Dying person should be the decider

A physician friend recently shared an insight he gained from a 68-year-old woman. Four years ago she was diagnosed with leukemia and initially responded to chemotherapy, which gave her some good years. Then she stopped responding to drugs, and finally underwent a bone marrow transplantation after total body irradiation. Unfortunately, she never recovered from the transplant, and with no more options for a cure, she was having repeated infections and other increasingly severe symptoms.

One day, when my friend visited her, she looked at him and said, "You got me into this mess, now get me out of it. Please help me die."

"It made me realize," my friend said, that we physicians and our technology had put her in a condition unknown just 50 years ago. We gave her some good extra life, but now she is in a medically induced state of extended suffering. And, he added, "she's right, we are the ones who are responsible for her present condition, and for how she is dying."

Today, most people die under medical management. Except for those who die suddenly, as from trauma, stroke or heart attack, most of us have life extended beyond the time we would have died naturally. Although we would rather die at home, most of us die in hospitals or other medical facilities.

And, after a series of medical decisions have changed our course over months or years, the great majority of us die following a specific medical decision, such as stopping a mechanical ventilator or antibiotics, or increasing a painkiller or sedative.

Few of us will die naturally. Medical decisions, commonly made by physicians in consultation with the patient and family, determine when and how we die. No one wants to revert to a state of nature without prolonging life when we first encounter our last illness, but in this bargain with modern medicine we have to understand that someone -- a human person(s) -- makes the final decisions about when and how we die.

Why shouldn't that someone be the person who is dying? Why must a dying person's final weeks or months be subject to decisions made by medical treatment protocols, the personal beliefs of individual doctors or the dictates of ideologies?

Some people believe that letting terminally ill individuals choose to die disregards the sanctity of life. Surely, to sanctify or respect life is the bedrock of all great ethical systems. But the concept of sanctity of life, formulated a couple millennia ago, is based on "natural law."

When death becomes more natural than life we should have no obligation to sanctify a life that has been medically transformed into something alien, unnatural, and a continuing source of suffering.

When a terminally ill person's religious beliefs lead him to conclude that his life has become contrary to the purpose of his God or personal faith, he should have the religious freedom to sanctify good life by ending his life of medically induced degradation. He should not be bound by those who would impose on all others their contrary beliefs on how we should die, nor should we impose the redemptive nature of suffering on those who do not hold the same faith.

From ancient times physicians have compassionately helped their patients die when doing so was less harm than keeping them alive.

Today, doctors help their patients die in a myriad of ways -- stopping life-sustaining treatments such as antibiotics or drugs to maintain blood pressure, withdrawing feeding tubes or mechanical respirators, and more active measures such as high doses of painkillers or sedatives. Most physicians have helped a patient die by one means or another, and although the Washington State Medical Society political leadership opposes Initiative 1000, the Death with Dignity initiative, more of its physicians approve of such a law than disapprove.

I-1000 recognizes the reality of how we die and gives decisions on lessening suffering to dying patients, not to government or the leadership of particular medical or religious organizations.