May I ask you what religion you follow (just curious)? Also, which religions support right to choose? Thanks.
I am a Unitarian Quaker. The Unitarian Universalist Association has, in 1988, approved in General Assembly we should have the right to end our lives with physician help.
Well it all depends, doesn't it? If you believe you made yourself, I suppose it is logical that you can un-make yourself. If you acknowledge that you had no say in the making of yourself, then it is logical that you can rightfully un-make yourself when you reach the age of reason, and you do get a voice, say at 7 years old. (Who is to say that an individual 7 year old cannot experience persistent, agonizing, emotional or physical pain, if that is the standard by which assisted suicide is permissible?) If you acknowledge that there may have been the hand of a Creator involved in your making, you may see life as a non-returnable gift. In this case it is not so logical to treat your life as if it were your own making. However, if you don't hold this view, I really don't see the difference between ending your ending your life because of illness or simply because you are just plain bored.
Yes, I think it depends upon our beliefs. If you do not believe you have this right you should not do it. I have NEVER encouraged anyone to change their beliefs about such ideas.
How do you ensure that the person is making the decision without undue pressures from other 'sources'?
Good question and scary one too. We start out assuming persons taking on such a difficult question have thought it through and are reasonable people. We then ask them questions and more questions. Even after we have accepted them to assign a guide, the guide will ask more questions and can back out of guiding at any time. Hopefully we are right in this. Do you trust your preacher or rabbi to tell you the truth? I hope so. Do you trust your doctor? I hope so. Both situations have a space for possible error.
Wish us good skill and also good luck, please.
How much suffering would you like to see yourself or someone you care about have, especially on an onging and constant basis? Think "Suffering" with 10 astorics after it, and is that not enough to relieve "that" suffering? Then ask yourself "what is LOVE or CARing really mean, short or long term? What is a true friend? I've seen so much useless pain and suffering it is worse than water boarding, stop it if you can, you are not "killing" a person or "soul", you are relieving torcher.
I became a physician because I do not like people to suffer. Now, do I have the skills to modify the cause of the suffering sufficiantly so that you can sort of get along in life? Most (well over 90%) cases that can be done. In Oregon, for example, the number of people actually using this service is well under 1%.
For patients living with intractable pain, why wouldn't palliative sedation be a preliminary or preferable step to suicide?
It is in about 99% of the cases. We are talking about that approxiamtely 1%
I presume that much of the opposition to assisted suicide is because of religious beliefs. Why should anyone who is not religious or does not share that belief be forced to abide by that rule? This only reason I can come up for opposing such a natural right would be the precautions necessary to prevent abuse or illegal acts.
I agree. If you a devout Roman Catholic following the words from Rome, you would NOT do this. However, I have had a couple of patients who were devout believers, one Catholic and one fundamentalist, both suffering horribly. They finally said enough is enough, I cannot handle it any more and called the Final Exit Network.
Yes, of course they do have the right to choose when they die, given that they're not suffering dementia or other mental incapacity that prevents a rational decision. Each person, who is aware of his/her decision, has the right to make the decision to terminate his/her life. Society can institute safeguards to minimize abuse of this right, but society does not have the right to prohibit it altogether. Such prohibition is just a remnant of religious beliefs concerning people's right to life and death.
I agree as long as they are rational and adult. The question that some people ask is "Are they rational?" I have met people who say that just wanting to hasten death defines one as irrational. Try that for a discussion point!
Dr. Egbert - what did your not-guilty verdict in the Arizona assisted suicide tell you about the future of authorities efforts in the U.S. to prosecute people like yourself in the future?
Legally it said I was not part of a conspiracy to organize the killing of people (you can see I am not an attorney). The prosecution in Georgia is using the RICO charge to say that we are a gang organizing killing. Essentilly I have interpreted the Arizona decision to suggest that is not so.
If, after the hood is placed and the tanks are opened and a minute of inhallation of the helium has passed, the patient tried to take off her hood, choosing life, would you let her remove the hood or would the amount of helium have done so much damage that life would never be as before? Is that why you hold patients' hands, to get them through that slight but very real possibility of ending up in a living place worse than where they started? Assisting the depressed patient was a mistake, I believe. Unlike ALS, advanced painful cancers, etc., depression can be medically managed. She may have had poor caregivers, subpar physicians, etc. You should have encouraged the patient to find a succesful regimen which can take years but is possible. Where do you draw the line?
