Faith and the End of Life

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This guest post is from Barbara Karnes, award-winning end-of-life educator and nurse who has been instrumental in creating the patient/family educational booklet for hospice. A former hospice nurse, director, and consultant, Barbara is the author of the booklets A Time to Live: Living with a Life Threatening Illness; Gone From My Sight: The Dying Experience; The Eleventh Hour: A Caring Guideline for the Hours to Minutes before Death; My Friend I Care: The Grief Experience; the book The Final Act of Living: Reflections of a Long Time Hospice Nurse and a family-oriented DVD/booklet kit New Rules For End of Life Care. She blogs at Something to Think About.

The definition of the word faith from the Free Merriam-Webster Dictionary is:

  • fidelity to one’s promises; sincerity of intentions;
  • belief and trust in and loyalty to God;
  • belief in the traditional doctrines of a religion firm belief in something for which there is no proof;
  • complete trust.

Approaching the end of our life generally promotes questions and searching about purpose, meaning and the direction our life has taken. Any of the above definitions for faith apply to our end of life search. These thoughts may not be shared with anyone but I believe we ask ourselves questions like: What have I done? Whom have I touched? What has this life been about? What is my belief about an afterlife? And, if a belief in God has been a part of our life, have I lived up to the expectations I believe are a part of a relationship with God?

Because our relationship with God, or absence of a relationship with God, is very personal it is not up to outsiders to try to influence that relationship unless asked. The operative words here are “unless asked.” Facing the end of life is not the time for conversions or saving, again, unless asked.

Because on many levels we are asking meaningful questions about the course our life has taken, major spiritual work takes place. The person approaching death does this work as the dying process progresses and withdrawal from this world reaches a place of introspection. It appears people are merely sleeping when really they are doing perhaps the most important work of their lives—figuring out what their life has been about.

The approach of the end of our life is a personal search and not a place for others to share their beliefs unless, of course, we are asked.

With people of the same religion, same beliefs, such as with members of a church, synagogue, mosque, shrine, or temple, in the months before death spiritual conversations are helpful if they are initiated by the person facing death. Some people welcome conversations, others prefer to find answers from within.

We must always respect a person’s choices. Remember, we approach this final challenge in our life in the same manner we have approached all of our challenges. If a belief in God or a specific religion was not a part of living our life our beliefs will probably not change now. I will add that sometimes we will return to the religion and belief we had when we were younger but this doesn’t seem to happen enough to really count on it.

There are many paths to self discovery. Religion is but one path. I walk a broader path in the hopes that each of us, regardless of our beliefs, may experience compassionate end of life care.

Image by Where Is Your Toothbrush?

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Life with Dignity

This guest post is from Karen Kaplan, who in 1992 became one of the the first 200 female rabbis in the world. In 2007 she became a board-certified chaplain and served in hospices on the East Coast for 7 years. She is the author of the book Encountering The Edge: What People Told Me Before They Died which consists of true quirky stories about her hospice patients and what they most cared about and believed in (the book is available on Amazon and wherever books are sold, as a softcover or as an ebook; excerpts and reviews are available at the website of Pen-L Publishing.). Karen also blogs at Offbeat Compassion.*

Being a healthcare chaplain is like being a detective. When a person on hospice talks with me about dying, I immediately want to hunt for what is beneath the surface. How are they talking about it? Why during this particular visit? What are they not saying? If they are asking to die ahead of schedule, I especially want to help them express what is driving this wish. I cannot help but wonder if some people who opt for a doctor-assisted death would no longer find it compelling if they only had the right venue to (1) unbury unresolved emotional and spiritual distress, and (2) to fully understand it and fully feel it by relating it out loud to a nonjudgmental listener who is willing to receive it. I strive to provide that safe and sacred place.

