Hospice eNews

What the Media Said about End-of-Life Care This Week

Week of February 28, 2005

…a service of Florida Hospices and Palliative Care

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OREGON’S PAS LAW HEADS TO US SUPREME COURT

 

            Last week, the US Supreme Court agreed to rule on whether Oregon’s Death With Dignity Act violates federal drug laws.  As numerous news sources reported, the challenge was filed in 2001 by the then US Attorney General John Ashcroft.  Ashcroft gave an order to revoke or suspend the licenses of physicians who assisted terminally ill patients in suicide set the stage for the current case.  The Oregon attorney general and several others challenged Ashcroft in court and a federal judge blocked the order.  Ashcroft filed an appeal and, in 2004, the 9th US Circuit Court ruled that he had exceeded his authority.  The day he resigned from the cabinet last November, Ashcroft asked the Supreme Court to reverse the Circuit Court decision.

 

            A Los Angeles Times article cited supporters of Oregon’s law as saying that they “were disappointed that the high court had intervened,” since voters had approved the law twice, and that two lower courts had upheld it.  Opponents of the law “applauded the court’s decision,” according to the article.  Dr. David Stevens, executive director of the Christian Medical Association, said, “The court has an opportunity to ensure that patients receive truly compassionate care and pain relief by limiting physicians’ use of narcotics for healing – not death.”  James Bopp, Jr., a longtime lawyer for the National Right to Life Committee, will coordinate “an all-out legal effort in support of the Ashcroft directive.”

 

            According to the article, the high court’s previous hearing of the right-to-die issue, which occurred eight years ago, had a different context.  The Supreme Court, in a 1997 ruling, unanimously overturned a 9th Circuit Court finding that dying patients had a constitutional right to physician-assisted suicide in spite of a Washington law that prohibited it.  The Supreme Court ruled that there was no such constitutional right, but added that states, not judges, should make the decisions on physician-assisted suicide.          

 

            The New York Times wrote that “although it has constitutional overtones, the new case essentially presents a question of administrative law, one that would be routine in most other contexts:  is a federal agency’s action authorized by its governing statute?  The appeals court concluded that the Controlled Substances Act was addressed to ‘drug abuse and prevention,’ and that the attorney general had exceeded his statutory mandate by seeking to apply it to assisted suicide.”  The Washington Post said, “The case presents a clash between the federal government’s power to regulate prescription drugs and the states’ traditional power to regulate the practice of medicine within their own borders.”

 

            The Salem Statesman-Journal framed the issue through the story of Char Andrews, a 67-year-old Oregonian with metastatic breast cancer.  Andrews says she “feels strongly about the law…  I don’t know what my death will be like, but there is comfort in knowing the law is there.”  Andrews has not asked for a lethal prescription from her physician but wants the law to be there “in case her dying process becomes intolerable.”  “After all,” Andrews said, “you are on your deathbed.  It’s not going to be misused.  There is so much written into the law to prevent misuse.”

 

            The current appeal, which has been refiled under the name of Alberto R. Gonzales, Ashcroft’s successor, will be heard in October, and a ruling is not expected until next year.  (Los Angeles Times, 2/23; The New York Times, 2/23; The Washington Post, 2/23; Statesman-Journal, 2/23)

 

 

“AT OUR MERCY” LOOKS AT DEATH AND DYING

 

            The Chico, California, Enterprise-Record recently published a three-part series, “At Our Mercy,” on death and dying.  In the first article of the series, “Death With Dignity movement meets challenges,” the author, staff writer Steve Brown, interviews Dr. Richard MacDonald, a physician in general practice for more than 50 years.  MacDonald is the medical director of End of Life Choices, an organization that wants to change laws to allow physicians to help terminally ill patients who decide they want to die.  He is also the founder of Caring Friends, which “works within the law to give information and counseling to people who are considering taking their own lives for medical reasons.”  The article cites MacDonald as saying that the current challenge by John Ashcroft to Oregon’s Death With Dignity Act “reflects Ashcroft’s personal religious beliefs and the desire of the Bush administration to maintain the support of the religious right.”

