Showing posts with label Right to Die. Show all posts
Showing posts with label Right to Die. Show all posts

April 2, 2015

Doctor, Patient and Now Right to die Advocate

Dan Swangard, a 48-year-old physician who was diagnosed with cancer in 2013, joined the lawsuit last month. (Anna Gorman/Kaiser Health News) 
Dan Swangard knows what death looks like.
As a physician, he has seen patients die in hospitals, hooked to morphine drips and overcome with anxiety. He has watched dying drag on for weeks or months as terrified relatives stand by helplessly.
Recently, however, his thoughts about how seriously ill people die have become personal. Swangard was diagnosed in 2013 with a rare form of metastatic cancer.
To remove the cancer, surgeons took out parts of his pancreas and liver, as well as his entire spleen and gallbladder. The operation was successful but Swangard, 48, knows there’s a strong chance the disease will return. And if he gets to a point where there’s nothing more medicine can do, he wants to be able to control when and how his life ends.
“It’s very real for me,” said Swangard, who lives in Bolinas, California. “This could be my own issue a year from now.”
That’s one of the reasons Swangard joined a California lawsuit last month seeking to let doctors prescribe lethal medications to certain patients who want to hasten death. If he were given only months to live, Swangard said, he can’t say for certain whether he would take them.
“But I want to be able to make that choice,” he said.
The right-to-die movement has gained renewed momentum in California and around the nation following the highly publicized death of an East Bay woman with brain cancer. Brittany Maynard, 29, moved to Oregon to take advantage of its “Death with Dignity” law and died in November after taking a fatal dose of barbiturates prescribed by her doctor.
The California lawsuit asks the court to protect physicians from liability if they prescribe lethal medications to patients who are both terminally ill and mentally competent to decide their fate.
The lawsuit argues that while it is against the law in California for anyone to assist in another’s suicide, these cases are not suicides. Rather, the suit argues, they are choices by a dying person on how his or her life should end and decisions about one’s own body protected under the state constitution.
Separately, two California state senators have proposed a bill that would allow doctors to prescribe lethal medication to certain terminally ill adults.
Three states—Oregon, Washington, and Vermont—already have laws allowing physician-assisted deaths. Courts in New Mexico and Montana also have ruled that aid in dying is legal, and a suit was also recently filed in New York.
Legislation is pending in several other states. Kathryn Tucker, an attorney on several of the court cases, is also spearheading the California lawsuit. This time, she and her legal team decided to include among the plaintiffs two doctors with life-threatening illnesses, Swangard and a retired San Francisco obstetrician.
Physicians “have a very deep and broad understanding about what the journey to death can be like,” said Tucker, the executive director of the Disability Rights Legal Center. “The curtain is pulled back. For lay people, death is much more mysterious.”
Historically, doctors have been some of the most vocal critics of assisted suicide, also called aid-in-dying. The American Medical Association still says that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.” Similarly, the California Medical Association takes the view that helping patients die conflicts with doctors’ commitment to do no harm. “It is the physicians’ job to take care of the patient and that is amplified when that patient is most sick,” said a spokeswoman, Molly Weedn.
But a recent survey of 21,000 doctors in the U.S. and Europe shows views may be shifting. According to Medscape, the organization that did the survey, 54 percent of American doctors support assisted suicide, up from 46 percent four years earlier.
Swangard is among those who believe that taking care of patients means letting them choose how their lives should end. That’s not the same as killing patients or facilitating suicide, he said.
Swangard completed his medical residency in San Francisco in the middle of the AIDS crisis; young men were dying all around him. Throughout his career as an internal-medicine doctor, a hospice volunteer, and now an anesthesiologist, he has become frustrated with how the medical system handles death. Doctors spend so much time trying to extend life that few focus on what patients want in their last days, he said.