Providing Life with Dignity

Such a place is rarer than we might expect. Almost anyone we talk to has their own agendas, their own emotional baggage, their own anxieties and discomforts. Most people rather talk than listen. We all know that, because when we are trying to talk about something that triggers strong emotions, we do not get very far without being interrupted. Even worse, the content of their interruptions often minimize or otherwise dismiss our feelings. Thus many people are deprived of the dignity of having their feelings honored. As a chaplain and as a hospice chaplain in particular, my aim is to provide life with dignity such that terminal patients will more likely be emotionally and spiritually at peace when they die. I think society should advocate for more of such care as yet another safeguard against a doctor-assisted death that need not happen. As much as the death with dignity movement wants to ensure a dying person’s legal rights to have control over his or her death, I do think it is their duty to put at least as much energy into ensuring all other alternatives have been exhausted. Thus, for example, properly trained chaplains for end-of-life care should be funded not just for hospice patients but for anyone facing death who is not on hospice and who wishes to talk with one.

The last time I was invited to write for this blog, I answered the editor’s question about why I chose to write my career memoir, Encountering The Edge: What People Told Me Before They Died. This time I would like to share an excerpt from this book that shows how one of my patients, who I will call Mrs. Wilson, grappled with her search for meaning as she discussed her own end.

From Encountering The Edge

I had a 97-year-old patient who could be witheringly blunt about her concerns about her own death as well as just about everything else. Mrs. Wilson usually turned down my offers to visit, but accepted just often enough for me to keep trying as I made my rounds in the assisted living section. Her refusals were very abrupt and off-putting, so I had to coax myself to keep giving a knock on her door and not give up. One day she was seated by a small round table sorting through her mail, and deigned to let me in “for a few minutes but that’s all.” She delegated the task to me of throwing away each rejected piece one by one. (Apparently they and not I were the object of rejection that day.)

Mrs. Wilson was mourning her own end, which she could not have been blunter about. She assailed me with question after question concerning her impending nonexistence. It was all I could do to force myself to keep my eyes on her face and not hem and haw. Looking at me as if ready to confirm I would disappoint her by having no answers, she asked, “How do I prepare to die? What do I tell my children?” I talked of reviewing loose ends in relationships and of pondering her legacy, but she rejected those options as readily as the doomed pieces of mail. “I have no loose ends to resolve,” she retorted. Given some mutterings over certain family members during former visits, I knew this was hardly the case. But there was no reason to challenge her. Furthermore, I believe that some of the things chaplains and social workers and therapists say to the people they serve are like time capsules. After the visit is long over, the patients may choose to release those words into their consciousness. Words that initially were jarring can soothingly cleanse away hurts that had been held in bondage for a good period of time. Before I left, she went on to say that my responses to her questions confused her. So she was already considering the provocative implications of my answers, while I was left wondering what she had hoped to hear me clarify.” (When I saw her a few weeks later, she had stopped putting up barriers to our interaction, acting more kindly than I had ever seen.)

The Final Lap

This particular excerpt is clearly not about someone who wants to have help with an early death. But it does show the complexities and ambiguities involved in making sense of our current and past life against the poignant drama of knowing we are in the final lap. May we not be too hasty in procuring our own end lest we miss out on some of the most significant scenes before the final curtain descends.

* This blog posts does not constitute Death with Dignity National Center’s endorsements of these publications. All subheadings are ours, not the author’s.

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California Senate Judiciary Committee Passes SB 128 – End of Life Option Act

The California Senate Judiciary Committee on April 7 approved Senate Bill 128 – California End of Life Option Act by a 5 to 2 vote.

With the vote, California took another step towards providing Death with Dignity as an end of life option to its 39 million citizens.

We applaud Senators Lois Wolk, Bill Monning, and others for sponsoring legislation whose time has come. We were pleased to play an integral role in the drafting and deliberations of the bill, and honored to speak before the Committee on the Oregon experience and our exemplary implementation of the law.

The End of Life Option Act will next be considered in the Senate Appropriations Committee, with a hearing to take place in May. In the meantime, we will continue to work with the bill sponsors to promote the bill’s passage.

Help make this bill become law!

