Saturday, October 17, 2009

Minnesota Nurse Accused of Encouraging Suicide.

The AP and other sources reported this week that a Minnesota nurse, William Melchert-Dinkel "feigned compassion" for suicidal individuals in a suicide chat room and then encouraged their efforts. His nursing license has been suspended but he has not yet been charged.

James Hart at CrimeSceneKC asks: What's the crime?


Barbara Wagner and the Myth of State-Encouraged Euthanasia.

Conservatives have embraced the story surrounding Barbara Wagner because, as they tell it, they think it best demonstrates state-encouraged euthanasia.

As I wrote in a recent article for AlterNet, Wagner is considered an example of killing by rationing. Yet, the facts of the case point to another story:

Take, for instance the sad case of Barbara Wagner of Oregon, a 64-year-old lung-cancer patient whose death has become a cause celebre of opponents of health care reform.

Under headings like "Oregon Offers to Pay to Kill but not Treat Cancer Patient," and "This is What Government Rationed Health Care Looks Like," Wagner's story went viral in the conservative blogosphere. In 2008, Wagner petitioned her insurer, a public health plan offered by the state of Oregon for people ineligible for Medicare or Medicaid, for coverage of a $4,000-a-month experimental drug prescribed by her doctor.

The Oregon Health Program denied her request with an unsigned, indelicate letter that listed her treatment alternatives: palliative care (pain management), end-of-life care through a hospice, and/or use of the state's Death with Dignity law, which permits terminal patients to end their lives. There's no question that her request could have -- and should have -- been handled with more compassion.

But a recent study of Tarceva, the drug prescribed by her doctor, showed little difference in the extension of life experienced by patients who took the drug: the median survival rate of patients like Wagner who took the drug was one month longer than those who took a placebo. After a raft of publicity, the drug-maker, OSI Pharmaceuticals, offered Wagner the drug for free. She died less than three months later.

We will never know what conversation Wagner had -- or should have had -- with her doctor regarding the end of her life, or how long she could have lived without the drug. What we do know is that a woman who was close to death did not want to die, was not ready to die and was led to believe that the drug denied her was her last chance to live.

And thanks to the bureaucratic insensitivity of OHP administrators (who have since enacted a more compassionate policy for contacting patients who petition for exceptional care), Wagner thought the state of Oregon would rather kill her for $50, the cost of lethal drugs, than let her live for $4,000.

In truth, it appears the greatest indignity Wagner suffered at the hands of her state insurance program and her doctor was their apparent failure to prepare her for imminent death.

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Smith Works to Deny the Dying of Their Rights.

Anyone who follows this blog knows my position on anti-choice in dying advocates' efforts to conflate depression and suicide with Death with Dignity as legal in Washington and Oregon: Those who elect to use Death with Dignity are lovers of life. Depression is a symptom of their terminal disease and impending death, not the cause. They know death comes and they wish to have a choice in how they die. Treating them for depression will not cure their terminal disease.

Who else but Wesley J. Smith would accuse advocates for Death with Dignity like Compassion & Choices for being uncaring killers of the suicidal? He's at it again, working to use definitions to confuse the issue, in a new article for The Church Report, excerpted in his post at FirstThings today:

Never mind that it is accurate. The dictionary definition of “suicide” is “the act or an instance of taking one’s own life voluntarily and intentionally.” And forget for the moment that fear of stigma can save lives. C & C is blatantly promoting a postmodern word engineering scheme that would sacrifice accurate and precise legal lexicon on the altar of emotional personal narratives.

Lest you think such subterfuge cannot succeed, it already has. Under Washington State’s newly legalize assisted suicide regime, participating doctors are legally required to lie on the death certificate by listing the cause of death as the underlying disease rather than the prescribed suicide drug overdose.

Smith knows that the term suicide is rightly loaded with connotations of mental illness and depression, that we as a society are obligated to help the suicidal in any way we can. But he also knows that Death with Dignity is reserved for those who are dying, not by choice but because they are terminally ill. After the horrors and work of fighting death - because they don't want to die but know they will - those who elect Death with Dignity only wish to choose when they die. They are mentally sound.

This is a very different situation than Smith is willing to acknowledge. Instead, he wishes to preserve the rights of the medical profession, the state, or of God (the church) to determine when and how a terminal patient suffers and dies.

Choice, in other words, is a personal right. Smith is advocating to prevent mentally sound, terminally ill patients from receiving a prescription from their doctor that will allow them to die they way they choose. We should not be fooled by his Smith's efforts to conflate suicide with Death with Dignity.

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