Oregon initiates first modern statewide refillable glass bottle system in the US


At the beginning of the century, refillable bottles where the only option when you purchased a beer or soda from the local merchant. With the invention of the steel can in 1938, however, that practice began to change. Within 10 years, the 100% refillable glass usage for beer had dropped to 84%. When non-refillable glass started taking over mainstream production, that number dropped to 8% by 1986 and, according to the Container Recycling Institute, refillable beer bottles now account for less than… View full post on Inhabitat – Green Design, Innovation, Architecture, Green Building

Oregon just approved the nations first tax on bicycles – and cyclists are furious

Because bicycling is good for one’s health and results in fewer cars being on the road (reducing carbon emissions), one would think governments would go out of their way to encourage more people to commute in such fashion. Right? Wrong. In Oregon — a state which is known for its avid bicycling culture, the nation’s first statewide bike tax has been approved. The new excise tax will require consumers to pay $15 in tax on a bike that costs more than $200 and has a wheel diameter of at least… View full post on Inhabitat – Green Design, Innovation, Architecture, Green Building

Oregon couple spends years building their net-zero ‘extreme green dream home’

Desert Rain features three renewable energy systems: a solar PV array; a solar thermal drainback system for heating domestic water and powering the hydronic floor system in the Main Residence; and solar “hot air” system, which aids in evaporating liquid from the composting system.

Related: California city could become the first Zero Net Energy city in the U.S.

+ Tozer Design

Via Living Future

Desert Rain home, tozer design, living future, sustainable homes, green design, Living… View full post on Inhabitat – Green Design, Innovation, Architecture, Green BuildingEco funeral – Inhabitat – Green Design, Innovation, Architecture, Green Building

Oregon Ducks hit a home run with ber-green Jane Sanders Stadium

The Oregon Ducks hit a home run recently with the addition of the Jane Sanders Stadium, a sleek new home for the university’s softball team that’s designed to achieve LEED Gold certification. As a beautiful example of sustainable stadium design, the sports venue features materials with high recycled content, prefabricated construction, and an energy reduction of 35 percent over the Oregon Energy Code. SRG Partnership designed the sustainably minded stadium that perfectly captures the Oregon Ducks… View full post on Inhabitat – Green Design, Innovation, Architecture, Green BuildingEco funeral – Inhabitat – Green Design, Innovation, Architecture, Green Building

Video captures vandals toppling 18-million-year-old sandstone formation in Oregon

An iconic sandstone formation on the Oregon coast known as “the duckbill” is no more, after a group of vandals forced the rocks to topple, leaving behind a devastated pile of rubble. The giant rock, known as “The Duckbill” measured up to 10 feet across, and was a sought-after destination just beyond the safety fence in Cape Kiwanda State Natural Area in Oregon’s Tillamook County. At first, park officials thought that the formation had fallen on its own, but video captured by a witness later… View full post on Inhabitat – Green Design, Innovation, Architecture, Green BuildingEco funeral – Inhabitat – Green Design, Innovation, Architecture, Green Building

Oregon Death With Dignity Act: Four Challenges that Ensured the Law’s Success

This article originally appeared in the Spring 2015 issue of Trial Lawyer magazine, the quarterly journal of the Oregon Trial Lawyers Association.

Just over twenty years ago, on November 8, 1994, Oregon became the first state to decriminalize “physician assisted suicide.” On that day, by a margin of 51 to 49 percent, voters passed the Oregon Death with Dignity Act, a ballot initiative now codified at ORS 127.800-127.897.

The Death with Dignity Act permits state licensed, Drug Enforcement Administration (DEA) registered physicians and pharmacies, to prescribe and dispense Schedule II and lower controlled substances to competent, terminally ill, adult patients seeking to hasten an impending death in narrowly defined circumstances (see, e.g., ORS 127.815 – Responsibilities of the attending physician).

