We Need Help for Better Dying

I have been involved in improving end-of-life care for 37 years while taking care of cancer patients. A bill by Assemblywoman Dion Aroner (D-Berkeley) allowing physician assistance in dying has passed both the Assembly Appropriations Committee and the Judiciary Committee. It will come before the full Assembly next January. It is desperately needed legislation for the humanitarian care of those few patients whose dying is uncontrollably miserable and dehumanizing.

Improving end-of-life care is greatly needed but it is a very complex task. It involves education of professionals in pain control and managing end-of-life symptoms. Pain control education is slowly improving, partly due to the public discussion of assistance in dying. It still has a long way to go. Comfort care is not offered to patients early enough or often enough as an option, while aggressive treatment is always discussed. Physicians frequently don’t have the time or take the time to ask patients about their feelings, fears and concerns in dying. Many patients are not informed when they are approaching the dying phase of their illness. Physicians are all too uncomfortable in discussing dying with patients. Patients and families are also all too uncomfortable discussing dying.

Education of the public is lacking. Americans tend to feel death is “an option.” Discussions about death are rarely held in families. People don’t make wills or complete advanced directives, which creates major problems for families and/or professionals. The general public poorly understands pain control. Hospice programs are poorly understood and used far too late in the dying process.

The negative aspects of dying--suffering, loss and sadness--often are magnified, instead of the positive ones. Goodbyes, forgiveness, reminiscing and closure are powerful positives. Only the body dies; the person is with us as long as we wish to remember them.

And in our humanness let us not forget those few who are suffering in the broad sense of the word. In spite of the best care of professionals and family, dying sometimes is still very cruel for the patient. If some believe it is best to end the dying, a very private and personal choice, let it be done in a very caring and professional way.

This is what Aroner’s bill would allow. It is closely modeled after the Oregon bill that has worked beautifully for more than a year. Public and professional support has grown as experience has shown it can be done safely and compassionately.

Assistance in dying is a small but important part in the whole spectrum of improving the care of the dying. Let us solve this problem by passing this bill, and by continuing to find better solutions for the other problems of the dying.