My linear, black and white thinking was serving me well until I came across someone who had lived it.
On June 9, 2016 in California a bill called AB-15 went into effect. This bill was also called the End of Life Option Act. In brief, the law allows a person 18 years or older suffering from a terminal medical condition to request life-ending medication to decide when they want to die. A recent report by the California Department of public health stated 111 people have taken advantage of the law since its inception. The law did make it onerous to go through with the process. The patient needs to request the drug on 2 separate occasions and in writing. They must be cleared by 2 separate doctors. They must have a life expectancy of less than 6 months. They much reaffirm this request 48 hours prior to the date of death and the medication must be self administered.
Initially when I heard about this bill I was appalled. I did not want the decision to actively assist in death to be in the hands of doctors. I got into this profession to do the exact opposite. I want people to live and be healthy. I remember my physician partner saying “we’re physicians not executioners” and I agreed wholeheartedly. It’s easy to make these claims when you’re not the one suffering or are close to a person who is. My linear, black and white thinking was serving me well until I came across someone who had lived it.
A few weeks ago I sat in one of our office rooms across from Nathan, an eighty something year old man in for a routine check of his blood pressure. His blood pressure was well controlled and I was ready to wrap up the visit and send him on his way when he wanted to let me know about something. “Doc, do you know about this Right to Die Act in California?” He asked. I said yes and briefly summarized my thoughts on it. “Well,” he said, “Let me tell you about my sister.”
His sister was younger than he was but had been diagnosed with a progressive muscular disorder which he didn’t know the name of but equated to Lou Gehrig’s disease (or Amyotrophic Lateral Sclerosis). The disease had progressed over years to involve her whole body except her head. She had no muscular control of the muscles affected and she was only able to talk and eat. According to Nathan, she was suffering and miserable. She decided she wanted to end her life. She went about the process described in the law.
Nathan states this was hard in itself because finding a doctor who prescribed the medicine was difficult. She eventually found a doctor in Irvine who worked with a doctor in San Francisco. She completed the process and was approved to end her life. When she received approval, Nathan states that her whole outlook on life changed. She was finally going to be able to control something in her life. She was “excited” to complete the process. The day of her death came.
She was prescribed a liquid cocktail of high dose Morphine and Digoxin, medications that in high doses alter breathing and the heart to the point of death. Some family members had been vocally against the process but had come to acceptance and were there by her side. According to the law, she had to “self-administer” the medication. This was to be accomplished by having her use a straw to suck up the liquid and swallow it (some of the last bodily functions she had control over). With family surrounding her, Nathan stated she “slurped up every last bit of the medication.” Ten to 20 minutes later, she had died.
Nathan was very clear that this was a good thing in his mind. His sister had been suffering for years and was finally at peace, which she entered on her own terms. It was her way of giving this disease the “middle finger” as she exited life. He praised the new law. At the end of our discussion he looked over at me and asked me again how I felt about the law. I fumbled my words this time.
Let me tell you why I have such a hard time getting on board with this law. There are 2 main reasons. The first is a wonderful program called Hospice. Hospice is for people in similar situations who are expected to live less than 6 months. The focus in hospice is to switch from treatment that cures a disease to treatment that relieves suffering as a person transitions out of this life. Medications are given to relieve pain, breathing problems and any other issues that causes suffering. It is not given to hasten or aid in death. The other reason for opposing this law is a moral one. In my mind prescribing a medication for the sole purpose of killing a person is akin to murder because it would be willful and premeditated. Again, putting this decision in the hands of doctors is scary. I became a doctor to help people live and be healthy. Part of that is relieving suffering but I believe that can be done without ending life.
Also, I am also a little confused about when our society became okay with the idea of doctors aiding in killing. I’m sure we all remember the conviction of Dr. Kevorkian in 1999 for second degree murder. He had “helped” over 130 people die to relieve suffering. Proponents of this law state that the current law is different from “physician assisted suicide” but I don’t see it. How is something that a doctor was sent to prison for just 18 years ago now a law?
Nathan’s story questioned my beliefs. I truly felt sorry for his sister and was relieved to hear her suffering was gone. I had an internal struggle that started. So it brings me to the question: Is it okay to end someone’s life it they are suffering? First what is suffering? According to the dictionary it is a state of undergoing pain, distress or hardship. We can treat all of these things and that is the goal of hospice. In the end I have concluded that I cannot make the leap to accept or participate in this law because we have hospice which is specifically set up to relieve suffering and allow a comfortable transition from this life to the next.
So what will I do if someone comes through my door and asks for a life ending medication? Nathan’s story rocked me but I’ll have to say I can’t do it. My conscience won’t allow it. I don’t even know if I would be able to refer to a doctor who does because in my mind this could make me an accomplice. I would hope I could convince this person of the benefit and beauty of hospice to relieve their suffering. No matter the outcome I will lead with compassion and be there to the end as his or her doctor because abandonment would be the worst thing to subject someone going through that much suffering to. I will care for, love and respect any and all of my patients no matter their feelings on this issue or others.
What are you thoughts in the issue? Am I completely unreasonable? Do you have a similar story? I’d love to hear your thoughts. Leave a comment below.