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Back in November 2008, I wrote a diary on Legalized Assisted Suicide. Up here in Washington State, Initiative 1000 was on the Nov 4 ballot and ultimately passed.  Several weeks previous to that diary, I had written about the controversy behind the issue of Assisted Suicide / Death with Dignity.

Well, Washington’s Death and Dignity Act takes effect today and not every hospital or physician is supporting the act as outlined in the Seattle Times.

Follow me below the fold for who's in and who's out and what this all means for the citizens of Washington State ..

University of Washington Medicine health system and Group Health Cooperative have opted in.

Swedish Medical Center is, for the most part, opting out.  Swedish will not allow providers to participate on Swedish premises and will not allow its pharmacies to fill prescriptions for life-ending medications.

Virginia Mason Medical Center's hospital will not be participating, though its outpatient clinics can.  Virginia Mason will not provide Death with Dignity services in its inpatient hospital. But individual providers in Virginia Mason's outpatient clinics — which includes a cancer institute — can choose whether to participate. Virginia Mason pharmacies will not dispense the lethal medications but its pharmacy staff may tell providers who will.

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Why?
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Since the law passed, health-care facilities have been scrambling to come up with policies. Now, it appears that about a third of the state's hospitals seem to be opting out, said Cassie Sauer, spokeswoman for the Washington State Hospital Association. That means caregivers operating in their facilities or on their behalf are forbidden from helping a patient die, and their pharmacies may not dispense the medications.

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And what does this really mean for the people?
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Compassion and Choices of Washington are standing their ground in issuing a statement that regardless of what hospitals decide, people should be about to find a doctor who will help them.  Their website provides documents, articles, and tips that a person can use to inform, educate and take action. Such as:

If you are dying, first and foremost, let your doctors know that you understand your condition and wish to avoid any treatment designed to prolong your life.  A good way to start this dialogue is with a Physician Orders for Life-Sustaining Treatment (POLST) form that summarizes your end-of-life wishes and requires a physician’s signature.

If any doctor hesitates or disagrees with any stipulation, give your reasons for and feelings  about what you are requesting.  Tell your doctors you expect their compliance with your end-of-life requests for medical treatment.  If you cannot reach agreement with one or more  doctors now, you may need to work around them or even get a new doctor.

You have to be specific and forceful in your request.  How you frame the request is critical. No doctor wants to be obligated in advance to giving you a prescription for lethal medications, or clearly agree to do so in a manner that could be held against him later if a  controversy arose over what he did.

Opponents to I-1000 have formed a grass-roots group called True Compassion Advocates. Demonstrations are occurring today outside of University of Washington's medical center.  The advocates for life-affirming choices that don't include ending the life of the patient who needs care are just as compassionate about their perspective ..

Assisted suicide directly threatens the lives of the most vulnerable people in our culture. People with disabilities, the dependent elderly, those who live with depression and mental illness and the poor are all directly threatened by assisted suicide in Washington State and elsewhere.

"Let's not underestimate that this is still a very controversial issue in the United States," said Paul Root Wolpe, director of Emory Center for Ethics in Atlanta.

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Personally, I'm still trying to wrap my head around the concept of dying with dignity, and what I would do if confronted with the possibility that I had a health issue that was going to end my life.  I'm still struggling with it because my faith asks me to believe in something else. I clearly see both sides of the issue and can embrace both arguments.

Clearly, though, the ongoing debate around this issue really demonstrates to me that our society continues to avoid the reality of death.  It's really the only universal. We all get to die. Don't even get me started on the funeral services scams, the Botox generation, our elderly spending their dying years in lonely nursing homes. I could go on and on.  But I won't.  

Originally posted to Silent Spring on Thu Mar 05, 2009 at 10:58 AM PST.

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Comment Preferences

  •  Share your thoughts. (17+ / 0-)

    Those who contemplate the beauty of the earth find reserves of strength that will endure as long as life lasts. -- Rachel Carson

    by Silent Spring on Thu Mar 05, 2009 at 10:58:37 AM PST

    •  I Want To Be Careful Here (6+ / 0-)

      Personally I'd fight to live with ounce of my soul. But there are times where you can't fight anymore. Many years ago, my grandfather ran into that situation. He had been a doctor for 50 years. His views on the topic were very clear. My parents honored his wishes and "help" him along. It is not even something even second guess for a second.

      All my other family members (including myself) have living wills and made our opinion on this topic very clear.

