Death With Dignity
How Does Utah’s End of Life Care compare to Oregon’s?
Hospice: Utah has several hospice and palliative care companies. Hospice is a team of professionals that help with the care of patients nearing their end of life. Intermountain Hospice provides nursing staff, a consult physician, physical therapists, social work and chaplain services. When a patient is nearing their end of life the purpose of hospice is to provide the patient with medical care, as well as emotional and spiritual care for both the patient and family. Typically these patients have a few months left to live. Nurses are staffed 24/7 to provide both their daily care for the patient and are available for emergencies. Hospital: Hospitals and emergency departments play a major role in end of life care, as hospice is not used by most patients. The emergency department or hospital may be where the patient initially receives their diagnosis, however most of the time these patients when not on hospice are in and out of the emergency department when they are having secondary complications to their health conditions. When admitted to the hospital and nearing the end of life, they may choose to receive palliative care. Which is essentially just keeping the patient comfortable and providing in hospital resources for the coping of the situation for both the patient and family. One issue encountered by hospitals with patients receiving hospice at an outside facility, is that the patients and family are not the ones always giving the medication at home, therefore they do not usually know the patients medications and dosages. This can cause delayed care for the patient. DNR/DNI: These are advanced directive forms that you fill out to choose your level of care you would like to receive in the event of an emergency where they may preform CPR and intubation in order to save your life. ("Do-not-resuscitate order:MedlinePlus Medical Encyclopedia") Most patients that are nearing the end of their life have these filled out and on file, however even with the technology we have today, these files are not shared between hospital facilities and most patients do not have the papers with them, when paramedics are called in an emergency. While family members may tell paramedics or emergency physicians that a patient has a DNR and/or DNI in place, medical workers take an oath to provide the best possible care to every patient. Therefore they have an ethical and moral responsibility to do everything they possibly can to save the patient. ("Greek Medicine- The Hippocratic Oath") How is Oregon’s End of Life Care different? Oregon has all of the end of life care options that Utah has, as well as the Death with Dignity Act. Which is a law that was voted in by the citizens of Oregon in 1994 and confirmed their approval and went into effect in 1997, it provides mentally competent terminally ill patients the option to receive a prescription to hasten their death. They have requirements in place in order to determine eligibility for a patient to participate in the Death with Dignity Act, which include: o Being 18 years or older o A current resident of Oregon o Being capable to making and communicating your health care decisions o Being diagnosed with a terminal illness that will lead to death in the next 6 months Each of these patients that meet the eligibility requirements then must have two different physicians determine the criteria has been met by the patient. There is a common timeline of events after meeting the eligibility criteria, which are o Oral request to your physician o 15 day waiting period o Second oral request to your physician o Written request to your physician o 48 hour waiting period before you can pick up the prescribed medications. ("How to Access Death with Dignity Laws") Many people worry that patients may be coerced into choosing this option, however Oregon has safeguards in place to prevent this, such as the verbal requests have to be made by the patient, with a 15 day waiting period between each request. Patient must make a written request to the physician, the request is witnessed by two people that are neither primary care givers nor family members. The patient can withdraw the verbal and written request at any time in the process. The patient must be able to self-administer and ingest the prescription given. When the patient is providing proof of eligibility, if either physician is concerned about the patient’s judgment, a psychiatric consultation is required prior to moving forward with the process. Each patient is encouraged to participate in hospice and palliative care by the physicians. The prescription most commonly