Not so Easy Sunday, this time
I posted on Friday about the assisted death of Robert Warren at age 95.
People asked me questions. Here are some answers.
1. "How does one connect with the people who will advise one on 'Death with Dignity.'"
If the patient is in hospice, the many caring people within the hospice organization will refer you. If the patient is not in hospice, one can call End of Life Choices Oregon. They are a non-profit organization with local staff and volunteers. They will walk you through the process. My experience was that people were helpful and respectful. They know what to do.
2. "Start to finish, how long did it take to jump through the hoops to meet Oregon's process?"
At least a month, start to finish, if everything goes smoothly. Every situation will be different. Bob Warren was judged to be in hospice, which meant that he had already been medically determined to be near end of life. Getting that assessment is a hoop, and a patient might be too healthy for this. Or a patient might not be healthy enough to take the end-of-life medicine on his own, which is another hoop. The Death with Dignity legalities involve getting the patient to sign a form saying he or she understands what is being asked. Two witnesses sign saying the person is not under duress. If the patient's mental competence is in question, then again, this path may not be available. The patient then needs a sign-off from two physicians, with visits spaced more than 15 days apart. That takes some scheduling, because doctors are busy. The pharmacy needs a hard copy of the physician's prescription. In two days someone can pick it up.
The patient can decide whether or when to take the medicine. They can take it within days, or never. Their choice.
3. "Peter, Bob Warren didn't look all that sick in the photo you published. Was he really near end of life?"
The photo above was from nine months ago. Out of respect for him I wanted a photo preserving his dignity and showing him looking good. Recent photos show the decline he experienced. I won’t publish those.
How near a patient is to death is a judgement call by physicians. There is no requirement that a patient must meet some schedule to die. If life expectancy is ambiguous or questionable, however, that may be a barrier. My experience was that at every stage and every hoop, the health care people seemed compassionate. This was a palliative care patient. They did not appear to me to be trying to find excuses for roadblocks.
4. Was it expensive?
The end-of-life medicine was $600. There were no other costs beyond whatever the small co-pays there might be for the doctor visits.
5. What really happened after he drank the medicine? Was it terrible?
No. For Bob, it was easy. The medicine goes down in two or three swallows. Bob sat quietly and in two minutes said he felt sleepy. He slumped back with his head on a pillow, and began snoring. I saw no sign of conscious distress.
I won't sugar-coat this next part. This was new to me, and hard. In a "good death" like this one, the conscious patient is gone after that two minutes, but the patient's body may take hours to shut down. I spent the time holding Bob's hand, rubbing his shoulder, and whispering in his ear. Hospice nurses and End of Life Choices Oregon people were there, too, holding his other hand. His skin slowly went pale, his lips got blue. His breathing became occasional deep sighs, every fifteen seconds at first, and then every minute and finally two minutes. It can take one or two hours or more before the patient's heart stops. You might find it very uncomfortable to be part of this.
You don't need to be there for this. You can say goodbye before or after the patient drinks the medicine and know that your loved one is unconscious and on his way. Hospice and Death with Dignity people will be there to supervise the death. I stayed with him. I had come that far, so I was going to finish with him. Bodies shut down and die, one organ at a time, and I watched. If this last part is too painful to contemplate, I understand. It is OK to let the professionals handle this. The patient is on a path. Our bodies know what to do. We were born knowing how to die.
I went through the dying process with my father. It was death by natural causes, but the process was as you described. He was not conscious and the process of his body and organs shutting down took several hours. It was harder on the living than the dying, but I am so grateful that I was able to be there with him through the transition. It made me think of the process of labor that brings us into this world and it seemed like a laboring process to leave it. That experience will stay with me as long as I live. You were a very good friend to Robert.
Thanks for telling this story, Peter. One update is that the legislature has created a faster path for people in cases where death is imminent. Here's what is posted on the OHA website:
Q: Are there any exemptions to the waiting periods in the DWDA?
A: Starting January 1, 2020, patients are exempt from any waiting period that exceeds their life expectancy. Patients with less than 15 days to live are exempt from the 15-day waiting period between the first and second oral requests for medication. Patients with less than 48 hours to live are exempt from the 48-hour waiting period between the patient’s written request and the writing of the DWDA prescription. The Attending Physician must file a medically confirmed certification of the imminence of the patient’s death with the patient’s medical record if any of the statutory waiting periods are not completed.