Tuesday, March 13, 2012

He Practiced What He Preached


Dr. Peter Goodwin, one of the first proponents of Oregon's Death with Dignity Act, ended his own life on March 11th after taking lethal medication, a fast-acting barbituate which provided a peaceful death in less than 30 minutes. He was 82 years old and suffered from a rare and fatal brain disease called corticobasal degeneration which affects balance, muscle control and speech as well as cognition. In January, he was given six months to live.

Under the Oregon law, doctors can prescribe medication to hasten the death of terminally ill patients with a six-month prognosis. The patients must be mentally competent and administer the drug themselves. More than 500 people have used the Oregon law to end their lives. The initiative, the first in the country, has survived a Supreme Court challenge. Washington also has laws allowing physician-assisted suicides.

A year ago, Dr. Goodwin said, "I don't want to die. No way do I want to die. I enjoy life; I enjoy company; I enjoy my friends. I have many, many, many friends." But the horrors of his illness apparently changed his mind and he died surrounded by his wife, four children and their spouses.

He practiced as a family physician in Oregon and Washington for five decades, and was instrumental in getting Oregon's Death With Dignity Act passed in the early 1990s when it was expected to fail at the ballot. He first became interested in the cause 20 years ago when a patient asked for his help. The patient had a fatal spinal tumor and was in severe pain. The patient's wife asked Goodwin if she could administer a prescription, but he reluctantly refused, telling her it was against the law.

He told the story to the Oregon legislature, saying his inability to act when the man was in such pain made him feel like a coward. "We cannot deal compassionately with people if we limit their options," he said.

At what point does a person determine that his quality of life does not justify being alive? It is inconceivable that one should ever be in that position, but it is also unimaginable to live in constant pain, or to be reduced to a set of involuntary impulses with all ones unique personality erased by a horrible disease. Most religions would have us believe that suicide is a sin or at least a most negative action, and that to commit it brings hideous consequences. I would like to think that any God worthy of our worship would be compassionate enough to understand that humans have limits.

In some ways, suicide is the final taboo. While it could be argued that our bodies belong to us alone, the concept of doing violence to ourselves is usually harder to grok than committing it on others. So we rationalize that those who take their own lives are not in their right minds. The Oregon law is an exception in that the doctor who prescribes lethal medication must first determine that his patient is in fact thinking clearly. Of course, this is hard to prove or disprove.

I cannot imagine the sorrow of losing a loved one by his own choice, yet who among us would choose to keep a loved one in great and incurable pain? It is impossible to condemn a person who exercises the right to choose his own death. The question really is, does he or she have that right? I believe so, although my heart breaks at the thought of it. What are your beliefs on this topic? I would really like to know.

19 comments:

nick said...

I do agree with you, and with the Death With Dignity Act. We should all have the right to end our own life if it has become intolerable, and it's absurd to be forbidden from doing so - the negative influence of religious strictures yet again.

Yes, it may cause distress to the loved ones and friends left behind, but if they respect your right to control your own life, they should accept your decision.

the walking man said...

Right around 1987 I had about 1/2 hour talk with Jack Kevorkian while his van was in the shop about why he was doing what he was doing. It was totally non confrontational. He said that he had spent time in Europe where it is a common practice to alleviate the suffering of the terminally ill at their request. This was before his first Not Guilty verdict.

As we talked I understood, even though at the time I had not gone through most of surgeries I have since then to relieve pain but I understand why now.

When he and I were talking it was right about that time that 25 years of chronic pain started for me, drugs , drugs and more drugs, hell as long as I could stand I could have another drug. At one time I had 11 scripts from three doctors all working in concert--I was too young, to work in this verified pain so mask it up with a narcotic and life is good again.

Bullshit.

Forced into retirement at 25% pay at age 45...bullshit. Now About 15 surgeries later I am coming off my 4th neck surgery because unfortunately the first accident didn't kill me. I won't take the drugs anymore because the kicking them is worse than the pain.

But honestly if I am ever diagnosed with a terminal state, the very doctor that tells me that will hear me tell him "eat shit, kiss my ass and thank you." I never have to see one of you bastards again. I will go home and live until I die.

Pain I have found I can handle, the thought of death doesn't scare me a whit but the thought of never being poked or prodded or looked at by another physician is a life relieving thing for me to look forward to.

If a person is known terminal, why the hell would we prolong their life if they didn't want it? Some people understand that death has nothing to do with spirituality, all things die and all seasons pass only to be born to a new life when the proper time comes. The creator set up life and death as a system not a fucking set of rules.
The rules stem from man's own fear overcome that fear and death suddenly begins to be a place in the light not the dark.

Bob said...

I don't understand what the big controversy over this is. Why not allow people to have a dignified death at a place and time of their choosing? I understand regulating it if you want a physician's assistance, mainly to indemnify the physician though. If your personal beliefs (religious-based or otherwise) are such that you don't believe in it, then don't do it - but don't prevent others who don't share your beliefs from having that option.