      "We are what we repeatedly do. Excellence then, is not an act, but a habit." - Aristotle

      by webranding on Thu Mar 05, 2009 at 11:07:24 AM PST

      [ Parent ]

    •  Prepare early and update when necessary. (6+ / 0-)

      I've had my will, medical power of attorney, and all other pertainent paperwork completed since I was in my 20's. My mother was very ill for years. We never had an end of life discussion so I would NEVER have considered that for her. But for me, I wanted to make sure MY choice was in writing if it ever became necessary. It's a personal choice to be made for ourselves, not for others. It needs to be regulated, but available to those that choose it. The government needs to stay out of my bedroom, my uterus and off my deathbed.

      I'm grateful Washington state is working hard towards making death with dignity a option for people.  

  •  I hope to have this choice if I want it (5+ / 0-)

    I also hope that nobody makes the choice for me if I don't want it.  (Don't wanting it does not include being lost in dimentia, but I won't know if I'm lost, will I?)

  •  Does it have to? (2+ / 0-)

    I'd really prefer to postpone the dying with dignity for a bit.

  •  I'm all for it. (11+ / 0-)

    I'm glad we have this option in Oregon, and I'm glad to see Washington followed suit. It's always bothered me that society doesn't seem to have any qualms about putting their pet out of misery, but let our loved ones hang on to the end, suffering.

    I hope someone is calling out TCA's complete BS, especially re: people with mental illness. There are strict guidelines to be followed - someone with a mental illness would not be allowed to "apply". I can't help but wonder how many people are being suckered in by the lies? >=/

  •  My brother in law (11+ / 0-)

    Had a total knee replacement done at the age of 68. He was in excellent health, his doc said he had the body of a 35yr old, but years of hard work had worn his knees down.

    I spoke to him the evening following his surgery at about 9pm, he sounded great and was anxious to get going. At approx 1am he became uncontrollable, he pulled all of his IVs out, was raging incoherently and only stayed in bed because his leg was secured in the machine that keeps it in motion.

    The hosp. staff did nothing, they didn't call a Dr. they were afraid of him, he was 6'4" and about 200lbs and black. He was raging! They did nothing. They called my sis at 9am and only called a Dr. after she arrived. They told her he was having a reaction to meds. She told them that this was neurological and they damn well better call someone.

    The rest of the story is too long, he was suffering strokes. He had a hole in his heart that could only be detected by a trans-esophogial echo. It took his short term memory, his sight, and after two yrs it took his life.

    He suffered a death that no one should have gone through. Unbelievable pain, they were going to amputate his leg the day he died, bed sores. I can not tell you how many times I contemplated killing him myself. I loved him, he was my true brother.

    The initial mistakes can't be undone, the mistreatment he suffered in nursing homes can't be undone, we are left with a kind of PTSD that only survivers of long slow death can understand. Regret, sadness, over adrenalized fear. My sis was left bankrupted and having to work till she dies.

    Hell yes, assisted suicide and mercy death for those who suffer and will never get better.

    Notice to dead enders and Daleks. "It's over now so drink your big black cow and get out of here." Steely Dan

    by high uintas on Thu Mar 05, 2009 at 11:28:20 AM PST

  •  This is a hard question. (4+ / 0-)

    Many disabled people's rights advocates fear that their lives, already considered less valuable than the able-bodied, will be more at risk with assisted suicide legal-- that they will be assisted to decide that their existences should come to an end.
    Some terminally ill people become (understandably) clinically depressed. If they are treated successfully for depression, they may decide that with other treatments to provide physical comfort  they do not want assistance to die. With the time remaining for them, they can resolve problems in relationships with loved ones and achieve a greater degree of peace.
    Often there is an overwhelming case to be made for assisted suicide, but it is necessary for all of us to make sure that there is no "jumping the gun."

    I could have been a soldier... I had got part of it learned; I knew more about retreating than the man that invented retreating. --Mark Twain

    by NogodsnomastersMary on Thu Mar 05, 2009 at 11:48:44 AM PST

  •  The other side of the issue does not sound like (2+ / 0-)
    Recommended by:
    Silent Spring, Clio2

    it has much to do with faith. I believe in the individuals absolute right to control their own body BUT... unscrupulous medical personnel will be tempted to encourage the less convenient amongst us to hurry-the-hell off and they will do so. That needs to be considered.

    - your thoughts here - contact me for exciting details!

    by sarayakat on Thu Mar 05, 2009 at 11:58:08 AM PST

    •  Yes, it does. (0+ / 0-)

      The right-to-life folks, and particular religions that have very solid platforms (i.e. Catholicism) on the sanctity of human life, were very much a part of the campaign 'wars' that went on in WA State when this initiative was on the ballot back in November.  

