The Diane Rehm Show

When I was 25 years old I watched my mother die slowly and painfully after being diagnosed with terminal cancer. She was in a facility. The staff was caring and wonderful, but the process of dying was terrible. It took more than five months for her to waste away. She experienced hallucinations and was frequently unable to recognize family members. She was only 52.

I am now 46 and two years ago I watched my 80 year old father die slowly while receiving hospice care in his apartment at an assisted living facility. I participated in his care, administering pain medication several times per day. Again, the staff and hospice caregivers were wonderful, but the process was still awful.

Although I genuinely appreciate the loving care my parents received, I don't see how the palliative care they received was more humane or moral than giving them the right to decide when to end their lives would have been.

I was with my 96-year-old neighbor in the last days of her life while she was hospitalized with pneumonia. The antibiotics gave her a systemic yeast infection, and the pneumonia ran rampant. The yeast was eating away at the inside of her mouth and she could not eat. She was a living skeleton. I begged someone - anyone - to provide her with relief. I sat with her for hours while she begged me to kill her.

I take issue with your guest who indicated that doctors will do everything to relieve suffering. They did the minimum – no one offered “sedation” as your guest prescribed; just getting Atavan and morphine for her was a struggle. No one offered hospice. I defy any one who comments here to experience that absolute horror and then assert that human beings should not have more control over their dying. I hope none of you ever witness, let alone personally experience, her complete and utter terror or her unbelievable pain and suffering.

My friend, you are the one with little grasp of all the facts -- never mind your anti-government feelings. We spend more and get way less than per capita in terms of all kinds of health outcomes than any of the so-called socialized medicine nations -- and most morally offensive, we do have thousands who do die prematurely simply due to a lack of care because without insurance, the price of prevention is beyond so many in our very unequal society of haves and have-nots. Yes, some doctors do arrive here but that is also a consequence of our capitalist system -- making more money trumps every kind of moral and ethical consideration. There is nothing Christian about denying health care to your fellow Americans because of a belief that the medical professions can charge whatever profit margin they please.

Justin Demoude, medical paternalism knows no gender bounds.

I am very sure that until we the people take up the banner for self-directed dying AND show up near end of life well-informed about the treatment path we want, medicine will do what it has and is doing: attempt to control. Now, compassionately, medicine also attempts to fill the void we all bring with us, to solve our end of life problems for us. But they do it the only way most of them know how, subject to laws, ethics, job security, and ever tap-dancing around the subject most people who become their patients are too chicken to even mention let alone study and decide upon.

In response to a previous comment regarding lack of care and starvation of the patient:

This is what I was talking about! Your guests in general and Dr. Lowe in particular were about as cold and dismissive as fish in addressing this concern. Why should people trust policy administrators at all if they can only expect denial and dismissal of an issue and the conditions that caused or flowed from it? Is this how far removed patient care really is from patients today?

The real question is how to fire all you bureaucrats and replace you with people who actually care and are unafraid to provide the real care necessary, whatever that may require. And I'm not just speaking about hospice care here, I mean the entire industry. Can you blame the people for the level of mistrust directed at the government and the health care industry today.

I think THE fundamental issue of this debate was spoken by the veterinarian, obviously Christian, politician who said essentially that my life is not my life, it is “God’s”, who gave it to me and will take it away from me when “he” is ready. This position also believes that for me to end my own physical life, i.e. “commit suicide”, is an offensive and wrong act in the eyes of this “God” and I am eternally condemned and my body is not allowed to be buried in “consecrated” ground. Suicide is still very much considered an “immoral” or cowardly act, and the families of those who take their own life in their own hands still feel the judgment of society and a misguided shame. I have to live with whatever “He” gives me, play the hand I am dealt, not allowed to fold. I, and many others in this country, do not believe in this “God” and the morality based upon such a belief. So, the debate is essentially and forever a religious one, and those who believe as he does are trying to prevent us from acting according to our individual and personal religious/spiritual beliefs, i.e. this is MY physical life and I can do whatever I want with it and I can terminate it when I want. “I am the boss of me.” This is suppression of the freedom of religious thought and act guaranteed by the US Constitution. Until we start having this conversation all the rest your panel talked about is endlessly debatable and essentially irrelevant.

While my father was dying, he was in considerable pain...and asked repeatedly to die, all the while under the care of doctors that were making a fortune off of his illness. Finally, when I hate to say, he aspirated on his own fluids in his breathing mask and was no longer aware, we were allowed to give him increasing doses of pain meds that allowed him to pass peacefully.

Assisted suicide should be allowed to all that suffer from diseases that cause excruitating pain and will eventually take the lives of people.

I heard it said that liberals hate people and love government, where as conservatives love people and hate government. I will side with any political party that values life over the culture of death any day.

As the daughter of someone who died of ALS, I believe it is unfair to assume everyone who is ready to die is asking for death. My father was ready to die, but experience overwhelming anxiety, fear, and pain as a result of his illness; an illness that is defined as having no cure - a death sentence. God's plan was for my Dad to die from ALS, but the manner of his death was gracefully helped by physicians and nurses to alleviate his pain and anxiety. The health care providers allowed my Dad to die in peace.

As a physician I am constantly reminded how death has been "medicalized" - most people can not die without spending significant time and resources in a hospital. Frequently this death process is to no avail other than to prolong suffering and drain a patient's finances. My wife (also a physician) and I both want no part of this. We wish to live life fully, die when we (and no one else) feel the time is right, and leave whatever we choose to our loved ones, not our colleagues and hospitals. We view this ability as a fundamental right of the individual. Anyone else's view or morality is theirs and has no place in my life.