prescribed in Oregon is 9g. of secobarbital capsules or 10 g. of pentobarbital liquid. When this lethal dosage of medication is taken, the patient will slip into a coma and the timing of when the patient will pass varies. It could be 25 minutes or it could be more than a day. Why is Oregon’s Law important to Utahns? On February 24, 2015 House Bill 391 was introduced by Rebecca Chavez-Houck. House bill 391 was a bill for a Utah Death with Dignity Act formed around the way Oregon’s law is. On March 12, 2015 the Bill was not passed by the house. Since Oregon has enacted the Death with Dignity Act in 1997, Washington, California and Vermont have also enacted a similar bill. Most of the patients requesting physician’s aide in hastening their death have cancer, which Utahns are not excluded from this illness. In 2013, Utah had 2,971 deaths due to cancer. (Centers for Disease Control) Which means those 2,971 people died, suffering from this illness in Utah without this option to hasten death. Although this isn’t the only illness that causes patients to look toward physician assisted death. Some of the patients have heart conditions, ALS and other diseases. When this option is not available, patients may turn to other means of hastening their death, such as suicide. Which Utah ranks 4th in the U.S. for rate of total suicides. 579 people committed suicide in 2013. (These numbers are a total number of suicides in Utah, it is not recorded reasoning for suicide.) When patients turn to this option, they may attempt to overdose or shoot themselves. This may not lead to death, it may lead to more suffering, as the patient may receive lifesaving measures in time, such as being on a ventilator with a tube down their throat forcing them to continue breathing. This patient may be brain dead and they will still continue with this treatment in hopes that they will miraculously recover. Why didn’t HB 391 pass? There is no way of saying exactly why HB 391 did not pass, however some of the most common arguments against physician assisted death are violating god’s commandments. (Religious Groups' View on End-of-Life") Utah has a high number of people that follow religions with this belief, I do believe this is a major reason the bill did not pass. Another issue some have with the idea of physician assisted death is that it becomes a “slippery slope” and may lead to physician’s encouraging patients to turn to this option or in the event that a patient is unable to express their wishes, physician’s may begin using euthanasia. I do not feel that this is an issue, as Oregon has been providing this with patients for almost 20 years and it has not become an issue. When I discussed my topic with a hospice worker, Elena, she mentioned that they have issues with family members taking the patients prescription pain medication. I could see this being a potential issue, however in most cases, these patients are still somewhat active and able to put the prescription in a safe place. Conclusion Intermountain Medical Center has the biggest emergency department in the state, having many nurses and doctors, including myself that see patients ranging from a stubbed toe to giving patients a terminal diagnosis to preforming CPR for an hour or more on an unresponsive patient. I have cared for many patients that have a terminal illness, that are wearing adult diapers, as they are no longer able to control their bodily functions, I have fed these people with a spoon, as they ate essentially baby food. I have watched patients writhing in pain, pushing the button for their pain pump, for one more dose, sooner than the pump will allow. These patients’ ages have ranged from 20s to late 90s. These patients taught me many things, like life is so very fragile and may be taken at any time. I have also learned that I do not want to be in that situation. I want to have my options. I will fight for Utah to become a state with the option of Death with Dignity. |
Informed ConsentIn February 2015 House Bill 391 was introduced by Rebecca Chavez-Houck, The bill was for a Utah Death with Dignity Act. Unfortunately, this bill did not make it past the House of Representatives. The purpose of the bill is to provide terminally ill patients the option to hasten death with the assistance of a physician. With the advances in medicine, we are capable of diagnosing patients with illness sooner and providing the most state of the art treatments. However at times this is not enough, there are still patients that are suffering from illnesses that they will eventually succumb to. Every citizens deserve to be fully informed on what the state is denying them of and why.
