A responsible death

An Oregon doctor who advocated for that state's Death with Dignity law now advocates for Md's.

Twenty years ago, as an Oregon oncologist, I was one of a handful of physicians who campaigned for Oregon's groundbreaking Death with Dignity Act.

Today, I have the same fatal brain cancer as Brittany Maynard, the 29-year-old who legally ended her life in Oregon last year. Her story recently brought death with dignity to the fore of public attention and elicited respect for people taking responsibility for their own lives.

But I have a choice that former Annapolis Ward 1 Alderman Dick Israel does not yet have. He does not have the option to exercise his right to a peaceful death in the state whose residents he has served his entire life. As a medical adviser for the Death With Dignity National Center, I urge Marylanders to support House Bill 1021 and Senate Bill 676, the Richard E. Israel and Roger "Pip" Moyer Death with Dignity Act.

Introduced by Delegate Shane Pendergrass, Senator Ron Young, along with 44 co-sponsors, and modeled after Oregon's 20-year-old law, Maryland's proposal provides that terminally ill individuals will be allowed to peacefully end their lives after undergoing a process full of safeguards to ensure they are mentally competent, are not being coerced and are within the final six months of their lives.

One of the greatest indignities of dying from a terminal disease is the loss of autonomy. All our lives, we are urged to take responsibility for our actions. Then, as we approach death, we are told that we have lost that right to control our end of life. The right to decide the exact details of where, when and how we will die is determined not by ourselves but by our illness. If the process involves nausea, seizures or insufferable pain, some argue we are just expected to endure.

In Oregon, we've had nearly two decades of experience in death with dignity. Each year, around 100 Oregonians, most of them well educated and receiving hospice care for their end-stage cancer, use the law to peacefully end their lives by self-administering medication. Typically they die surrounded by friends and family. It is a law that has worked exactly as intended.

As a specialist in hospice and palliative medicine, I have found that my dying patients want everything medical science can offer to minimize symptoms and side effects and prolong their enjoyable lives. I can assure most patients that good hospice care can control most pain, nausea and other debilitating symptoms. But all too often that comes with side effects including sedation, the inability to communicate, loss of bodily control, confusion, agitation or even being placed in a permanent coma. That is why death with dignity laws, like Oregon's, should be available for terminally ill people who meet the conditions of the law and choose to use it.

The people of Oregon first legalized physician-assisted dying in 1994 and reaffirmed it with a second vote in 1997. Legal challenges prevented implementation until the U.S. Supreme Court upheld our state's right to enact this law in 1997. Now Maryland has a chance to enact its own law.

The great advantage of using Oregon's law as the model for Maryland is that it comes with safeguards that have proven effective for 17 years. Available only to mentally competent adult patients with a life expectancy of six months or less, the Maryland law would:

•Ensure protections against use of the law by clinically depressed persons by allowing second opinions and psychiatric evaluations;

•Require multiple oral and written requests, including one signed by a witness who is not the attending physician;

•Not allow minors or the disabled who don't have a terminal illness to use the law.

There has been no report of coercion, failure or misdeeds in Oregon or Washington, which enacted its Death with Dignity Act in 2009. Far more people ask their doctor about the law than actually use it, but many find comfort knowing the law is available if their symptoms cannot be controlled. And families of persons using the law are significantly less likely to subsequently suffer from depression or pathological mourning than others.

Personally, I take comfort in knowing that when my cancer produces symptoms that can't be controlled by even the best hospice care, as an Oregonian I will retain control over the circumstances of my death.

I applaud Delegate Pendergrass, Senator Young, and their many co-sponsors for their forward-thinking efforts to offer Marylanders the peace of mind and a compassionate response to suffering in their final days.

Dr. Peter Rasmussen is a retired physician in Salem, Ore., and a voluntary advisory board medical director of the Death with Dignity National Center. His email is peterras2@gmail.com.

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