“I don’t think we know how to die,” he said. “We fight tooth and nail to keep that from happening.”
Swangard’s own illness was discovered in early 2013 during a long-overdue check-up. He hadn’t been worried about his health—he was obsessed with fitness, swimming regularly, and seeing a trainer twice a week. But when the doctor pressed on Swangard’s stomach, he felt a mango-sized mass.
He had a visceral feeling, he said, that “something bad was happening.”
Within a week, a surgeon found a neuroendocrine tumor in the pancreas and metastasis in the liver. It was the same cancer that took Steve Jobs’ life—one that doesn’t generally respond to chemotherapy or radiation. “My fears became real,” he said.
The doctors told him they believed they got all the cancerous cells. But Swangard was tormented by questions: Am I going to be alive in a year? Is my cancer going to come back?
“I wasn’t sleeping, I wasn’t exercising, I was marinating in my own sadness and fear of what this all meant,” he said. “I thought, ‘This is going to kill me.’”
Since his diagnosis, Swangard said he has had a greater understanding of his patients’ struggles. Occasionally, he holds their hands and tells them he has been where they are.
Earlier this year, a physician friend asked him if he’d be willing to join the California case. Swangard didn’t hesitate. He didn’t go into medicine to help dying people linger and wants to help change that approach—for his patients and for himself.
When he dies, Swangard said, he wants to be surrounded by people he loves. He doesn’t want to be in a drug-induced haze, nor consumed by worry about what’s next. He wants to be able to say goodbye.
“It is a little bit of a blessing to know how I might die,” he said. “I don’t think a lot of patients have insight into what to expect.”
These days, he wears a Buddhist prayer bracelet, a reminder to focus on the present. He cut his work hours, swims as often as he can and meditates regularly. At home, he stares out at the ocean, often watching dolphins pass by. He makes every effort to stay calm and healthy.
He is in remission but he knows that what happens with the cancer is largely outside his control. An MRI last year showed a small lesion in his liver, which doctors are watching closely.
“It’s this big unknown,” he said.
Robert Liner, a fellow plaintiff who only recently met Swangard, lives with the same uncertainty.
On his 69th birthday in May 2013, the retired obstetrician had a bad cough. He felt tired and short of breath. His wife took him to the hospital, where doctors discovered malignant masses on his kidneys—advanced-stage lymphoma.
After radiation and chemotherapy, the tumors shrank. He also is in remission. But if the cancer comes back, he said, “the prospects are not going to be good.”
He often thinks of a former patient, a 25-year-old woman with metastatic ovarian cancer. She wanted to die while she still was able to communicate. Liner wasn’t able to help ease her death because the law wouldn’t let him. “I felt like I’d failed her,” he said.
Years before his diagnosis, Liner, now 70, became involved with Compassion and Choices, an organization that promotes aid-in-dying. He has a shelf of books in his San Francisco home devoted to the subject: Being MortalDying RightKnocking on Heaven’s Door.
Robert Liner, a retired obstetrician and a
plaintiff in the lawsuit (Anna Gorman/
Kaiser Health News)
He keeps a stack of notecards with quotes about the end of life, which he often recites in speeches to church groups or senior centers. One reads, “The best preparation for death is a life well lived.”
He believes having medication to hasten death helps terminally ill people live fully in their last weeks or months without being immobilized by fear. “If you are riddled with anxiety, you are not free to concentrate on what’s most meaningful to you,” he said.
Like Swangard, Liner doesn’t know if he would take the medication. He recently married the woman he calls his “beloved” and said he has lots of plans for his retirement years, including writing a screenplay and improving his piano playing.
“My wife says I’d be hanging on to life by my fingernails,” he said.
But that decision should be his to make, with his family and his doctor, he said. “I want the comfort of knowing it’s up to me when enough is enough,” he said.