1. If the patient said as the helium was starting to take effect, that he wanted to change his mind, I would quickly take the exit hood off.
2. I hold their hands as comfort and tell them that they should not bump the exit hood by mistake if there is a twitch. When you go to sleep normally at home, you often twitch a bit. At lest that is what my wife tells me. But so far every patient doing this in my experience has been glad to have me hold a hand while a spouse or child or friend holds the other hand.
Every day hundreds of people in the US go to dialysis. Every so often a dialysis patient decides to stop treatment which will result in death. Is this person committing suicide? Please discuss the similiarities and differences. Thank you for clarifying an issue that has many nuances.
Such a patient is certainly hastening death. However, this is NOT suicide. It is saying I do not want more therapy and everyone agrees you do not have to have therapy. You can decide not to start or you can decide later to stop. That is agreed to by everyone. Check and read the book, NO GOOD DEED, by Lewis M. Cohen,MD, a very thoughtful book.
Was there any concern over the detail included in the article? My first thoughts were that a number of people may attempt to do this alone, unsuccessfully. Is there any danger from high, though not lethal, doses of helium? Or danger of suffocation from not being able to remove the bag if not enough helium is used?
So far, I have not heard of any concern. Incidentally, everything I have said technically was published years ago in FINAL EXIT written by Derek Humphry. Be sure to buy the 3rd edition. I think many thousands of these have been sold and are in your libraries.
Did the doctor ever take a Hippocratic oath or something similar that stipulates that a physician will do no harm? When did he discard that aspect of being a physician?
Yes, this doctor, me, Larry Egbert did take the Hippocaratic oath. We all die. Helping people stop suffering is what we do. If you can do it in a less dramatic way, go for it. A small number of people cannot be helped. Most people do not need our guidance.
As a resident physician at Johns Hopkins, I find myself completely inundated with desperate pleas from people who wish to extend their lives, not shorten them. Why did Dr. Egbert decide to use his medical knowledge for assisting suicide instead of for saving lives, especially since so many methods for non-assisted suicide already exist?
I do not assist in a suicide. I help people stop their suffering. Lots of physicians are helping patients stop the suffering as I am sure you do. I have taught for years at Hopkins and can tell you some of your fellow students have witnessed a staff physicians helping their patient hasten the process. The problem is that your staff physicians do NOT like talking about it because of things happening like what happened to the seven of us who wre willing to help. Want to talk some time? I can be reached by e-mail or check with your Departmnet of Anesthesiology or come some Friday noon for lunch at the Blaustein lecture.
I remember when Dr. Kervorkian's opponents characterized him as a profiteering seducer, talking people into end their lives for his own benefit. I always felt that the description was unfair, partly because it glossed over the difficult issues involved. The opponents seemed to assume that no patient in that position would willingly choose to end his or her life, or that doing so is merely a temptation like drugs or sex. Do you think that assumption stems from denial? Do you share my impression that the opponents tend to be absolutists who believe in pure good versus pure evil, and thus have trouble wrapping their heads around issues where the morality involves huge shades of gray?
I never met Jack Kevorkian. I have read his biography and a book he wrote and I have met a Unitarian minister who had one of his parishioners seek out Kevorkian help. Kevorkian was incredibly thorough, never talked anybody into anything. It was the patient talking him into helping. Same with us. No one, but no one talks anyone into doing this when we are helping. We spend hours trying to make sure the patient decides rationally what is right for her to do. Thanks for adding the word, gray, here. Think of the devout born-again Jesus convert who is either vomiting or screaming in pain and then asks Jesus to forgive her for taking this medicine.
instinctively (each person has the right to choose, and I know how I deal with pain, for example), but what troubles me about allowing assisted suicide is: who is qualified to say when a person really is ready to end their life, and won't change their mind, and when they're going through a crisis, or suffering a mental disease that would be treated with therapy? I know Kervokian, for example, said he was sure who was ready to die. But who really knows? Will we certify death doctors? And can we guarantee that no family members would sue?