I was a lead author of the Oregon Death With Dignity Act. I was also the lead political and legal strategist during the 1994 campaign to pass the law, and again during the 1997 campaign to prevent its legislatively inspired repeal. I also represented the law’s chief petitioners during the first round of federal court litigation (1995-1997), and a physician and a pharmacist during the second round of federal court litigation (2002-2006).

Key to understanding the lens through which I view end of life issues is knowing that I have two physicians in my family (both now deceased) and, as a new lawyer, I worked for a firm defending physicians. This exposure has provided me with valuable perspective, particularly with respect to the all important medical standard of care. More important, however, was the time I spent as an undergraduate student in religious studies, an experience that informs my thinking on ethical issues as much or more than does being a lawyer.

And key to understanding the Oregon Death with Dignity Act is knowing that the law has never been as controversial as many may have first assumed.

Four days before its passage, 20 years ago, Pulitzer Prize-winning columnist Ellen Goodman quoted me as saying, “We haven’t tried to change the way people die or the way people ask for help. We have attempted to bring something out of the dark and into the light and at the same time provide safeguards.” [Ellen Goodman, "Gentle Into the Night," The Baltimore Sun, November 4, 1994] My point then was that dying patients were already hastening their deaths by accumulating and ingesting prescription drugs, occasionally with assistance from their physicians, and we had codified that covert practice into a ballot initiative. We had also proposed a medical standard of care, along with sensible public policy limits, that we termed “safeguards.”

Although I did not view the narrowly written Oregon Death with Dignity Act as controversial, controversy was plentiful in the early 1990s. The so-called “right to die” movement was riding a fresh wave of support. By 1990, Dr. Jack Kevorkian was already notoriously famous when Janet Adkins left her comfortable southwest Portland home and traveled to Michigan to hasten her death in Dr. Kevorkian’s Volkswagen bus. The next year, 1991, Derek Humphry, a prominent advocate working and living in the Eugene, Oregon, area, published his book, Final Exit, a how-to manual for those seeking to hasten death. It went straight to the top of The New York Times bestseller list. That same year, Washington voters defeated Initiative 119, a citizens’ initiative that would have permitted euthanasia and lethal injection. The following year, 1992, California voters defeated Proposition 162, another similar proposal that would have permitted euthanasia and lethal injection.

It was in this politically charged climate that the Oregon Death with Dignity Act was drafted by a small group in 1993. One of our goals was to remove the controversy. We sought to keep Dr. Kevorkian’s conduct illegal, while rendering Derek Humphry’s book unnecessary, at least in Oregon. We very briefly debated, but unanimously rejected, the concepts of euthanasia and lethal injection. These concepts were central to the recently defeated ballot initiatives in Washington and California and they were very important to the political advocates at the time, but they were also concepts borrowed from other countries. What I discovered through my direct observations during the 1991 and 1992 campaigns in Washington and California, and what we all learned from our work in Oregon leading up to 1993, is this: Political advocates aside, no patient or family member was asking for help along the lines of euthanasia or lethal injection. Patients and their families, instead, wanted access to oral medications that they could later ingest, with the guidance and support of their physicians. They not only wanted it, they were getting it, sometimes with the help of their physicians. Once we understood and accepted this fact, we were able to draft the Oregon Death with Dignity Act, a public policy breakthrough. This is the point I was stressing to Ellen Goodman (quoted above) four days before that fateful election 20 years ago. We had codified an existing covert practice and added a medical standard of care with clear boundaries.

