They say that in a person’s life, there are only two sure things: death and taxes. While I would bet that there are some claiming “tax exempt” status that shouldn’t, there is no getting around death. Unfortunately, not everyone has the chance to die in a dignified manner. A manner in which there is no pain or suffering. Most terminally ill patients face the prospect of having 6 months or less to live. When enduring a terminal illness, that patient needs to have the option to end life before the onset of unbearable pain, humiliating experiences, and the emotional pain of our loved ones seeing us in that condition. It would be a relief. They could remember us in a comfortable state, dying peacefully. Often times, diseases ravage individuals to the point that the person and their families pray for death. The phrase “it was a blessing” comes out of mouths often when discussing the death of a terminally ill family member or friend. Not only does the person endure a tremendous amount of pain and suffering, but they are in-and-out of the hospital, racking up medical costs in an effort to ease the suffering. What if the terminally ill patient wishes to terminate their own life at some point during the progression of the disease to end the excruciating pain, decrease the economic affliction for the surviving family or simply to die in a dignified manner on their own terms? In a democracy where we love to tout the freedom of choice, why do we persecute the Dr. Jack Kevorkians of the world for helping the terminally ill die with dignity instead of praising their humane work? Our blog will not only outline the reasons why a person should have the right to choose a course of death upon the diagnoses of terminal illness, but also propose solutions to assist the terminally ill in escaping this prison.
What is Death?
What is life? What is death? To be able to have an opinion, one must know the definitions. Merriam-Webster’s Dictionary defines “life” as “the quality that distinguishes a vital and functional being from a dead body.” This same resource defines “death” as “a permanent cessation of all vital functions.” For our blog, we will use these definitions.
The high cost of keeping someone on life support when they don’t even want to live anymore.
Americans are afraid not just of dying, but of talking and thinking about death. It’s hard to pay those costs from beyond the grave, so who gets stuck with that bill? Well, once you die, debts are paid from your estate and then the remaining estate is passed along according to your will (if you have one). Although your family isn’t responsible for paying for any remaining balance IF your estate doesn’t cover everything, with the price of staying alive, will you have anything left to pass along to your spouse, your off spring, or any other loved one? Will your immediate family need to downsize their lifestyle due to your estate being gone. It sounds inhumane to measure a person’s life in dollars, but keeping terminally ill patients alive in their last days cost from $50,000 to $100,000. Severely suffering patients typically spend their last eight days in the Intensive Care Unit, sometimes either comatose or on ventilators. An aticle title “Cost savings at the end of life. What do the data show” by Emanuel EJ, states that existing data suggest that hospice and advance directives can save between 25% and 40% of health care cost during the last month of life with savings decreasing to 10% to 17% over the last six months of life…’ End of life consumes 10% to 12% of the total health care budget and 27% of the Medicare budget. A terminally ill patient not only worries about the emotional burden they put on their family but also the financial burden. The insurance maximums and the financial mess that could be left once the person is deceased. Some patients would say “Why would I put my family through these difficulties when I know I am a terminally ill patient.”
One article from the New England Journal of Medicine published a quote stating, 30-40% of the medical care expenditures incurred are compiled in the last month of life. An excerpt from the Archives of Internal Medicine read: “Managed care and managed death are less expensive than fee-for-service care and extended survival”. Recent Medicare data reveals an average cost of terminally ill cancer patients who die after conventional treatment at $30,397.00. With approximately 33% of the cost incurred during the last month of life, if an assisted death were requested, the savings would be about $10,118.00, still leaving two-thirds of the cost to come from the terminally ill patient’s estate….if there is any estate left. A survey published in the New York Business Wire, and completed by MetLife, revealed that 1/3 of the families surveyed remained financially vulnerable 5 to 7 years after their spouse’s death. This information demonstrates the longevity of the impact. Neglecting to recognize the unavoidable financial burden placed on surviving family, by the eliminating of one’s estate, is clearly representative of an irresponsible failure.
Hospice
Hospice is an option that a the terminally ill require at times also. Although hospice is provided at a much lower cost, it’s still a cost that, depending on the length of time a person hangs on to life. Most of the people that administer hospice are saints! They don’t make as much as those working for a hospital. This is not to downgrade hospice, but to point out that they are not “non-profit”. Let’s not deny the fact that this cost is taken from one’s estate upon their death though. According to a local hospice provider in Flint, Michigan, the cost of hospice provided as a resident at the hospice facility averages $700 per day, while the cost of hospice care in the home setting averages $160 a day. If a terminally ill patient resides at the hospice for 6 months, using the average cost, the bill is $126,000. How many terminally ill patients have the luxury to not spend anytime at a hospital or a hospice-type facility? To say that a terminally ill patient that lives for 6 months could die for $28,800 (the average cost of home hospice care) is not likely.
