Today, Explained - When it's time to die

Episode Date: September 17, 2019

This week Maine joins several states allowing terminally ill patients to end their lives with medication. Cyndie Rogers explains why she eventually wants to take advantage of Maine’s Death with Dignity Act. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Kids are back in school, but that doesn't necessarily mean that they can't learn about science, technology, engineering, art, math when they come home from school. Just slip in one of those KiwiCo crates and see what they come up with. KiwiCo is offering today's Explain listeners the chance to try them out for free. To redeem the offer and to learn more about their projects for kids of all ages, go to KiwiCo.com slash explained. There's a never-ending, in-your-face kind of fight in the United States over abortion, termination before birth. But there's an under-the-radar battle being fought over termination near death, too. Something called death with dignity. The federal government leaves it

up to states. Oregon was the first to allow it over 20 years ago. California, Colorado, Hawaii, Vermont, Washington, Montana, New Jersey, and D.C. followed suit, and this week, the state of Maine will join them. You know, it's difficult to speak about death on days such as this, where spring is lifting up dormant life and summer is inviting us to such happier times. Governor Janet Mills signed the main Death with Dignity Act into law earlier this summer. It is my hope that this law, while respecting the right of personal liberty, will be used sparingly, that we will respect the life of every citizen with the utmost concern for their spiritual and physical well-being, and that as a society we will be as vigorous in providing full comfort, hospice, and palliative care to all persons,

no matter their status, location, or financial ability, as we are in respecting their right to make this ultimate decision over their own fate of their own free will. Just like pro-choice and pro-life, the terms most people use in the abortion debate, the phrase death with dignity is divisive. So we have aid in dying, assisted suicide, euthanasia, if you want a throwback. Allowing people to end their lives, hasten their deaths prematurely, is very controversial for religious people, for advocates for disabled people. They have a very difficult time with not letting people just achieve what they call a natural death.

Jonel Alicia covers end-of-life care for Kaiser Health News. One thing it has is people who choose this option are very wedded to the concept of individuality and determining their own fate. So that might be a big factor in these places all across the country. How do the laws work? What exactly do they allow? So you have to be deemed mentally competent and you have to have a terminal illness with a confirmed prognosis of having six months or less to live. And it's with a certain types of illness. Dementia doesn't qualify, for instance.

So a doctor has to diagnose you and has to say that he or she would not be surprised if you died within six months. And then patients have to drive it. They have to request the drugs. They have to say a few different times, orally and in writing, that this is what they want, that it's voluntary, that they're not being coerced by anyone, and that it's their intent to end their lives because of their underlying terminal illness. And you say request the drugs. How are those drugs taken? Is it orally? Is it intravenously?

No. One key factor is that the patient has to be able to self-administer the drugs. They have to be able to ingest the drugs themselves. And that's a tricky thing. Like for people with ALS who could lose the capacity to swallow, sometimes they have a narrow window when their condition will even allow them to use medical aid in dying, even though they qualify for it. But a key factor is that no one can give the drug to the patient. There's no injection allowed. They have to be able to take these drugs and swallow them, ingest them themselves. And why do patients want to have this option to go get a drug from, let's say, a state-sanctioned provider that will end their lives when, obviously, you could just take too much of any kind of drug

and end your life. Yeah. You know, it's actually a lot harder to kill yourself than one would think. And so the options for people who want to end their lives can be not particularly certain. You can say, oh, I'll just take a bunch of whatever kind of drug, and it might only make you sick and not kill you. So that's one factor. Putting together a lethal dose of a drug is actually pretty tricky, even for the doctors who have been working on these laws for such a long time. But, you know, we have more than 20 years of data in Oregon. And overwhelmingly, what people say why they want this option is because about 90% of them say it's because they fear losing their autonomy, and almost an equal amount say it's because they

can't engage in the activities that make life enjoyable or make life worth living. So those are the two top reasons that people give when they ask them, why do you want to end your life in this way? Three quarters of them say they fear the loss of dignity that comes with the decline with the terminal illness. And a little bit less than half in 20 years in Oregon say they don't want to burden their families with their illness. I guess we'll have to wait and see how this goes in Maine. But what about in all the other states that have some form of legalized assisted suicide, aid in dying, whatever you want to call it? Have there been some serious legal challenges, or is it all kind of settled? So it's by no means settled. It's controversial

almost every time it goes before the public. Colorado legalized medical aid in dying in 2016, so it's only been there for a couple years. You know, not a huge number of people have taken advantage of the law yet or used the law yet, I should say. And the situation in Colorado is there is a man, Neil Mahoney, who just found out in July that he has terminal cancer.

