June 22, 2018
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‘What’s a good death?’ Sometimes, it involves choice

Abigail Curtis | BDN
Abigail Curtis | BDN
Bill Jose of Yarmouth spoke about his terminally ill wife's decision to end her life at the annual meeting Saturday of the Funeral Consumers Alliance of Maine at Granite Hill Estates Retirement Community in Hallowell.


“What’s a good death?” Bill Jose asked, when describing the last days he spent with his wife, Polly Keller. The Yarmouth woman had suffered symptoms of a terminal, degenerative disease of the brain for years. She didn’t consider it “living” to keep experiencing ever-increasing dementia and debility, her husband said. So after talking with professionals and doing research, Keller decided to simply stop eating and drinking. She died two weeks later.

In the debate over whether to legalize physician-assisted death, also called physician-assisted suicide, some may forget that, every day, deaths are already informally hastened. Sometimes it’s by drugs administered to ease pain that also accelerate death. Other times, people choose the best way — for them and their family — to end their life, as Keller did. Most of the time, though, the public doesn’t hear about it. The issue is difficult to discuss because it raises questions about whether people have a right to end their own life — when it becomes understandable and when it doesn’t.

Maine has tried for a couple decades to set standards on how and under what circumstances a physician may help a terminally ill patient die. But legislation has always failed. And despite surveys showing public support, Maine voters defeated a ballot measure in 2000, 51 to 49 percent, that would have legalized the practice.

As long as there are safeguards to protect against abuse, terminally ill patients should be able to talk with their doctor about ending their life and decide for themselves whether they wish to go that route. There are laws in other states that Maine could use as models. Washington, for instance, enacted a law in March 2009 that allows terminally ill patients — who must be Washington residents with less than six months to live — to request lethal doses of medication from physicians. The Seattle Cancer Care Alliance added more safeguards to the way it administers the program, including no advertising and voluntary participation by doctors.

Reports on the program show only a small number of people both choose and follow through with physician-assisted death. In 2012, medication was dispensed to 121 individuals in Washington, and only 83 are known to have died after ingesting it. A study of the Seattle Cancer Care Alliance’s Death with Dignity program, published in the New England Journal of Medicine, reported, “Patients, caregivers, and family members have frequently expressed gratitude after the patient obtained the prescription, regardless of whether it was ever filled or ingested, typically referencing an important sense of control in an uncertain situation.”

Rep. Joe Brooks, an independent from Winterport, has been involved in the effort to legalize physician-assisted death in Maine since the 1990s. Most recently, last spring, he sponsored an unsuccessful bill to allow a patient who is terminally ill to decide the care he or she will receive at the end of life and shield physicians from liability. Brooks watched his father — who he described as tall, tough and proud — die a painful death, caused by lung cancer that spread to his brain.

“He had dignity. To me, he was John Wayne,” Brooks said. “When he landed at God’s front door, he weighed 35 pounds.”

While Brooks’ bill, LD 1065, needed more protective provisions for patients — such as to better define when someone has mental capacity to approve physician-assisted death and to define when someone is terminally ill — its goal to improve patient choice was well-intentioned.

Keller found a way to die that suited her situation and the people she loved most. But someone else may have preferred a different path.

It’s important, Jose said, “to think about not just ending your life but ending it in a way that’s good for all the people around you.” One of the positive aspects of ceasing eating and drinking was that it allowed his wife time to change her mind. “The downside of course is that it takes a long time.”

But it was the best option for his family. It gave them time to talk to her and say all the things they had ever wanted to say.

It’s likely only a few people in Maine would choose physician-assisted death each year. Legalizing it wouldn’t mean everyone who sought the option would or could choose it. (For instance, someone might have longer than six months to live and wouldn’t qualify.) But it’s a choice that should be available for those who want that control, for them and their family, at the end of life.

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