Who is ready to say when a person is ready? I start with asking that of the person. I also think a lot about what other patients have put up with and what I might be willing to put up with. Think of the person with ALS, cannot breathe well, and when swallowing liquids a lot ends up down the trachea and chokes. Is such a person ready? Well, the famous astronomy professor in England has put up with that and says he is not ready. People are different. The real question you ask here is, Is Dr. Egbert qualified to say both the choking person and the astronomy professor are rational and making a reasonable choice and your doctors are human too so might just make a mistake now and then. Please do not let any physician know that I wrote this!!
My father shot and killed himself when I was a teenager. My older sister, just 22 at the time, found him, and both the image of her walking in on his body, and the image of him all alone trying to steady the gun for that one final, fatal shot have haunted me for over 20 years now. Acknowledging that I'm uniquely biased here, I have immense empathy both for those who are suffering (my father had been ravaged by rheumatoid arthritis and was in constant pain) and for their families. I wish he's had another option, one that could have included us, one where he wasn't alone right at the end. So my question for the doctor here (thanks for taking the time today -- I enjoyed the article), is where he thinks the law is heading? Does he think more states will follow in Oregon's footsteps? Or are we going the other way, where it'll remain outlawed for the forseeable future? Oh and one more, if I may -- what can a supporter, like me, do to help the cause?
What can you do to help? As a starter get a speaker from Final Exit Network or Compassion and Choices to come to your neighborhood and give a talk. In Baltimore, we meet next early in March at the Enoch Pratt Library on 33rd street.
I think society is moving towards more freedom to make decsions for ourselves. Join the ACLU or human Rights Watch to work more for freedoms in general. Specifically, ask your own doctor how to plan for this. I assume you and everyone taking time to ask these questions has made plans for the end of life, written them down, arranged for the process with a Health Care Proxy and filed this with their doctor AND their attorney. Me, I have made plans that when my time comes, my wife will make sure the body goes quickly to the Johns Hopkins UNiversity Parkinson Research lab.
How many of the patients that you have worked with were using the services of hospice?
I did not keep a statistic so I will guess at 25%. You will notice in the Final Exit Network advertisement we do not require patients be terminal. Chronic suffering is the key. Mentally competent adutls have a basic human right to end their lives when they suffer from a fatal or irreversible illness or intractable pain, when their qulity of life is personally unacceptable, and the future holds only hoplessness and misery.
I should add here that to enter hospice one is supposed to be expecting to die within six months and doctors have a very time in saying that time is come with real predictability.
I am an attorney in Washington State where assisted suicide is legal. I am also President of Choice is an Illusion, a non-profit corporation opposed to assisted suicide. In Washington, proponents promised that legalization would enhance patient choice, but our law does not deliver on that promise. The emperor has no clothes. Our law is a instead a recipe for elder abuse. Key provisions in our law include that an heir, who will benefit financially from the patient's death, is allowed to actively participate in signing the patient up for the lethal dose. Once the lethal dose is issued by the pharmacy, there is no oversight. Not even a witness is required. Without disinterested witnesses, the opportunity is created for an heir, or someone else who will benefit from the patient's death, to administer the lethal dose without the patient's consent. Even if he struggled, who would know? See this. The current proposal in Massachusetts has the same defects: Link.
Do not be deceived.
Margaret Dore - www.choiceillusion.org
Dear Margaret Dore,
I do not share your disrespect for the physicians or the patients in your state. If you say your former governor was working on something unreasonable (which I guess you do), then why are the voters of Washington so dumb? I do not think they are. Nor were the voters in Oregon. When I lived in Boston, I was repeatedly impressed how the voters often made quite good sense. I wish you luck with your own end of life and merely ask that you do the same for me and DO NOT take away from me the right to decide for myself what I want to do with my life. My choice to do in my home with my loved ones attending me is the key here and I wish you the same.
Not only do I support state legislation that would permit assisted suicide, most of which seems to be focused on horrible physical ailments, I think we need to allow people, while still competent, to pre-determine the right to die in the event of mental incapacity caused by dementia or similar diseases. At the point I can't figure out how to eat, recognize my children or use a bathroom, I am ready to move on. Not sure why we are so committed to extending the quantity of life when there is no quality of life. Thanks for your thoughts.
