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End of Life Options

In 2001 I interviewed director Mike Nichols about Wit, a TV movie he had directed for HBO, starring Emma Thompson, based on the 1995 play by Margaret Edson that won the Pulitzer Prize for Drama in 1999. It’s the story of a Professor of English Literature, diagnosed with metastatic stage IV ovarian cancer. Her oncologist prescribes experimental treatments of chemotherapy that cause her extreme pain and nasty side effects. A compassionate nurse, who witnesses her suffering, suggests she request DNR (Do Not Resuscitate). However, a young doctor, who used to be her student, ignores her wishes and orders CPR (Cardiopulmonary resuscitation).

WitWe have all heard horror stories of doctors bringing back to life people who are terminally ill and in great pain. The explanation that I was given by my father’s cardiologist, a friend from childhood, was that it is his duty to keep patients alive. As I do not wish that to happen to me, I asked Mike Nichols his opinion about the opposite option, to ask for a doctor’s help in dying. He replied that, until the laws change in our country, doctors risk their career if they help you, so they can’t.  And if you want to make this very personal decision yourself, you should belong to the Hemlock Society, and have everything well prepared in advance.  He gave the example of Bruno Bettelheim, who had the proper equipment, the right pills and the plastic bag ready, so he could go when he wanted to.

Igby Goes DownI saw the plastic bag over the head technique, that allows you to die quickly and painlessly by suffocation, demonstrated by Susan Sarandon in the 2002 movie Igby Goes Down. Dying of breast cancer, she asks her grown sons to help her die; it is a darkly comedic moment, and I made a mental note. Then I joined the Hemlock Society and ordered the book Final Exit by Derek Humphry, with detailed instructions.  I haven’t read it yet, but it’s comforting to know that it’s in my bookshelf, if I need to consult it.

The Barbarian InvasionsIn the 2003 French-Canadian movie by Denis Arcand Les Invasions barbares (The Barbarian Invasions), I saw another method that seemed more pleasurable, an overdose of heroin. A son, wishing to help his father, who is dying of cancer in a Quebec hospital, hires a young woman to inject him with this illegal drug, that he heard is 800% more effective than morphine to relieve pain. That was actually the choice of an Italian friend of mine, who was dying of progressive paralysis. It comforted him to know that he could pass on to other side that way.

The Sea Inside

In the 2004 Spanish movie by Alejandro Amenábar Mar Adentro (The Sea Inside), I watched Javier Bardem interpret the true story of 55-year-old quadriplegic Ramón Sampedro, who conducted a 28-year campaign for the legal right to end his own life.  Eventually he takes cyanide and videotapes his own death in 1998, to make it clear that he did this himself, so as to not incriminate the people who helped him.

Grace & Frankie. jpgIn 2016, in episode 12 of the second season of the Netflix comedy Grace and Frankie, I watched Lily Tomlin help a friend die, after throwing a big goodbye party, when she decides not to fight a recurrence of breast cancer a second time.

Thanks to the efforts of the former Hemlock Society, now called Compassion & Choices, since June of 2016, when the “End of Life Option Act AB 15” went into effect, Californians, who are terminally ill and mentally capable adults, and have less than six months to live, may ask their doctors for medical aid in dying (AID), as Oregon residents have able to do since 1997, after the passing of the “Death with Dignity Act.” This option is also legal in Washington State since 2008, Montana since 2009, Vermont since 2013, Colorado since 2016, District of Colombia since 2017.  AID is not the same thing as assisted suicide or euthanasia, which are legal in the Netherlands but not in the US.  In these 6 states, you may request prescription medication that you can take to die gently in your sleep, if your suffering becomes unbearable.

This week I attended a panel discussion at the Hammer, moderated by Ian Masters. Watch video podcast at this link. Among the speakers was Dan Diaz, husband of Brittany Maynard, the 29-year-old woman diagnosed with the aggressive brain tumor GBM (glioblastoma), who moved from San Diego to Portland Oregon, since the AID law had not yet passed in California. He said this was not suicide, that his wife did not want to die, she wanted to live, but feared suffering a stroke that would leave her unable to walk or talk or swallow. On November 1, 2014, she took the prescribed medication, 100 capsules of Secobarbital, that you have to open and dissolve in water. She was asleep in 5 minuted and passed away in 30.
UCLA Professor Cindy Cain explained that AB 15 would not apply to Alzheimer patients, who no longer have the mental capacity to qualify for the program, once they are given a 6-month prognosis. She wrote a Brief about “Implementing Aid in Dying in California,” that you may download at this link.

Dr. Haider Warraich, a young Pakistani cardiologist who wrote the book Modern Death, said that doctors are required to take the Hippocratic oath, that prohibits euthanasia, and only 57% support this law, as opposed to 70% of the general population.

Barbara Coombs Lee, President of Compassion & Choices, said that the biggest resistance to the passing of these right-to-die laws comes from the hierarchy of the Catholic Church. She warned that, just as the Republican-controlled Congress and President Trump have been trying to repeal Obamacare, they could easily declare a federal crime to provide medication to hasten someone’s death. She urged everyone to mobilize and become active.

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P.S. Hemlock is a poisonous herb that was used in ancient Greece to execute prisoners condemned to death.  As described by his disciple Plato in Phaedo, Socrates was ordered to take it in 399 BC after being convicted of “refusing to recognize the gods” and “corrupting the youth”. No, not for advocating homosexuality, but because two of his students had briefly overthrown the government of Athens.

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