The state of assisted-suicide laws

We still don’t know — we may never know — what led financier Irwin Jacobs to allegedly kill his wife, and then himself Wednesday at their mansion in Orono.

But the suggested scenario of the couple’s situation from Dennis Mathisen, a business associate, may prompt some thinking about something we don’t ever acknowledge we think about: Would we choose to end our life if suffering is the alternative?

Maybe this is a question the Jacobs considered; maybe it’s not. We just don’t know yet.

Mathisen told the Star Tribune Jacobs’ wife, Alexandra “had been in a wheelchair for the last year or so and had signs of dementia. Irwin was just distraught over her condition.”

On a list of cruel and inhumane diseases, Alzheimer’s and dementia is at the top. There are no happy endings.

That fact is at the heart of the legislation in eight states that allow people to end their life as they see fit if death is immediately imminent.

New Jersey is the latest. The Assembly approved the “Medical Aid in Dying for the Terminally Ill Act,” by a 41-33 vote three weeks ago after it passed 21-16 in the State Senate.

Two other states last month, however, rejected the idea, according to Governing magazine. It fell a vote short in Maryland. And in Connecticut, supporters didn’t even have enough votes to get a vote in a committee.

Oregon was the first state to legalize assisted suicide. Since 1997, prescriptions had been written for 2,217 people, and 1,459 people have gone ahead with their plan, according to the Connecticut Post.

“Let’s be clear: this bill will become law in Connecticut someday soon,” Tim Appleton, campaign manager for Compassion & Choices in Connecticut said. “After two decades of experience with the law in Oregon, without any of the dire consequences predicted by opponents, legislatures across the country are passing aid-in-dying bills, most recently in New Jersey. Connecticut will do the right thing.”

In Minnesota, 19 representatives (all but one DFLers) sponsored similar legislation in the House this session. Seven DFLers sponsored competing legislation in the upper chamber. All were sent to their bodies respective committees where they’ve languished without hearings and will likely die.

The Death with Dignity organization published a poll in 2016 showing overwhelming support for such legislation, even among Christians. But it’s also on the radar of the powerful Minnesota Concerned Citizens for Life, which opposes it. And some bioethicists note that what voters say in the polls don’t always track with what voters say at the polls.

Like many other issues, there is a reckoning coming on the issue.

But not until it gets talked about.

  • KariBemidji

    I think about this article a lot when this topic comes up.

    Being present the last two weeks of my dad’s life, I would’ve given anything to be able to slip him a pill to ease his way to a more dignified death.

    • Lois Gaetz

      I am sorry about your father’s passage. My parents ad veright Advanced Directives, I was their appointed decision maker, the hospital, [ while I was absent and my sister was present and kept telling them to call me] chose to intubate him when he had a brain seizure from his terminal cancer, thereby insuring 6 weeks in a nursing home. Their explanation when I showed up was that he did not have a DNR blue wristband on, I found his AD in his records and asked why that wasn’t flagged so they would not do exactly what he did not want them to do. All my family now have universal AD’s with DNR’s and we have appointed all our children to act, in lieu of our ability, independent of each other.

      • AL287

        It’s been drilled into physician’s heads since their first day of medical school that they are there to save life, not end it.

        Add to that the fear of lawsuits and the emphasis on performance rates and marketing strategies (Let’s face it. There is no such thing as a truly “non-profit” hospital in the current era) and you have the perfect storm capable of causing needless suffering.

        It is a well known fact that doctors ignore advanced directives even when it is clearly documented in a patient’s chart hence your father’s predicament.

        I am thinking there was no one who could have provided care in their home so your father could have been admitted to hospice care. Not everyone has the ability these days to take a leave of absence from work but that’s okay. We do what we can for our aging parents.

        That being said, if the patient’s family decides to admit them to a hospital it is considered restorative care, hospice care is revoked and the patient is discharged from the hospice agency.

        Any patient who has a living will or advanced directive must have it documented on the face page of their chart so it is clearly visible for all providers caring for the patient.

        In your father’s case the fault lies with the admission process and the fact that nurses are expected to carry a patient load as well as admit new patients. The days of having a designated charge nurse who handles all orders and new admits are ancient history.

        As a retired nurse (hospice, LTC, home health) I am so sorry your father and his family had to go through this.

        • Lois Gaetz

          When my father ended up in the hospital he had been living in his own home with my son, he had a brain seizure which caused my son to call 911 and they transported. I have no real quarrel with the aftercare once he was discharged just that the day he had the second seizure he had spent the day with all of my children playing cribbage, and having them help him sketch a design for a device to hold his fishing rod as his left side had stopped working. What a glorious day to have left.