Obviously you and I agree. The trick here is that if you are depressed today, should we not first help you with your depression? Only, let me repeat ONLY when you have thought it over and over and with loving guidance made the decision, is it reasonable. Now, I am not telling you that you have to be reasonable all the time. My job was to try and figure out if you were reasonable and then decide yes or no and then decide did I want to be your guide? A lady from Philadelphia once gave me a call and offered several thousand dollars to come up and kill her. She did not sound very reasonable and I declined. But suppose she had offered me a $100,000? Oh ho! You see the slippery slope. (She did not.)
Of course we have the right to kill ourselves. The real question is, when is it okay to give up? When we are always depressed? When we are always in pain? I wish people who don't believe in this inalienable right would understand what it is like to be in significant pain 24 hours a day. Then they would understand.
I like to think we have the right to do what we want in our own homes alone or with another adult as long as what we do not harm one another and no one coerces the other. You can see how the sufject can be broadened. IN summary, I cannot imagine a God who would want me to suffer altho I am quite aware that some people have thought sufering religiously good.
Now, when to give up? Derek Humphry wrote that his wife made a theoretical graph of suffering and put a hypothetical point on the graph that said maybe there would be such a point and if she could find that, would he then accept her opinion and help her get it over with.
The patient of Dr. Quill did a similar calculation with her leukemia and he wrote her a prescription and then wrote up the report for the New England Journal of Medicine! I read somewhere that he was only regretting that he was not there to hold her hand while she took the medicine.
You've mentioned chronic suffering as an indicator several times. If I were ever diagnosed with Altzheimer's, I would want to end my life before the disease had robbed me of the ability to think, recognize my family, etc.--even if I were not in chronic physical pain. How does that fit with your thinking about accelerating the end?
Complicated. Had a patient like that. She was definitely properly diagnosed. Her children had offered to move her to where they now had their families and care for her but she had her home, her town, her surroundings. Her son took her to evaluate a nursing home. NO, she did not want to do that.
Now, what did I see? A healthy looking very attractive intelligent woman of 80, rather forgetful but quite charming. I guided her thru the process but it was not good. All I can say is that the alternative of the police taking her by force off the street somewhere and institutionalizing her (she had had a bit of warning on that too) would be worse.
Often there are only bad choices and one has to take the least bad. Patients with Alzheimer's have a time when they are (hopefully) reasonable and we warn them that there is a window of opportunity that will close some time and I do not predict when. .
What are the options for an American to seek assisted suicide abroad? My husband (who has watched 3 parents die of cancer) has always said he'd prefer heading to the Netherlands for his little black pill rather than die a long, lingering, and painful death. Is this even possible these days?
Yes, but I do not think to the Netherlands. Try Dignitas in Zurich, Switzerland. Do not even think of Oregon. Good luck.
I am a clinical social worker in the field of end of life care, formerly hospice and now supporting those living with ALS. I am a proponent of the right to choose and actually surprised that I have not encountered more people considering this. I was caught off guard the other day when my mother stated that she wanted to get more information about it - especially as there is nothing in particular "wrong" with her - just normal aging issues. She says she is not considering it but only wanted to know more. However, it left me with the question of, despite supporting it in theory, could I in any way participate in it within my own family. I wondered if family members are generally involved and how that works. And what you do when the person, of sound and reasonable mind, is adamant but the family is strongly opposed.
I would suggest you and your mother together get in touch with Final Exit Network and get kus to send her a guide and have some more discussions. One of my best friend colleagues had her husband want to die with ALS (Lou Gehrig's disease) and she supported his desire to finally get rid of the disese and sufering but was never happy. No good answer here. However, your mother is lucky having a child like you who is really to mull over the troubles and cares.
