End-of-life freedom under attack by Montana legislature

Modern medicine has greatly extended and improved our lives, and advances in palliative care can help most people die in comfort, provided they have access to it. But as a board -certified physician in family medicine, hospice and palliative medicine, I know from nearly 30 years of experience that some dying patients experience pain and suffering that no medication can relieve. Anyone who tells you otherwise is kidding themselves.

Some people live beyond the end of their natural life, to what I call the “bitter end.” This is when aggressive treatment has actually intensified and lengthened suffering to levels never experienced before in the history of mankind. These people, and others in intractable pain, should have access to aid-in-dying medication from their doctor if they want it.

Death with dignity has been authorized in Montana for five years. In the Baxter decision, the lower courts ruled that end-of-life freedom, privacy and dignity are rights protected by the Montana Constitution. Then the Montana Supreme Court ruled that Montana Code Annotated protects these rights. The court wrote safeguards into their decision. They said patients must be terminally ill, over 18 years old, mentally competent and must self-administer the medication.

Rep. Brad Tschida and his friends are hell-bent on taking this freedom away. HB477 would send me and my colleagues who provide this compassionate option to prison for 10 years. This bill delineates aid in dying as distinct from palliative care by the intent of the physician. How do lawmakers expect to discern this thought crime? Will doctors be afraid to provide adequate palliation for fear of being second-guessed by prosecutors?

I will never understand why they want to insert government into the sacred doctor-patient relationship. Death with dignity has been authorized in Oregon for 17 years without any instance of abuse. This has been rigorously observed by journalists, scientists, and health workers from the Oregon Health Department. The facts are simply indisputable.

Last week at a hearing in Helena, I heard one doctor say she thought terminally ill people should be able to end their lives, but that doctors shouldn’t help them. I would consider this a failure of the medical system. That I should abandon my patients to end their lives violently and in secret is heinous and devastating to the surviving family members. In Oregon, violent death by people in hospice has virtually disappeared since aid in dying became authorized.

People who utilize aid-in-dying medication are not committing suicide any more than the patriots who jumped from the twin towers to avoid death by fire did. All of the patients I provided this option for wanted to live, but they understood they wouldn’t, so instead they wanted to control how they died.

I have written aid-in-dying prescriptions for a number of patients. My colleagues and I follow the best-practice Oregon criteria. While the exact type and dose of medication has varied, the process is the same. The medication is mixed with water or juice, the patient ingests it, falls asleep in five to 15 minutes and stops breathing in 30-90 minutes.

Some of the patients I wrote prescriptions for never took the medication, but having it on hand helped them to enjoy their final moments. Knowing they could use it if things got bad enough relieved their anxiety about the dying process so they could focus on the life they had left.

I have been at the bedside of four patients when they ingested their medication. All of them died the way most people say they want to die: awake and lucid, at home, surrounded by loved ones who may have traveled thousands of miles to be at their bedside. They and their loved ones have been universally grateful to me for providing this option and to the state of Montana for allowing it.

I want to say thank you. All public polling and personal experience assures me that Montanans overwhelmingly want end-of-life freedom. Thank you to the hundreds who wrote me letters of support and to the strangers who hug me on the street. Thank you to my courageous colleagues in the medical community who have supported me and now prescribe aid in dying for their patients who ask for it. Thank you to my friends who work to advance this cause. And thank you to the hospice nurses, sitting at bedsides at this very moment and all through the night.

You can show your thanks for end-of-life freedom by contacting Montana lawmakers and telling them to protect Baxter.

— Eric Kress, M.D. is a practicing physician from Missoula