The right to decide you want to die a humane death.
“Humane Death” or “dying with dignity” is defined as a death done without inflicting any more pain than is necessary with an emphasis on respect for the one’s beliefs and values. Key phrase: one’s beliefs and values. End-of-life care issues such as this need to be addressed in a proactive, comprehensive, and compassionate way. Fear of death exists only because of the lack of insight to accept it. What should we fear? We should fear pain and suffering. If a terminally ill patient has accepted their own death then it is the right of that patient to end their own suffering – or have help in doing so. The idea that there’s a right to the most expensive health care while you want to be alive is not all that different from the idea that there is a right to swiftly die once the quality of life is gone, the pain becomes unbearable, or the decision to die is made. is dying in a way that is consistent with a person’s conception of themselves. An individual choice which for some is the pursuit of life despite the pain, while to others it is a quicker death so as to avoid unbearable pain, humiliation, and the financial meltdown of their estate.
The other 49 states need to follow Oregon’s lead!
The State of Oregon found that most people want to die at home with a proper sense of pride and self-respect. In 1994 and again in 1997 voters in Oregon approved a measure allowing physicians to prescribe lethal medications when requested by a mentally competent adult who is suffering in the final stages of a terminal illness. The law established the “Death with Dignity Act”. In physician assisted suicide, the medication is prescribed by a doctor, but it is up to the patient, if they wish, to make use of it. It is an individual’s right to be allowed to make this choice and die with dignity and peace. In 2006 the US Supreme Court upheld Oregon’s assisted suicide law by a 6-3 vote in the case of Gonzales v. Oregon, after the administration of President George W. Bush challenged the laws’ legality. This has set the precedent needed to empower terminally ill patients the right to a humane death.
Dr. Jack Kevorkian.
A few years ago, there was a Michigan pathologist who became renowned for bringing the issue of euthanasia forward into public debate, Dr. Jack Kevorkian. He became famous for his definition of humane death and his high-profile antics in support of voluntary euthanasia. Dr. Kevorkian also invented a “death machine”, a device which allowed a user to self-inject an anesthetic and then a lethal dose of potassium chloride. Kevorkian soon became known as “Dr. Death” because of his keen interest in helping the terminally ill. His initial “assisted suicides” led to a law here in Michigan in 1993 that specifically prohibited him from assisting others in committing suicide. The law did not hinder him from continuing this practice, in fact, he openly defied it!
Dr. Jack Kevorkian is a hero who helped more than 130 terminally ill people end their own lives with dignity, one might even say “humanely”. An ordinary man who wanted to help people decide how they wanted to die and when they wanted to die. A choice he believed was theirs to make. Not a decision made by an insurance company, or physician whose motivation was to keep the patient alive at all costs. He was an extraordinary man with an unordinary mission in life.
While Dr. Kevorkian’s patients all died by voluntary euthanasia, involuntary euthanasia occurs when the person who dies wants to live, but is killed anyway….like prison inmates. The death penalty has been a form of punishment for the worst crimes committed against humanity. In 1977, Oklahoma became the first state to adopt lethal injection as a means of execution, due to the thought process that it would be a more humane way for a death row inmate to die. Lethal injection is now the main method of execution in all but two state due to our desire for the worst of the worst to die in a dignified manner, yet we want the terminally ill to endure suffering, pain, humiliation, and the erosion of their estate without giving them an opportunity to choose the time and method of their death?
How can we ensure that the terminally ill are spoken for? Currently, only Oregon allows their voice to be heard. The State of Michigan snuffed out the voice for their states terminally ill in 1998. A great start would be for Congress to enact a law providing any terminally ill patient the ability to seek a humane, dignified death by lethal injection. Of course, terms of “how many doctors agree the patient is terminally ill” and the lethal injection concoction should be determined. A law of this nature only helps, it doesn’t hurt. If a terminally ill patient decides to terminate their life, how does that hurt you? Like the seat belt law or motorcycle helmet law, how can it hurt?
