Late last year,
Oregon voters approved a law that
would permit doctors to prescribe lethal drugs to patients judged
to be in the last six months of life. Oregonians are setting out
on a path that the Dutch have traveled for the past 20 years.
The Oregon law, now under a preliminary injunction pending a determination
of its constitutionality, is the latest result of our failure
to develop a better response to the needs of the terminally ill.
Fear of dying in unbearable pain or of being kept alive in intolerable
circumstances leads a frustrated public to action that only compounds
It is impossible to predict with certainty that a patient has
only six months to live, which makes mistaken or falsified predictions
inevitable. The Oregon law, like law in the Netherlands, permits
assisted suicide when patients are neither in physical pain nor
imminently about to die, and will encourage people who fear death
to take a quicker way out.
A few years ago, a young professional in his early 30s who had
myelocytic leukemia was referred
to me for consultation. With medical treatment, Tim was given
a 25 percent chance of survival; without it, he was told, he would
die in a few months.
His immediate reaction was a desperate preoccupation with suicide
and a request for support in carrying it out. He was worried about
becoming dependent and feared both the symptoms of his disease
and the side effects of treatment. His anxieties about the painful
circumstances that would surround his death were not irrational,
but all his fears about dying amplified them.
Many patients and physicians displace anxieties about death onto
the circumstances of dying-pain, dependence, loss of dignity,
the unpleasant side effects resulting from medical treatments.
Focusing on or becoming enraged at the process distracts from
the fear of death itself.
Once Tim and I could talk about the possibility or likelihood
of his dying-what separation from his family and the destruction
of his body meant to him-his desperation subsided. He accepted
medical treatment and used the remaining months of his life to
become closer to his wife and parents. Two days before he died,
Tim talked about what he would have missed without the opportunity
for a loving parting (Hendin 1994a).
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