Right to die: Please help end needless suffering

As a physician, I urge the state Senate to advance a death-with-dignity law.

By David B. Plimpton

March 22, 2015 at 12:10PM
Dean Rohrer/NewsArt
Dean Rohrer/NewsArt (The Minnesota Star Tribune)

On Monday, the Minnesota Senate Committee on Health, Human Services and Housing will debate the newly introduced Minnesota Compassionate Care Act. This bill is based on Oregon's 17-year-old "Death with Dignity" law, under which a mentally competent adult with a terminal illness may legally request of a physician a prescription for a lethal dose of medication that when self-administered will bring about his or her death.

The committee's decision will determine whether the bill is moved forward toward the full Senate for debate and vote.

Death-with-dignity or aid-in-dying laws are already in place in five states: in Oregon and Washington by ballot initiative, in Montana and New Mexico by state supreme court decisions, and in Vermont through legislative action. Like Minnesota, some 28 other states and the District of Columbia are considering such legislation.

I am a recently retired internist/gastroenterologist. My professional and personal experiences have led me to strongly support the right of a competent, terminally ill adult to exercise rightful autonomy in health care matters through a self-administered lethal dose of medication.

We already have in place advance directives, through which individuals declare their long-term health goals; physician orders for life-sustaining treatment paradigm (POLST), which allow a person to refuse specific life-sustaining therapies such as IV fluids, blood transfusions, intubation, mechanical ventilation for respiratory failure, hemodialysis and tube feeding; hospice care, which is one of the great advances in end-of-life care, providing comfort care and support while allowing a natural death, and palliative care, a newer specialty, which focuses on controlling pain and harmful symptoms in the non-terminal setting due to chronic illness, physician-ordered treatment or just the fragility of aging.

But these measures to prevent futile, life-prolonging treatment do not prevent suffering. An example of needless suffering is illustrated by my patient, a mentally competent 80-year-old retired businessman hospitalized with end-stage congestive heart failure. He knew he was dying, which was confirmed by his physicians. He asked what his options were for hastening his death to escape from the life he now found intolerable.

I told him that it was against the law for me to write a prescription for a lethal dose of barbiturate. We reviewed the likely sequence of events should he stop eating or drinking — thirst, hunger, weakness and shortness of breath, followed by delirium, coma and death.

Starvation was the course he chose. He was discharged home in the care of his wife with support from hospice. He died 14 days later, after both experienced needless emotional and physical pain through his dying process, suffering that could have been avoided by the availability of an aid-in-dying law.

Medical ethics have evolved from a paternalistic physician trying to do no harm while prolonging life to the primacy of patient autonomy, fully informed by physicians with the intention of doing no harm while maintaining the quality of that life.

If a patient has a terminal illness (fewer than six months to live), is competent and not depressed, the modern involved physician who is concerned about his patient's well-being (that is, the quality of remaining life) must ask of the patient:

"What do you want?"

"What are you afraid of?"

"How do you want to spent the time you have left?"

And if that patient says his or her goal is to prevent or end the suffering, then the physician must be legally able to provide the means to hasten death. My experience has been that recently, more patients have asked about aid in dying, and polling data suggests that at least 60 percent of Americans agree the option should be available.

It is my strong hope that the committee votes "yes" so there can be a full Senate debate and ultimate passage of the Minnesota Compassionate Care Act.

David B. Plimpton is a retired physician in Minneapolis.

about the writer

about the writer

David B. Plimpton

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