First steps down a long path

Although voters passed the Death with Dignity Act in November 1994, a significant accomplishment in itself, our work was only beginning. There would be a succession of legal and political challenges initiated by our opponents that would all fail but help ensure our eventual success. First, before Oregon’s new law could take effect, it was enjoined from operation by a federal district court. [Lee v. State, 869 F. Supp. 1491 (D. Or. 1994)] The law would not go into effect for another three years, until a reversal was obtained from the Ninth Circuit Court of Appeals. [Lee v. State of Oregon, 107 F.3d 1382 (9th Cir. 1997)] What has never been acknowledged is that the district court’s injunction helped us. But for that injunction, the Oregon Death with Dignity Act would have taken effect 30 days after its passage (OR Const. Art IV § 4(d)). Few, however, and certainly not the institutional stakeholders necessary to the law’s eventual success, were ready so soon after the 1994 election to implement such a major policy reform. With the benefit of hindsight, the federal court injunction intended to forever prevent the law, instead preserved it for successful implementation three years later, in the fall of 1997.

Second, because our eventual success on appeal seemed highly likely in 1997, opponents had been lobbying the Oregon Legislature to repeal the new law. A direct legislative repeal was not possible because Governor John Kitzhaber, M.D., said he would veto a repeal. Instead, the legislators referred a repeal measure, Ballot Measure 51, to the voters. Thus, in 1997, to preserve the Death with Dignity Act, we were now required to win both our appeal and a second statewide election. We won both. The Ninth Circuit Court of Appeals reversed the lower court and vacated its judgment, Lee v. State of Oregon, supra, 107 F.3d 1382, and, in October of 1997, the United States Supreme Court denied the government’s petition for certiorari. [Lee v. Harcleroad, 522 U.S. 927, 118 S. Ct. 328, 139 L. Ed. 2d 254 (1997)] The law was in effect. Soon thereafter, on November 4, 1997, Oregon voters defeated Measure 51 by a margin of 60 to 40 percent. The repeal effort had backfired.

Before the second election, opponents often criticized the narrow passage of the Death with Dignity Act in 1994 as evincing too little support for too controversial a subject, but the 1997 repeal effort changed all that. It produced a clear voter mandate—60 percent of voters defeated the repeal of the Oregon Death with Dignity Act. Voter support had never been higher. Popular support was higher still. The second statewide election, like the district court’s injunction, ensured the eventual success of Oregon’s new law. The political controversy in Oregon had been settled, and, with the benefit of three more years of public discussion while the Death with Dignity Act was under injunction, all involved were not only better prepared, but much more willing to implement Oregon’s new law.

Having won two statewide ballots (1994 and 1997) and the first round of federal court litigation spanning 1995-1997, the Oregon Death with Dignity Act was for finally free of legal or political challenge. It was only the quiet before the storm, however. The third significant challenge was about to unfold in Congress, where members concerned about Oregon’s new law, including then-Senator John Ashcroft, sent a letter in 1997 to the Director of the DEA, contending that the use of controlled substances to hasten a terminally ill patient’s death was not a legitimate medical practice and therefore violated the Controlled Substances Act (CSA). That letter further invited the DEA to prosecute Oregon physicians and pharmacists who aided patients under Oregon’s novel law. Although the director of the DEA, Thomas Constantine, responded favorably, Attorney General Janet Reno concluded that the DEA could not prosecute Oregon practitioners who acted in accordance with Oregon law, because the CSA did not authorize the DEA to “displace the states as the primary regulators of the medical profession, or to override a state’s determination as to what constitutes legitimate medical practice.” Soon thereafter, legislation was introduced in Congress to grant to the DEA the explicit authority that Reno found lacking. The Lethal Drug Abuse Prevention Act was introduced in 1998, followed by the Pain Relief Promotion Act in 1999. Either Act would have enabled prosecutions of practitioners acting under Oregon’s new law, but neither passed. The Death with Dignity Act survived yet another challenge, this time from Congress.

