Last week, the first Washington resident took advantage of the new Death with Dignity law, and chose to end her terminal illness with her family and her dog by her side. Another half-dozen individuals in the state have received the medication after being certified by physicians. This law, as in Oregon, is only used by a few dozen people a year. No one gets excited about people using the law, but supporters still work to make sure that people know it and can discuss it with their doctor. As Barbara Coombs Lee from Compassion & Choices explains in the Huffington Post, it pays off:
Most Compassion & Choices supporters would eagerly bargain away a few days of extended life in an intensive care unit in exchange for final days spent at home, in relative comfort and meaningful communion with those they love. Such folks don’t adhere to the doctrine of redemptive suffering and would rather slip away peacefully if imminent dying would be otherwise prolonged and agonized.
Well, the evidence is in. Recent studies indicate the single most powerful thing a person can do to improve the chance for gentle dying is — simply and courageously — to talk about it.
Talk to whom? First and foremost, talk to your personal physician. It’s never too early for this conversation. This March an important study appeared in the Archives of Internal Medicine. A large, multi-institutional study, it evaluated the quality of life at the end of life for people with advanced cancer.
Lo and behold! Those individuals who had discussed end-of-life values and preferences with their doctors experienced significantly less suffering in their final week of life. A significant reduction in intensive care hospitalizations and high technology interventions accounted for this desirable outcome. Not too surprising, the patients who had talked with their doctors, and who experienced a more peaceful, pain-free end of life, also received less costly care than those tethered to the tubes and machines meant to extend their lives.
But one finding is stunning enough to be a game-changer in end-of-life care. For all the suffering they inflicted and all the cost they incurred, the tubes and machines actually bought no life extension. None.
Coombs Lee goes on to give some good advice on how to start up that conversation with your doctor, as most doctors will not initiate it. Compassion & Choices has been doing a tremendous amount of work making sure that Washington’s law works as well as Oregon’s, where even death with dignity opponent Sen. Ron Wyden conceded in front of Congress that the law has worked incredibly well when it comes to improving end-of-life care:
While I do not know how I would vote if the issue were to appear on the Oregon ballot once more, I believe it is time for me to acknowledge that my fears concerning the poor elderly were thankfully never realized, and the safeguards appear to have worked quite well in preventing potential abuses.
What is often not discussed by opponents of the Oregon law is the Oregon Death With Dignity Act has brought about many improvements in end of life care in Oregon. Pain management has improved. My state remains the only state to discipline a physician for the under-treatment of pain. However, perhaps the most important side effect of the law is that families, health professionals and patients know they can, and should have conversations about how they want to die and what their wishes are concerning treatment.
The end-of-life rules before I-1000 was passed into law allowed for physicians to make decisions on end-of-life care that should have been left up to patients. Changing that protocol and allowing for conversations about different choices to take place is not just giving patients better options, it’s also improving their care overall.