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.