There are no issues more moving than those tied to deeply held personal values. The debate on spending and taxes is decidedly different from debate as personal as our wishes on how our lives draw to a close. Last week, the House passed S.77, an act relating to patient choices and control at end of life. As of this writing on Monday, May 6th, it is in the Senate where its future lies in the hands of one or two senators and the use of senate rules to either move it into law or stop action. My hope is that it has moved forward.
Modern medicine is good at staving off death with aggressive interventions—and not always so good at listening to the patient and knowing when to focus, instead, on improving the days that terminal patients have left. This does seem to be improving with advances in palliative and hospice care, and I was proud to vote for increasing access to these services in 2010. Without hospice and palliative care in place, any discussion on S.77 would have been premature.
I have long been a supporter of “Death with Dignity” and have listened to many people, both for and against this end of life option. Everyone knows someone who has died and most of us have stories that describe peaceful deaths as well as tortured ones; families brought together and families torn apart. While death itself is no surprise, the timing and uncertainty around it is, requiring us to make conscious our deeply held moral, cultural and religious values. This was evident in the Vermont House of Representatives last week, as many legislators made these views explicit either through personal stories or their interpretation of law, ethics and government’s role.
During debate last week, arguments for and against were often indistinguishable, particularly when discussing the role of government. “Death should be between the physician, the patient and his or her God,” stated one against the bill, but this seemed to resonate just as well with the other side. One who voted against the bill reasoned “government should not insert itself in such decisions,” which was precisely the reason those in favor said the bill was needed – to ensure a patient’s autonomy in such decisions.
Those in opposition described cases in which a six-month diagnosis proved incorrect, with a patient living months or years beyond the six months. Yet research shows that not everyone who asks for the medication ends up using it, and most use it when it is clear that they are really in the last days or hours, not months of life.
Several spoke of the “slippery slope,” fearing this final decision could gravitate out of the hands of the patient and into the hands of insurance companies or greedy relatives. This was precisely why I supported the House version rather than the Senate bill, which only protected the doctor, removing all safeguards to protect the true and voluntary wishes of the patient.
Hospice and palliative care have done wonders to make the end stages of illness more bearable. For those few who find the suffering unending and their lives over, it seems only decent to allow them to be surrounded by loved ones and use this prescription to drift off in peace.
Tuesday, May 14th will be my last morning meeting at Bruegger’s. After that, I can be reached by email, phone, or by appointment: firstname.lastname@example.org or 802 233-7798.