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 the problem.
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 acute 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).