In October 1997, Oregon was the first state to introduce the Death with Dignity Act, which provides terminally- ill Oregonians the option to end their life through self administered lethal medications. Since this time, California, Oregon and Montana have enacted similar bills for the citizens of their states. Why are some states denying their citizens this option? "Assisted suicide diminishes the focus on patients choosing to fight and survive a terminal diagnosis, it reinforces the implicit and explicit message from doctors, insurers, and government that people living with a 'terminal' prognosis or disability may be better off dead." (Hansen). I do not find this statement to be true, as I researched Oregon’s 2014 Death with Dignity statistics, 155 patients had prescriptions written for this lethal medication, of those (as of February 2, 2015) 94 patients had ingested the medication. Oregon’s total number of deaths for 2014 was 34,160. Less than 1% of the residents that died in Oregon had a prescription written for this medication. This information shows that patients that are diagnosed with a terminal illness do choose to participate in Death with Dignity. To say that this diminishes the focus on patients choosing to fight and survive a terminal diagnosis, I believe the statistics prove this to be a false statement. Patients are not doing this, simply because they choose not to fight. They are at a point in their illness where fighting is no longer an option, acceptance is. “Patients will have to be told the full extent of the pain, suffering and hopelessness of their medical condition all at once rather than in gradual, tolerable stages, in order to safeguard the legal requirements of informed consent needed for truly voluntary euthanasia. Patients not wanting euthanasia would inevitably hear about their dreadful prognosis from other patients with similar medical conditions, relatives and so on, and have to bear the burden of such unwanted information.” (Arguments Against Euthanasia) Every patient should be fully informed on their diagnosis; that is part of a physician’s responsibility. Typically people do not go around telling people that are terminally ill that they are going to suffer or the awful experience that some people had with the same diagnosis. Patients being diagnosed with a terminal illness will not be a new thing for the public just because assisted death is an option. “The doctors and nurses who devote themselves to the care of dying people reject euthanasia because it is a tempting substitute for diligence and creativity. People with exceptionally difficult end-of-life illnesses can have reversible palliative sedation, which preserves their life and completely alleviates their symptoms.” (Johnston) I have had several years working in the hospital with both solid organ transplant patients and now in the emergency department at a level 1 trauma center. Although I do not work in hospice/ palliative care, I have a lot of experience with death and patients being diagnosed with terminal illnesses. Prior to working in the hospital, I never would have thought I could have such a strong opinion for the Death with Dignity Act. However it is the things that I saw patients experiencing and the overwhelming emotions that come with a poor prognosis. Most of the nurses and medical staff I work with in the emergency department have similar opinions due to their experiences as well. With the way that Oregon has written their Death with Dignity Act, if a patient seems to have any psychological symptoms that may be contributing to their decision, they are referred for a psychiatric consult prior to a physician participating in their choice. One common assumption made is that people tend to think that patients are less likely to participate in hospice and palliative care due to this option. A report done in 2010, 93% of patients that requested participation in Oregon’s Death with Dignity Act were enrolled in hospice, (deathwithdignity.org). In 2012 the total numbers of deaths in the U.S. were 2,543,279 with 1,113,000 patients participating in hospice. With those statistics that equals out to approximately 43% of people who died in 2012 participated in hospice. In 2012, only Oregon, Washington and Montana had active laws in place to allow patients to participate in the Death with Dignity Act. These statistics prove this common assumption to be false. “Most if not all terminally ill patients who express a wish to die meet diagnostic criteria for major depression or other mental conditions.” (Harned) As mentioned above, if a physician is concerned with psychiatric health, the patient is referred for an evaluation prior to being able to participate in Death with Dignity. A study published in 2007 was done to survey family members that had a loved one that requested to participate in Death with Dignity (Ganzini); the purpose was to determine the reasons for the patient’s choice to participate. 83 decedents were surveyed, most being the female spouse, using 28 possible reasons for making the request for physician assisted death. The following information was reported by the surveyed participants.
o 7 patients could not find a physician willing to participate in their request. o 4 patients did not meet the legal criteria. o 11 patients died during the 15 day waiting period between requests or before filling the prescription. o 5 patients lost the ability to swallow or make decisions. o 1 patient refused a psychiatric consult.
o Loss of dignity. o Patient wanting to die at home and having concerns about loss of independence. o Quality of life was declining. o Concern with ability to care for self in the future. Family members did not identify social support, depressed mood or financial reasons as important reasons for the request. Patients should have the right to decide whether they want to continue their last few months in hospice/ palliative care and have a natural death or if they feel that due to their condition they can no longer continue on, they should have that option. Since I work in the emergency department, I see a lot of patients that have terminal illnesses; I see suicide attempts and sometimes even people that succeed in their attempt. Providing this option is not creating an option of suicide. I have had patients with terminal illnesses come in with self inflicted injuries or intentional overdoses. These patients typically do not start out depressed; they become depressed over months of agony, without any relief. Hospice and palliative care are great options, but if they fail and the patient is mentally competent to make a decision related to their life, I think they should have this option. I know if I am ever in the situation that I have seen some of my patients, I hope this option is available where I am living. I refuse to become that patient that is completely dependent on everyone, unable to do everyday things, such as brushing my teeth, going to the bathroom, or taking a shower. I will die with my dignity. |