Tuesday, April 25, 2006

Euthanasia Part II...Subtitled, "It Just Isn't Legal In These 50 States"...

In 1986 and 1987, my grandmother was diagnosed with ovarian cancer. She chose to try standard chemotherapy and also underwent surgery to try and rid her body of this horrible disease. Neither was successful.

By April 1987, my grandmother was again hospitalized with irretractable pain and a spreading of her cancer to other organs. She was by no uncertain terms “suffering” from disease. She was admitted to a Catholic hospital where her doctor suggested yet another surgery and treatments to try and lessen her pain, but was told these options would not prolong her life. My grandmother considered these options, then willfully made the decision to stop eating or taking fluids instead. Within a matter of days, grandma Goldie died in this hospital.

My grandmother had become quite close with a couple of the nuns and a priest who visited and cared for her while hospitalized, even though she herself was not Catholic. I found it odd these dedicated people of faith did not attend her funeral. When I inquired further, I was told they were not “allowed” to attend BECAUSE of their faith. My grandmother’s willful act of refusing treatment and nourishment was considered SUICIDE by the Catholic institution and they could not condone this act. My grandmother’s death certificate does not list “suicide” as cause of death, however. Ovarian cancer is what is legally listed and also what I believe caused her death.

Euthanasia is not legal in any of our great 50 states. In “legal-eze”, the act of euthanasia involves a doctor injecting a patient with a lethal dose of medication and this act is generally considered murder, unless said doctor is a vet! However, even veterinarians are only allowed to practice this act on non-human patients. It has always seemed a bit twisted that I can put my dog or cat to death to relieve their pain and suffering, but this is not a choice for humans.

So, when is the act of making a conscious choice to end your own pain and suffering from disease considered suicide versus dying with dignity? This is some deep and murky water I am about to tread in, so here I go!

All 50 states have laws about suicide and most incorporate these laws into some type of mental health code. In Washington State, for instance, RCW71.05 and RCW71.34 state (this is a very rough interpretation) it is against the law tokill yourself if you are suffering from a mental disorder. There is no set standard for the interpretation of what consists of a “mental disorder”, however. And it is generally believed anyone who is contemplating suicide probably HAS an underlying mental disorder, unless proven otherwise. This is the law I work under and the branch of Washington State government I enforce. So as you can see, I will be treading lightly when discussing this issue.

Most states define suicide as the willful and intentional act of ending one’s own life and it is generally accepted this act is the result of violence toward self. On average in the county I work in, approximately 200 people are ruled death by suicide each year and these deaths occur from self-inflicted gun shot wounds, jumping, carbon monoxide poisoning, overdose, hanging, fire, drowning, etc. It is not difficult to make a connection between the violence inflicted to self as the cause of death. There is also investigation into the history of a mental disorder and indications of despondency at the time of death before being ruled a suicide. In other words, if you have a documented history of a mental disorder and leave a “good-bye note”, chances are your death WILL be ruled a suicide, no matter what method was chosen to end your life.

Now this is really splitting legal hairs, but basically if you weren’t “crazy” by history or at the time you chose to intentionally or willfully end your life in the State of Washington, your choice of death would not “technically” fall under this Washington State statute. But trust me…if you are choosing to blow your brains out or die by any other obviously violent means of ending your life, someone (often from my office) will certify you “crazy” and lock you up to protect you! Violent, self-inflicted death is just not considered OK by anyone in this state.

So what about people who don’t have a mental disorder (or history of such) and STILL choose to end their own life by willful intent? What about people who are suffering relentless pain and disease? Is this an OK option to end their suffering by willfully and intentionally ending their lives? Here is where the waters get even deeper and where I am certain to attract the attention of religious followers.

Even though our constitution and founding fathers made every attempt to write law to “separate church and state”, the fact of the matter remains this has NEVER happened in the history of the United States government. After all, the majority of the constitution’s founders came to America to ESCAPE religious persecution! They formulated laws based on their specific moral codes, which were deeply rooted in their religious beliefs. This still goes on today.

Before I go any further, let it be known I am NOT RELIGION BASHING HERE. Hold your emails please! I fully support everyone’s need and right to organize around common beliefs, even if those beliefs may differ from my own. And I generally support the legal limitations of our laws because the laws are/were written based on the majority of the moral codes in our country—the people would surely rise up and protest if they weren’t! But our laws surrounding death, suicide, euthanasia, assisted suicide, death with dignity, right to die, and even murder do not and have not adequately addressed “suffering” and what constitutes a reasonable end and/or definition of intolerable suffering.

