Good morning.  Welcome to Forum.
We have one Forum rule: that no one pose a second question or comment until everyone has had a chance to speak once.

When talking about the right to die, it’s a little difficult to start with a joke like people are supposed to do.  The closest I can come is to tell you that a lady once invited me to speak about the Hemlock Society.  When she discovered I wouldn’t be talking about the Hemlock Division of Girl Scouts, she dis-invited me.

Let me start by putting the right to die in historical perspective.  Most people know that the Greeks practiced euthanasia from the 5th century, B. C.  We also have heard that Socrates drank a hemlock extract. Most people don’t know that his beverage was plant juices from Coniium maculatum, a different species of hemlock than our Pennsylvania state tree.  The plant was originally widely distributed in the world, but because a few drops of the extract can kill a small animal, farmers have largely eradicated.  Nonetheless, it has been used to treat neuralgia and cancer pain.  That makes me believe that it might not lead to a painful death.

The first modern euthanasia society was formed in London in 1935.  Then in 1969 Elizabeth Kubler-Ross’ book, Death and Dying, triggered debate about treatment of the dying. The American Hospital Association prepared model Patient Bill of Rights in 1973.  The first American hospice was formed in New Haven, CT in 1974.  The Netherlands Supreme Court approved voluntary euthanasia in 1984.  The Unitarian Universalist Association resolved to affirm right to die in 1988.

Choices in Dying
Today, there seem to be three ways to die: let nature take its course, put one’s life in the hands of a hospice with the assurance that adequate pain medication will be available, or determine the time and place of one’s own death.

Who can make decisions about your life?
You can make decisions yourself as long as you are able.  If you can no longer speak for yourself, it’s important to complete an advance directive and to designate an agent to speak for you when you cannot.  I think it’s advisable to pick someone who will be forceful in demanding that your wishes be carried out and give that person your medical power of attorney.  Otherwise, physicians may be making decisions on your behalf and some of them are unable to admit that they cannot cure a patient.  Even well-meaning relatives may be making decisions and they sometimes argue about what treatments to authorize or insist that a dying relative get every possible treatment, even painful, futile treatments.

The consequences of not having your wishes clearly specified and not having a forceful agent to represent you were described by a former intensive care nurse, writing in Washington Post, “Authorities arrested Kevorkian for helping patients find relief in death, but not me for tormenting patients as they declined and died.  I used high-tech tools on people everyone knew couldn’t be helped and didn’t want treatments.  I prolonged their agony, and I knew what I was doing.”
I’m a staunch supporter of the right to die mainly because I watched my mother die by what I call medical mauling.  That experience made me determined not to relinquish control of my life.

How to Take Control
 If you want some control over what happens to you at the end of your life, you need to prepare an advance directive, or living will, to make clear what treatments you do and don’t want while you’re able.  Hospitals require a directive when you are admitted, but it’s not good to wait until you are already ill to make such decisions.  Advance directives have been legal in all 50 states since 1994.  You can get forms from any hospital or you can ask your attorney to prepare a directive for you.  You also need a medical power of attorney for your representative (your spouse, one of your offspring, or a good friend) to make sure your wishes are followed.
It is very important to make sure your representative and your primary care physician have copies of your advance directive and medical power of attorney.  You might want to keep copies in your vehicle and where someone can bring them to you if you are suddenly hospitalized.  Call Judy Henry, Centre Community Hospital, 231-7000, for   information packet about advanced directives.

The law in Pennsylvania is not clear about whether your agent can refuse treatment on your behalf, especially if the recommended treatment might be considered beneficial.  And that’s all the more reason to be as specific as you can be about unwanted treatments.

Do we need right-to-die legislation?
My answer is a resounding YES.  If I’m in agony, not going to get well, or I soon won’t know who or where I am, I want to die as quickly and painlessly as possible.  Without right-to-die legislation, the only way terminally ill patients can hasten their deaths is be refusing food and/or water or self-administering some drug in quantities that might not work.

Where is aid in dying legal?
Aid in dying can be provided within the United States only in Oregon.  It is also available in three other countries: Netherlands, Belgium, and Switzerland.  The Swiss law was established in 1942.  Beginning in 2000, organizations began forming in Switzerland to allow people to come to that country to end their suffering.