Fight not over

As fate would have it, a fourth challenge was looming. In 2001, Senator John Ashcroft was appointed United States Attorney General. Exercising his new role presiding over the DEA, Ashcroft sought an opinion from the U.S. Department of Justice, Office of Legal Counsel, on whether a prescription issued to hasten a death under the Oregon Death with Dignity Act was a valid prescription under the CSA and its implementing regulation. On June 27, 2001, the Office of Legal Counsel issued a memorandum concluding that “assisting in suicide is not a ‘legitimate medical purpose’ that would justify a physician’s dispensing controlled substances consistent with the CSA.” On November 6, 2001, Ashcroft released an Interpretive Rule, published in the Federal Register on November 9, 2001, that adopted the analysis of that memorandum and declared that “assisting suicide is not a ‘legitimate medical purpose’ within the meaning of 21 CFR 1306.04 (2001) and that prescribing, dispensing, or administering federally controlled substances to assist suicide violates the CSA” [66 Fed Reg 56608 (2001)]. The Interpretive Rule further provided that the “Attorney General’s conclusion applies regardless of whether state law authorizes or permits such conduct by practitioners or others and regardless of the condition of the person whose suicide is assisted.”

In response, the State of Oregon, a physician and a pharmacist (my clients), and several terminally ill patients challenged the Interpretative Rule in federal court. The U.S. District Court for the District of Oregon, Honorable Robert E. Jones presiding, issued a temporary restraining order and then a permanent injunction preventing the attorney general from enforcing his Interpretive Rule. [Oregon v. Ashcroft, 192 F Supp 2d 1077, 1084 (D Or 2002)] On May 26, 2004, the Ninth Circuit Court of Appeals affirmed the district court’s analysis and judgment. [Oregon v. Ashcroft, 368 F3d 1118 (2004)] In holding the Interpretive Rule unlawful and unenforceable, the Ninth Circuit held that it, “violates the plain language of the
CSA, contravenes Congress’ express legislative intent, and oversteps the bounds of the Attorney General’s statutory authority.” [Id. at 1120] The Ninth Circuit concluded:

“In sum, the CSA was enacted to combat drug abuse. To the extent that it authorizes the federal government to make decisions regarding the practice of medicine, those decisions are delegated to the Secretary of Health and Human Services, not to the Attorney General. The Attorney General’s unilateral attempt to regulate general medical practices historically entrusted to state lawmakers interferes with the democratic debate about physician-assisted suicide and far exceeds the scope of his authority under federal law. We therefore hold that the Ashcroft Directive [i.e., the Interpretive Rule] is invalid and may not be enforced. [Id. at 1131]

Our fight was still not over. The battle continued on to the U.S. Supreme Court where the justices affirmed the Ninth Circuit:

“The Government, in the end, maintains that the prescription requirement delegates to a single executive officer the power to effect a radical shift of authority from the States to the Federal Government to define general standards of medical practice in every locality. The text and structure of the CSA show that Congress did not have this far-reaching intent to alter the federal-state balance and the congressional role in maintaining it.” [Gonzales v. Oregon, 546 US 243, 275, 126 S Ct 904, 925, 163 L Ed 2d 748 (2006) (Kennedy, J)]

Twelve years after passage of the Death with Dignity Act, the second round of federal court litigation had concluded. The legal controversy was settled. The opinion of the U.S. Supreme Court in 2006 was the last word, leaving no doubt that it was the state’s proper role to regulate the practice of medicine, even when that practice allows a physician to prescribe a controlled substance to hasten a terminally ill patient’s death. Proponents of the Oregon Death with Dignity Act had beaten back a fourth significant challenge.

Down a road of reform

With the benefit of hindsight, the campaign to pass and protect the Oregon Death with Dignity Act was a 14-year campaign, spanning 1993 through 2006. Newly freed of the need to defend the Oregon Death with Dignity Act, proponents immediately began work with other states to bring about similar reforms. The most notable successes include the 2008 voter-approved Washington Death with Dignity Act, codified at RCW 70.245.010-70.245.904, and the 2013 Vermont Patient Choice at the End of Life Act, codified at 18 VSA §§ 5281-5291.

That work continues.

Eli D. Stutsman, JD, is a private practice lawyer specializing in appeals. He was a lead author of the Oregon Death with Dignity Act and served ten years, from 1995 to 2005, as the founding President of the Death with Dignity National Center. In the photograph, he is pictured speaking to reporters in front of the U.S. Supreme Court, in 2005.

