The Void Between My Ears

DWD (#comfort)

Michael glowered at me from his hospital bed, his distaste of doctors palpable. He'd avoided them his whole life and ignored alarming symptoms for two years. Now he had little time left. 

"I want the drugs," he said curtly," and I want to go home."

"I understand," I replied, trying desperately to come up with a strategy in my head to connect with this clearly private and unsocial man, "but the state requires us to have a discussion about it."

Years earlier, I'd sat in a coffee shop contemplating this moment, staring at a person across the street for over an hour who was collecting signatures to get an initiative on the ballot. So, steeped I was in my own thoughts, I can't remember a single feature about that person, only that they had caught me off guard on what should have been a quick ten-minute errand. 

I'd always signed the clipboards held by the do-gooders standing in the cold outside the market. I admit I didn't always listen to why they felt compelled to gather enough signatures to get the initiative onto the ballot. But this one hit me like a freight train because this law, if passed, would ask me to do something I didn't want to do and, in my youthful naivete, didn't think should ever be necessary. As a family doctor trained in geriatrics, the care of older adults, I'd just recently agreed to supervise the palliative care service at our hospital for a few weeks a year. While palliative care involves caring for anyone with a severe, potentially life-limiting illness, it also encompasses end-of-life care. With good comfort care through hospice, I argued to myself, no one should ever need physician-assisted suicide. But there I was, being asked to sign a petition to get the Death with Dignity law on the November ballot. 

There are always exceptions, I finally thought after an hour of silent deliberation. I bussed my table, walked across the street, reluctantly signed the ballot, and bought my eggs. 

Now I and a two-week waiting period were Michael's only barrier to accessing the new state law. 

"Tell me a little bit about what you enjoy doing when you aren't sick or in the hospital," I began. Slowly, and reluctantly Michael began to answer my questions.

The type of people who access the Death with Dignity law tend to be those who fiercely value independence and control. Michael fit that bill, and while he didn't fully open up personally with me, he met the requirements for a prescription. He agreed to enroll in hospice to help him manage at home during the required waiting period, but he declined a home visit from me the day he ingested the prescription. 

In over ten years, Michael is the only patient for whom I agreed to prescribe who lived through the waiting period and took the medication. But as I've gained experience in palliative care, I learned my initial instinct was right. There are indeed exceptions. 

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The Washington State Death with Dignity Act passed November 4th, 2008 and went into effect March 5th, 2009. This act allows terminally ill adults seeking to end their life to request lethal doses of medication from medical and osteopathic physicians. These terminally ill patients must be Washington residents who have less than six months to live.