Tuesday, January 17, 2006

Supreme Court upholds Oregon's assisted suicide law


Flashback: Spring, 1990. "The Hemlock Society called," says Mike. Their local chapter wants someone to tell them about "depression and suicide." I'm finishing my fellowship at Large Urban Medical Center. My program director told them to call me. Might I give them a brief talk?

"Of course," I tell them. I'm young and terribly naive. I bring my slides and handouts to their meeting.

They greet me warmly. It's a genteel group. They're all over sixty. I start my spiel: symptoms, statistics, treatments. There are conditions that cause such suffering, such hopelessness, that patients want to kill themselves. But often they improve when they're treated. Then patients say that they're glad they're still alive.

The group listens closely. (But "Please speak up, dear, we don't hear well.") Half of them have walkers. Some have oxygen. One in the back...looks awfully thin. Another is pale. Question time; any questions?

"Doctor, don't you think, if someone is terminal...and suffering intolerably...shouldn't they have the right to end it all, if they choose?"

Well, I say. Let me explain, I say. (Is it getting awfully warm in here?) Often that hopelessness is due to depression and pain. We can treat depression, we can treat pain...

They are patient, they are polite. They press me gently...then, firmly. They won't let go. "Suppose there is no hope. The suffering is not endurable. Even if you are trying to help us, it's just not endurable. Then shouldn't we have the right...and the means?"

Now they start to talk about themselves. One says she has advanced cancer. So do I, says another. Strokes, MS, pain...terrible pain...They peer at me across a chasm of illness and suffering.

An elderly man struggles to his feet. "I'm sick, do you hear me? Sick! And I'm dying! If I want to kill myself, I will, dammit! That's my choice!" The group applauds him. I'm sweating profusely now. My notes...my slides...did I volunteer for this?

Things continue in this vein, until they pry a tortured statement from my lips: If conditions are truly as they've described them...then they each have an important message that deserves to be heard, and respected. Ah! The relief in the room! They're beaming. The sandwiches are here; let's eat!

Their leader clasps my hand. "They love you!" he says. (Mike whispers, "Shrinkette, they want you to kill them.")

"Take me home, please," I moan. "My headache is killing me..."

Two months later, they call me again. They're worried about a new member. He's not terminally ill. He's not even physically sick, but he has some strange ideas, and he's suicidal. He sounds like some of those people I was telling them about. Could I please see him?

"Of course!" said I.


Anonymous Anonymous said...

This is an unbelievably complicated subject.

On one hand you have suffering people with no hope of recovery or a decent life; it is just a matter of time, with each hour more painful.

On the other, how do you know with certainty that there is no hope of recovery or a decent life?

I'm not trying to trivialize this, but every pet owner goes through this with a suffering animal who can't really tell us what's going on, and you have to make the decision based upon a best guess for what tomorrow will be like.

For anyone reading this, the Hospice workers were absolutely wonderful when my old mom was dying. I had no idea any group could be so helpful and kind.

8:37 AM  
Blogger Joel said...

If my psychiatrist or any of my docs told me that s/he gave out meds to the suicidal, I'd fire her or him.

God, what a position you must have been in!

8:02 PM  
Blogger Joel said...

I linked you from here:


8:25 PM  
Blogger Dr. Deb said...

I have mixed feelings about this subject.

5:27 AM  
Blogger Medicoglia, RN said...

I have mixed feelings on this too. After watching my grandfather die after horrible pain for several months, I really don't know what I would do if someone I loved asked for help in dying...he never asked me thank God...I don't know if the subject was ever brought up with anyone else.


6:43 AM  
Anonymous Anonymous said...

Talk about moral dilemmas! However,I have heard of the Hemlock Society.

5:19 PM  
Blogger Donna said...

I'm with Sera and Deb. I have mixed feelings on the subject. Thank heavens I have never had to make the decision except one time. My father had a massive brainstem stroke at age 45. My family and I chose to turn off the machines because he would have had no life at all. It took 36 hours for him to die. If the guy had been able to communicate and said something about wanting to die, I would have not hesitated one moment to help him. But, I have to say, part of the desire to help him die was because he was such an evil person.

I would never wish this decision on anyone.

Interesting aside: part of the word verification for this post was "die"

7:47 PM  
Blogger Greg P said...

"Dr. Deborah Serani said...

I have mixed feelings about this subject."

I worry about people that don't have mixed feelings on the subject.
In this day of 24 hour news consisting of a gazillion soundbites, it's hard to get people to understand the personal, individual issues before they've made up their mind about it.

On a personal note, I don't feel that I went into medicine to give people the means to kill themselves or be their executioner.

6:33 AM  
Anonymous Anonymous said...

I have come across a fair number of patients who, when hale and hearty, have said that they would want their lives ended if they were terminally ill with no hope.

In the UK a lot of people put what are called "living wills" in their family doctor notes which basically say "need to strive officiously to keep me alive...."

I have not yet met a single patient who, when terminally ill, has referred to these notes, not have I ever had a patient who has asked for his life to be ended.

Maybe I have lived a sheltered life.


8:24 AM  
Blogger David said...

This issue is basically uncomplicated, but baby boomer types can't concieve of getting things they want without screwing up society in the process. Who's actually physically preventing people from killing themselves? Being able to die isn't the problem, the problem is that they demand the approval and participation of other people, in the name of institutions that have already got enough to do without diversifying into killing people who'd do it themselves if they really needed to die so badly.

5:01 PM  

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