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Oregon Health Authority Releases 2014 Death with Dignity Report

Oregon Health Authority, the state agency that oversees the implementation of and compliance with the Oregon Death with Dignity Act, has just released the 2014 Annual Report.

A total of 155 terminally-ill adult Oregonians received a prescription for medications under the provisions of the Oregon Death with Dignity Act in 2014, while 105 of them (67.7%) ingested the medications to die peacefully. This corresponds to 31 Death with Dignity Act (DWDA) deaths per 10,000 total deaths, or 0.3%.

Other highlights from the 2014 Annual Report:

  • Of the 105 DWDA deaths during 2014, most (67.6%) were aged 65 years or older. The median age at death was 72 years. As in previous years, decedents were commonly white (95.2%) and well-educated (47.6% had a least a BA).
  • While most patients had cancer, the percent of patients with cancer in 2014 (68.6%) was lower than in previous years (79.4%), and the percent with amyotrophic lateral sclerosis (ALS) was higher (16.2% in 2014, compared to 7.2% in previous years).
  • Most (89.5%) patients died at home, and most (93.0%) were enrolled in hospice care either at the time the DWDA prescription was written or at the time of death.
  • As in previous years, the three most frequently mentioned end-of-life concerns were: loss of autonomy (91.4%), decreasing ability to participate in activities that made life enjoyable (86.7%), and loss of dignity (71.4%).
  • During 2014, no referrals were made to the Oregon Medical Board for failure to comply with DWDA requirements.

Since 1998, the year in which the first person in Oregon took medication prescribed under the law, a total of 1,327 patients have received the prescription, of whom 859 (64.7%) ingested it and died. These figures continue to underscore not only that only a small number of people use the law but also that more than one third of those who received the medication took it, finding great comfort in merely knowing it was available to them. Oregon’s Death with Dignity Act continues to work flawlessly and to provide ease of mind and relief to Oregonians facing the end of life.

The board members and staff of Death with Dignity National Center, as the successor of the organization that passed Oregon’s law in 1994, are proud of our accomplishments. We are honored to be able to count on your support in promoting and passing Death with Dignity laws based on the Oregon model throughout the United States.

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Will Vermont Soon Join Oregon & Washington?

George Eighmey, photo care of Patient Choices Vermont
George Eighmey, photo care of Patient Choices Vermont

George testified before the Vermont Senate Health and Welfare Committee about the proposed Death with Dignity bill (Senate Bill 77) last week. He observed the hours of hearings that went on throughout the week. Below are his observation of the proceedings.

The Vermont legislature is poised to pass an Oregon like Death with Dignity bill within the next few weeks. Attempts to enact a right to die act in Vermont have been going on since 2007, but it appears 2013 may be the year it finally passes. Vermont Governor Peter Shumlin made passage of the law a high priority and has enlisted the speaker of the house and president of the senate, both Democrats, to shepherd the bill through the legislative process.

Senator Claire Ayer, chair of the Vermont Senate Committee on Health and Welfare, held hearings on the proposed end-of-life care bill during January and February. Testimony was received from supporters Ann Jackson, former director of Oregon’s Hospice Association; Margaret Battin, PhD, distinguished professor of philosophy and internal medicine; former Oregon Governor Barbara Roberts; George Eighmey, former director of Compassion & Choices of Oregon, an organization facilitating patients and medical professional in using Oregon’s Death with Dignity Act; and from dozens of Vermonters including the Vermont medical director and a Vermont palliative care specialist. In addition, Dr. Charles Bentz, a member of a small group of Oregon physicians opposed to the law, testified along with the usual “Not Dead Yet” people, religious opponents and anti-government people.

