The Right to Die- Death with Dignity Act and Jack Kevorkian

The recent Death of Jack Kevorkian startled me. I was expecting to hear that he had died by his own hand, not in some hospital after a short illness.
I have been interested in Dr. Kevorkian’s mission, since I became a nurse ten years ago. It has taken me ten years to fully understand his mission. He was a great man who tried to ease the suffering of others. He was judged very harshly by his peers and society. He refused to give up his mission even while in prison.

In 1999 a jury had found him guilty of 2nd degree murder after Dr. Kevorkian had videotaped himself injecting Thomas Youk, a patient suffering from amyotrophic lateral sclerosis (Lou Gehrig’s disease), with the lethal drugs that caused Mr. Youk’s death on Sept. 17, 1998. (The New York Times June 3 2011) He had sent a video tape of his death to 60 mins and that this was one of the reasons that they convicted him. Dr. Kevorkian was sent to prison and was released in 2007 with the stipulation that he could not assist anyone else with dying. He also lost his medical license.
I of course, knew about him from the countless hours of discussing and studying the process of grieving and dying in nursing school. At first I was not a believer in Doctor Assisted suicide. For that matter, I was against Suicide of any kind. I have had several members of my family and a few close friends that committed suicide. I watched the pain and grief that suicide brought to my family and friends. I felt that it was the chicken shit way out. For lack of a better word. It wasn’t until I had a patient that was suffering from COPD that I began to believe that Dr. Kevorkian was on to something. Dying from COPD is a horrible way to die. Most suffer for years with shortness of breath, recurrent infections and huge medical bills. They end up living on O2. They have to rely on family members to care for them as they slowly watch themselves die. If you even been unable to catch your breath after a coughing fit, imagine being like that every day, day after day. It is not a nice way to spend the rest of your life.

My patient, had been suffering from COPD for several years and was in the end stage of the disease when her family brought her to the hospital. We did everything we could for her. The doctors continued to run tests and give her treatment to help her breathe. By the 10th day or so, of this she was exhausted. Her IV had come out for the 4th time in 3 days. Her veins were shot from the steroids that she had been on almost continuously for the later part of her life. I called the Doctors and let them know that she would need another IV. The order was given for a PICC line to be placed. (A picc line is a type of IV that can be left in for weeks at a time, as long as it is properly taken care of. It requires a special nurse that is trained to place it with an ultrasound.) The family and the patient agreed to have the PICC placed. While we were waiting for the team to come in, I was sitting at the bedside talking to the patient and her family. She was soft-spoken and always had a kind word for the nursing staff. I was not very busy that day and took some time to sit and talk with her. She told me and her husband that she was exhausted and tired of being stuck all the time. Her husband’s eye filled up with tears when she told him this. I told her she did not have to be stuck anymore if she did not want to. She looked at me and shook her head “No”. She wanted to do what the doctors told her to do. I said ok and left the room to take care of my other patients. On my way down the hallway, her husband came out and halted me. I stopped and began to talk to him. He told me about her life, how they had met and that she loved to dance. He was upset at seeing her like this with all the machines and tubes around her. I told him that she did not have to live like this anymore. That she could go home with hospice. He asked me what hospice was and I explained the way hospice worked in Texas. He was surprise that she could stop all the treatments and go home to die. He was aware that the doctors had told her that there was not much else they could do for her. He agreed that he wanted her to be told about hospice. So I went and gathered the information and took it to them. This was my 1st time to talk about hospice with a patient so I made sure that I had all the information that I needed. I let the social worker and the doctors know that the family asked me to talk to my patient about hospice.

I walked in the room to see her husband sitting in the chair by her bedside. She looked up at me through the oxygen mask and nodded a greeting. I sat in the chair opposite her husband. I told them about hospice choices. We talked for about an hour. I had let the other nurses know that I would be in her room for a while so they would look after my other patients. I answered all of their questions and I gave them time to make a decision.