  • Thank the Senators voting Aye. The bill moved out of this committee by a vote of 5 to 2, along party lines. Please contact Senator Hannah-Beth Jackson (Chair, D-Santa Barbara and Ventura Counties), Senator Robert M. Hertzberg (D-LA/San Fernando), Senator Mark Leno (D-San Francisco/San Mateo), or Senator Bob Wieckowski (D-Fremont/Alameda and Santa Clara Counties) (Senator Bill Monning, SB 128 co-sponsor, also voted in favor) to exppress your appreciation for their vote, especially if you live in their district.
  • Thank the bill sponsors. Call, email, or send a letter to SB 128 sponsors, Senators Bill Monning (D-Carmel) and Lois Wolk (D-Davis) in appreciation of their leadership on the issue. Or use our online Thank You card below.
  • Share your story. Heartfelt personal stories were a crucial part of the Committee testimony in favor of the End of Life Option Act. Please fill out this simple form to let us know how you got involved in the Death with Dignity movement or why you support California’s proposed legislation.
  • Make a contribution. We remain optimistic the law will pass, but for that to happen we need your support. It is thanks to you that we are able to do our work in promoting Death with Dignity laws in California and elsewhere. Your gift will stay in California and help promote SB 128 as it moves through the legislative process. Thank you.

About SB 128 – California End of Life Option Act

The California End of Life Option Act closely follows the model of the Oregon Death with Dignity Act with some modifications, most of which are required to comply with the California statute. Similar to the Oregon law, the California End of Life Option Act provides that only qualified, terminally ill adults who are residents of California may request and obtain prescriptions from their physician for medication that the patient has the capability to self-administer. A person may not qualify solely because of age or disability.

In order to receive the prescription the terminally ill patient is required to have two physicians confirm the patient’s prognosis of six months or less to live and that the patient has the mental competency to make health care decisions for him or herself. Two oral requests to be made to a physician, a minimum of 15 days apart, in addition to one written request with two witnesses attesting to the request before the prescription can be written.

In addition, the proposed bill includes voluntary participation by doctors, pharmacists and healthcare facilities, safeguards against any coercion of patients by establishing felony penalties for coercing or forging a request, and a patient’s right to rescind the request.

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California Senate Health Committee Approves SB 128 – End of Life Option Act

Image: California Senate Health Committee hearing on SB 128

“Some years ago, my precious brother Jeff died a death I would not wish on anyone. Yesterday my spirits were lifted.

At the Senate Health Committee Hearing on SB 128 – California End of Life Option Act, I was privileged to witness the powerful testimony of families who, like my own, had to stand like giants in a moment after they were just ordinary people. Those brave people who provided testimony in support of SB 128 spoke for their loved ones. And they stood for us all.

It was a landmark day in California as the Senate Health Committee approved SB 128. This is one of several hurdles the bill faces, but California is poised to catch up to Oregon in this push for greater choice in how we meet end of life challenges.”

This first-hand account from the California Senate Health Committee Hearing on SB 128 – California End of Life Option Act comes from our supporter Kate P., a Sacramento, California, resident.

It was, indeed, an emotional hearing. Along with hundreds of others in attendance, I was moved by the powerful personal testimonies. These stories highlighted what we know from the Oregon experience: Death with Dignity as one of several end of life options provides peace of mind and control for the terminally ill while safeguarding against coercion for those who are vulnerable. SB 128 would allow patients who are mentally competent and have fewer than six months to live, as determined by two physicians, to obtain prescriptions for medication to end their lives in a humane and peaceful manner, while protecting the vulnerable with strict guidelines and procedures.

Yesterday afternoon the California Senate Health Committee approved the proposed Senate Bill 128 – California End of Life Option Act. I was pleased to be instrumental in working with both bill sponsors, State Senators Lois Wolk and William Monning, to craft the law.