 

            MacDonald’s long years of practice have given him his perspective on death.  He remembers when there was no way to prolong life but says that changed drastically when the use of respirators became common.  He says he doesn’t understand why it’s less ethical for a person to decide to end their suffering than to “die from the ravages of a disease.”  Speaking to those who call physician-assisted suicide a “’slippery slope’ that will loosen constraints against people being able to take their own lives,” MacDonald says, “A slippery slope is possible in anything.  That’s why any legislative measure has guidelines, so it’s not a slope.  It’s step-by-step procedure.”

 

            The second article, “Pastor says medicine’s purpose is to heal,” focuses on an interview with the Reverend Peter Hansen, rector of an Anglican church and a member of the bioethics committee of Enloe Medical Center.  Hansen says that people who want to kill themselves should have the responsibility for that decision – it’s not necessary to make it a joint responsibility.  He thinks assisted-suicide laws will affect the consciences of healthcare personnel who are not in favor of hastening a person’s death.  He also states that though medicine should be focused on healing, “it also needs to know when to pull back.”

 

            One of Hansen’s fears is that if choosing death for medical reasons becomes “morally neutral,” people may begin to use it when there is only a perception of suffering.  Using Alzheimer’s patients as an example, he says, “We look at them and question the value of their lives…  This is still a person.  It’s impossible to assess what the value of their life is.  I believe there is spiritual reality that isn’t affected by the suffering of the physical body and the brain…  How do we learn compassion if we become a society that says kill the sufferer?” 

 

            The third article, “Time is short, now what?,” is based on interviews with hospice staff members about end-of-life issues and their roles in the lives of dying persons.  Pat Walters, an RN at Enloe Medical Center, believes that if dying people get the support they need, “usually the whole idea of ending your life early goes away.”  Rich Briggs, a physical therapist at Enloe Hospice, says, “We use the best medical tools, but we don’t prolong life.  The philosophy of hospice is not to hasten death or delay it.” 

 

            Over the 26 years that Enloe has been providing hospice care, the staff has learned that “the last months of life aren’t necessarily the worst.”  Walters says that most of the hospice staff members have been working in hospice a long time.  “In each patient,” she says, “we see a story unfold.  Most of the time, it’s a very tender and sweet story.” 

 

            The article also examines and rebuts a number of myths about dying – that death is frightening to talk about, that people always die the way they lived, that dying is always painful and that dying people see white lights and tunnels.  The series is online at www.chicoer.com.  Scroll down to the “Death and Dying Series” link in the left-hand column.  (Enterprise-Record, 2/17)

 

 

PUBLIC POLICY NOTES

 

            *  Representative Deborah Pryce (R-Ohio) introduced the Compassionate Care for Children Act in the US House.  (See HNN, 2/8, for information on the Senate version.)  The bill would provide grants for establishing and expanding palliative care programs and training healthcare personnel and would promote changes to the palliative care system to improve care to children with life-threatening diseases.  (US Fed News, 2/18)

 

            *  A new government projection says that, by 2014, the cost of the nation’s health care could account for nearly 20% of the US economy, up from 15.4% today.  Today’s cost per individual is $6,423 and is expected to rise to $11,045 in the next ten years.  The report also expects Medicare and Medicaid’s share of the burden to rise from 45.6% in 2003 to 49% in 2014.  (USA Today, 2/24)

 

            *  At the recent governors’ meeting in Washington, Mark Warner (D-Virginia) said, “Even in the worst-case scenario, Social Security isn’t going to go broke until 2042.  Medicaid is going to go broke long before that.  At its current rate, it will break the bank for states in the next 10 years.”  President George Bush’s (R) plan to cut $60 billion from Medicaid over the next ten years is running into bipartisan opposition from Congress and the governors.  (Sacramento Bee, 2/21)

 

 

END-OF-LIFE & PAS NOTES

 