Basically, he said you have esophageal cancer. He says non-operable. And he is a former Catholic who no longer shares that religion and who wants the right to end his life. I want to make sure I have some kind of control over this, at least make it as easy on my family as possible. He watched his mother die a terrible, agonizing death, and so it's legal. He voted for it in Colorado, and so he wanted to use it.

His doctor, Dr. Barbara Morris, works for Centura Health Corporation in Colorado, and it has a policy that says that its providers aren't allowed to participate in aid in dying. The issue is that Dr. Morris and her client, Neil Mahoney, they said that the hospital's policy went beyond what the state allows. So the state law allows an opt-out where entities like hospitals and like a third of the hospitals in Colorado are religiously oriented, religiously run. And they have said, we're not going to do this. And they're allowed to do that under the law. They're allowed to say, we don't want to do this. But the law stipulates that they can tell their doctors that they can't write prescriptions for aid in dying to be used on the premises. It doesn't say anything about writing prescriptions

for patients at home. And so Dr. Morris and Neil went to court to clarify that, to say, hey, is this policy broader than the state law and does the state law apply here? And what happened is a few days after they filed that lawsuit, Centura fired Dr. Morris. As it makes its way through the court system, might it have implications in other states? Yeah, there's the idea. The legal scholars I talked to said that this is increasingly an argument that conservative religious entities are making, that the First Amendment protections allowed by the Constitution actually overrule any particular state law that might be enacted. And they expect that to be an argument going forward. I mean, whether it goes to higher courts, you know, remains to be seen.

And here in the United States, where you've got a few states that allow it and most of the states that don't. What happens to all the other people who may want this option but don't get it? Well, in the recent years, we've heard stories about people moving to states where aid and dine is legal. I'm sure folks will remember the story about Brittany Maynard who moved from California to Oregon because she had brain cancer in order to access the state's law. On New Year's Day 2014, to my great shock, I learned I had brain cancer. Despite the efforts of advanced medicine, my cancer is aggressive and currently without any cure. It's really difficult to do.

You have to establish residency while you're this sick. That's not a thing that a large number of patients can do. You have to establish residency while you're this sick. That's not a thing that a large number of patients can do. People who are dying in other states simply don't have the option. And I guess I have to say that even in the states where this is legal, it is highly controversial. And patients like Neil Mahoney in Colorado, now he has lost his primary care doctor and he still would like to be able to use the law, but it's very difficult for patients to find doctors who are willing to participate in aid in dying. Many doctors just don't want to do it. They feel like that's not the purpose of medicine. They feel like it's outside the scope of medicine.

Now, some doctors, they feel compassionate about the patients who are dying and feel like this is a help to them. But medical societies are divided about whether this should be allowed or shouldn't be allowed. So even in states where it's legal, patients can have a very difficult time accessing the law.

After the break, you'll hear from someone who's planning on taking advantage of Maine's Death with Dignity Act. I'm Sean Ramos from This Is Today Explained. When I was a kid, my parents would have me and my brother, when we got home, do extra schoolwork, like to brush up on grammar mechanics and the old mathematics. We would have these workbooks that they bought for us on the textbook black market, and we would just have to do more drills before we could watch a half an hour of TV or go outside and play. I don't know. Anyone with me? Maybe it's an Asian thing. It wasn't the best. I kind of wish my parents had KiwiCo crates because then I could have been building stuff, further understanding the world, and maybe making one of those like arcade claws that you drop and pick up prizes or my next Halloween costume or who knows, learning about whales.