Near the end of my shift, the husband came back to find me. He let me know that she had agreed to do hospice and so they were going to honor her wishes. I began making the phone calls that needed to be made and got the hospice ball rolling. When I called the doctor he told me to tell the patient and her family that she may not make it home in the ambulance due to her condition was getting worse. She was able to understand me when I told this to her family and her. They all agreed that she still wanted to go home and die at home, if that is what would happen. They were ready. I was not. I was not ready to say goodbye. But I finished the paper work and got them sent on their way. About an hour after the transport had come to take her on her last ride, her son showed up at the nurses’ station. His father had given me his keys to his motor home that he had been staying in, in the parking lot. He wanted to ride with her in the ambulance and asked me to hold his keys to his motor home so his son could pick it up. I expected the son to show up and I would give him his keys and he would leave. But, as I was standing up to give him the keys he grabbed me in a huge hug and started crying. He kept thanking me for helping his family though all of this. I don’t know how long we stood in the hallway of the hospital. I know that it was a good 3or 4 mins. I let him cry and I tried not to cry myself. Finally, he let go of me and thanked me again for helping his family, I gave him his keys and he left. I walked to the bathroom where I proceeded to collapse on the floor in a heap of tears.

I never saw them again. I do not know how long it took her to die once she was home with hospice care. I pray that she passed quickly and did not have to suffer, which is part of the reason for having hospice care.

I often wondered after this case, if physician assisted suicide was the right thing. I knew we had hospice care for people who were terminally ill, but for reasons much too long to type here, hospice was not always the answer for many. I know several of my patients had talked about if there was some way that they could take care of themselves when the time came, that they would. The choice of being in control of the way you die was always on my mind. I became an advocate for patients for hospice care. Many nurses did not like to speak to patients about hospice care. So when they had a patient that either asked about it or the Doctor had ordered a hospice evaluation, I was asked to go speak to them.

I have watched many patients die alone in the hospital. I have sat with patients after my shift was over, just so they had someone with them in the end. No one should die alone. They died with a diaper on, unable to hold their bowels, with tubes hanging out of every orifice. They died in a sterile, unfamiliar environment alone, because they out lived their family and friends or because they did not have any family or friends.

I recommend the movie “You don’t know Jack” about Dr. Kevorkian, if you want to learn more about his mission. It gives you a view of his world and all that he tried to do for people.

You can find more information regarding Oregon’s Death with Dignity Act on Oregon’s government website, they describe the Death with Dignity act as an act “which allows terminally ill Oregonians to end their lives through the voluntary self-administration of lethal medications, prescribed by a physician for that purpose”. The more and more that I worked with terminally ill patients, the more I began to understand where Dr. Kevorkian was coming from. I began to understand his mission, He was about choice. The choice to say I do not want to live like this anymore; I do not want to suffer. I do not want to be a burden on my family. The Death with Dignity act allows that. The patient and their family are set up with a team that specifically works with patients who want to end their life on their own terms. The team of volunteers meets up with the patient and discuss the process of ending their life. They go over everything from the prescription costs, to what the medication will do once the patient takes it, how long it will take, and more importantly that at any time the patient can decide you don’t want to take the medication the patient does not have to take it. So the patient has choices while they are still able to care for themselves and in their right mind.
HBO has a documentary out now called “How to die in Oregon”. It discusses many of the points I listed above. The Documentary at times is hard to watch due to it covers individuals who are terminally ill and choosing to end their life before they become a burden on their family or before they are unable to care for themselves. It is worth the effort to watch.

In my opinion, we treat animals better than we do people. Many times, pet owners will put their beloved pet “down” so they will not suffer if they have been hurt or have cancer or some other fatal disease. Why do we continue to let our loved ones suffer in a hospital bed getting poked and scanned and pumped full of medications that are not going to change the end result?
Anytime I would try to talk with other nurses, medical personal or doctors about Dr. Kevorkian and the Death with Dignity act, they would give me the deer in the headlight look and find something more pressing to do… The question I would often raise, is in a state where we have hospice care, why can we not have a Death with Dignity Act similar to the one in Oregon? Whenever I brought up Dr. Kevorkian’s name, they would reply, “Dr. Death? he is crazy, why do you want to talk about that?” Why is it in our civilized country, we are scared to talk about the right to die? What is it about dying that makes it so uncomfortable talking about it? We all are going to meet the same end. No one gets out alive. (Har-de-har) I have met a few who would sit down and talk with me about the issue. I found that there were other medical professionals that felt the same way I did. We should have a choice how we want to die. When my time comes, I want to have the choice. I don’t want to lie up in some hospital bed for months or even years having someone wipe my butt, or feed me through a tube. I want to go while I still have some Dignity left.

I said a little prayer the day I found out Dr. Death had died. I said, please God don’t judge him too harshly, he was only trying to ease the suffering of others. He was judged so harshly while on earth, I believe he should be able to rest now. R.I.P Dr. Death see you on the flip side.