Wednesday, April 23, 2008

Not so Live Blogging of Death with Dignity Forum

Public Service Informational Forum
Cosponsored by the Tri-City Democrats and the Associated Students of Columbia Basin College.

The goal of the forum series is to provide factual information on initiatives and referenda that potentially will be on this year’s ballot.

This forum is about the Washington State Initiative 1000.

In Laurel Piippo’s introduction of the speakers she noted that her grandfather insisted that constitutions of the states carved out of the Dakota Territories include the rights of initiative and referendum.

Moderator will be Dan Blasdel, Frankln County Coroner.

Dr. Linda Olson is from Tacoma.
She works with the Death with Dignity campaign. She has been involved with this issue for more than 50 years. From a career in nursing she has gone on to a PhD from University of Washington. With a specialty in ethics she has been a nurse educator and professor of nursing at Pacific Lutheran University and the University Washington. She has followed the Oregon law from its inception.

Chris Carlson is from Spokane.
He has a radio program there. He is a founding member of the Coalition against Assisted Suicide. He has pursued journalism, public relations, and political life. He founded the Gallatin Group public affairs firm. A former press secretary to Idaho Governor Cecil D. Andrus, Chris directed the U.S. Department of the Interior Office of Public Affairs during the governor’s four-year term as Secretary of the Interior under President Jimmy Carter.
Following his position in Washington, D.C., Chris was appointed to the Northwest Power Planning Council by Idaho Governor John V. Evans. In 1984, he became regional vice president of public affairs for Kaiser Aluminum in Spokane
To start the thing off Blasdel read the text of Initiative 1000.
“This measure would permit terminally ill, competent, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity.”

The forum rules are that responses to questions are limited to 1 minute. No personal attacks are allowed.

Chris Olson won the toss and elected to speak second.

Opening remarks from Chris Carlson:
He offered his thanks to sponsors for putting the forum together. He considers the right to petition is an important right but key phrase is “when legislature refuses to act”. On this particular issue the legislature has not had a chance to act. It has not been explicitly brought before the legislature such that the legislature could go on record one way or another. The failure of this one technicality is one of the reasons he opposes the initiative.

Mr. Carlson was told he had less than 6 months to live by 2 doctors. He had a rare form of cancer that was at stage 4. He would qualify under the initiative. But he decided to be aggressive about pursuing treatment. He was able to access an experimental treatment that has kept the cancer at bay. He considers fighting for life to be natural.

He sees fatal flaws in Initiative 1000. He worries about how economics would play into the process. Some past proponents have said that Initiative 1000 would save money by not spending it on doomed efforts to preserve life. He fears this economic consideration will take control of the process. Another flaw is that it does not require notification of next of kin. He fears that very young people can be stampeded into it for financial reasons. There is no mandated counseling for the understandable depression that frequently accompanies an imminent terminal prognosis. He believes there is a flaw in the Oregon law. There is no requirement for doctor to report the number of people avail themselves of the option and no investigative mechanism to audit whether it is being used properly. The data being used by the proponents may be flawed.

Many states have rejected initiatives of this sort.

Mr. Carlson fears that life will be seen as having a determinate value instead of priceless.
He admits he has signed an advance directive to prevent the use of heroic techniques to keep him alive if and when the time comes.

Hospice nurses say most pain is manageable and pain should not be a reason for terminating a life.

He sees this as suicide and objects that under the initiative and the Oregon law that doctors are allowed to list the disease as the cause of death rather than suicide..

Dr. Linda Olson’s opening remarks:
Olson will not respond to Carlson’s specifics. She makes the point that the law allows the choice. The law allows the patients to be in control of how they die when death is inevitable. It is rooted in the concept individual rights. She reiterated the safeguards, some of which Carlson criticized. The structure is such that it is completely voluntary. In fact very few have actually used the Oregon law but every terminal patient has benefited because they can choose from a fuller range of options. In Oregon hospice use is quite high. Oregon patients have access to better pain control than most. The experienced statistics are that approximately only 1 out of 1000 terminally ill patients actually requests the option. Of those, only 1 out 6 qualify as eligible. Of the people who are given the option only 2 out of 3 actually use it. In the deaths of 36,000 terminal patients only 46 were self-administered. The experience of the law as actually applied is that it does not stampede people into death. Sometimes having the option actually gets people to fight harder to live.

The law does not affect insurance or survivor benefits since the cause of death is not listed as suicide. She sees the law as a benefit to the citizens.

The editorial board of the Oregonian newspaper (the major Portland metropolitan paper), was initially against the law. But ti has changed its mind. They wrote, “The dire consequences predicted did not pan out.” No abuses have been found.
On the question of medical expense and economic impact the usual case is that by the time people apply for Death with Dignity all the expenses have all been paid out and everything that can be done has been done.

The moderator then gave the speakers an opportunity to speak to some prepared questions.

How is mentally competency determined?
Olsen: Mental competency is an issue for things other than assisted death. The mental competency standards used in other contexts are applied here.
Carlson: The assessment of competency is outside of my expertise. But suicide is an irrational act. Just asking for the opportunity to commit suicide indicates to me that a person isn’t competent.

What effects would this have on the family unit?
Carlson: I see this as bad for family unit because a person can cut the family out of the decision process.
Olson: In 95% of the cases the individuals talked with family about it. One can decide to withhold other means of medical treatment as Mr. Carlson has done without including the family. I don’t see this as much different than that..

What are the legal ramifications to previously written wills?
Olson: I don’t know that there are any.
Carlson: I’m not a lawyer but I can envision a scenario in which an assisted death could be challenged as a sign of incompetence.

How is this better than a living will?
Carlson: I don’t see it as better. I wonder why people want government into how they deal with a terminal illness. But I concede that there is the gray area.
Olsen: I see this as complementing living will. Sometime the living wills are not honored. This gives the person sure control.

What are results or problems from Oregon?
Olson: I think the results are good and we couldn’t find any problems.
Carlson: I disagree. I think the way the Oregon law is structure the data collected may very well be bad. I can cite a case where the drugs didn’t work. Activist groups have a list of such cases available.

Now there were questions from the audience.

In the Hippocratic Oath life is considered as the ultimate purpose. Has that changed?
Olson: At end of life the duties of preserving life and reducing suffering intersect. What is the point of allowing suffering to continue when death can not be kept at bay?
Carlson: No, the charge in the oath is to do no harm. Doctors don’t want this law. Professional medical organizations do not want it. Doctors don’t want to be forced to tell patients about the death option.

Would you be more willing in severe cases with intractable pain, declining mental capacity, and sure and painful death to support this law?
Carlson: No. Pain can be handled. There is a broader issue present about access to the good pain medications.
Olson: Yes. Not all pain is physical. There is the indignity of how one dies with some of these illnesses that drugs don’t begin to touch.

What about people taking their lives in a more dramatic fashion?
Olson: This should be avoided. It is not a good thing.
Carlson: Strangely enough I agrees with Dr Olson on this point. I think people should do all that they can to stay alive.

Has the legislature had any hearings on this issue?
Olson: Legislators won’t touch this issue because of the controversy it could potentially be brought against them..

Does this law justify self-determination? We don’t have to subscribe to someone else’s definition of competency.
Olson: There are standards of mental competency in our legal system whether we like it or not.
Carlson: I see the proponents making too much of the issue as choice issue. I think that this law would be a step toward the state defining when the “choice” can be taken. I find it curious that often the same people who object to capital punishment by injection also support death in a similar fashion with assisted suicide.

[At this point I had to leave so I don’t have any information about the closing remarks.]

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