You can help to make this bill become law:

  • Thank the bill sponsors. Call, email, or send a letter to SB 128 sponsors, Senators Monning – D-Carmel, and Wolk – D-Davis, in appreciation of their leadership on the issue.
  • Thank the Senators voting Aye. The bill moved out of this committee by a vote of 6 to 2 along party lines. Contact Senators Hernandez (D-LA/West Covina, Committee Chair), Hall (D-LA/South Bay), Mitchell (D-Culver City), and Roth (D-Riverside), particularly if you are in their district, to express your appreciation for their courageous vote.
  • Share your story. Heartfelt personal stories were a crucial part of the testimony in favor of the End of Life Option Act. Let us know how you got involved in the Death with Dignity movement or why you support California’s proposed legislation by completing this simple form.
  • Make a contribution. We remain very optimistic the law will pass, but for that to happen we need your support. It is thanks to you that we are able to do our work in promoting Death with Dignity laws in California and elsewhere. Your gift will go a long way in promoting SB 128 as it moves along through the legislative process. You can make the difference. Thank you.

The End of Life Option Act will next get a hearing in the Judiciary Committee on April 7. We’ll be there again, continuing to work with the bill sponsors to promote the bill’s passage.

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Exclusive: A summary of the announcement of End of Life Option Act in California

As we recently wrote, our representatives attended the announcement on January 21, 2015, of the End of Life Option Act in the California State Capitol. A recording of the 45-minute long press conference is available online. Today we bring you an exclusive summary, including our introduction. Please take a few minutes to watch the video and share your thoughts in the comments.

The Announcement of California End of Life Option Act from Death with Dignity National Ctr on Vimeo.

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End of Life Option Act Introduced in California

Press Conference Announcing End of Life Option Act at California State Capitol, 1/21/2015

Representatives from Death with Dignity National Center attended the announcement of the End-of-Life Option Act at the California State Capitol in Sacramento on Wednesday, January 21, 2015. Sponsored by Senators Wolk and Monning, Senate Bill 128 provides peace of mind and control for the terminally ill while safeguarding against coercion for those who are vulnerable. We are pleased to have worked with Senators Wolk and Monning to draft the proposed California legislation, the End of Life Option Act, and we will deliver our political and strategic experts who have worked successfully to pass legislation in Oregon, Washington, and Vermont to assist the California efforts.

George Eighmey, DDNC Vice President, said: “We are proud to be here today to support Senators Wolk and Monning as well as the people of California, in proposing a Death with Dignity law to provide a peaceful and dignified death for those suffering from terminal illnesses. The time is right for California to adopt this law.”

The Golden State has always been a leader in progressive policy reforms protecting individual rights. Thanks to this leadership, our movement traces its earliest roots to California, as the Death with Dignity National Center was founded here in 1993. We were proud to join these efforts yesterday.

Watch the full press conference below:

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Demystifying Death: A Life Moment

Photo by Alex Dodd
Photo by Alex Dodd

Stacey Tinianov is a caffeine-powered working mama and shiny object follower, runner, suburban environmentalist, cyclist, breast cancer ass-kicker, and empowered patient advocate. Follow her on Twitter, @CoffeeMommy.

Several weeks ago, my almost 13-year old daughter sat in the backseat as I drove her to a sports activity. Frequently, as she nears her teen years, this drive time is spent in silent meditation (aka: ignoring Mom’s questions about the day) but occasionally, we sing along together to the radio.

Without exception, my favorite days are the days she peppers me with questions that instigate an open dialogue.

“What do you think happens when you die?” she asked as if she were asking what we were having for dinner.

“What do you think happens?” I asked back immediately. The verbal sidestep is a typical mom move designed to create the opportunity to hear her untainted view as well as give myself time to think about my own answer.

She was patently unmoved by my attempt to deflect.

“I asked you your opinion,” she deadpanned and we locked eyes in the rearview mirror.

“Well,” I stammered thoughtfully, “I don’t exactly know.”

It wasn’t as if I hadn’t given a great deal of thought about the process of dying and what comes after death. We have said goodbye to several close friends and family members recently and the topic has been at the top of my mind.

“Some people believe in an afterlife, some people believe in reincarnation, some people believe that dead is dead and life is simply over,” I paused. “I suppose that since energy can neither be created nor destroyed, I believe our spirits live on in some way shape and form. Maybe as energy in a star.”