It was apparent supporters were more credible. We were able to point to 15 years of data, published by the Oregon Department of Health, that the law has been flawlessly implemented. The law, used by 673 terminally ill Oregonians through 2012, has provided countless thousands with comfort knowing the law is available. Opponents in the meantime produced no proof of misuse, but continued their unsubstantiated allegations by citing to their own opinion pieces, published as letters to the editor, that the law doesn’t work.

The Health and Welfare committee approved the bill by the end of the week and sent it to the Senate floor where it was referred to the Senate Judiciary Committee for further hearings. Kathryn Tucker, legal counsel for Compassion & Choices and who is considered one of the national experts on Oregon’s law, will testify in support of the bill while opponents plan to have a few less than credible people testify.

Sometime in February, the Judiciary Committee chair, who is opposed to the law, will hopefully send the bill to the Senate floor with a no recommendation vote. If he does so, it looks very good the bill will pass the Senate by a close margin, and then go to the Vermont House of Representatives where it will go through a similar process. It hopefully will pass sometime in March in the House and be on the Governor’s desk for his signature in late March or early April. Supporters continue to be cautiously optimistic, but as we all know the opponents have fear instead of reason to undermine our rights.

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Dr. Morris from “How to Die in Oregon”

Dr. Morris care of NW Surgical Oncology
Dr. Morris care of NW Surgical Oncology

Dr. Katherine Morris was Cody Curtis’ surgical oncologist. They were both featured in the groundbreaking documentary, How to Die in Oregon. Dr. Morris is currently an Assistant Professor in Surgical Oncology at University of New Mexico, with clinical and research interests in Upper GI (stomach, liver, pancreas, etc) cancers.

I’m not a person who likes getting her picture taken. So, how I ended up in a documentary discussing the most difficult and emotionally laden decision I’ve ever made in my professional career still occasionally puzzles me. Voting for Oregon’s Death with Dignity law was a clear decision for me given the amount of respect I have for individual autonomy, and through my practice I’d learned how much people can suffer at the end of their lives. Even so, the decision to be a prescribing physician for a patient I was very attached to was incredibly difficult.

I had struggled through that decision process with the help of my family and friends when my patient introduced the idea of a documentary she was participating in about the process. She brought it up gently, saying, “Well…I’m being filmed and interviewed for a movie that is being made on the Death with Dignity law. The documentarian is a very nice young man—very respectful. He’s from Oregon, and his first film made it into Sundance! I’m sure he would love to have you bat your eyelashes for the camera…” (This last being a bit of an inside joke between two feminists.)

“Wow…I don’t know about that. I’m still reeling from this myself.”

“No problem—whatever is good for you—I can keep you entirely anonymous if you like. Would you like to just chat with him on the phone or by email? I can give him your contact info if you’re OK with that.”

“Interesting,” my heart thought.

“Hell no!” My brain thought.

“OK,” my mouth said.

I could’ve remained anonymous. No one would have ever known I was her prescribing doctor. The anonymity was attractive. The movie, however, was very important to my patient. She wanted the story to be told. I thought a considerable amount of time about participating and finally decided I could do a voice interview. We recorded for about two hours in May, when Cody was doing exceptionally well and I still had hopes she wouldn’t need the medication. This little bit of denial allowed me to think more clinically about the subject—it was easier to show the CT and PET scans and discuss the disease process and her clinical course. It was like I was explaining it to a family member of a patient, except this family member had what looked like a 35 pound camera on his shoulder, using it for sound recording only.

The next step down the path was filming her office visits when she came in for drain checks and assured me she was feeling as well as possible. Cody was the focus of these, and it seemed so important to her. I liked the documentary maker, Peter, and it was somewhat natural. I generally forgot he was there given the intensity of our discussions, except for the time I told the tale of my first time hosting Thanksgiving with my Mom and the in-laws while troubleshooting her drain. After sharing somewhat pointed humor about myself, my husband, the references to f-bombs, overly salted gravy, and disagreements between family members, I suddenly remembered the camera and blurted out, “this part better not land in the film.”

