Prescribing Peace of Mind

Precribing Peace of Mind, Nov. 5 2007

EUGENE, Ore. -- Ted Pomerantz still hasn't pictured what he calls "the last scene."

As a pretty decent golfer, he knows how the mind is real and powerful and it motivates the muscles and reflexes to send the little white ball where his eye wants it to go.

On the green, he positions his feet just so, tightens his fingers around his club handle and imagines the sweetest, cleanest swing.

But the 82-year-old Oregon man is in a peculiar spot right now. He knows he's dying and he knows he wants to leave this world in the way he lived his life -- on his own terms.

Just a few months ago, he and his wife Ann Councill were taking brisk, hour-long walks in their quiet neighbourhood. Last year, they trekked around China with a tour group half their age.

This morning, Pomerantz takes a few sips from a mug of tea, takes a nibble from a half-eaten cookie and leans back gingerly on the black leather couch in the couple's livingroom.

He's done the chemo, the radiation, the naturopathic supplements. He's come to terms with the fact that he's dying and the "Las Vegas odds are not too great."

Since he was diagnosed with inoperable pancreatic cancer in March, the retired engineer and brokerage firm manager has struggled with a sharp left turn in what's been a happy and charmed life.
"My options are not bountiful at this point," says Pomerantz of his prognosis that has left him with a few months left to live.

But at a nearby drug store, one option is ready. With one phone call, a pharmacist will prepare the prescription and Pomerantz can pick it up whenever it suits him. It's a powder to make six ounces of a desperately bitter liquid. If Pomerantz chooses to take it, it would be the last drink of his life, killing him within minutes.

Like others with a terminal illness, Pomerantz has lost his appetite and craves sleep. His clothes hang off his tall, gaunt frame.

But he's now a member of an exclusive, if ambivalent, club. Pomerantz can choose when he will die and the state will help him end his life.
If he decides to take the lethal medication, he will become one of nearly 300 Oregon residents since 1997 who have used the Death With Dignity Act to hasten their death.

He could swallow the drink or ingest hundreds of capsules and then curl up with Ann in their bed and take his last breaths in her arms. But today, he hasn't decided when -- or even if -- he will take the overdose that would kill him.

"We're not there yet," he says with a slight smile as his wife looks on from a nearby loveseat.
"It gives me a choice or an option," Pomerantz says. "I may never use it. I may never have the courage to use it ... it's good for me to know that this is available to me."
 

For the last nine years, a terminally ill person in Oregon with a prognosis of six months or less to live can obtain a lethal prescription of barbituates from a doctor. The person must be competent, with no psychiatric or mental health problems, and capable of taking the medication by him or herself.
Last year, 35 people died after taking the prescription. Since the Death with Dignity Act was passed in 1997, 292 people have ended their lives with lethal medications through the law.

In terms of statistics, the three dozen people make up only 0.1 of 1% of all Oregon deaths in a given year.

For the woman who helped turn a 1994 citizen's petition into law, the aid-in-dying law revolutionized how nearly four million Oregonians talk about dying.

"Even if not one patient in Oregon ever took medication to cause their death, it would still have an enormous beneficial impact on end-of-life care," says Barbara Coombs-Lee, president of Compassion and Choices, the national nonprofit organization that lobbies for choice in end-of-life care..

"The law gives terminally ill people the freedom to talk to their doctors, their family and their friends about how they want to die," says Coombs-Lee.
Speaking at the September 2006 conference of the World Federation of Right to Die Societies in Toronto, Coombs-Lee described the lethal prescription as a symbol of how the dying take control of their last days.

"It is in their bedside table, it's under their pillow. It's their safety blanket, it's their parachute, it's their insurance policy. They close, they know it will be there when then need it but they don't need to take it," Coombs-Lee told the conference.

During the last nine years, 40% of those who have waded through the law's red tape never ended up taking the lethal drugs to end their own lives.
In his family health clinic in Portland's southeast district, Dr. Nicholas Gideonse sprints up the stairs to his second-floor office. Like other Oregon physicians, the medical director at the Richmond clinic of the Oregon Health and Science University delivers babies, treats infections and counsels dying patients about having a hastened death.
Since 1997, Gideonse has written nine lethal prescriptions for patients.

Seven of his patients ended up taking the drugs to end their lives and another six patients are now at various stages of the consulting process with Gideonse.

Before he voted in the citizens' initiative in 1994, Gideonse worried about the proposed law's slippery slope—how the poor, the socially isolated and the disabled might use the law to end their lives. But talking to cancer patients and other physicians helped him work out his views.

"When they were having their worst days on chemotherapy, there was nothing left but their worst days. Just knowing the option was really available would be tremendously relieving," says Gideonse.

Before the law, terminally ill Oregonians would speak in whispered code about what Gideonse calls "that deepest personal need."

"I'm just very grateful to be freed from that kind of need of thinking of going out of the country or making an illegal request or a misunderstood nod and a wink," he says.

Now, patients have what Gideonse calls "the Conversation" — talking out in the open about getting the lethal prescription. Pomerantz recalls how his first meeting with his consulting physician went "beautifully."

"She took us through all the hoops, right down to the 'You know what happens when you take this stuff? You get dead-ed,'" recalls Pomerantz.
Most patients who take the first steps to get aid-in-dying want to stay in control during their last weeks, says Gideonse. They also worry about unbearable pain and getting lost in an overmedicated fog, he adds.

No doctor in Oregon is obliged to approve an aid-in-dying request but Gideonse says some patients get a "sense of abandonment" when a doctor won't talk about it or refer them to another doctor.
However, some Oregon physicians feel the law — which survived several court challenges from 1994 to 2006 with a U.S. Supreme Court ruling — has done serious damage to the doctor-patient relationship.

"People at the end of life are vulnerable and the law just takes away this sort of protection where we used to protect people," says Dr. Charles J. Bentz, the president of Physicians for Compassionate Care, an association of physicians formed in 1994 to fight the Oregon law.

Bentz adds that "patients that used to be helped are now just being killed."
 

EDITOR'S NOTE
Ted Pomerantz, 82, died Oct. 14, 2007, less than a month after sharing his story with Sun Media. In early October, as his health deteriorated, Pomerantz decided he did not want to die suddenly and chose not to take a lethal overdose of barbituates, available to him through Oregon's Death With Dignity Act. Shortly after he took his last breaths in the early hours of a still-dark Sunday morning, Ann Councill, Pomeantz's wife, wrote these reflections.
"He made it easy for me and all of us, truly. I was stroking his brow and reminiscing about our Perry County solar home and our wonderful camping trips in our funky little trailer. He was smiling. The breathing stopped. A mensch all ways, always."

By Donna Casey, Winnipeg (BM) Sun