I anticipated a flurry of questions related to the loved ones who have died in the past six months but none came. Instead, my daughter regaled me with her opinions on death and dying. She was intent on explaining her fear of death is not exactly a fear of death and what comes or doesn’t come next, but a fear of missing out. Fear of not being ready to be finished with life.

“I mean I cannot imagine just not being here. I just have so much to do,” she clarified.

I smiled hearing my daughter discuss death with profound honesty and without a trace of sadness. I smiled not simply because we were having an open conversation about a topic long swept under the rug but because in the context of demystifying death, my daughter and I were sharing a life moment.

This week, I’ll lead the #DWDchat discussion on Twitter to discuss our thoughts and fears about death, how they may have changed over time, and how we bring these up with loved ones. Please join us on Thursday at 7:00pm EDT to share your thoughts.

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A Social Worker’s Role at End of Life

Kevin Kozin, MTS, LICSW, is a clinical social worker and therapist and formerly worked as a hospice social worker. He’s currently a board member of the National Association of Social Workers in Massachusetts and serves as the Chair of the Mental Health and Substance Abuse Committee. He works with adolescents, adults, couples, and families through psychotherapy and grief counseling, which lead to healing results.

The New England Journal of Medicine published an article this April titled, “Implementing a Death with Dignity Program at a Comprehensive Cancer Center”. This well-written article takes a candid look at the demographics and experience of a particular cancer center in Washington state, where the Death with Dignity Act has been in effect since March, 2009. Death with Dignity refers to the Washington and Oregon statutes which allow individuals who have six months or fewer to live (as determined by two physicians) and have the capacity to make medical decisions the option to request prescribed medication which allows for a peaceful and painless death.

The article’s conclusion states, “Overall, our Death with Dignity program has been well accepted by patients and clinicians.” As a practicing clinical social worker and former hospice social worker, this comes as no surprise to me. The National Association of Social Workers in Washington continues to be a strong proponent of the Death with Dignity law Washington passed in 2008. As a board member and Chair of the Mental Health and Substance Abuse Committee of the National Association of Social Workers in Massachusetts, I know our chapter also worked in support of legislation through a ballot initiative here and the initiative lost by less than 1%. The ballot measure was modeled on the assisted dying laws in place in Oregon and Washington. Why would our organization of social workers support this legislation so enthusiastically? Because social workers stand for giving people—especially the dis-empowered—as much self-determination as possible.

Perhaps one element of this New England Journal of Medicine article which was highly edifying to me is the role of the social workers at the Seattle Cancer Care Alliance. In practice, a social worker is assigned to each individual who’s considering requesting the medication allowed under the Death with Dignity Act. The social workers’ role, as advocate, is to assist the individuals in understanding their options as well as providing a safeguard to ensure decisional capacity, screening out clinical depression and anxiety, and coordinating across multiple disciplines. The social workers coordinate with family, friends, pharmacists, physicians, care staff, attorneys, insurance companies, and anyone involved in the process to help the individual make a clear and thoughtful decision. The role of a hospice social worker in Massachusetts is very similar in that we’re constantly looking to empower those who are dying with whatever resources are available to them and enable them to make their own decisions, when possible. Hospice social workers are experts in care coordination and hearing all of the various stakeholders in the care of the dying individual, making sure all voices are heard, and ensuring the dying individual’s choices are respected.

In reading “Implementing a Death with Dignity Program at a Comprehensive Cancer Center” in the New England Journal of Medicine, I’m once again reassured the small percentage of dying individuals in Washington who qualify for assisted death are getting excellent care, and social workers are playing a strong role in ensuring these individuals’ choices are respected. I look forward to a greater understanding of Death with Dignity throughout the United States—one which isn’t based on fear but on compassion—and allows for more options and self-determination for those at the end of their lives.

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A Matter of Life and Death: What Are The Choices?