In the clinic appointments I was doing my job as a surgical oncologist—trying to help and support Cody and her family—so, it was much easier to be filmed. I still hadn’t committed to an actual on camera interview about my feelings on the subject. They were—and quite frankly, often still are—raw. I was very conscious of how little I knew from the philosophic and rigorous ethics standpoint. I hadn’t spent a lifetime focusing entirely on these issues like many people before me. I felt inadequate to talk about it, and I wasn’t inclined to show as much of my underbelly as it would take to discuss this in front of strangers who’d see the film.

By the time December arrived, Cody went into rapid decline. She decided to take the medications, dying at home, with her family around her, the icy wind and a large digital camera outside her room. Her and her family were beautiful in their love for each other. I was present when she took the medication and honored to be a part of her life. When she had drifted off to sleep, I drove home and hugged my cat, finally able to really cry about it. That was a Monday.

The following Saturday night my husband and I were watching the public access station. We’d only just started a cable subscription when TV went digital because the TV didn’t work without cable. Not wanting more excuses to sit on our backsides in front of the TV than we already had, we got the cheapest plan, leaving us with the major networks, PBS, three Spanish telenovela channels, and public access. Even with that meager selection, we were still sitting on our backsides in the living room. Channel flipping brought us to the Women’s Hour show, wherein a local religious lady had a couches and mugs format talk show with important people in her community. That Saturday, it happened to be one of my former medical school professors. A devout Catholic, very much in the full Roman tradition, this professor had caused controversy during my medical school days because he wasn’t willing to prescribe birth control.

He was discussing how sick our society was that it allowed a “very small group of doctors” to go around “making their living off prescribing lethal medications to vulnerable, suicidal patients.” The comments went on, and seemed to me increasingly hostile and entirely divorced from the process I’d just gone through with my patient. Although I had tears streaming down my face, I was angry. Fire spittin’ mad. My husband changed the channel, but I raged on. At that moment, I realized it was critical to tell my side of this story as well, even if it meant tearing up on camera, looking like Austen Powers in a wig.

Peter came over to our house a few days later, and we did my on camera interview, doing our best to not let the swirling cats make too much noise during the recording. I was a bit excited and moderately terrified when the movie came out and I learned HBO had picked it up. I worried about what my friends who disagreed with me on this subject would think. I worried about my patients, past, present, and future, whose religion so sustained them that I feared they wouldn’t feel comfortable with me after viewing the film. I recalled all too well the period of time when members of our OB/Gyn department were having their names and home addresses listed on the internet as people who “needed to be crossed out.” Mostly, however, I was scared of being misunderstood; terrified people would mistake my desire to honor a patient’s decision with a disrespect for the force of life I spent so many hours of my life trying to support.

When I saw the rough cut of the film and heard Nancy Niedzielski’s story for the first time, I knew I’d made the right decision. Her bravery was so huge and heroic compared to my fears that I took courage from it and became a little bit proud of not silencing myself—even if I couldn’t be perfectly composed and eloquent about speaking my mind.

Since then, I’ve seen the film many times, generally through tears. Cody is so alive in the movie and I miss her. In addition to the sadness, however, is the growing knowledge of how eloquently she crafted her message, turning her part in the documentary into a kind of love letter to the planet and people she was leaving.

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Nancy Niedzielski from “How to Die in Oregon”

Nancy Niedzielski worked tirelessly in Washington to advocate for the state’s Death with Dignity Act which voters approved in 2008. Her efforts were documented in the groundbreaking documentary How to Die in Oregon which was honored at film festivals all over the world and was recently nominated for an Emmy Award. Documentary award winners will be announced October 1, 2012.

When it was announced the documentary How To Die In Oregon was nominated for an Emmy, memories of the Washington campaign to pass the second Death with Dignity law, flooded my mind. The documentary placed a bookmark at a historical event for people around the world to see. And see it they did with an outpouring of love and support for those who dedicate time and money to ensure terminally-ill patients have a choice in their dying pain. Film Festivals around the world honored the documentary with awards, which for my way of thinking, honors the patients. My husband suffered in his dying, and the Oregon Death With Dignity Act couldn’t help him.