Had a patient one time who had suffered for years with Huntington's Chorea. He wanted and was ready to give up the suffering. His daugher was not sure, yes, be there, no, it would be horrible to see. Back and forth. We went over the options with her. She went off alone and thought it over, no good choices available. She decided to come and be with her father. As he prepared to take his medicine, she said she would like to say something about him. She then said a eulogy: what a courageous and decent man he had been. All these years of awful suffering but never took anything out on his family. He was such a good man and so brave and.... We,his wife, the brother, and my other go-guide, started to cry and I am now again. There is no good anser to this, friend, but with love pushing us along, somehow we seem to amke things go. Thank you.
It seems that members of FEN have trouble keeping your stories straight. In several news stories and/or op-eds, I've read members claiming your organization helps the "terminally ill" and doesn't mention that your 'eligibillty' is far more expansive. Frank Kavanaugh does this often. Others like yourself tend to be more open about just how wide and nonquestioning of suicide requests you are (like wondering if someone on Chantix was a good candidate - since quitting smoking is at odds with a desire to die and the drug itself can induce suicidal ideation).
Interesting you note that even we who work at this complicated field and not all constantly on the same page. Frank came on the Final Exit Network board as I was getting arrested. Final Exit Network for a while was put out of business. How they resurrect the organization is not something I am privy to so I guess you should ask Frank to get his stories straight. All of my stories told in the article and in my talks are out of date by three years. I was arrested three years ago and have only second hand or old stories to share.
I am always just a bit nervous about people who insist too much on consistency. Every patient I have seen has been different.
What types of suicidal people should get suicide prevention rather than support to carry out suicide?
Every one who is irrational or below the age ranage of probably rational. We have had a few such patients and frantically tried to get them therapy to prevent what they were planning.
The point here is that who we do guide are thoughtful so we are thorough, caring and that includes certain persons who might be less than thoroughly thoughtful. Our skill and luck is that our patients who do die with our guidance have thought it thru and decide properly. One thing that helps me in this kind of thinking is to never refer to hastening death as suicide. If you are reading my other comments you will have noticed I have described this also has stopping the suffering.
I had a patient one time dying of cancer and her son said when I was coming Monday to kill his mother, what time of the afternoon was I going to be there? I asked him to change his vocabulary. His mothr was planning on ending her horrible and chronic pain on Monday at 3PM. And his mother was told that she should make sure he had his vocabulary straight. She grinned and said she would.
In the interview, you denied being a "true believer," but I think you protest too much. Jack Kevorkian always *claimed* that he only accepted a small percentage of the requests that came his way (the claim is unverifiable). Kevorkian's behavior and frequent rants made it easy to brand him as a zealot or fanatic. Yet your own behavior - approving almost every single request that you encountered - would seem to be even more deserving of the labels 'zealot' or 'fanatic'.
I certainly am a fanatic at believing we all should have the right to choose how to live. Therefore, to be consistent, I believe you have the right to think of me as a zealot or fanatic.
However, I like to think that both Dr. Kevorkian and the many doctors who have helped patients hasten the process including myself are thoughtful and caring. The only person I know personally who was with someone using Dr. Kevorkian's assistance thought him cautious and caring. Sorry I have yet to see the movie, Have You Met Jack?
Some suggest that instead of considering suicide when a person is in intolerable pain, a preferred option would be to medically induce a coma? Thoughts?
Thanks to you for this note. One time I had a patient who had been a practicing psychiatrist all her adult life. She was suffering horribly from a cancer which was in bone and liver and lung.
As she prepared to take her medicine, she stopped and looked my colleague and me over rather carefully. She said then that she had been an atheist all her life but, then she hesitated and grinned, "God bless you!"
I am so very disgusted with the medical profession's attitude of "life at any cost". My husband had an inoperable brain tumor and went through chemo/radiation to prolong his "life" for another few months. Those months were hell. The surgeon who performed the biopsy was honest about looking at quality versus quantity but he spoke to me, alone, for only a few minutes. I was left to convey the news to my husband. How do you begin to approach a task like that?!!! The oncologist gave him hope when he knew..HE KNEW ..that there was no hope. We need more honest doctors and hospice providers to help people face end of life issues. I believe that death isn't the end, it's only the beginning. People are so afraid of "death squads" that the issue of assisted suicide starts them ranting and raving. If it were me and I had a choice between living for a few months in total pain, on drugs, out of touch with my loved ones who were caring for me 24/7 and someone giving me meds to put me to sleep ....forever....I would choose the forever. I recently had to put down my loving cat companion. It was really tough, but at least we can spare our pets end of life pain. I guess it boils down to faith issues and how we view suicide. Does God want/need us to suffer? Why is it so very difficult to get out of this world when you don't want to be here any more? Is it o.k. for us to make that choice? I have more questions than answers. Good luck with your task.