One case publicized recently concerned a 74-year-old paraplegic in constant pain, who went from his home in England to Switzerland.  He was examined by a physician and found to be terminally ill.  Later that day he sipped a barbiturate solution through a straw and died in 4 minutes.  Four Swiss organizations now provide aid in dying, and so far only small numbers of foreigners have taken advantage of the law: 3 in 2000, 38 in 2001, 55 in 2002.  Most patients are from Germany where strict post-Nazi laws prohibit aid in dying.  The Swiss are not keen on becoming a tourist suicide center.  The feature of their law that makes this possible is that it has no requirement that the patient and the physician have a long-term relationship.  Other places that allow aid in dying require that such a relationship exist.

What restrictions are imposed?
In addition to requiring a patient-physician relationship, aid-in-dying laws generally require that: (1) a patient must have repeatedly requested aid in dying orally and/or in writing and that (2) two physicians must judge the patient’s condition terminal.  Some jurisdictions also require that palliative care be considered and/or a psychological examination show that the patient is of sound mind.

Who opposes aid in dying?
The strongest opposition to aid in dying comes from the Roman Catholic Church and conservative Protestant groups.  Legislators also seem to oppose such laws even though a majority of their constituents approve of them.  Harris and Roper polls have rather consistently shown for several years that about sixty percent of Americans do approve of the right to die.

What organizations help people who wish to end their lives?
According to data on the web, the U. S. has 8 right to die organizations and Canada has six.  Also, twelve European countries, India, Japan, Colombia, Union of South Africa, and Zimbabwe each have at least one.  The World Federation of Right to Die Organizations has thirty-three member organizations.

The two organizations most familiar to me are the Hemlock Society, of which I am a member, and Compassion in Dying.  Both have programs that provide trained volunteers to sit with dying patients and make sure their wishes are followed.  These organizations also work to educate people about aid in dying and lobby state legislatures to pass laws that would permit aid in dying.  At this time, Arizona and Hawaii are the closest to getting such laws passed.  States that also have legislation pending include Washington, Maine, New York, and California.

Hemlock Society, P.O. Box 101810, Denver, CO 80250-1810
e-mail:hemlock@hemlock.org  1-800-247-7421

Compassion in Dying, 6312 SW Capital Hwy # 415, Portland, OR 97239
503-221-9556

The Oregon law has been in effect for more than four years.  Statistics for 1998-2002 found on website: Deathwithdignity.org/resources/oregonstats.htm show that 198 prescriptions were received by people who requested them, 129 prescriptions were used to induce death.  The median age of those who died was 69 and the deaths by prescription accounted for 0.09% of all deaths in Oregon during the time period. Of those who used the prescriptions, 98% had insurance; 97% Caucasian; 55% men, 45% women; 47% married, 22% widowed, 25% divorced, 6% never married, 51% high school or more education, 38% college graduates.  The most common end fo life concerns were: losing autonomy- 85%, decreasing ability to participate in enjoyable activities- 79%, burden on others- 35%, and inadequate pain control- 22%.

 Attorney General John Ashcroft has attempted to abolish the right to die in Oregon.  A hearing in the case of Ashcroft v. Oregon will take place in the 9th Circuit Court, Portland, OR on May 7.

How do hospice programs mesh with aid in dying?
The goal of Hospice is generally to emphasize palliative care and to provide effective pain relief even if the medications shorten a patient’s life.  I’ve not found information on the relationships between Hospice and the acceptance of aid in dying.

In summary, I think legalization of aid in dying is an idea whose time has come. It would allow suffering patients to avoid painful futile treatments.  And nobody would be obliged to take advantage of the law.

Recommended reading
Spong. John H. “Death: A Friend to be Welcomed Not an Enemy to be Defeated,”
End of Life Choices vol.1 No. 4, Fall 2002, p.13-16.  Published by Hemlock Soc.
(UU World recently carried a short article by Bishop Spong.)

Yeoman, Barry.  “Colleen’s Choice,” AARP, March & April 2003, p.66-8,71-2, 84.
(Includes an insert about Diane Meier, MD,  former supporter of aid in dying who now says patients want to die because of despair.)
 

Also, watch for Joan's new book of essays, LIFE IN A SLOWER LANE.