Background
Under the 1997 Death with Dignity Act, Oregon was the first of the now-handful of states to allow physicians to write a prescription that, when filled and administered, would cause intentional death.
Let me be clear: Death with dignity is not offered to Oregonians en masse or even on a whim. To legally qualify, a patient must be 18 years or older, a resident of Oregon, capable of making and communicating health care decisions for him or herself and diagnosed with a terminal illness that will lead to death within six months. No secondary person can request death with dignity on behalf of a patient. A patient’s death certificate will document natural cause, as the patient’s death was set into motion by the illness that carried a six-month prognosis. Providers in Oregon are not required to write a prescription if it opposes their own values, but if they choose to write a prescription they must offer to be present at the time the medicine is taken.
The process takes at minimum fifteen days, is expensive, and requires patients to submit a series of documentation. As in previous years, the three most frequently mentioned end-of-life concerns documented in the 2013 state report were: loss of autonomy, decreasing ability to participate in activities that made life enjoyable, and loss of dignity.
From the vantage point of a student
As a medical student in Oregon, I have had several opportunities to speak with patients who sought to initiate the process by working with the director of my clinic, who, in his leadership role, has chosen to act as a consulting prescriber for patients who qualify.
My first experience was in clinic. A woman came in with her lifelong husband, a retired pathologist, and her adult daughter who stood in the tiny patient room and dutifully took notes throughout the conversation, making sure to ask the detailed questions regarding paperwork and documentation of her mother’s impending death.
The patient herself was well into her eighties and had pancreatic cancer that had already metastasized and a prognosis of less than six months. She was eloquent, cheerful, and still appeared to be well, save her bloated belly which housed the source of her cancer. Her decline in function would be steep. With the support of her husband and daughter, she came to us to discuss how she would want to die. She was firm on the matter that she was not afraid of death and quick to remind us that she was already living in death’s shadow.
In a sense, it felt as if the space in that small room in which death and its imminence could be aired with frank discussion was its own form of empowerment. She may never choose to drink the bitter concoction of barbiturates even if she spends the nearly $1,300 to purchase the prescription, and that is her sole right. Not everyone who fills the prescription takes the dose, yet knowing the option is there may impact the quality of her remaining life.
Thoughts on my future role
I do not take the topic of human life lightly, but neither can I as a responsible physician consider what it means to live a good life or die a good death to be homogenous in nature. It was a humbling experience to attempt to understand how this woman felt she might die with the most dignity and to offer myself as an ally to her goal.
It is both a responsibility of mine to consider the health of the populations that I serve as well as a professional duty to consider the individual nature of illness experienced by each of my patients. I trust my ability to artfully balance the two. I trust my ability to sit in front of my patients face-to-face, to hear what they have to say about their illness, to collaborate with my colleagues in moments of uncertainty and to compassionately ally myself with their goals to alleviate suffering to maintain dignity.
It is a future role I do not underestimate and the burden and beauty of the responsibility I accept is mine to bear.
Heather Alva is a medical student. This article originally appeared in The American Resident Project.