This article appears courtesy of Kaiser Health News.

October 8, 2014

When is a good Time to Go?

Adam visiting mom’s burial
How old do you want to be when you die? Im talking about those that would have a choice. I have made a choice myself which is late 60’s-70’s with a specific number in mind. I do so because if Im giving the choice to die speaking only for me, I think is the right option for me, in  a field where options are very limited..

What does it mean?

 It means that regardless of what ever sickness or closeness to death I have been since born I might be given the opportunity for better or worse to be alive in the ages mentioned above. Knowing what old age will bring and because I have no one to take charge a nursing home would not be a good choice for me. As I proceed along in this path I am very aware of what life means and I am very curious about when I pass from having a body to be not having one and be dissolved into soil for the earth. My mom did not go until 92 and I wish she would have lasted more. She had me and she had lots of grand kids. For her I think 92 was way too early. So you see there is no particular age for everyone because we all have different circumstances.

I think Ive done everything I could and Im sure I missed opportunities to do better for me and others but the important thing is that Im going with clear mind that I’ve done the best I could and further I am proud that I did well  and better than anyone in my family, It was not for a long time and sickness and living without very little fear brought it’s toll. But here I am thinking of what disaster old age could be for me and single gay men in my position. 

As I seat here and write to you, suicide has not cross my mind not even once. I do believe that when the heart tells the brain it’s time, it will be time. Scientifically the heart wants to pump for ever do its only job programmed to do, pump until it can no more because of aging muscles and other reasons beyond it’s control. The mind wants to live for ever and does not want to stop even when the heart does. Give it oxygen and the mind will go on for ages until it’s electrical conductors become inoperative because of prolong use and it stops conducting the electric pulses. I believe though that the heart is always in control and I don’t mean a pump inside your chest but that in you, that you recognize as you, even without a reflection, that part that carries the happiness and the sadness and the love for others. That part no one knows if it ceases or if its a geneses  for more creation. 
Adam Gonzalez, Publisher

When is a good age to die? Perhaps 80, like the heroine of the 1971 cult film Harold and Maude? Or maybe 85 or 90? Or are you one of those hardy souls who hope to make it to 100?

In this month’s Atlantic, the oncologist and author Ezekiel J. Emanuel, 57, makes the case that, for him, 75 will be the best time to die.

Collective gasp. For some of us, 75 doesn’t feel all that distant.

“I won’t actively end my life,” wrote Emanuel (brother of Chicago mayor, Rahm), a bioethicist who opposes assisted suicide and euthanasia. “But I won’t try to prolong it, either.”

(MORE: Help Parents Avoid Unwanted End-of-Life Treatment)

At 75, Emanuel said, he will stop seeing doctors, decline medical tests and avoid any treatments except those to ease pain. If he is diagnosed with cancer, he will opt not to treat it. If he contracts pneumonia or a UTI, he will refuse antibiotics, letting nature take its course — and take him out.

Why 75? By then, Emanuel believes, you’ve had a life. You’ve seen your children grow up (if you’re a parent), traveled, enjoyed professional and creative successes. Your active life is behind you. Ahead are the mental and physical debilities of extreme old age.

Moreover, he argues, you’ll be doing your children a favor by letting them become the heads of the family and not turning them into your caregivers as they approach their own retirement years.

(MORE: The Single Most Important Discussion You Can Have)

And oh yes — you won’t outlive your money.

What Is A Fair Share Of Life?

Emanuel insists he is not proposing a scheme to ration health care. He’s not even asking anyone to agree with him and knows that most people (including his family members) won’t. He’s simply looking at the quest to extend the human life span and asking how much is enough. How many years do we wish to accumulate, and how many experiences? Does the time come when we can say we’ve had our fair share?

Certain Eastern yogis and holy men are said to have left their bodies when they felt it was time, nonviolently finessing their own deaths. Is 75 a good time for that?

(MORE: Choosing Death: Aid in Dying Gains Support)

The Atlantic article brought me face-to-face with my own measure of denial about aging — my belief that if I adopt the right diet, exercise and take supplements I can stave off the worst of it. Emanuel has a phrase for people like me — he calls us the “American immortals.”

The sad truth is, it’s all going to all fall apart in the end, no matter how much mangosteen and maca I consume.

Nor is it useful to point to the exceptional elderly, those who are still pursuing higher mathematics, running marathons or weaving tapestries at 90. These “outliers,” as Emanuel calls them, are not the norm.

For the vast majority of us, physical abilities atrophy and creative output stalls at a certain point in life. If you haven’t written the great American novel yet, you’re probably not going to write it at 75.

The Mysterious Importance Of Aging

Emanuel makes an interesting case and raises some provocative questions. But there’s one thing he gets wrong, I think — and it’s a biggie. He makes the mistake of assessing old age from the vantage point of youth, applying the values of productivity and accomplishment to a period that might better be suited to contemplation.

Perhaps the life task of extreme old age is not to contribute in the ways we are used to thinking of as important. Maybe the job is to downshift and, I don’t know, breathe.

