While the views presented here may not necessarily represent the views of GIIG, we recognize that the issue of death with dignity is an important consideration for healthier living and the decisions associated with healthier living.

Stan Seagraves, MD, contributed his thoughts to this discussion  An Internist for over 20 years in Missoula, Seagraves is currently practicing at Missoula's St. Patrick Hospital, as the medical director of their hospitalist program.

Death with Dignity and the Baxter Decision
by Stan Seagraves, M.D.

October 13, 2010

In December of 2009, the Montana Supreme Court ruled, in Baxter vs. The State of Montana, that a practitioner who provided “aid in dying” to a terminally ill patient would not be subject to criminal prosecution. This landmark decision permits physician assisted suicide in the state of Montana. We now join Washington and Oregon as the only states in the Union granting this option to providers, and the first to arrive at this point though the judicial rather than legislative route.

Medical practitioners are as divided and animated on this issue as the general public. Some links are provided for you to check out. The ruling itself is in the usual soporific legal verbiage – but worth a read if you really want to understand the background for the decision. Also provided are links to an August 2010 Missoulian editorial by a retired oncologist (and plaintiff in the case) as well as a panel discussion at the University of Montana Center for Ethics, held last March. Lastly, Thomas Preston M.D., a physician from Washington, and a advocate for physician aid in dying, will be speaking this Thursday October 14th, 7PM, at the Gallagher building on the UM campus. This is not a plug for him or an endorsement for his position – but rather an opportunity to hear what one man thinks about this subject. I am hoping there is some healthy give and take following his lecture.

In 20 plus years of medical practice, caring for many terminally ill patients, I have never written a prescription with the intent that it would be used to end a patients life. I have been asked to write such a prescription on two or three occasions. This does not mean that I have not unwittingly participated, via the intentional “misuse” of a prescribed drug. Nor does it mean that I have not, in attempting to aggressively treat the profound discomfort of a dying patient, hastened their death, through the direct or indirect effects of a pain treating drug. And it is usually along this sharp and jagged line that doctors find themselves divided on the issue.

Is it splitting hairs to distinguish between the above scenario, and the “active” prescription, given with the sole intent of hastening the patients death? I think not. I worry some (but not a lot) about the potential for misuse. I worry more about the devaluation of life and slippery slope that can accompany some assisted suicidal thinking.

One undeniable positive of the Baxter decision for Montanan's is that it gets back in the spotlight the deficiencies that still exist in end of life care. There is little debate over the sad fact that too many people go through terminal illnesses and end of life anguish without the control of symptoms and dignity that early referral to hospice can provide. This is where greater efforts must be focused. How to deal with the extraordinarily rare patient who's terminal symptoms cannot be otherwise controlled, and how to prevent and deal with the misapplication of terminal care, which will undeniably occur, has not yet been addressed.

http://www.umt.edu/ethics/Events/aidindying.aspx

http://missoulian.com/news/opinion/columnists/article_97e0d2ba-b43c-11df-906c-001cc4c002e0.html

SPECIAL GUEST COMMENTARY: This contribution was made solely for the benefit of readers of this web-site and is not an endorsement of GIIG, it’s products or services.