Friday, May 6, 2011

A personal perspective on Death with Dignity laws

At 52, Cody Curtis was diagnosed with cholangiocarcinoma, a cancer affecting the bile ducts of the liver. Soon thereafter, she would undergo a surgical removal of the primary tumor, during which most of her liver was removed as well. Though the surgery was deemed successful, complications ensued, and she was hospitalized for some time afterwards. I remember visiting her while she was in the hospital soon after the surgery – she was clearly in pain and wasn’t fully coherent. I remember thinking how hard it must have been for her husband, Stan, and her children, Jill and Thomas, to have her there, but not really there.

After an extended stay in the hospital, things started looking up – she was in apparent remission, she was upbeat, and she was regaining her strength. I remember visiting a couple of times in that time period. Cody was weak and easily fatigued, as anyone recovering from cancer would be, but was making strides towards health.

This upward movement was not to last, however, as she suffered a recurrence of her liver cancer a year later, and additionally, it had metastasized to her lungs and lymph nodes. At that point, her doctors said that there was nothing more that they could do.

A resident of Portland, Oregon, Cody decided to take advantage of the ‘Death with Dignity’ law that has been on the books since 1994. Death from cholangiocarcinoma is not pretty. It’s slow, it’s painful and it’s degrading. Having already been through so much pain and suffering, and having seen the toll that it took on her family, she decided to ask her physician for a lethal prescription.

In 2008, Washington state passed Death with Dignity legislation. When it had first appeared, I was in favor of it. After all, it was only humane. My own mother had passed away after a protracted battle with ovarian cancer that became uglier as time went on, and I felt others should be allowed to decide to avoid that.

However, when I reached the voting booth, I faltered. I found myself thinking of loved ones and couldn’t decide what I would do when placed in that situation. Faced with a terminal diagnosis, could I ask my physician for a lethal prescription, or support someone doing the same? I abstained. I wouldn’t mark no, but I couldn’t mark the yes box. I left the voting booth with an empty space on my ballot.

Cody changed that, and I can now honestly say that I am fully in support of Death with Dignity laws. Most of us would probably want to go quietly in our sleep if we could, but that is not a luxury afforded to those with terminal illnesses. Adding to the already difficult process of getting affairs in order, preparing to leave family members, and coming to terms with mortality, there is an element of fear that pervades life. Fear of painful symptoms, fear of hospital visits, fear of the suffering your family will go through. Additionally, there is treatment. Remarkable as it is to say, though treatment for the dying can provide some comfort, it also prolongs the agony, and adds to the fears and stresses. I can speak to that myself; a dying person is in and out of hospitals in their final months, they have symptoms, they eat more medication than food, they have side effects and they have pain.

Additionally, there is the subject of coherence. Late stage diseases are often terribly painful, and are heavily treated with pain-killing medications. While a patient may not be in pain, their ability to think, speak, and interact is heavily impaired. A drawn out, terminal illness allows the time to have family and friends visit and say goodbye, but sometimes that comes at the price of knowing they are there.

Having the lethal prescription available freed Cody from the fear of what would be come of her and her family. Taking charge of how and when she would die allowed her to focus on the most important things in life. She spent time with her husband and children. She went walking in the park on those rare, but beautiful, sunny days in Portland. She cooked a delicious and lavish last Thanksgiving dinner (I was there – it was fantastic). She was free to truly savor her remaining time on earth and do so knowing that when her illness became overwhelming she didn’t have to put herself or her family through it. She knew that suffering wasn’t in her future. Somewhat ironically, she was filled with an optimism that many people in the prime of life don’t have.

She passed away peacefully in December of 2009, surrounded by her family. It had not been an easy path to tread, but I know her husband and children wouldn’t have had it any other way. In a culture where death is feared and hidden, Cody both lived and died with a grace and dignity that should serve as an example. Her story is both somber and inspirational, and I consider it an honor to have known her.

This year, the Grand Jury Prize for a Documentary film at the prestigious Sundance Film Festival went to the film How to Die in Oregon, which follows Cody through those final months of her life. It is currently being shown at film festivals around the country, and will be premiering on HBO at the end of the month. I have not had the opportunity to view the film, but the reviews say that it is a beautiful, though challenging, film. I urge you all to mark your calendars and tune in.