Maybe old age is a prayer and the nursing home, a cloister. Maybe all those old folks who look like they’re doing “nothing” are in fact doing something mysteriously important.

Sean Strub in Body Counts, his memoir of the AIDS epidemic, described a dying friend who felt that suicide might be an option if things got too bad. But in the end, a shaft of sunlight coming in his bedroom window proved so beautiful and beguiling that he felt life was still worth living so long as he could see it.

Maybe we, too, will experience these small moments of grace more fully as we age. Maybe they will give us reason enough to live past 75 — even if we are no longer able to climb Mount Kilimanjaro.

acqueline Damian is a writer and editor living in Milford, Penn. She wrote Sasha’s Tail: Lessons from a Life with Cats, and pens Lost in the Sixties, a weekly column for boomers for the Pocono Record.

October 5, 2012

Woman in NY Wins The Right To Die Through The Courts

A cancer-stricken woman fighting a right-to-die battle against her parents won the backing of an appellate court Friday, which ruled that the 28-year-old bank manager from New York City who is paralyzed as a result of a brain tumor may decide her own fate.
The emotional case has been playing out in Grace SungEun Lee’s room at North Shore University Hospital on Long Island, and on a Facebook page, Save Grace SungEun Lee, created by those who sided with family members desperate to keep Lee on life support. As word of the appellate court’s decision spread Friday, the page was swarmed with comments from people arguing for and against it, underscoring the passionate debate that surrounds the issue of individuals’ rights to choose death over terminal illness.
 Only two states, Oregon and Washington, permit people with terminal illnesses to request prescription medication to bring about death. But in all states, mentally competent adults may decide for themselves if they wish to go on with life-prolonging treatments even in the face of terminal illness.
That’s the situation Lee faced when she became paralyzed from the neck down in September as a result of a brain tumor and was given a few months to live. Lee has been on a ventilator since September, and her doctors at North Shore say she has clearly expressed a desire to be removed from life support to end the suffering.
Lee’s parents insist she is depressed and heavily medicated and in no position to make such a decision. The deeply religious couple also say that hastening death would be “a sin.”
“I cannot imagine my daughter is suicidal,” her father, Man Ho Lee, a minister at Antioch Missionary Church in the New York City borough of Queens, said at a news conference before the court’s ruling.
“I believe when someone sets a time and date to die, that is considered a suicide and a sin,” he said, speaking through a translator as Lee’s mother, Jin Ah Lee, wept. “It is very important for us to let doctors know … they have no right to take somebody's life.”
Lee added that, despite his daughter’s prognosis, he believes “she can win this battle.”
Jeffrey Forchelli, a lawyer representing the family, said that a hearing last week on the family’s request to extend a temporary restraining order keeping Lee on life support was “just a short hearing that really didn’t cover all the issues.” He had said a more comprehensive hearing was needed. The family had hoped to keep the order in place and be put in charge of their daughter's medical care.
The bottom line, Forchelli insisted, is that the parents “know best what their daughter thinks” and are convinced she wants to keep living.
On Wednesday, the family bolstered its argument by posting to YouTube a video they said shows Lee expressing to a cousin her desire to be moved into a nursing home and put under her parents' care. The video shows Lee, unmoving in a hospital bed and a tube in her throat, listening as a man leans in close and asks if she is willing to sign over her medical proxy to her father.
Lee cannot speak but moves her mouth, saying "yes," according to the cousin.
Newsday reported Friday that a spokesman for North Shore, Terry Lynam, was "in no rush" to take action. "Her attorney will be meeting with her to determine what her wishes are, and the hospital will abide by whatever she wants to do," Lynam said, according to Newsday.
The case is reminiscent of the long battle that pitted the husband of a Florida woman, Terry Schiavo, against Schiavo's parents, Robert and Mary Schindler, after Schiavo collapsed and fell into a coma in 1990. But unlike Lee, who is fully conscious and, according to her lawyers and doctors, fully competent, Schiavo was in a persistent vegetative state as her parents fought to keep her on life support.
Schiavo's husband, Michael, eventually prevailed in a court battle that lasted from 1998 until 2005. A judge ordered his wife's feeding tube removed in March 2005, and she died later in the month.

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