Living Will
Another solution to the problem that terminally ill patients that want to end their life encounter is by completing a living will. A living will is a legal document that outlines your wishes regarding your medical care at the end of life. This should be constructed while you are capable of giving competent responses. The living will gives some voice to your wishes from health care to refusing certain medications/treatments so you will die quicker. The original purpose of a living will was to have a written directive to your health care representative or physician(s) that specifically state that no prolonging treatment should be sought or continued if you’re terminally ill, injured, permanently unconscious, or otherwise unlikely to survive or have the mental capacity to make decisions.
Conclusion
In conclusion, people of all walks of life agree that death with dignity is a choice that allows them to have to leave this world in a dignified, painless way. Legally we are allowed certain rights in the constitution. The right to avoid pain, humiliation and loss of dignity should be included.
References
http://pewforum.org/docs/?DocID=251
Balkin, Karen F. 2005. Assisted suicide. Greenhaven Press, Farmington Hills: MI
Whitman, Wynne A., Glisson, Shawn D. (2007). Wants, wishes, and wills. Pearson Education, Inc, Uppersaddle River: New Jersey
Leaf A. Medicine and that aged. N Engl Med 1977; 297:887-890
-La Puma J. Managed care and managed death. Arch Intern Med 1995; 1553
-National Hospice Organization. An analysis of the cost savings of the Medicare hospice benefit. Miami: Lewin-VHI, 1995. (National Hospice Organization item code no. 712901)
-Emanuel EJ. Cost savings at the end of life: what do the data show? JAMA 1996; 275:1907-1914
Avalon Hospice, Flint, MI
Variation in Patient’s Hospice Costs, Haiden A Huskamp, Joseph P. Newhouse, Jessica Cafarella Norcini, Nancy L. Keating, Inquiry-Excellus Health Plan. Rochester: Summer 2008. Vol. 45, Issue 2. Page 232
What Does Hospice Cost? HOWARD G. BIRNBAUM, PHD, AND DAVID KIDDER, PHD
American Journal of Public Health July 1984, Vol. 74, No. 7
Submitted by:
Dr. Nixon’s MSA – 604 Class-Fall ’09:
Julie Bondy, Daniel Patillo, Don Wallo, Jennifer Mitchell, Brent Upson, Rachel Williams, Karen Boice, Angellicia Lane, English Stone, Desiree Londrigan, Sandra Gragg, Linda Loving, Raymond Wilson, Lakeysa Adams, Rita Schubert, Evilia Jankowski, John Stewart
17 comments
Comments feed for this article
October 7, 2009 at 12:51 pm
Bryan Berent
It is an interesting pint to bring up the cost of treatment and hardship on survivors as a primary argument in support of euthanasia. I had not considered this in the past. The problem with this argument, as I see it, is that it is to difficult to discern where to draw the line. I can envision situations where elderly folks are getting pressure from their families to end their life early, or where elderly folks have signed away their decision making rights to a family member who makes the decision for them. This is a slippery slide andthese diecisions can obviously not be reversed. Money should not be a primary driver for deciding death, rather we should focus on how to make the financial burden easier on surviivors so people don;t have to decide between life and money.
October 9, 2009 at 5:22 pm
Jackie Lardie
Your site offers some interesting points on costs and dignity but noticably skirts any of the moral issues. This may be intentional to avoid any religious arguements but omission won’t defer them.
The commandment says, “Thou shall not kill”. It doesn’t discriminate between thou shall not kill others or thou shall not kill thyself. The Bible doesn’t say that there will not be suffering but does offer hope to those who endure. Many religions look upon suicide as a sin and others exault those who sacrifice themselves, unfortunately often taking many others with them that had no choice at all. World view runs the gammet!
I personally opt for Hospice. When utilized appropriately, it allows the person to make choices on their own behalf, be with their loved ones, participate in their care, prepare themselves and others for death and removes the fear of pain and suffering.
You are absolutely right regarding the silence surrounding the topic of death. As stated before, ” no one gets out of here alive”! I don’t have an answer for how to change this characteristic of our society. But, I do think if death was able to be taken off the taboo list and discussed openly the darkness and fear would lift and possibly relieve us from having to legislate our end of days.
