Jay Kuten: Do not go gentle into that good night

Death is intimate, personal and private. For all its ultimate certainty, death is very hard to talk about. One's own death is hard even to think about. That's why it's not really surprising when some famous rich person dies without a will.

When I first heard of the ELOC (End of Life Choice) bill I was skeptical and frankly curious.
I had yet to read the bill, itself, when I attended a meeting convened last February by Kate Joblin, advertised as "informational" on the subject of the bill.

To my disappointment, the meeting turned out to be less informational ie exploring the many potential viewpoints and the facts about assisted dying, than ideological, ie an advocacy of one position - opposition to the bill.

The panel, three well-regarded palliative care physicians, made alarming statements, comparing the essential element of the ELOC, assistance by physicians to voluntary suicide of terminally ill patients, to the Nazi programme of involuntary euthanasia of "undesirables." And that was only a part of the fear-mongering I heard that evening.

As a result I felt the need to inform myself, to read the text of the bill, and that of the Death With Dignity Act, the law in the US state of Oregon, upon which ours is based, the 89 page report of the Justice Select Committee, and relevant research from effects in Oregon and Canada as well as in Europe.

I would like to believe that both supporters and opponents of assisted dying are acting out of compassion. But it was strikingly clear that opponents of choice were willing to say almost anything in order to "win".

Their fear- mongering took many forms. The bill would normalise and encourage suicide. The bill would act to encourage the elderly and disabled to see themselves as burdensome and thus encourage them to ask to die.

The bill would be a slippery slope from narrow requirements as to age or the definitions of eligibility to a broadening of categories and a change from the requirement of both a competent and voluntary choice to one of imposed dying, an involuntary death for which opponents used emotionally loaded terms, terms like "killing" the patient or "euthanasia."

To support these frightening claims opponents pointed to European countries where they claim such excesses had occurred. (They hadn't)

Despite strong ideological opposition the select committee made a few minor emendations, leaving the bill close to the form of the Oregon law (DWDA) which has been in force since 1997.

Here is the Oregon experience. Oregon's population mirrors ours in numbers, 4.2 million. Since 1997, 1545 prescriptions for lethal drug doses were given out but only 991 patients actually died from lethal drugs. 90.1 per cent died at home, most enrolled in hospice care 92 per cent. Median age was 73 years.

Most had cancer (76 per cent) but also 8.3 per cent with neurodegenerative illness (ALS). Three most frequent reasons given were decline in quality of life, loss of autonomy or loss of dignity. Disability per se was not qualifying.

Dr Sherwin Nuland's National Book Award winning How We Die (1993), took a look at the facts about dying. Instead of a quiet death with dignity, surrounded by family and at home, most Americans (80 per cent) were dying in hospitals or nursing homes.

In many of those cases people lived out their last days isolated from family and friends attached to ventilators in intensive care units. This isn't the way most people would envision the ending of their lives.

Doctors who have sat with dying patients know too well the downside of medicalised dying. For many, if not most doctors, their choice for themselves would be a death, at home, with loved ones, and assisted, when the necessary time arrived, by their voluntary self-administered lethal dose, probably of barbiturates, to make that passing, quick, painless and peaceful.

It's that group of doctors who support assisted dying for their patients who are competent and voluntary, on the compassionate ground that what doctors, themselves wish for, should not be denied to their patients.