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Not Just an Inadequate Understanding of Hospice

February 21st, 2015  |  by

Recently, a young woman with a terminal brain cancer moved to Oregon and ended her life utilizing Oregon’s “Death with Dignity” act. This goes against everything I witnessed in my recent Palliative care and Hospice fellowship where young adults, almost without exception, hold onto life despite all our attempts to push them onto another story. The Oregon Public Health Department reports that from the beginning of their assisted suicide program in1998 until January 2014, only 6 people under age 34 (0.8%) took advantage of physician assisted suicide.

This young Oregon woman had a different agenda than most dying young people. She set a date for her suicide and given she had the wherewithal to travel to the Grand Canyon in the weeks before, that date seemed pre-mature to me. In the interviews I read she talked about “ having control” and “ leaving a worthy legacy”. Her choices had little to do with what was available to her through a Hospice program, and the media exploited her story in an attempt to shift the focus of the debate over physician-assisted suicide, to a younger generation.

The Oregon Death with Dignity Act wisely mandates that a discussion about Hospice take place before any lethal prescriptions can be written. I have had many of these discussions introducing Hospice, and most begin with the patient saying I don’t want Hospice. I tell them Hospice services can be delivered in their own home. The support is not only for them but for their caregivers as well, who are often exhausted at that point. The focus is on controlling both physical and emotional pain. The nurses, doctors and social workers who do Hospice work are experienced in listening to your accounts of pain and doing whatever is needed to relieve that pain. Listening is often the most powerful support of all. Narcotics are titrated with proper timing throughout the illness. At the end of life those drugs can be given until you are unconscious, if needed. After that discussion most patient’s then enroll in Hospice. It is true that most enroll in Hospice in the Oregon assisted suicide program as well. I wanted to know how patients in the Oregon program receiving lethal prescriptions took advantage of Hospice services. Did most use Hospice and hold the lethal prescriptions in reserve? I wrote the advocacy organization behind the law, Compassion and Choices,  and I tried phoning (503-525-1956). Each time I got a voice mail that said they would call me back within 24-48 hours. I received no calls back.

The media, including social media, have a powerful influence on how we understand ourselves, and the message in this case was in support of a grass roots movement that encourages a tendency to view life less as a gift and more as a possession.

Those who oppose assisted suicide don’t have to oppose it in all cases. Sometimes claims of compassion will outweigh Medicine’s need to extend life. Medicine must attend to those claims in dealing with end of life concerns, while addressing the moral burden of hastening death. I look forward to a time where physician assisted suicide is available, but seldom used, because Hospice care is more adequately understood.