I'm a big fan of life - even if it isn't easy. But I understand that that isn't an absolute, that death sometimes is a viable option. I would like that option open to me should I need it. I hope my wife has the courage to make that decision for me if I am incapable (the Terri Schiavo fiasco comes to mind).

I just don't get why so many people want such control over my life and choices while they speak of less government intrusion into their lives - out of the other side of their mouths.

Jo said...

You're right. Suicide is the last taboo. But I completely agree that a person should be able to decide when the quality if life is no longer worth living, and I know there are compassionate doctors, who have seen enough suffering to know that assistance with the final act of a person's life is sometimes the most humane thing to do.

When my mother was in her last days, she was suffering terribly. It caused my daughter and me so much anguish to watch Mom suffer like that, and not be able to help her. I kept looking at her and saying to myself, "Please Mom, stop breathing, stop breathing". She suffered so much. Her primary care physician had tears in his eyes, watching her. He said to my daughter and me, "I am going to give her something for the pain. You girls wait in the hallways for ten minutes." When we went back in, my mother had the most beautiful, peaceful expression on her face, as she took her last breaths. My daughter and I held her hands, and no one said anything. To this day, I bless that wonderful kind, compassionate doctor. I understood what he did.

Lex said...

I was definitely raised to believe that suicide was the unpardonable sin. And I think that's rubbish -- as do I the entire doctrine of sin, but that's for another post.

I believe in one's right to make choices for one's own life: whether to have a baby or not, whether to marry or not, whether to suffer or not. Period.

Too many prohibitions like this one are made out of fear for the survivors and, honestly, I think that's a bit selfish. One person's anxiety about what may or may not happen to another's soul if s/he choose to suicide doesn't preclude that person's right to do so.

I have only been to a couple of funerals of people who have died by suicide and I really hate them. It really is the last taboo. It's like some dirty secret in the room that no one dare utter. No one ever acknowledges the suffering the person has freed himself from and I think that's awful.

Secret Agent Woman said...

It probably doesn't surprise to see all your readers weighing in on the side of being allowed to choose to die. It's insane to me that pets are afforded a more humane death when they are suffering than people are. I sincerely hope to be able to die a peaceful, natural death but I would take an overdose before I suffered through a prolonged debilitating terminal illness. I just hope I am able to see it coming in time to do something about it.

Elaine Steward said...

I am a strong proponent of death with dignity - which means the dignity of the person who is dying is respected and they are permitted to choose life or death when the time comes.

My father came as close to physician assisted suicide as one can in most of the US. He declined treatment and found a doctor who agreed to keep him comfortable regardless of the consequences of the comfort. My father made sure that we kids met with the doctor so that we could let the doctor know that we supported his decision.

My husband committed suicide which, as far as I and anyone who knew him know(s), was a different matter altogether.

I have done what I can to see to it that if the time comes, everyone involved (family and durable power of attorney person) is concerned knows that I do not wish to be kept alive unless there's a reasonable expectation that I will come out of whatever it is in at least as good shape as I went in to it. I have a durable power of attorney for health care, a just plain durable power of attorney (not sick in the traditional sense, but not competent),and a Five Wishes document (available on line). My doctors have copies of durable power of attorney for health care. I tell the appropriate people when some new twist comes up (e.g., in CA paramedics HAVE to resuscitate unless you have a specific Do Not Resuscitate - Advance Directive signed by a dr).

I may still be kept alive against my wishes, but at least I can say that I have done what I can to relieve my family and friends of any guilt whatsoever if I am fortunate enough to have my wishes honored.

mischief said...

It all leads me to wonder if there's a difference between choosing to die because the physical pain is intolerable, and choosing to die because the emotional pain is intolerable. For some reason it is easier to accept the first than the latter. At least, it is for me. When my loved ones have been diagnosed with terminal illness, and lived their last days in intolerable pain, there has been no question in my mind that they are entitled to die with dignity. However, when loved ones have chosen to die because they have been unable to tolerate the emotional suffering any longer, my heart has struggled to accept it.

That is, I don't question a person's right to make that decision in any case, not really, but I find it a more difficult decision to accept. There's a whole lot more "what if" and self-recrimation that goes along with that decision. Especially when we're talking about young people. It's so hard to accept the suicide of a young person because I want, so badly, to believe that things could have changed.

And I think about passive suicide versus active suicide. It's one thing to take a lethal dose of medication. And it's another to neglect one's own needs in a chronic way that results in slow deterioration leading to death.

Oh Susan, you ask such difficult questions. My heart hurts when I think about all the nuances.

I want the right to make decisions about my own body, my own life. But that's because I trust myself. I hate the idea of someone else making that decision in case they're wrong, in case there's still room for something to change. Not only for themselves, but for those who love that person.

I do not know if my sister's death was active or passive suicide. But in either case, there is peace in knowing she no longer suffers her pain. And yet, I cannot help but wish that there had been some other way for her to escape it. A person in her condition was in no state to make a logical decision.

The lines get so blurry, don't they? Is that because of the tears?

seventh sister said...