There's all sorts of different KiwiCo crates out there. KiwiCo would like to give you the chance to try them out for free. They've got projects for kids of all ages. Check them out at KiwiCo.com slash explained. They just want to inspire your kids, y'all. Okay, my name is Cindy Rogers, and I go by Cindy. I'm 69. I'm from Gray, Maine. I've lived in Maine my whole life.

I care about death with dignity because this is what I want for myself. In 2015, I was diagnosed with follicular lymphoma and underwent in 2016 chemotherapy for six months for that. And then in 2018 of November, I was diagnosed with invasive carcinoma of the right breast, and I had those two sections removed and underwent radiation. When I first learned that I had cancer, the lymphoma, I was planning my funeral, and I think that's common with anybody when they first learn that they have cancer. See, I live by myself. And so when I was first diagnosed, I was like, it was 3 o'clock in the morning. There was nobody to talk to, you know.

My family's in bed, and I didn't want to interrupt them. And so I started a Facebook page, I'm Holding Your Hand Sin. So when I started feeling scared and feeling overwhelmed, I would write that on my Facebook page. Yes, yes, I'm scared, you know. And I would get so many positive feedbacks and posts. Then I would look at that and I would say, gosh, if they could be that positive, I guess you can and it helped. It especially helped during the times like when I couldn't sleep or when I really felt down. But it makes you start to think about your end of life where before you don't.

It's like anything. When you hear the word cancer, you don't take one day for granted. You live each day to its fullest. I have a bucket list. My high school friends and myself, we got a tattoo. My tattoo is a heart with part of the heart has dog prints and then there's flowers on the other part. And then it has a trailing vine of flowers and leaves. It hurt though, dear. It hurt. It definitely hurt when I had it done, but I'm so pleased with it. We have spent a couple of three days on the ocean.

We even tried marijuana. We never had tried that before, so we tried that. You know, your day gets so caught up in work and, oh, you've got to clean your house, you've got to do your grocery shop, and you have to do everything, and you're just busy, busy, busy. And when you have a cancer diagnosis, you look at the sun every single day and say, wow, you know, that feels warm. Oh, that makes me smile. There's what the big difference is. And that's everything in life, dear, not just the sun. There's no cure for blood cancers.

And it waxes and wanes. And right now, my lymphoma is at bay. As far as the breast cancer, I will find that out in December when I have a 3D mammogram and I'll find out whether the radiation was successful on that. 26 years of my life, working life, I was a veterinary technician. And that was the hardest for me to be in the room and hold an animal that was being euthanized. I would talk to the owners, tell them what to expect, answer questions, and devote most of my attention to the owners. And then I devoted all my attention to the animal. And they go down so peacefully. Every one of them go down so peacefully. though it's not the same definitely not the same between people and and animals oh so many people say that it's not the same

I've witnessed euthanasia for for animals and I think that's a lot easier way to go and a kinder way to go than to let each bodily function fail no matter how long that takes. I've had conversations with my family about this. My family feels very strongly, as well as myself. They've gone through, watched people go into hospice and fade away over time, and it was a bad memory, a very bad memory for us. I don't want my family or close members to sit and watch me deteriorate no matter how long it takes and have them have their memory of me to be a bad one. I want to be able to take the solution and just go off to sleep.

And at my choice, when I am terminally ill, and I'm not terminally ill yet, but I want that when that happens. I don't want to have to move to Vermont, which is the closest state to us that had death with dignity. I wanted to die here in the state of Maine. They say it's suicide. I've heard that. and maybe it is.

But it's no different than doctors giving unlimited amount of morphine until somebody passes. And in Maine, we've tried to pass this many, many times, and it got defeated. And this time, it passed by one vote. Well, I know with me I'm going to live every minute to my fullest until I can't, and I'll know when that time comes. I'll feel it.

I mean, the science will tell me, the doctors will tell me, and I will know when I'm ready. Thanks to KiwiCo for supporting the show today. They're on a mission to empower kids not to just make their projects, but to also make a difference. A lot of their projects you will find are about how kids can make a difference in the world. KiwiCo is offering today's Explained listeners the chance to learn about their projects right now for free. To redeem the offer, go to KiwiCo.com slash Explained.