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Death With Dignity
By Barry Yeoman, March-April 2003
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Colleen Rice never imagined she'd be choosing between a pain-ridden life and a dignified death when she visited her doctor in September 2000. She was suffering from breathing trouble that had left her fatigued, and doctors suspected asthma. Then a CT scan showed a tumor on one lung. Follow-up tests confirmed the severity of her illness.
Scott, her husband, had accompanied Colleen on all her doctor visits, so he was prepared for the worst, doing most of his grieving in long phone calls to Colleen's sisters. But when Colleen calmly told her daughter the news—that she only had six months to live—Cathy collapsed. "My life got sucked out of me," remembers Cathy.
Colleen remained strong—a strength that had only grown throughout her life. One of six kids in an Irish Catholic family in Ottawa, she married a neighborhood boy at 20 and moved to a military base in a remote subarctic town in Manitoba, where she scrubbed the tile floors daily and kept the radio tuned to reports of polar-bear sightings. It was only after her divorce 10 years later, and her move back to Ottawa, that she began the inner journey she had long delayed, taking classes in religion, dreams, and meditation, and meeting her future husband, Scott. She was 39. He was 22. "She was young for her age, and I was old for mine," he recalls three decades later. "She was loosening up and learning to play." They married in 1976 and eventually moved to Oregon, where they took an interest in an art form called CireCraft, which uses crayon wax, a travel iron, and a hot plate to create intricate landscapes. Before long they bought an orange and black Cabana motor home, christened it Pumpkin, and began a three-year road trip to show and sell their art. In 1985, Colleen began her last great adventure. She signed up for a Writer's Digest correspondence course and started a historical novel, which would occupy the rest of her life and involve three research trips to Ireland's rugged Atlantic coast.
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| THE PAIN A still-grieving Scott with his dog, Jasmine. |
Now, with her book unpublished and her health going downhill, Colleen kept a calm exterior. There were decisions to make. The doctors told her that chemotherapy might extend her life by months but would not cure the cancer. Colleen decided she had too much unfinished business to be crippled by chemo's side effects. Instead, she opted for palliative, or comfort, care. Hospice workers provided oxygen to help her breathe, along with morphine to ease the pain and relieve her sense of breathlessness. They treated the side effects of her medication and made available a 24-hour nurse who could be telephoned in emergencies. With her basic comfort provided for, Colleen used her final months—there were only three, it turned out—to complete the most important tasks of her life: healing some long-standing conflicts with Cathy and enlisting the family to help edit her novel.
She also began the process of requesting a lethal prescription. Colleen had been aware of the physician-assisted suicide issue for almost a decade and had supported it during the 1994 and 1997 referenda. "People treat their dogs better," she had said of the American medical system, which generally requires that doctors keep patients alive no matter what. She surely knew the profound, almost ironic effect the law has had on end-of-life care in Oregon. The more patients inquire about hastening their deaths, the more doctors search for alternatives to alleviate their suffering. Since the state's first death-with-dignity vote eight years ago, health care institutions have been scrambling to stay on the cutting edge of quality-of-life care for the terminally ill. In 1995, OHSU started building its own comfort-care team for dying patients in hospitals—a radical innovation in a profession that aims to cure rather than soothe the sick. Professional organizations are presenting more end-of-life-care workshops. "People wouldn't go to those before the law," says Barbara Coombs Lee, president of the Compassion in Dying Federation. "Now it's standing room only."
The law has also pushed the state's news media to examine end-of-life issues, including pain management and hospice availability. In turn, Oregonians are increasingly insisting on top-notch care for terminal patients. "When I was in medical school, you'd never see a family walk up to a doctor and say, 'This is not what our mother would have wanted,' " says OHSU's Susan Tolle. "The Oregon vote was a wake-up call for medicine."
But critics such as Joanne Lynn, director of the Washington Home Center for Palliative Care Studies in Washington, D.C., warn against applying the lessons of one state to the rest of the country. Oregon has been successful, she says, because it's a forward-thinking, fairly affluent place that guarantees health care to its citizens. It had a strong infrastructure to care for the terminally ill. By contrast, Maine (where voters defeated a proposed death-with-dignity law in 2000) has one of the lowest uses of the Medicare hospice benefit of any state. It would need to guarantee universal hospice and palliative care if such a law were passed, says Ganzini, the OHSU psychiatrist. Allowing assisted suicide in Maine, she says, "seems like a pretty bad idea."
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