October 15, 2009 at 2:40 am
Ray Wilson
Jackie, You make several great points in your response to the topic however; isn’t the foundation of the Bible based on Choices? Man has always had the ability to Decide one’s own fate. Did Jesus not give the people the Choice to accept his father as Lord and Savior? Would you agree that as Men/Women/ People we tend to Inflict our own personal beliefs on others. Just because I personally don’t agree with assisted suicide doesn’t mean I have the Right to tell you what to do with your life. If the Lord wanted every head Bowed and every knee Bent, would it not be so? So, if this is truly not about choices then why doesn’t God inflict his will and completely do away with this matter?
October 9, 2009 at 6:38 pm
don wallo
We live in a capitalistic society, and therefore money does in fact have an influence on every decision we make. Regardless of what that decision is. The argument just briefly touched on the money aspect so that you can have it in the back of your head when you decide to make your decision. Others factors come into play as well. One of the important factors would be pain and dignity. If you have a horrible disease, such as cancer that is eating away at you, and you only have a few weeks left to live. Why should you be forced to live in pain and suffering for those next couple of weeks, when during that time you are spending tens of thousands of dollars just to live a miserable life? In fact, that is just increasing the financial burden on the family.
October 10, 2009 at 3:29 pm
Linda Loving
Thank you for your input about Hospice. This insight is very helpful to the readers of this blogs. Although we have written our expressions and points of view in summary concerning euthanasia, this particular topic could have indeed been lengthier and taken on many other areas of concern. Yes, the moral issue comes up in every way of life – especially when it comes to dealing with life and death matters. I agree that this topic is one that needs to be discussed more and more– even in a broader aspect of the moral issue. As you have stated, just because the moral issue wasn’t elaborated, doesn’t mean that it will not come up. To be moral concerning this matter is important because death is inevitable for everyone. Obtaining factual information on this topic, learning what one needs to know, and what choices are available to them is helpful in preparing everyone when faced with such decisions.
October 11, 2009 at 1:25 pm
Karen Boice
Thank you for replying Jackie. Moral issues are indeed absent from the blog, focusing on the point of easing suffering and not seeing the pain and suffering of our loved ones, and this specific choise is not for everyone. Maybe just having the choice would erase some of the fear for people. I think the fear of suffering is much greater than the fear of death.
Each individual has a degree of morality and what they view as moral. I think that discussing the “taboo” topic of death would enlighten all of us. Fear of the unknown is the reason I believe for the silence, faith is that which lends hope to each in that respect. I think that possibly it might be allowable even in religious aspects that frown on this act when the outcome is certainly clear, in that death is very near and ending the suffering before it is unbearable is a blessing.
Simply allowing for such a choice would be up to the individual and they would take into regard their individual beliefs, fears and knowing that they have some aspect of control to the end would maybe ease that fear.
I do not know how I would behave in such a situation, and again it is unique for everyone..I know that for the animals we have as pets and cherish, it is impossible for us to watch them suffer, which is the basis for the choice. Then again, we are not animals. Anyone suffering, and believes in life after death would welcome the chance to live again without the pain sooner rather than later I think.
October 14, 2009 at 2:56 pm
Julie Bondy
It is difficult to discern between what is morally and legally appropriate in this case. There are many of us that would state that it is inhumane to let someone suffer when there is an alternative. There are also many of us that would state that only God has the right to take a life. Should this be left up to the individual? Should this be left up to the family? This will be an argument that will continue well past our lifespan because it is too ambiguous and grey of a subject to agree upon.
October 14, 2009 at 6:04 pm
Desiree Londrigan
Thank you for your input about Hospice and for taking the time to respond to this blog. Evidently, this is a topic that interests you. I think we all know someone who believes that an individual should have the right to decide when and how to die and is frustrated that he or she lives in a State/Country, which does not permit one to decide. As one of the contributors to this blog, I want you to know that your insight is very helpful to the readers of this blog. Because this topic is such a sensitive topic–one that many of us think about, but are afraid to talk openly about it makes it even more important for us and others to hear your view point.
As humans, we must consider both the moral and ethical issues which we face in every walk of life – especially when it comes to dealing with life and death matters. It’s tough to determine or should decide when it comes to human death. If death is chosen there are NO second chances of life.
October 17, 2009 at 7:27 pm
Lisa C.
We can all say something is right or wrong and even judge people on their decisions, but there is truly not one of us who can say we wouldn’t make the same decision because we are not the ones faced with the decision. Our life circumstance, our beliefs, our physical capabilities, our psychological status and so many other factors go into the equation and there are no two equations that are the same.