I first met filmmaker Peter Richardson during our Washington state campaign. He heard about my husband who had the opposite experience of others featured in his documentary. At 55, Randy was diagnosed with brain cancer that metastasized to his spinal cord and nervous system. Randy had some decent years but his death was long, ugly, and painful. When Randy entered hospice, only Oregon had a Death with Dignity Law. He was desperately envious of Oregon’s law. Being a member of a Brain Tumor Support Group, we knew the kind of death he would endure as we watched those we loved die horribly.

With no option but to suffer an agonizing death, Randy begged me to change what he felt was a cruel system under which the government insisted terminally-ill patients had to suffer and couldn’t seek assistance in dying. Randy asked me to promise I would change the law in Washington so terminally-ill patients had a choice—one he didn’t get. I promised him. But how? You promise anything to someone you adore as they lay dying.

After Randy’s death, I agonized about that promise. I searched for a way to fulfill it. In that search I came across the non-profit organization, Compassion and Choices of Washington. I was led down a campaign path that provided the opportunity to keep my promise to Randy. It became my full time commitment. I was willing to do anything and everything to keep that final promise to Randy.

On that journey, I marveled that just as it takes a village to raise children well, so also does it take a village to pass a Death with Dignity Law. I met hundreds of donors dedicating money so terminally-ill patients would have a choice in their dying pain. It takes a lot of money to educate the public about a new law and counteract lies perpetuated by the opposition. I met hundreds of volunteers committing countless hours in memory of a loved one or ones who just felt this was the compassionate thing to do for those who share your village. I met thousands of voters who understood this law doesn’t force any belief on anyone. No one has to use it. It just offers another medical option.

When I first watched How To Die In Oregon with Peter Richardson in the safety net of my home, my reaction was one of both sorrow and anger. I felt sorrow for those in the film who, like me, grieved a loved one. Alongside that sorrow sat anger that Randy suffered in a way the patients in the film didn’t. The peace and comfort they experienced in the final days leading up to death because they had a choice was something Randy craved and begged to have. I mentioned the anger to a friend who responded, “That’s why you worked so hard to pass the Death with Dignity law. Now, no terminally-ill patient in Washington will have to suffer like Randy did.” My anger melted away as a promise kept was recognized.

At a showing of the film, I met a man whose wife used the Washington Law. He expressed gratitude for her peaceful death. How odd it was to hear the words gratitude and death together. He said the law was a legacy to Randy. Knowing that because of the law, his wife’s death left him with less haunting memories than Randy’s did for me, I felt comforted. Randy was kind, gentle and caring. He would be the first to say if his suffering in dying meant others had a choice he didn’t get, then it was worth it. None of us know for certain what our death will be like or whether we’d want to use this end-of-life option. One thing I do know for certain: I want a choice.

As I write this, I’m on a plane to the funeral of Randy’s sister-in-law. She died too young of cancer. Fortunately her suffering was managed by hospice; for that I’m grateful. Randy wasn’t as fortunate. Not all dying pain is manageable. There is no guarantee any of us will leave this world peacefully, free of pain, surrounded by loved ones. This law brings terminally-ill patients closer to that possibility.

The intimacy with which the documentary shows why patients choose this option is told better than I ever can. I will always be grateful to filmmaker Peter Richardson and editor Greg Snider for their respectful approach. They educated the world on why advances in medicine that keep people alive longer need to be balanced with the choice to end one’s pain in dying. The Oregon and Washington Death with Dignity Acts change the deaths of terminally-ill patients and in so doing change their lives and the lives of their families for the good. I will always be grateful for being able to meet so many wonderful people who work tirelessly for others so they have this choice. They have changed my life for the good.

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