        • KariBemidji

          Thank Al287. We had wonderful hospice care in home and I can sing their praises for days. They made it as comfortable for him and (my mom) as they could. And it was still awful.

          • AL287

            For the majority of hospice patients, oral morphine drops provide the needed pain relief.

            What is most distressing for family members who are present just before death is agonal breathing or what is commonly referred to as the “death rattle.”

            Hospice nurses can attempt to explain it but nothing can prepare you for it.

            The rule is to give as much morphine as necessary to alleviate pain which can be very large amounts. The nurse has to check with the hospice physician before a larger dose can be given.

            This will often cause the patient to stop breathing.

            Let me be clear. This is not to be confused with euthanasia or assisted suicide.

            The nurse is doing what is needed to alleviate suffering and she/he must have an order from the physician documented on paper or electronically if she is using electronic documentation.

    • joetron2030

      When this topic comes up, I now think of this article from the New Yorker a few years ago

      I’m going to read the article you linked to. Thanks for sharing this one!

  • Al

    Before I say this, know: I am all in for people deciding when and where they choose to die, and I only speak for me and my own experience. For those of us living with friends and family with dementia: I’m sorry. It’s awful to live alongside, and many of us lose someone over years or even decades. It hurts.

    I’d like to suggest that dementia and Alzheimer’s, while cruel to us because we know what’s been stripped away, may not always be inherently cruel to those with dementia when they are in the thick of it. Hear me out.

    The nature of the disease and the inability of those with it to communicate fully with us about what they’re feeling means that you and I can’t know what it’s like to have dementia. Only people with dementia know what it’s like, and the disease presents so radically differently in each person that we can’t make broad generalizations about how someone must be feeling. That’s us putting our own lens on their experience.

    Yes, I know the cruel, painful, awful physiological breakdown that comes at the end with dementia–I’m not talking about that part. I’m talking about the rest of it beforehand, when many folks are physically well but struggle mentally.

    I’ve watched my grandparents be frustrated with dementia, and be peaceful with dementia. One had Lewy Body disease, and another Alzheimer’s. We suspected one would’ve liked to end his life early, and I wish I could’ve helped him die on his terms if that’s what he wanted. I wrote my thesis on sexual health and dementia and the ethics of barring sex in long-term care facilities, and given these experiences I think:

    We don’t know what we don’t know when it comes to dementia, and we can’t make broad statements implying that living with dementia is no way to live, because we don’t know that. Only people with dementia can make that call.

    Instead, I’d like us as a society to pursue dementia treatments that have proven to provide them comfort where they’re at: Facilities that take their disability into account, programs that meet them where they’re at instead of being shoehorned into sort-of working, and a general societal mindshift that it’s our job to care for people where they are and how they are rather than pitying them and feeling nothing but sorrow. Living with dementia often becomes no way to live because we as families or as a society aren’t equipped to care for people in the way they deserve.

    TL;DR: Dementia isn’t a death sentence. I don’t know if I’d want a pill or not at the end, but don’t pity me or assume I’d want to end my life if I’m happy where I’m at. And this is me. This looks different for you.

    Again, if you’re loving someone right now who has dementia, I’m really, really sorry. I know how that feels. If you feel completely differently about what you want for your family or yourself, that’s okay. We’re all different, and that’s how it should be.

    • I think for purposes of discussion, there is no movement to force anyone to take a pill in a (significantly) diminished mental capacity.

      • Al

        Agreed, and not where I’m going. I want to make sure we don’t hear “dementia” and automatically move to generalizing that all people with dementia must be miserable and are to be pitied.

        • Debby

          Amen. My mother died at 96 after about 10 years of slowly progressing dementia. She was a pleasure to see on a nearly daily basis, even when she didn’t know who I was. We were able to interact, at her ability level, and even laugh until the last months. She was content throughout this time. Indeed, that is not the case for everyone, but that is our experience.

          • Al

            I’m sorry for your loss.

        • BdgrGrrl

          Very, very true. My husband has had frontotemporal degeneration, a form of dementia, since some time in 2010, although he was not actually diagnosed until September 2012. His neurologist is a nationally-renowned, if not world-renowned, researcher and clinician in Alzheimer’s and other forms of dememtia. He believes that if people with Alzheimer’s/dementia are free of pain (which is almost always possible), kept clean, are well-fed, receive good medical and nursing care, and are shown love, they are generally content. They enjoy the simple pleasures in life: music, fresh air, human touch, favorite foods, a walk if they are ambulatory. I thoroughly believe this. It’s made me realize that should I develop Alzheimer’s or dementia someday (and my siblings and I are at higher risk since our father died of complications of Alzheimer’s), I will face the diagnosis with grace and courage. My advance directives have no provisions for shortening my life under any circumstances, including Alzheimer’s/dementia.