      Those who contemplate the beauty of the earth find reserves of strength that will endure as long as life lasts. -- Rachel Carson

      by Silent Spring on Thu Mar 05, 2009 at 12:08:15 PM PST

      [ Parent ]

  •  On the whole I agree with this, but (2+ / 0-)
    Recommended by:
    Silent Spring, marybluesky

    in practice....I worry.

    On the one hand. I saw a family member die from lung cancer, the hard way. He had hospice care, but oxygen and painkillers did not prevent him from suffering as his lungs filled with fluid and his body shut down. I believe he would have wished to be spared the final days when he became unable to speak or swallow or do anything but linger, dying in a state that we cannot know but which I am afraid was agonizing.

    And yet.

    It takes very little imagination to conceive how insurance companies and other medical institutions could encourage those on the way out to end it more quickly out of a sense of hopelessness, fear of pain, or "for the sake of your family," financially and/or emotionally speaking. It would not be difficult to implant or encourage these thoughts without saying them is so many words. This is what I rather expect to be one of the outcomes and we may find ourselves on the other end, one of these years, fighting for the right to keep fighting for our existence, after the insurance company and/or the medical profession has determined that according to their balance sheet, we should give up.

    •  My mother-in-law died 2 months ago. (1+ / 0-)
      Recommended by:
      bablhous

      She was fine one day and the next suffered from a brain aneurism.  It was about 2 weeks from start to finish until she passed.  And she died 'naturally' in a hospital surrounded by her children and grandchildren.  We all watched the life support being removed.  We all watched what happens to a human body as it begins to die in its final hours.  It is not pretty.  It's devastating.  Yet the grandchildren (all teenagers) got to grieve that passing of their beloved grandmother in a good way.  We surrounded her with stories, love, laughter, tears, and the gut wrenching last rites of the Catholic faith.

      Grief is not easy. Saying good-bye is not easy.  And I think this is what the opposition to this initiative is trying to convey.

      I know some will have a hard time with this, yet it was a beautiful experience watching and saying goodbye to a wonderful woman.  She was given enough morphine that she was not there.  We were all counseled quite humanely by the Death with Dignity person at the hospital and how her death would be in accordance to the Catholic Church.

      Those who contemplate the beauty of the earth find reserves of strength that will endure as long as life lasts. -- Rachel Carson

      by Silent Spring on Thu Mar 05, 2009 at 12:16:21 PM PST

      [ Parent ]

      •  Yes (1+ / 0-)
        Recommended by:
        Silent Spring

        Still, I think some of the opposition may be more blunt:

        For instance, 20 years from now, when I am deadly ill with something, I don't want my doctor telling me,

        "It's my determination that you aren't going to recover from this, you might have 2 days or 2 months, but no more, and there is nothing more we can do. In the circumstances, your insurance company won't pay for any further treatment or hospitalization beyond what is necessary for you to make your peace with God. Of course, you can always discharge yorself and go home to die 'naturally,' or you can stay here at  your own expense, but I would recommend you do the ethical thing, the courageous thing, and let your family know that you are ready to go. If they can arrive here by tomorow, we can schedule your departure tomorrow evening at 6:00 p.m."

        Or even, "Well, it's up to you, but we're leaving a hypodermic in the drawer here and what you do with it is up to you."

        Because I am d****d if I intend to die for or at anyone's convenience. And I don't think anyone should be pressured into it.

        •  That's what frightens me, too. (1+ / 0-)
          Recommended by:
          Clio2

          That in the future, the dignity part will become less and less of focus to be replaced with what's best for the insurance companies and the savings accounts of loved ones and the horrific idea that we can make an appointment to die on a given day and time depending on what is convenient for everyone involved.  Sick, sick, sick.

          The way that the hospital carried out our family's wishes with my mom-in-law, and in accordance with our faith, was just wonderful.  No rushing, no pressuring.  We knew what she would want. Yet they strategically helped all of us get our needs met .. honoring her wishes and giving us time to let go.

          There was a special floor on the hospital where they sent her and all of us, after life support was removed, that was just a place with quiet and clean little rooms.  She laid in her bed until she died.  There were clouds painted on the ceilings.

          Those who contemplate the beauty of the earth find reserves of strength that will endure as long as life lasts. -- Rachel Carson

          by Silent Spring on Thu Mar 05, 2009 at 01:04:57 PM PST

          [ Parent ]

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