance directive. It says, among other things, that she doesn’t want to be kept alive on feeding tubes and the like if she is completely out of it (e.g. in a coma) with no chance of recovery.

  5. Michael Enright January 9, 2016 at 1:38 am #

    I have thought about this issue a lot; starting when I was a child. I find the following information instructive. The problem at this stage of her illness is her ability to organize the materials and take the steps necessary herself.

    In the absence of self administration, I would arrange for hospice care and advise them of the circumstances. They are good at know how much morphine to administer depending on her wishes and her circumstances. The end described is truly horrible. That she may not be mentally competent to protect herself from it is frightening.

    The conditions of the Oregon law are exceedingly restrictive to the point of being a literal prohibition; it is the result of a typical legislative compromise where nobody wins and cowardice prevents action. I would search the euthanasia society for people willing to assist with a legal solution.

  6. Jo Meyertons January 9, 2016 at 3:17 pm #

    My brother in law died quickly and peacefully with the help of Oregon’s Assisted Suicide Law on this day in 2010. Untreatable cancer was the cause. Four years later, my wife had pancreatic cancer was unable to use Assisted Suicide as she had often requested, because the doctors made it hard for her to get the drug in time. She slipped into a coma waiting for it and it took her an agonizing week to die, during which I slept only a few hours. One of the doctors delayed sending the prescription to the pharmacy because he “wanted to allow the cost of the drug to sink in.” At that time, the cost was $1,400 for seconal. I am still extremely angry at the doctors about this. We have come a long way, but we have far to go to get death with dignity right, starting with better education for doctors and ending with access to decent drugs at a decent price.

  7. Marilyn Gayle March 4, 2016 at 11:46 am #

    Martha, Here in New Mexico, Chris, a woman I’ve known very distantly for a long time, chose to starve herself to death. This also entailed drinking no liquids. While she was on the way out, a friend of mine (who was closer to her than I) visited her to say good-bye. She told my friend: “I am happy. This is easy.” She died about two days after my friend’s visit. Chris was a very physically active woman, a hiker, explorer, artist and weaver who once co-founded a weaving school, whose advice to those she was leaving behind was that we all should seek a life of adventure. (Her memorial service featured a video of her giving this advice from her deathbed.) Though I believe in other respects her health was not failing, she had lost the ability to walk, and she didn’t wish to continue to live immobile in bed. I believe that her message to my friend was that her method of dying was a good choice. I hear it took about two weeks.
    Marilyn Gayle

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