California Assembly chamber, photo by LWY on flickr
California Assembly chamber, photo by LWY on flickr

Yesterday, Mike White, former board member of the Death with Dignity National Center, spoke before the California Assembly Committee on Aging and Long-Term Care about Death with Dignity laws. Below is the transcript of his testimony.

There is tension between the beliefs that end of life choices should be founded mainly on respect for the sanctity of life or on compassion for those who are suffering: sanctity based on religious and moral principles or compassion based on respect for personal autonomy. I resolve the matter for myself by focusing on the belief that lawful physician assisted dying extends the lives of those who are terminally ill.

In California, a terminally ill person who wishes to have the benefit of all medical resources that are available, or not, has that choice. However, a person who wishes to have the assistance of a physician in the dying process—either due to unremitting pain and suffering or the absence of adequate quality in life—does not have that choice. As one opponent to legalization of assisted dying once said in a debate with me, “So long as there are bridges and tall buildings from which a dying person can jump, there is no need for a law that would permit a physician to prescribe medication to end a person’s life.”

For a terminally ill person who wishes to end his or her life, the nonviolent choices available in California are (a) terminal sedation—that is, being rendered unconscious by a physician to end unremitting pain and suffering—and withdrawal of food and hydration until death occurs, or (b) electing to cease taking all food and hydration until death occurs, in short, starvation. In either case, a person’s discomfort may be palliated by medical support and supervision.

In the more than quarter century that I have been part of the effort to adopt the Death With Dignity Act, a statute which permits a physician to prescribe life-ending medication to a competent, terminally ill adult, an important change has occurred in the medical community, in part as a result of the perceived threat of enacting such a statute. Palliative care as a medical specialty has developed and its implementation has greatly improved the care given to those who are dying and suffering. A focus on the relief of such discomfort has become nearly uniformly viewed as an important, legitimate treatment objective. The question remains then, if such improvement in care has been made, is physician assisted dying even necessary?

I believe the question that ought to be considered when it comes to the matter of how one should be treated as death approaches is a very personal one. The extent to which the law should define the choices we have is the debate that has been going on for three decades and more. If I wish to ask a physician to help me at the end of life by prescribing medications for self-administration, should I have such a choice as a lawful option?

Is the issue a legal question? Is it a matter of public policy? Or is it a question of morality, founded on religion or other basis? I believe the simple answer to each of those questions is, “Yes.” And that is the problem.

If it is simply a religious question, respect for each person’s religious beliefs resolves the debate. If it is a matter of public policy, the debate will be waged by generally well-meaning stakeholders each contending they know what is “best” for us. And if the question is only one of law, then you as legislators must deal with those stakeholders, religious advocates, public policy gurus, lobbyists and organizations committed to the implementation of law that advance their agendas. For some of you, it is a matter of dealing as well with your own personal religious, moral, and ethical views.

Three states, Oregon, Washington, and Montana, and a number of European countries, now provide that option for its residents. Oregon and Washington adopted the Death With Dignity Act by initiative process. A similar statute was offered by initiative in California in 1992, and most recently in Massachusetts last November. Though public opinion supported the passage of the Death With Dignity Act in both California and Massachusetts, both failed. Conservative religious opposition succeeded in defeating the measures by spending about five times more money than proponents of the Act.

In Oregon, there has been 15 years of experience in implementation of the Death With Dignity Act; in Washington, the statute was enacted in 2008 and implemented in 2009. In Oregon on average, 45 persons per year have availed themselves of the statute. There are no reports from either state of any coerced or involuntary deaths; that is because there are adequate safeguards—hurdles to overcome—before a person may receive lawful assistance in dying from a physician.

In Oregon, about 60% of those asking for prescriptions to end their lives have used them. The percentage of deaths for that state occurring as a consequence of the implementation of the Death With Dignity Act is 0.0015 per cent (15 ten thousandths). If translated to California, a state in which there are at present about 233,000 deaths per year, that number would be about 360 who might avail themselves of assisted dying.

In Europe, physician assisted dying has been legalized in Switzerland, Belgium, Luxembourg and the Netherlands. The laws in those countries either permit a terminally ill person to request the assistance of a physician in dying or have decriminalized physician assisted dying.

