What Is a Natural Death?

Elana Premack Sandler at Psychology Today asks her readers what they think about assisted suicide as she feels her way through the subject in the wake of a host of publicity. I appreciate her nuanced and open willingness to examine the topic, particularly when so many do make a snap-judgement about assisted suicide. I recommend you read her entire post and comment! But there's a point in one of her paragraphs that I want to jump off from. She writes:

Does assisted suicide undermine suicide prevention? "Obviously!" you might think. Working for a suicide prevention organization, and as a suicide survivor, I really wrestle with supporting idea of suicide - at all.
Since so many people who choose assisted suicide are suffering from incurable degenerative diseases, the cessation of pain - psychache or not - is very appealing. Just as I wish that people who are in extreme emotional pain did not have to experience such terrible pain, I wish the same for people in extreme physical pain. But, will a person who dies by assisted suicide experience more dignity and peace than they would have if they had died by natural causes?

Ok, maybe a quick point. Then I'll jump off. The recent report from the first year of legalized Death with Dignity in Washington state shows that most of those terminal patients who elected for DwD said their reason was autonomy. More so than fear of pain or existing pain. I'm always suspect of polls that ask people in crisis and distress to identify what the cause is. It's almost unfair to ask a dying patient to identify why they are ready to die. But nonetheless, a majority of patients said autonomy. End of point.

What I want to take up from the above paragraph is that tired but prevalent phrase: "natural causes." Once was a time when death meant the rather simultaneous cessation of heart beat, breathing and brain function. Those days are over. Medicine now can maintain heart beat and breathing almost indefinitely. That leaves brain function. As I noted yesterday, Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo proved that many, particularly those in the extreme religious right, oppose the use of brain function as a determining factor for death. This brings the term "natural causes" to a new definition.

All three women could eventually breath on their own. All had functioning hearts. Both functions were essentially resuscitated via CPR, or other techniques that shock the heart and lungs back to operation. Prior to the invention and widespread use of defibrillators, CPR, respirators, and even 911 in the early 70s these women would have died of their initial injuries. Their lives were, after resuscitation, prolonged via artificial nutrition and hydration and the battles over their lives stemmed from their family members attempting to remove them from ANH.

The prevalence of amazing, life-prolonging technological and medical advancements does extend American lives. This is a wonderful and miraculous thing. But it has changed how we die and what we now call death. Few deaths these days can be considered natural, however. It's time we reconsider the term and in doing so, start to talk about what death now means.

What Then Is A Natural Death?

Alex Schadenberg warns those vulnerable and child-like seniors, incapable of making their own health care decisions, to stay far, far away from those evil living will forms because their lawyers, their family, and doctors are trying to kill them!

Can you think of a greater disservice anyone with the public's ear could do for seniors? Convince them that living wills are deadly? When we living in an age where every citizen should write up a living will as soon as they reach voting age?! And update it annually.

It is just this sort of irresponsible fear-mongering and redefining of natural death, or rather illogical defining of "the culture of death," that alarms me about those who ascribe to a "pro-life" perspective on end of life care. Shaming or scaring seniors into making the decisions you feel they should is coercion, plain and simple. And perpetuates the fear of death and dying that our society battles.

From his site, Euthanasia Prevention Coalition:

Living Will - Killing Will

During the last few days I have received three Power of Attorney/ Living Will legal documents that in fact are designed as Killing Will documents.

A Power of Attorney for Personal Care is a legal document that assigns a person to make medical and care decisions on your behalf when you are unable to do so for yourself. These are important documents because the wording of the document will either protect your life and or may give medical professionals the right to abandon you or even dehydrate you to death.

My concern is that many people will visit their lawyer and have a Will and Power of Attorney documents drawn up for them without understanding that the language in the Power of Attorney document may be neutral, may protect their life, or may actually hasten their death.

Last week a supporter contacted me after reading his Power of Attorney for Personal Care document. He was shocked that he had signed a document that instructed the physician to dehydrate him to death if he were terminally ill or living with a chronic condition.

The Euthanasia Prevention Coalition distributes the Life-Protecting Power of Attorney for Personal Care to protect you from being killed. We charge $25 for this document. The information for ordering the document is at:http://www.euthanasiaprevention.on.ca/lifeprotectingpowerattorney/LifeProtectingPowerAttorney.pdf

Today, I received a Power of Attorney document from a supporter that was by far the worst one I have seen in a while. It stated:

If and when it becomes clear beyond any reasonable doubt that I am afflicted with or suffering from an irreversible injury, disease, illness or condition that is terminal, then:
(a) I direct that I be allowed to die, and that I not be kept alive by artificial means or invasive measures of any kind. Measures of prolonging life that are to be avoided, withheld, withdrawn or discontinued include:
(i) electrical or mechanical resuscitation of my heart;
(ii) nasogastric tube feedings, gastric tube feedings or parentral nutrition;
(iii) artificial mechanical respiration when my brain can no longer sustain my own breathing;
(iv) radiation treatment and chemotherapy, unless used strictly as palliative measures;
(v) any treatment for any other illness or disease (such as pneumonia) which I contract when already afflicted with a terminal disease, illness or condition (such as Alzheimer's Dementia); and
(vi) dialysis when my kidneys fail.
(b) I request that a "Do Not Resuscitate" ("DNR") notification be kept with me at all times - whether I am at home, living with family or friends, or in a hospital or other health care facility.
(c) I desire that medication be mercifully administered to alleviate pain and suffering, even though the result may be to hasten the moment of my death.
(d) If I am under the care of a physician whose moral, religious or personal professional beliefs are not in sympathy with the directives set out herein, I direct my attorney for personal care to ask that physician to withdraw from my care and to arrange for me to be cared for by another physician whose beliefs and views accord more closely with my directives, and, if necessary, to transfer me to a different hospital or health care facility to better ensure that my wishes as expressed herein are respected.

The problem I have with this document is that it not only orders the physician to not provide any medical treatment, other than palliative care, but it also orders the physician to dehydrate the person to death, even if they are not in the dying phase. Read section (a), subsection (ii).

Further to that, the person who sent me this document was a suppoorter of our work and this was the document that his lawyer was suggesting that everyone obtain.

The fact is that many unsuspecting people have obtained, legally signed, and put-in-place, similar power of attorney for personal care documents without knowing how the document will be interpreted.

Further to that: Power of Attorney for Personal Care documents are only legally binding when the person is incapable of making legal decisions. At that point the document can't be amended.