Understanding End of Life Choices

Many supporters of assisted suicide among the general public genuinely but mistakenly believe that assisted suicide is a necessary option in a health care system in which too many people die in hospitals and on ventilators.

Unfortunately, some of the advocates of I-1000 try to capitalize on patients' fears of dying in pain and may give people the false impression that there are only two options: dying in unrelenting pain and misery on a ventilator, or taking a lethal overdose to end your life.

The fact is, this is not and need never be the case.

No one today needs to die in pain and suffering, and no one needs to receive unnecessary medical care. Here are some important resources to prepare for end-of-life challenges:

Enormous advances have been made in end of life medical care in just the last ten years. An entire new specialty in medicine has sprung up, called Hospice and Palliative Medicine, with thousands of physicians now certified as experts in hospice and palliative medicine*. Greater experience and advances in the use of medicines now allow physicians to control all symptoms of pain and anxiety at end of life. The hospice movement has been growing and growing; while still unfortunately underutilized by both physicians and the public, hospice provides people at end of life the ability to die in their home surrounded by those that they love.

Many options exist for patients to decide exactly what kind of medical care they will receive and what care they will not receive. From the simplest DNR (Do Not Resuscitate) orders for people who elect not to have CPR or be placed on a ventilator, to POLST forms, to Advance Directives such as Living Wills and Durable Power of Attorney for Health Care, everyone can and should discuss with their family members and their doctor what kind of care and intervention levels they want, so that they do not find themselves receiving care they would not have chosen. The following is a list of options patients and family members should explore, with links for more information.

By availing yourself of these options to determine the kind of interventions you wish to receive, and with the help of the hospice system and with expert physicians such as those board-certified in Hospice and Palliative Medicine, no patient should ever feel trapped into taking their own lives. I-1000 is bad medicine and bad public policy, and Washingtonians should resoundingly reject it.

The Washington State Medical Association (WSMA) and the Washington State Department of Health have collaborated to establish a secure online Living Will Registry whereby patients can make clear to their doctors and to hospitals what their end of life care choices are in case they are unable to communicate them. More information on Living Wills.

POLST forms (Physician Orders for Life Sustaining Treatment) are documents that translate the wishes of patients with advanced illness into actual physician orders that can limit or expand the kind of care you receive. For example, you might elect to receive antibiotics and IV fluids but might decline to go on a ventilator. The WSMA maintains a helpful link with further information about the POLST form, and you can also discuss this with your doctor. More information on POLST forms.

Advance Directives include both Health Care Directives (Living Wills) and Durable Power of Attorney for Health Care. The Living Will is a legal document specifying your wishes regarding the care you receive at the end of life should you be unable to communicate them. In Washington State, the directive is used only if you have a terminal condition where life-sustaining treatment would only artificially prolong the process of dying; or if you are in an irreversible coma and there is no reasonable hope of recovery. The Durable Power of Attorney for Health Care is a legal document allowing you to name a person as your health care agent - someone who is authorized to consent to, stop or refuse most medical treatment for you if a physician determines you cannot make these decisions yourself. Once appointed, your health care agent can speak on your behalf anytime you are unable to make your own medical decisions, not only at the end of life. More information on Advance Directives.

Patients may also receive a free brochure from the WSMA via the above link.

* Did you know? The vast majority of physicians reject assisted suicide, with only a very small minority of physicians supporting it. The less physicians know about pain control and palliative medicine, the more likely they are to favor assisted suicide, while the more physicians know about pain control and palliative medicine, the less likely they are to favor assisted suicide. Tragically, I-1000 does not require doctors advising patients about assisted suicide to know anything at all about palliative medicine or hospice options, much less require them to make a referral to a physician who is an expert. In many cases this may leave patients completely uninformed about their options and effectively trapped by their physician's ignorance into choosing the only option their suicide doctor knows anything about, which is assisted suicide.