Controlling Pain and End-Of-Life Options
Death does not always come suddenly or unexpectedly. Rather, it can be the result of a long-term or painful illness. Following are discussions of several options a person might have when facing the end of life.
- Physician-Assisted Suicide. As of January 1, 2001, Oregon was the only state that had a statute permitting doctor-assisted/physician-assisted suicide (DAS/PAS) for a terminally ill patient. Other states have recently held referendums on this issue and narrowly defeated DAS/PAS measures. In November 2000, Maine’s PAS ballot measure was defeated with just 51% of the vote (332,280 no; 315,031 yes). Most states have statutes that expressly prohibit DAS/PAS and a few states have used common law to prohibit DAS/PAS. The debate over DAS/PAS began early in the 20th century when Ohio legislators’ drafted the first euthanasia bill. In 1973 the American Hospital Association created the Patient Bill of Rights, which includes “informed consent” and “the right to refuse treatment.” In 1976 California passed a “Natural Death Act” which gave legal standing to living wills and protected physicians from being sued for failing to treat incurable illnesses. Now all fifty states and the District of Columbia recognize either living wills, health care powers of attorney, or both. Recent surveys have found that doctors disregard most advance directives (powers of attorney and living wills). Although Oregon passed its Death with Dignity Act in 1994, it wasn’t until 1998 that the first publicly acknowledged doctor-assisted suicide took place. So although a patient is free to request his or her doctor to assist with the patient’s suicide, it is unlikely to happen-even in Oregon.
- Palliative Care. A palliative care specialist is a hospice trained doctor, a cancer or HIV/AIDS specialist, or other specialist who frequently cares for dying patients. Palliative care consultants are used as second opinions outside of the primary doctor-patient relationship to assess the decision-making capacity of the dying patient and provide an understanding of the ethics of end-of-life decision-making.
- Terminal Sedation. When suffering cannot be controlled by ordinary means, a patient may be sedated to unconsciousness. The medications used to relieve pain and sedate the person may be administered in a hospital or home setting. The patient enters a coma-like state that is maintained through the delivery of continuous medication. During terminal sedation, all fluids and nutrition are withheld. This is most easily accomplished if the patient has a health care power of attorney that authorizes the withholding of nutrition and hydration. During terminal sedation, the family may stay with the patient until death. The usual cause of death is pneumonia.
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