I have heard this so many times but it still horrifies me. A colleague when I first came back to Hopkins, said he would be glad to help me with some research. Then he added, "You should know I don't believe in assisting a person to hasten death." Then he grinned and said, "Well, maybe unless it was my mother."
Think of the veterinarian who cannot understand us physicians. Would you put your dog thru this? I asked a group of our students. None would put their thru all this but most would not help a patient get it over with. Thank heavens some of the students then added "until we change the laws to be like Oregon or Holland."
I'm an American living in Belgium and have witnessed a dear 88 year old friend diagnosed with fatal leukemia request and receive euthanasia a week later under Belgian law. Very humane and dignified treatment. A huge amount of American medical costs are in the last three months of life because of unwillingness to be honest with ourselves and accept the inevitable. Strictly controlled self-requested assisted suicide is far more humane than keeping people alive 'at any cost' or in 'any condition'. Thanks for helping open up the debate and discussion on this topic.
My response, of course, is to say, Bravo. However, that the Belgians have universal health care AND they have a much more homogenous pop[ulation. Their medical care is better. They live longer than we. They suffer a lower infant mortality. And, oh heavens, they do not even have the death penalty.
Is it all about what the individual believes? Or, does society also have an interest, a right, to say who may or may not terminate his or her own life...with assistance, or without assistance? If society has such an interest, what is the basis for that interest? Is it a matter of fostering sound public policy that ensures the strength and growth of a nation? Or, is society's interest based on something else?
A supreme court justice in 1928 wrote that ou founding fathers gave us the right to privacy. We have said Congress shall make no law respecting or establishing of religion or prohibiting the fee exercise thereof, or abridging the freedom of speech, or of the press. (Amendment to the Constitution I abbreviated)
I hope a lot of you reading here will be telling Manuel Roig-Franzia that he wrote a great article. He was incredibly thorough and thoughtful even when having his photographer taking pictures of me bicycling home.
I also hope you all will reread the interview with the wido of Mr. Kahn or the current living June Lennon struggling with her breathing day in and day out. We should ask those who have shared the trenches about all this.
Of course, society has an interest, a right, to say something. All I am saying is that I want some privacy in my bedroom and I demand that same respect for you, If you want the State to join you for advice or to command you, I can respect that. I fear that a lot of people do want control of others in their private lives. Did you know tht the State of Connecticut once had a law that married couples could not use contraceptives in their own homes? Google the words, Griswold vs. Connecticut.
Our edition of The Peaceful Pill Handbook shows that Nembutal is a better method for ending one's life, compared to Helium. Any comment?
I think this idea came from Australia. There are differences between nembutal, morphine, helium and stopped eating and drinking. Speed is one difference. If you want the process tobe quick helium is best. If you prefer to swallow someone, morphiine or nembutal is best, and if you want a loving caring several weeks with family and loved ones, stopped eating and rinking is best. Up to you. I have witness them all and no question they are different. Your choice.
How do you protect people who get pressure to end their lives because they have become "a burden" on their family. I'm in favor of assisted suicide, but know that for many people there are serious concerns about how to keep the societal pressure that a "disabled life" is not worth living from turning a good thing into eugenics?
The disabled are worried. After we were listening to the Supreme Court in Atlanta last October, we went outside to hear Not Dead Yet people talk. No once did they sy they believed in a choice and that such freedoms should be protected. Not one word about privacy.
Now, the disabled definitely are often treated with disrespect. So are the elderly. So are children. So are women. So are black people and Asians and Mexican Americans. This list could go on quite a lot longer.
Now the dedicated Washington Post is ready to quit the days work. OK. Y'all just keep talking. Set up your own group of Final Exit Network.
It is your choice. Good night. Peace!