Currently Oregon State is the ONLY state in the Union who has addressed this issue via their Death With Dignity Act, which passed in 1997. But even this law makes it nearly impossible to choose death as a means of ending physical suffering from disease. There is an unlimited list of criteria that must be met BEFORE a person can choose this option to end their suffering in Oregon.

First, the individual must be an established resident in Oregon, so don’t go thinking you can just pass through one day and “end it all” with the blessings of this law.

Second, the individual must be of age 18, capable of communicating healthcare decisions for themselves, and diagnosed with a TERMINAL ILLNESS that will lead to death within 6 months. MS is NOT considered a terminal illness, however sometimes complications of MS CAN be terminal.

Once all of these criteria are met, the individual must find an attending doctor who is willing to participate with them in the Death With Dignity Act. (Good luck with this one because few physicians will.) The person must prove they have met all the necessary qualifying criteria to the physician in Oregon (no, your PCP in New York can’t participate), THEN make two oral requests to this doctor 15 days apart, stating they wish to enact the Death With Dignity Act. But that’s not all…the individual must also provide WRITTEN request to this doctor signed by two, unrelated witnesses. But still there is more!

The attending physician must then consult with another doctor to verify the diagnosis and prognosis of the individual, determine the person’s capacity to make healthcare decisions (if they think you’re impaired, you must agree to a psychological evaluation), and FINALLY inform the individual of feasible alternatives to doctor-assisted suicide. This is all done just to get a LETHAL PRESCRIPTION that you must administer yourself. If anyone else gives it to you, it is considered murder or in it’s least noxious definition, “euthanasia.” And by the way, just to refresh your memory, neither murder nor euthanasia is approved of in the United States…someone WILL do jail time for either act. Oregon remains the only state where physician-assisted suicide is not a criminal offense. At least for now it isn’t.

Whew! So where am I heading with all of this? It’s probably easier to die from the result of disease than to prematurely end your life before the disease kills you! And, there is really no legal loophole around this. You just will not have the blessings of the government OR your life insurance carrier if you choose to end your own suffering by self-inflicted means.

Now, for those suffering from horrible pain or extreme disability from Multiple Sclerosis, you may be saying, “Frankly, I don’t give a rat’s ars. I’m going to do what I’m going to do about this issue”, and I have to say that is your choice. If there is anything I have learned from my 20 years of experience in the psychiatric field it is this: If someone is determined to end their life, there is little that can be done to stop them. And when I use the word “determined”, I am not talking about those still contemplating ending their own life. I am talking about the decided.

My only advice to those who are at this stage in their disease process and in contemplation is that you not make a hasty decision. If this is the decision you are contemplating to end your suffering, be absolutely certain you have explored all other alternatives, whether that be spiritual, mental, or physical alternatives.

What I have often told “suicidal” patients who are “suffering” from a mental disorder is this: “Why today? Have you even tried this, this, and this? Why not give yourself the benefit of the doubt and try these things (which they usually haven’t) and say, in six months to a year, if you still feel this way, you can always kill yourself then. There’s obviously no hurry since you have the rest of your life to do this.” Sometimes this approach has worked and sometimes it has failed.

I can only strongly implore you to, at the very minimum, obtain a Healthcare Advanced Directive and Durable Power of Attorney in the event your disease renders you incapable of making your own healthcare decisions. But even these legal tools will not express your wishes or end suffering prematurely as long as you are CAPABLE of making your own healthcare decisions. They will prevent you from being hooked up to machines, tube feedings, and from being kept alive forever in your incapacitated state if this is not your wish, but ONLY (under most conditions) if you are considered terminal or with no reasonable likelihood of recovery. They WILL eliminate a lot of media coverage, however, if your family argues what your expressed wishes are/were…unless of course you live in Florida.

There are simply no good answers or choices when it comes to ending your life prematurely due to intolerable suffering because there is still so much stigma, emotion, and legality attached to this issue. We don’t want to talk about it because it is easier to ignore since death usually comes unexpectedly to most and we all want to believe we are somehow immortal. And I certainly can’t offer you any legal or spiritual advice on the matter. Those issues are between you and your lawyer and you and your Higher Advisor/God/Maker/Guru.

My hope is you will at least begin to THINK about these issues and make conscious choices for yourself while you are still capable of doing so. Perhaps you already have and I commend you. But for some, these choices are not so black and white when faced with the desire to end suffering and the innate reflex in all of us to live. May you simply find peace in your decisions.

All this talk about death and dying has just depressed me…but now that I’ve put THAT in writing on the Internet, I won’t even be allowed to take advantage of Oregon’s Death With Dignity law should I even WANT to! Someone somewhere will say I was “depressed” in 2006…oh well. Perhaps a trip to spend some money will improve my mood today AND I think it might even be cheaper than Prozac!

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