Having scanned through the comments today, may I point to a couple and bring a little sanity to this discussion please? I don't know what "Republicans" believe (as though they all believe alike) or what "Conservatives" believe (as though they all believe alike) but I know what I believe and I know why I believe it. So ...

billtmore wrote:
"GOP is hell bent on imposing their will in the beginning and end of life but those 60 70 80 years between, you are on your own jack, don't ask us for any assistance."
Essentially correct. The government should not and cannot take care of everyone between the womb and the tomb. That's your job, Biltmore, if you are able. But, one of the purposes of government is to protect those who are least able to protect themselves - those who are most vulnerable. In a civil society, the more defenseless a life is, the more it is up to us to give it value and defend it. That is why I am pro-life at birth, because the unborn deserve a say. The mother looks out after her interests. The doctor looks out after the interests of the mother, but the unborn have no one to speak in their interest but the state. Which brings me to this:
Freedom rocks wrote:
"There can be no greater Freedom than deciding when and how to end one own life". Yes. So, can we have some consistency please?

End of life is another matter, however. There, a rational person should be able to make that determination, but with the stipulation that the decision is their's and their's alone without coercion.

Those are the only points of view that are truly consistent, I believe, and represent the unltimate in self-determination.

Legal assisted suicide destroys choice for most.

1. In an environment in which medical cost cutting is a priority, people will feel selfish choosing care rather than suicide.

2. Caregivers, even doctors, can inadvertently give patients signs that their care is a burden.

3. Unassisted suicide statistics in Oregon, where rates began to rise after assisted suicide was implemented and were 35% above the national average in 2010, are consistent with suicide contagion.

4. Legal assisted suicide devalues the lives of people with disabilities. When doctors help some people commit suicide because they fear loss of autonomy, it sends a message about people who simply cannot survive autonomously.

5. Legal assisted suicide leads to insurance programs' steering people in that direction. Oregon Medicaid denied two people coverage for chemotherapy but offered to cover the costs of their assisted suicides.

6. Allowing doctors to assist in suicide provides cover for abuse. In Oregon, upfront safeguards protect doctors, but there are absolutely none once patients fill the prescription. The law requires no witnesses at the deaths. We will never know if a person is pressured, coerced, or murdered.

Any person receiving prescription pain medications can commit suicide without help. The leading cause of unassisted suicide among Oregon women is poisoning. There is no need for legal assisted suicide.

While clarifying that it is a crime to assist in suicide, the Montana law exempts from prosecution a doctor who prescribes medication adequate to treat pain, even if it has the unintended effect of hastening death.

The Montana law protects everyone's choices.

While I should note that I was only able to listen from about 10:30 until 10:50, I was rather appalled at the cold and dismissive manner in which some of the panelists, and in particular Dr. Lynn, were responding to issues concerning this most difficult and important period of life. Death and dying are not one-size-fits-all experiences, and people should not have to lose dignity and agency simply because they are approaching the end of their life. I feel that this basic recognition of the individuality and the humanity at the heart of every end-of-life situation was completely ignored by several of the panelists, and indeed run completely roughshod over by Dr. Lynn. It's truly scary to think that these are some of the people with the most power over policy and practice relating to end-of-life care.

I didn't hear the portion of the program involving the veterinarian, but it sounds as though it was equally troubling. I would love to have heard more from Barbara Coombs Lee, who seemed reasonable and compassionate.

Diane,

On my way home, I caught your show about assisted-suicide. Very interesting and agree that we need to have this conversation about dying and how we die. I was lucky enough to have time to help my mother as she declined during the past three years. I watched the pain and suffering and her wanting to die and join my father, but her doctor was rather clueless. But the hospitals and rehabs got a nice chuck of change and would send her home. I asked for Hospice -- no reply from her doctor or a supply of consistent steroids to help her breathe. It would have long-term affects on her bones, etc. She wasn’t going to be around to see these effects: I knew it, but could not understand why her doctor didn’t see it.

If you ever watched someone die of emphysema, (throw in heart failure, too) it’s a very painful death, and honestly, her pain could have been eased if she had a doctor that didn’t see himself as “God.” A few weeks before she died, he wanted to do a risky lung operation. Thankfully, the surgeon said, you’re crazy. What’s the point? (I’m paraphrasing.)

So thank you Diane for this conversation. To understand what is going on in the country about how we do or don’t deal with death, I’ve started a site called The Mortality Project. Feel free to post your thoughts.

http://pinterest.com/ctfarming/mortality-project/

PS – follow the money as Time Magazine did

http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-...

Diane,
I am a long time listener and I have never commented before but I am noticing as are friends of mine that there have been several instances where you have been really misdirecting the conversation. I recall being frustrated when you shut down a recent caller on gun violence who raised some very interesting questions but today was even more frustrating when you shut down your geriatrician guest.
She was really right on the point and no one does want to talk about it. As a member of the sandwich generation I am all too familiar with aging and dying in our society. I personally and at least 4 of my friends, have experienced exactly what your guest was talking about. A situation where a combination of illnesses has diminish quality of life with no outlook for improvement. The patient just wants it to end and the family is put through hell watching their loved one waste away along with their life's savings. Yes, providing relief from intolerable pain is interesting but the situation that I am talking about is much more common.
In at least two cases that I have been involved with the patient finally just stopped eating and then died within a week. I wondered why this didn't come up in your discussion. In any event I think your guest was right on and it would have been a very interesting discussion to have. (I think your other guest who contradicted her must be missing something. I presume people aren't going to say that money or pain in watching their loved one is the main reason in a survey. Of course they are mostly concerned about their loved one and straddled with guilt and a complex stew of emotions but these other issues are real and should be talked about.) I am disappointed in you Diane.