I would like to say I could never kill another human being (myself being one of those human beings) but I cannot say that given a certain set of circumstances that my current belief would hold true. I cannot say that if I were suffering from a painful and debilitating illness that I would just want to ride it out, see what god (the little “g” was intentional) had in store for me. What I would want is the option and the access to a way to peacefully end my life. This is not to say that is what I would do, but I would want the option. I would not want to attempt the feat myself only to screw it up and become even more debilitated and even more of a burden on and cause even more heartache for my loved ones.
Why is it most of us do not see it as a bad thing to decide to put down a beloved pet who is in pain but find it wrong to let someone decide for themselves that they can no longer endure their suffering?
October 20, 2009 at 1:14 pm
Jen Mitchell
Lisa, that is a very good point that you make about putting down a pet. While obviously a pet is an animal and humans are people, many people regard their pet as a member of the family. It is a very hard decision to put down a pet but we do it just same to “end their suffering.” I had not considered this before but you make a very good point.
October 15, 2009 at 1:57 am
sgragg
While much is said concerning terminally ill patients in pain and the effects on their surviving families I believe a related issue has not been touched on. A terminally ill patient who may be not in a state of mind to make personal decisions concerning life or death, who have no family and all of their close friends have passed on. For example, a nursing home patient who ends up connected to life support. Who decides for them? At some point a decision needs to be made if this person will never come out of their coma due to age (many are over 90) and progression of their illness.
No one wants the responsibility of “playing God” including Doctors. States need to look at developing a recourse and plan of action health care facilities can follow in situations such as this. Realizing that many factors will affect each individual case. I have seen these terminal patients connected to life support for months racking up phenomenal heath care costs at no benefit to the patient. This is another reason why the proposed end of life couseling is so important in our effort to curb the escalating health care GNP.
October 15, 2009 at 1:02 pm
Beatrice Kendall
Excellent explanation of life and death.
I do not believe that death should ever be taken into man’s hands.
We did not give life and should not take life.
Naturally, the unknown is a mystery, that is why everyone should have a spiritual side to their life. I live knowing that all things, bitter or sweet are a process that was made for me and my trust has to be in HIM knowing it is for me. When the process is complete, HE will take care of the rest, that is why you live every day to the fullest with HIM being at the forefront.
October 20, 2009 at 1:21 pm
Jen Mitchell
Beatrice,
I agree with you on the fact that we did not give a life so therefore we should not take a life. However, based on your argument how do you justify keeping someone alive on life support? Would that not be giving someone a life instead of letting God take care of them? Your argument is inconsistent.
Jen
October 16, 2009 at 5:50 pm
Jenny
The Bible and its messages should not come into play in this argument. Though many people regard it as the “word of God” (About 67 percent of Americans say that the Bible holds the answers to the basic questions of life.), the percentage of people that do not go to the Bible for life’s answers is far to high to cite the book as something we all follow or should follow.
I believe that if a person decides that it is his/her time and would like to avoid the suffering for themselves and the family, then that is their choice and it should be granted.
As we all sit here and type away on our computers in our homes, giving our two cents on an issue that will most likely not be resolved in any of our life times, maybe we should think about asking the opinion of someone in a nursing home, someone with stage 4 cancer, someone who has gotten the “we don’t think he/she is going to make it through the night” calls far too many times…
October 16, 2009 at 5:51 pm
Jenny
* http://wiki.answers.com/Q/What_percentage_of_people_read_the_bible
October 17, 2009 at 8:33 am
Savannah
Awesome blog!
I thought about starting my own blog too but I’m just too lazy so, I guess I‘ll just have to keep checking yours out.
LOL,
October 26, 2009 at 3:00 pm
Deborah Hamilton
This is an age old concern that I also did a paper on in my college tenure. We are not God and cannot determine when life should start of end. Our attempts to assist are successful only if God says yes. It makes it easier on the family if the person impacted makes their desire known whether they want life support or not. This is a great financial strain on family income, is physically and is mentally taxing to the family member caregivers. I support living wills regardless of health circumstance. If no declaration has been left by the person who is terminally ill, the family must make the call when to or if life support should be used. This can pre empt any need for assisted death and yet allows person to “die with dignity”. Medications and services can be withheld complying with wishes of impacted persons as communicated prior to inability to decide on their own. I do not agree with injections or medications to end a persons life while maintaining my earlier statement to comply with the wishes of a living will.