However, from my experience with terminally ill persons attempting to avail themselves of physician assisted dying in Switzerland, non-Swiss citizens are greatly discouraged from utilizing the process by significant administrative roadblocks and substantial expense.

Physician assistance in dying, when permitted, “benefits” only those who choose that option; it does not in any direct or meaningful way affect those who object to the practice.

My experience in working with people who gain the knowledge that they may control their dying process informs me that providing compassionate assistance at the end of life extends lives; it does not shorten them. It reduces anxiety of dying persons and their loved ones. Once having gained the control they desire to end their lives if suffering is too great, precipitous action is avoided—bridges and buildings return to the functions for which they were designed rather than jumping off points for those abandoned to die alone.

For the most part, people do not fear death—what they fear, and wish to avoid, is unnecessary suffering during the dying process.

There have been efforts in a number of legislatures over the years to advance the Death With Dignity Act as well as other failed initiative efforts. Currently, in New Jersey and Vermont, there are bills moving toward possible implementation. In Montana, physician assisted dying has been sanctioned by court proceedings, a process, unfortunately, which results in a lack of safeguards, a major reason to implement the process by legislation.

Public support for physician assisted dying has grown over the years. This is reflected consistently in our news media, as prosecutors resist prosecution of compassionate efforts that result in the death of loved ones and judges are reluctant to impose jail sentences in such cases. These are not the cases in which a person takes the life of another for financial or other personal gain. They are the cases in which relatives or friends are drawn into committing a criminal act in order to relieve the suffering of a dying person.

Were a convicted criminal allowed to starve to death by involuntary denial of all food and hydration or being thrown from a tall building to impose a death penalty, is there any doubt it would be determined cruel and unusual punishment under the Eighth Amendment? Yet, those are essentially the legal options available to a terminally ill person who is not a condemned criminal.

In a debate I once had with a person who opposed the Death With Dignity Act, he said in all sincerity, “You know, there is redemptive value in suffering.”

My response was and is that I respect the right of my colleague (opponent) to suffer as much as he chooses, to seek all the redemption he wishes or needs. I only wish that he could similarly respect, rather than oppose, the right of others to choose a more compassionate and legally authorized dying process such as that contemplated by the Death With Dignity Act of Oregon or Washington.

There are arguments against legalizing physician assisted dying: It is immoral, it is contrary to religious doctrine, it could be abused, it could be a first step on a slippery slope to taking lives involuntarily.

But as we contemplate the array of choices one might have at the end of life, should a request for assistance of a physician in the dying process be respected and not prohibited by law? Surely such a request if honored does not in any way impinge on the rights or values of those who oppose it, for they are in no way obligated to choose that option.

I appreciate this opportunity to provide a view about the choices that pertain for those who are dying. I know from my experience in working with those who request assistance in dying that when they know that they have control of the dying process, their anxiety is lessened and they do not seek a bridge or tall building from which to relieve their suffering.

Why is it that we are reluctant to trust the desires of dying patients to engage in decisions with their physicians that are founded on relief of suffering? What justification is there for the continued ineffective criminalization of acts which relieve anxiety, extend lives and remove government from one of those very unnecessary intrusions into the personal lives of citizens? This is a question that ought to be resolved between physicians and patients—not by prosecutors and judges.

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Sarasota Bay Parrot Head Club Reef 7-2010 Check out the life and growth

For the past 6 years the Sarasota Bay Parrot Head Club has been creating a reef ball reef off of Sarasota, FL. This reef is adjacent to the Eternal Reef memorial reef site on Silvertooth Reef. The life and growth on this reef site is incredible and is making a real contribution to the marine environment and to future generations. Each time a Parrot Head chooses to be memorialized as an Eternal Reef we add another reef ball to the SBPHC site with a plaque identifying the Parrot Head and the club they were a member of. Visit us at www.eternalreefs.com and become a fan of Eternal Reefs on Facebook, www.facebook.com/eternalreefs Thanks, George