            *  Two California Assembly members have introduced a right-to-die bill modeled after Oregon’s Death With Dignity Act.  In 1992, Californians rejected a law that would have allowed both physician-assisted suicide and euthanasia.  A 1999 bill that would have allowed physician-assisted suicide was never voted on.  One of the sponsors, Patty Berg (D), said, “There’s no use pretending that dying people don’t receive help to end their lives.  We want to bring it out of the dark, and encourage patients to talk about all of their concerns and be aware of all their choices.  It’s only right.”  (San Francisco Chronicle, 2/20; Eureka Times-Standard, 2/10)

 

            *  Florida’s Pinellas Circuit Court Judge George Greer ruled this week that Michael Schiavo can have his wife’s feeding tube removed on March 18.  Schiavo’s parents, Bob and Mary Schindler, plan to appeal the ruling.  The AP article reports that “Greer said he was no longer comfortable granting delays simply because the parents filed new motions and that the couple and their attorneys needed to demonstrate that their requests ‘have merit and accordingly are worthy of a stay.’”  (AP, 2/25)

 

            *  An article in the Charlotte Observer asks why, since they offer low-tech birthing, medical centers can’t offer low-tech dying?  The author suggests that hospitals provide counselors to assist family members in coming to terms with a loved one’s imminent death.  The author also suggests that the growing number of hospitalists makes the establishment of end-of-life centers more feasible.  (Charlotte Observer, 2/22)

 

            *  An article in USA Today says that the Vatican has not said whether Pope John Paul II has left an advance directive spelling out what kind of end-of-life care he would want if he were incapacitated.  But, the article asks, “Who could – or would – disconnect the pope?”  Reverend John Paris, a moral theologian at Boston College, says there’s never been a living, but incapacitated, pope and also says that there is no rule or Vatican tradition saying who could make decisions for him.  (USA Today, 2/25)

 

 

OTHER NOTES

 

            *  The American Alliance of Cancer Pain Initiatives will move from the University of Wisconsin Medical School Department of Pharmacology to the University’s Comprehensive Cancer Center, which is also the home of the Pain and Policies Studies Group.  A FAQ accompanying the announcement foresees “little noticeable effect” on State Pain Initiatives but says that the change “will increase the capacity of the national office to develop resources for the State Pain Initiatives.”  (Letter from Robert Twillman, PhD, Chair, AACPI Advisory Council, 2/22)

 

            *  The Association of American Medical Colleges is recommending a 15% increase in US medical school enrollment by 2015.  The recommendation suggested concentrating the increases in areas where the population is rising quickly.  The current restriction on Medicare-funded residencies and fellowships, says the association, should be lifted.  (AHA News Now, 2/22) 

 

            *  NHPCO’s “Caring Connections” preconference, to be offered in Atlanta on April 20, before the NHPCO Clinical Team Conference, has been designated as an event of the 2005 White House Conference on Aging.  Information on the White House Conference on Aging is available at www.whcoa.gov.  (NHPCO NewsBriefs, 2/24)

            *  Euthanasia for adults is legal in both Belgium and Holland and a growing number of supporters want it to also be legal for terminally ill children.  One objector is Henk Jochemsen, director of the Lindeboom Institute for Medical Ethics, who says, “In certain circumstances you have to stop treatment and accept the death of a baby.  But I think that you cannot define the conditions beforehand under which you could intentionally end the life of the baby.”  Jochemsen argues that, “Giving broad legal protection for health workers who euthanize children would only encourage the practice.”  (NPR Weekend Edition, 2/19)

 

            *  An article on the benefits of palliative care featured the program at Boca Raton Community Hospital.  The program, which began last April, has seen such great demand that Helen Berggren, director of oncology at the hospital, thinks that an inpatient palliative care unit will be established more quickly than they had originally planned.  Other local units with inpatient beds include Hospice of Palm Beach County, Jay Robert Lauer Hospice and Palliative Care Unit, Delray Medical Center and the Charles W. Gerstenberg Center.  (The Sun-Sentinel, 2/25)