About Death with Dignity
In Death with Dignity, Orfali makes a compelling case for legalized physician-assisted dying. Using the latest data from Oregon and the Netherlands, he puts a fresh new slant on perennial debate topics such as “slippery slopes,” “the integrity of medicine,” and “sanctity of life.” His engaging writing style brings clarity to these issues. The content is thought-provoking; the arguments are well-researched, air-tight, and original.
This extraordinary book provides an in-depth look at how we die in America today. It examines the shortcomings of our end-of-life system. You’ll learn about terminal torture in hospital ICUs and about the alternatives: hospice and palliative care. With laser-sharp focus, Orfali scrutinizes the good, the bad, and the ugly. He provides an insightful critique of the practice of palliative sedation. The book makes a strong case that assisted dying complements hospice. By providing both, Oregon now has the best palliative-care system in America. Reading this book, above all, may help you or someone you care about navigate this strange landscape we call “end of life.” It can be your gentle and informed guide to “a good death” in the age of hospice and high-tech medical intervention.
Read excerpts at Death with Dignity
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Q: The doctors, pharmacies and all those involved in the medical field benefit from patients staying alive. In essence, it is job security for the medical field to keep people alive. One of the big factors also is that Medicare and most insurances pay for all this medical treatment. Do you think that one of the reasons that we have not legalized physician-assisted suicide is because the business of saving lives now belongs to big business or corporate America?
A: I’ll give you the long answer by presenting the facts and then let you draw your own conclusions:
In my book, I analyze 13 years of assisted dying data from Oregon and 30 years from the Netherlands. There are no slippery slopes to report: no credible claim can be made that physician-assisted dying weakens hospice and palliative care, threatens people with disabilities, or discriminates against elders, minorities, or vulnerable populations. At this point, only the arguments based on religious faith remain intact.
Interestingly, the medical profession remains a house divided. After extensively studying the Oregon record some of the top U.S., medical organizations are now in favor of physician-assisted dying. The list includes the American Medical Women’s Association (AMWA), the American Medical Student Association (AMSA), the American College of Legal Medicine (ACLM), and the American Public Health Association (APHA). In 2007, the American Academy of Hospice and Palliative Medicine (AAHPM) shifted its stand from oppositional to neutral.
Oregon demonstrates that physician-assisted dying complements hospice. By providing both, Oregon now has the best palliative-care system in America. This includes number of deaths occurring at home, better use of pain medication, number of patient referrals to hospice care, and improved quality of end-of-life care.
According to a 2010 Medscape poll of 10,000 U.S. physicians, 59.3% are in favor of assisted dying for the terminally ill. Yet, the AMA hierarchy continues to oppose it. Why? It could be that there is just too much money to made at the end of life. Here is what I found out. Modern medicine allows people to live longer, but the price they pay is prolonged dying often with suffering akin to torture. The sad truth is that 80% of Americans will not leave life the way they would have liked to: “at home and without needless suffering.” By closing their eyes and letting the system follow its course, over half a million people may end up intubated in an ICU at the end of their lives. Hospice provides a gentler death but it has its own problems. For most, hospice comes too late. The median length of stay in hospice is, sadly, 18 days with 33% enrolled for just 8 days or less. In addition, the practice of palliative sedation—the only way to alleviate terminal pain for many—varies dramatically among hospices: the variances are between 1% and 52%. Unlike the self-administration of Nembutal (the lethal barbiturate), palliative sedation, also known as “slow euthanasia,” is a slow death. The patients are sedated into oblivion and then allowed to die slowly by whatever comes first: morphine overdose, starvation and dehydration, pneumonia, or the disease taking its course. The process usually takes about 10 days and is very painful to watch as the patient shrivels into a living cadaver. Slow euthanasia is legal in most advanced countries.
If patients were to self-administer the Nembutal and take their own lives, it would, on the average save about 10 days of stay in hospice or the ICU. The ICUs charge about $4500 per day and $700 per tube. So it’s a big loss for them. The hospices charge a lot less, but 10 days is still a loss given their average stays. Interestingly, Oregon has not witnessed a death stampede. There was no mad rush for the Nembutal. The fear, however, is that baby boomers are much less pain-tolerant than their parents; they may decide to take the Nembutal route in large numbers if that choice were made available to them. Baby boomers are now entering the end-of-life queue and the polls show that they want that choice to be on the table when their time comes.
I hope this answers your question. The short answer: Yes, there is money to be lost, but not that much currently. The fear is that baby boomers may change that equation.
About Robert Orfali
Robert Orfali, the guru of client/server systems in the early days of Silicon Valley, co-authored three best-selling books that demystified the complexity of these mission-critical systems and made them understandable to a whole new generation of programmers. The books sold over a million copies. In this book, Robert uses his analytical skills to deconstruct the most complex system he has yet encountered: our modern end-of-life system. He wrote this book after helping his soulmate and coauthor, Jeri, navigate her death from ovarian cancer in 2009. The deep emotions Robert felt allowed him to look at how we die from a different perspective, another angle. Robert also wrote Grieving a Soulmate.