Steven Wallace recently shrieked away his last terrible days in Kennewick, Washington. Died beyond the boundaries of agony even though there was a legal means to speed him to his inevitable demise. Died even though he vowed 22 years ago when cancer devoured his wife that he’d never go out the way she did, begging for more morphine.
This occurred even though he followed all the steps required of him under the state’s new death-with-dignity law. For Wallace that law might just as well have never been on the books. He couldn’t get a doctor to agree to prescribe the drugs that would end his life. So, instead of standing at his bedside and saying their peaceful goodbyes, his family had to flee his screams. It may not be so long before most states have such laws on the books. And it’s likely that people who live in less populous and more conservative regions of those states will run into exactly what Wallace did. If such laws are to mean anything, a solution must be found.
I was raised a Catholic until I was 13 and then redirected to a conservative branch of Lutheranism after my mother married my stepfather. Suicide was anathema under both doctrines. I was taught that anybody who commits suicide goes automatically to hell because there is no way to ask forgiveness for murdering yourself after the fact. So I believed for several years that my great-uncle, who took his own life with a .32 pistol a few months after his wife died, never got to see her in the hereafter because he went down and she, who attended Mass several times a week, went up. There has been a clerical softening of that particular view of the afterlife in the 40 years since I became an unbeliever, but, of course, strong religious objections to suicide remain.
Not being religious, I have none. Suicide, to me, is merely a personal choice.
I just think there ought to be three rules: Leave a note; don’t make a mess for your loved ones to encounter; and don’t take anybody with you (as some well-armed guys upset about a lost job or adulterous wife or life in general choose to do each year).
Actually, I have a fourth rule: If you’re on the verge of killing yourself, think again; talk it over with your family and friends; deeply consider the pain you may cause in your effort to evade the pain you feel; don’t take action until you’ve sought professional counseling. And if you call me, expect that I’ll probably do all I can to discourage you from doing yourself in. I know, I said suicide is a personal choice. So why would I try to delay you or talk you out of it? Because I would want to be absolutely utterly totally certain that you are absolutely utterly totally certain you want to end it all. I might agree with you, I might not. Whichever the case, ultimately, you would have to do what’s right for you.
I am likely to agree if you have a terminal illness and the unavoidable end is approaching. It would probably be my choice. Not that I am saying everyone terminally ill should off herself. I just think every adult should have the right. However, not everybody has the williness to jump off a building, sling a rope over a beam, put a razorblade to their wrists, put a pistol under their chin. And, of course, those crippled, paralyzed by disease or trauma, and the otherwise bedridden can’t end their own suffering. So, what’s most important – what Washington’s and Oregon’s and all death-with-dignity laws are ultimately about – is that everyone has the right to assistance.
Washington’s law, passed by voter initiative last November and coming into force just two months ago, seems to have plenty of built-in protections for doctors, pharmacists and patients. Among them:
The patient, who must be a state resident, must be a mentally competent adult diagnosed with a terminal illness that will kill him or her in six months or less. The patient is required to ask orally for a lethal prescription, then apply in writing, then ask orally a second time at least 15 days after the first request. The written request must be witnessed by two people, one of whom is not related to the patient nor will receive even a nickel of the patient’s estate, and none of whom can be the operator, owner or employee of a health facility where the patient is being treated. A patient may change her mind at any time. Only doctors of medicine and osteopathy can prescribe the life-ending drugs. Doctors and pharmacists who participate in good faith compliance with the law cannot be censured by professional organizations or a health care providers, nor can they face criminal or civil liability. Doctors are not required to prescribe to anyone. Pharmacists are not required to fill such prescriptions.
In that last bit lies the hurdle for the Steven Wallaces of the state, and of Oregon, where its 11-year-old death-with-dignity law is much the same. If you live in Seattle or Portland – and, someday, let us hope, Manhattan, Austin or Memphis – you’ll have no trouble finding a doctor willing to prescribe the medication you seek. Indeed, three residents of Washington have already done so. Last year, 85 Oregonians requested such prescriptions, although only 46 used them.
But Kennewick isn’t Seattle. It’s the largest of the "Tri-Cities" nestled on the Oregon border at the confluence of the Columbia, Snake and Yakima Rivers, a fast-growing area of 165,000 people just southeast the notoriously toxic, now-decommissioned Hanford Nuclear Reservation. The plutonium for Fat Man, dropped on Nagasaki – and other nuclear weapons – was processed there. That’s where Wallace had worked much of his life. One of his tasks was to transfer radioactive, chemically noxious stew from one leaky tank to another. His children think that’s what gave him the pancreatic cancer that killed him. Such connections are impossible to prove.
Wherever it came from, Wallace didn’t want to let it take its natural course. Given only weeks to live by his physician, he chose to die in his own bed with an assist from a prescription of barbiturates, and his family agreed. He was prepared for a dignified exit.
But as Kim Murphy at the Los Angeles Times wrote, he was denied that. His doctor wouldn’t write the prescription.
The family appealed to the hospital, got nowhere, and called two other hospitals in towns nearby. None of the doctors in the area was willing to give Wallace, 76, the pills for his deadly sleep. ...
It was very hard to watch my father die that way," said Tricia Crnkovich, who took turns with her brothers and sisters in Wallace's small bedroom as he shrank from 250 pounds to 60, losing most of the weight in the two months before he died. "I'll tell you, if I ever get cancer," she said, "I don't want to put my kids through that." ...
[So the law] leaves residents east of the Cascades [mountain range] who choose to utilize the statute with the same problem women seeking abortions in conservative rural communities have faced: It's legal, but health providers' moral qualms mean it's essentially unavailable.
The Hippocratic oath admonishes physicians to do no harm. That is not something to be taken lightly. The world doesn't need any more Josef Mengeles. But many doctors, and 60% of Washington’s voters, apparently believe that a physician does no harm by prescribing lethal pills to someone whose death is already near at hand. Rather harm is caused by not prescribing.
But the law says doctors don’t have to participate, It probably wouldn’t have passed without that voluntary provision. This seems likely to be true in other states, too, where death with dignity laws have been kept off the books so far but will surely soon be enacted, just as medical marijuana laws have been.
Such being the case, what is the solution?
If we had a sane health-care system in this country, every community would have a public health clinic staffed with professionals – both allopaths and eastern practictioners - providing preventive care, vaccinations, exercise and nutrition advice, birth control devices and pills, abortions and, when appropriate, prescriptions for the terminally ill. But that’s a "socialist" pipe-dream. We’ve yet to get 50 million people covered under the inadequate system we’ve got now.
Are mobile units the answer to this predicament, where women’s reproductive choices and everyone’s end-of-life choices are incomplete because no local person will do what the law sets forth? While there’s some appeal to the idea of teams of doctors and nurses traveling a circuit, willingly providing what local health care providers refuse, that’s not much more likely to happen than those above-suggested clinics. First thing you know and we’ll have rightwing snipers taking out the "deathmobiles."
But, if Oregon’s and Washington’s and all death-with-dignity laws are to mean anything then we need to find a way so that Steven Wallace and all those like him actually get to make the choice that his fellow citizens and his family said he had the right to make.