I suppose on Memorial Day we should be paying tribute to our soldiers who lost their lives in the service of their country, whether long ago on the shores of Normandy or last week in Iraq. Our government seems only to acknowledge those who died in battle rather than those who die, sometimes much later, of the aftermath of war.
Listening to NPR this morning, I wept at the story of a soldier who ended his own life after returning safely from Iraq, unable to cope with the effects of post traumatic stress. He returned to his career in law enforcement but had difficulty remembering procedures. Sometimes, his wife said, he couldn’t even tie his shoes. His dream of being the youngest officer to achieve the agency’s highest rank was dashed. He taped a loving message to his wife, took up his service revolver and ended the anguish. His wife, a librarian, listens to the tape to keep his memory alive.
In the newspaper yesterday was the story of Linda Martinez, a gifted pianist and composer, at 29 enjoying success, busy, upbeat, but hiding from the world an inner battle with insomnia and back pain, her mother said.
How is it possible that these good people could find no help? It seems our society has more empathy for those suffering the relentless physical pain of terminal diseases like cancer. Why else would our state lawmakers be dealing with physician-assisted suicide?
Essentially, a copy of Oregon’s Death With Dignity Act, AB 654, would allow those with incurable illness to get a lethal prescription, which they must take on their own. The bill has other safeguards against impulsive decisions to end life. The patient, who must be at least 18 years old, must request the drug in writing once and verbally twice with a waiting period of two weeks. Two doctors must confirm the diagnosis, determine the person is capable and inform them of alternatives, including pain control.
Despite resistance from the Catholic Church and the federal government, the Oregon law has been described as a success. Not because it has been widely used, but precisely because so few people have used it. Since it became law in 1998, fewer than 70 prescriptions have been written each year. Of those, between 16 and 42 annually have actually taken the drug and ended their lives. Some patients say they don’t believe they will ever take the lethal dose, but that it’s comforting to have a way out if things become unbearable.
Where one stands on suicide, assisted or not, depends a lot on religious belief. As a young Catholic, I was taught that suicide was the ultimate moral sin, one that would preclude one’s going to heaven, even being buried in a church cemetery or having a requiem mass. Evangelicals seem to feel the same way, except that they’re bent on forcing a ban on doctors’ prescribing lethal doses at patients’ request. Former U.S. Atty. Gen. John Ashcroft went so far as to threaten revoking Oregon doctors’ licenses under a federal statute regulating prescription drugs. Overruled in court, Ashcroft appealed to the U.S. Supreme Court, which agreed to hear the appeal sometime next term.
Of the many friends and relatives I know who suffered from terminal illness, all but one wanted to end their lives, but either lacked the means or fought the impulse on religious principle. None wanted to die in a hospital, but they all did. One brave World War II veteran with an extraordinary tolerance for pain, collapsed from an overdose of alcohol and pain killers, was taken to the ER and subsequently diagnosed with metastasized cancer, probably from a melanoma removed a year earlier. Asked by a friend who is a nurse if he was afraid to die, he said, “Not at all. I’m afraid to live.” His son was afraid that if he were allowed to return home he would demand a gun to end it on his own terms. Fortunately it didn’t come to that. He went into a coma and died within a week.
Now, a dear friend, retired after working for our family since his discharge from the Marines after fighting in Korea, has been diagnosed with brain cancer. The prognosis after surgery is six months survival. At what level of competency, the Veterans Affairs doctors won’t say. Even having signed an advanced directive and appointing a durable power of attorney, will he be allowed to refuse treatment? Surely doctors at a federally funded hospital wouldn’t be permitted to prescribe a lethal dose even if the California law is enacted. And if he is allowed to return home, even for a short time, will he find his old service revolver and make sure he won’t have to die in a hospital?
The VA doesn’t provide hospice care and the Wadsworth facility has a waiting list that grows weekly as soldiers are shipped back from Iraq. As a survivor of an earlier war, he’s been told it’s useless to apply. Veterans’ services are trimmed by budget cuts even as we send more men and women to war.
How do we care for the most vulnerable among us, according to their own wishes and beliefs, allowing for compassionate, but not artificially extended, end-of-life care? If California’s version of Oregon’s Death With Dignity Act provides one answer, then I support that.
We must find a way to give more autonomy to patients so that those who refuse to live in a drug-induced stupor can maintain some control over their lives and ultimately their deaths. If nothing else, it would save families the trauma and guilt of losing a parent, a spouse or a child by a self-inflicted gunshot.