Why I Do Not Support I-1000

HorsesAss.Org » Blog Archive » Why I Support I-1000, or, Dyin’ Ain’t Nobody’s Business But Your Own:

Respone to Michael Hood of Blatherwatch who support the Deathe woth Dignity Initiative

Michael"

I do not think this legislation accomplishes your goals.

The number of folks using the law in Oregon is small. Clearly there is much less demand than anticipated by the proponents.

Even for those 50 or so folks using the law, we have no way of knowing whether the law has made this choce easier or harder. As noted by Charlie Kee above, the actual prescription of these drugs is now legal/ Though the intent may be more subtle than some folks would like, as far as I know there has never been a legal challenge to the current practice.

The number using Oregon’s law may be smaller than anticipated for at least two reasons. First, the class served … people wishing to die sooner after being diagnosed with only six months to live and with enough peace of mind to be able satisfy the pyschological issue, may be very small. Second, since prescribing this cocktail is not illegal, the added requirements of I-1000 may put many off.

The bottom line is that the Oregon law seems to have had little effect. So, one can choose to argue against I-1000 as accomplishing nothing or for it because it seems to have done little harm.
In my opinion there can also be harm"

Here is the beginning of my post. And here is the rest of it.

To explain why I think there can be harm, let me tell my own story of a recent death.

My 92 yo Dad had been sick for several years. We knew that eventually he would die as a result of accelerated aging changes in his lungs attributed attributed to many years of tobacco smoking as a (much) younger man.

This time he went into the hospital and … as with your Dad .. there was the usual terminal issue of prolonging life vs. prolonging suffering. We … my Dad, the family, and the medical team worked together in a way that I will always treasure to find a golden mean. He worked out his wishes as to how much effort he was willing to make to keep alive and conferred legal authority to one of us in case he could no longer express those wishes. When the time came , quietly, knowingly and with great love he was helped through these last few minutes.

I understand that some would say that this story is about a wink and a nod. That is a terrible oversimplification of a process that I suspect is impossible to define by law.

I am afraid that legalization of something that is not now illegal would create its own troubles. As it happened we did have some dissent in the form of a rabbi, a friend of the family, and one non-immediate family member. If we had been in Oregon, I can easily imagine that there could have been insistence that a second physician and a psychologist be called. The Oregon law and I-1000 are very unclear about who these arbitrators might be but it is not hard to imagine the basis for legal mischief. In the worst of situations, it is not hard to imagine docs who turn such a thing into a “specialty.”

Because the designation of legal authority was very clear and frankly because of the skills fof the physicians in managing us all, there was, in the end, no problem.

So, based on my own recent experience and the talent of the crew at Boston University School of Medicine, I am grateful that we did not have to jump through extra hoops.

My final concern is based on another story.

The story is almost identical to my Dad’s story with one exception … my friend and his dad had less money than we did.

As his Dad approached death, he was approached by the social workers about ways of becoming impoverished. In his state, you can get terminal care in a hospice or hospital if and only iff you have the money or have so little money that you qualify for state funds. There are even specialized social workers and even nurses who make a living helping people plan for impoverishment. (my sister in law once had such a business)

Imagine the pain his friend’s dad went through as the “system” systematically drained his funds .. especially because those funds were important to support his surviong but quite ill wife, now his widow.

There is NOTHING I can do that overstate this Kafka-esque situation.

What would I-1000 have achieved in this case? My guess is that my friend’s dad would have sold a few days of his life to allow his wife to have some dollars to relieve her own end.

If you will permit me to be macabre, this story shows a “fatal flaw” in I 1000. There should never be a financial incentive to die. The moral stress placed on the patient in this story is too cruel to imagine.

The story also shows a second “fatal flaw” in I-1000. The law puts the decision to offer a suicide cocktail in the hands of the same individual responsible for the patient’s care. Under HMO rules, that individual’s pay likely will depend on the costs of care for his patients. As proud as I am of my colleagues, I fo not think anyone should be placed in that sort of conflict of interest.

So, wiht respect to a lot of good friends who will vote for I-1000, please think about the oath that we physicians take on graduating medical school:

primum non nocere first, do no harm.