I think the key element is the person being able to make the decision for him/herself. I would love to see people supported in that. What we call death is just a leaving of this body. The person who departs feels relief. It is those 'left behind' who feel loss and need support as well.

heartinsanfrancisco said...

Wow! What intelligent,compassionate
comments from ALL of you. I am floored at the brilliance of my blog friends (and those of you I know in person.) I've been absent for a while and am humbled by the fact that you didn't give up on me and even more by your expressing my views so much more beautifully than I could. Thank you!

Maria said...

I am totally in agreement with you. I think it should always be a person's right to say when they have simply had enough of pain and suffering. And we are each different. I don't mean to sound like a braggart, but I have a very high pain threshold. I have rheumatoid arthritis, meniere's syndrome, migraines and pre-lupus. I'm also a cancer survivor. I am used to pain, it accompanies me almost everywhere.

Now, on the other hand, there is my partner. She has been healthy her entire life, has never even had a headache! She gets colds, etc. and just shuts down. She is now experiencing back problems and while she doesn't sit around complaining, she is very depressed. I look at her sometimes and wonder how in the world she would handle a serious illness if she can't handle this.

We both have agreed to help the other if one of us is dying and wants to leave early. We've read the books, discussed the methods and come to a decision. What utterly astonishes me is that if the worst should happen, our biggest worry would not be saying goodbye to each other. It would be worrying about covering our tracks well enough that the survivor is not arrested.

Isn't that just ridiculous?

Jocelyn said...

Thank you for the story of this doctor. So often we follow the passage of a huge piece of legislation but then fail to follow on its real-life ramifications.

I have respect and compassion for those who decide their lives need to reach their end. Could there be a more difficult proposition to have to mull over--how to toss that idea back and forth? At some point, the pain and sense of loss of one's former, "true" self must be so profound that putting a stop to gradual degradation seems the only way to retain the Self we've always known.

Claudia Hall Christian said...

I think you know that I facilitated my father's death. He'd told me the entire time I knew him, it was something he'd told me he believed. At the moment, however, the body and mind yearn for more life. I had to do it for him, for the man I knew.

And it was tremendously painful. I wish he'd had the opportunity to have my sisters around him. I wish it had been calm and peaceful instead of a sneaky and contrived.

More than anything, I wish he'd had a chance to make the choice himself.

It's very hard for me to believe that we have a 'right to life' and want to force rape victims to carry the children to full term, but refuse to guarantee any quality for the life that's hoisted on the child. Crazy world.

Thanks for the conversation!

heartinsanfrancisco said...

Maria,

After watching Flip lose more and more of himself to his disease(s) I told someone I love and trust that we would have to plan a way to end my suffering if I ever show signs of losing my mental processes without him or her getting into trouble with the law. It's a sad commentary on how stupid and inhumane our laws are.

Jocelyn,

I think that even death is preferable to becoming a living collection of cells once the spirit and mind that inform them has departed.

Claudia,

I did not know about this, only that you and your father were very close. It must have been the most difficult thing you ever did, an incredibly brave and loving act.

The "right to life" contingent becomes ever more grim and inhumane with every political victory they attain despite the many inconsistencies in their positions which seem to have only one thing in common: bullying.

PeterAtLarge said...

I share your belief that each one of us has the right to make this decision, no matter how agonizing to ourselves or our family.

Sextant said...

From a practical stand point I lean much towards Mischief's commentary. From a more spiritual aspect, which BTW only applies to me...I am not an evangelist, I believe the mind and body are tools for the Soul. The Soul's purpose is to learn and experience. When the body and mind are no longer functional to the Souls purpose, the Soul has every right to depart by what ever means it sees fit.

However I do draw a line a suicide. There is a huge difference between a person who is dying and an otherwise healthy person who wishes to die. The difference being, can the person solve the crises and will they lead something that approaches a normal life. In my more esoteric readings, I have read that people who commit suicide spiritually find themselves with the same problems but no Earthly abilities to solve the situation. One has thrown away their took kit. Sinful? No I don't believe so unless the goal is to punish others by killing oneself, then it is murder.

Ian Lidster said...

I have always found Oregon to be a very progressive state and that is why I like traveling there so much. That, and the beaches. But seriously this is a conundrum for so many and none of us knows truly unless we are faced by the reality the good doctor was.

Cro Magnon said...

It isn't the act itself, of ending life, that is the problem; it's the complications surrounding any legislation. The whole business of assisted suicide is open to all sorts of abuse, and any change in the law must be such that no abuse can possibly occur.

Personally I am FOR a change in the law. All humans should have control over their own destiny; however and whenever they see fit.

In my own close family, I have known one pointless murder, and one understandable suicide. The murder I shall never come to terms with; the suicide I have to accept as a matter of 'choice'.

Wanderlust Scarlett said...

I would want to let go and journey on the the great Whatever Is Next in the Universe.

I don't think it's murder, and I don't like the idea of calling it suicide, although to be honest, that's precisely what it is... I suppose.
When death is waiting, is it suicide? Maybe not. Maybe it is rowing oneself across the River Styx.

Thinking of you both, often, with love and peace.

Scarlett & V