          • I think the worst part of Alzheimer’s, the suffering part, is when you’re slipping away and you’re conscious of it. Not when you’re already gone.

          • Al

            Thank you for sharing this.

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  • Bradley Williams

    Yes 60% favor the concept but 95% reject legalizing euthanasia after they learn the extent of wrongful deaths allowed.
    Potential for abuse abounds with laws allowing euthanasia.
    There are many documented cases of abuses in the Oregon model death laws. The problem cases only come to light through media and medical or legal journals, but many are in documents on the Disability Rights Education & Defense Fund website. 

    There is no oversight or assurance provided by the Oregon model death policy that can prevent wrongful deaths due to: 
    1. A wrong diagnosis.
    2. A wrong prognosis. 
    3. When unaware of available treatments.
    4. When there is no access to pain management.
    5. When denied funding for medical treatment.
    6.When the mentally ill are at risk (a huge possibility).
    7. When there is ableist judgement of “better off dead” which is a prevalent medical and social bias.
    8. When there is undetected bullying or coercion.
    9. When there is a killing after changing their mind or while resisting. This is likely in 20 percent of assisted suicides, according to an extrapolation from Oregon statistics.
    10. When the social contagion of suicide is involved (likely in 5-12 percent of cases, as per the Centers for Disease Control). 
    11. When the death is not a rapid or peaceful death (likely 25-72 percent of the the time according to a study by Bill Gallerizzo).

    Expect expansion of categories due to “category creep” in this climate of promiscuous medical standards.

    • Al

      There is no oversight or assurance provided by the Oregon model death policy that can prevent wrongful deaths

      Which, honestly, isn’t surprising the way much of our legislation is created: with no funding to support said legislation or oversight thereof at the executive level.

    • kat

      There are many checks to the Oregon system- people aren’t just rollin’ up and taking pills to end their lives. I don’t have time to counter each point of your long and oft repeated argument- I see your discus history commenting on nearly every article on this subject- but it doesn’t take much google searching to show you are not making true statements here. Disabled and mentally incapacitated people are not being killed.
      A very few people are choosing to die with dignity.

      • Bradley Williams

        Hold that thought till next March 1st which is Disability Day of Mourning where they read the names of those killed by their families…..

      • BdgrGrrl

        Both you and Mr. Williams are probably partly right and partly wrong. You correct, kat, in that the rate of assisted suicide in Oregon is far lower than that the euthanasia rate in The Netherlands and Belgium, where their criteria are far more liberal than those in Oregon and other states that have legalized physician-assisted suicide.

        But Mr. Williams is right in that little accurate data exists about at least a number of the items he has enumerated. We do know, for example, though, that physicians’ prognosis is often way off, just by the Oregon statistics. Some people receiving their prescription for their lethal medication do not take it for well over the six months that is supposed to be the cutoff date for receiving it in the first place. How many people might be shortening their lives by many months because they felt the need to take the medication before it was really necessary? How can we really tell whether anyone was ever coerced to request a prescription? Elder abuse is far from uncommon. It is highly unlikely that two physicians, neither of which may not even have a prior relationship with the patient, will be able to detect subtle pressure from family or staff at long-term care centers to end their lives when they receive a terminal diagnosis. Or that they not seek a second opinion about a terminal diagnosis or pursuing treatment because they are too old, frail, etc. We simply do not know.

  • Credit Warrior

    A difficult, complicated, gut wrenching subject which needs to be discussed. Allowing humans to make decisions about how they or other designated family can control the final decision of their death seems beyond reason from a legal/law standpoint. It gets more sticky when medical professionals are required to be involved in that decision. On the other hand, the majority of humans are caring, compassionate and don’t want their loved ones to suffer. One could argue that Alzheimer’s and other mind robbing diseases removes all of the human characteristics from oneself leaving only a shell of person. Rights/laws/emotion/compassion/dignity. How do you arrive at an answer that meets all of these issues as it relates to assisted suicide? No easy answer. There are several good books that researches all sides of these issues. I have read books by Robert Orfali, Neil Gorsuch and Lynn Keegan over the past several years about end of life issues. All three give different perspectives.