Real Life on the TV.

Marc Siegal at the LA Times gives us a recap of an episode of the TV show "Grey's Anatomy" on assisted suicide that takes place in Washington state, where Death with Dignity (the name of the bill/law) is legal, and tells us how accurate it is:

"Grey's Anatomy"

ABC, Thursday, March 25, 9 p.m.

Episode" "Suicide is Painless"

The premise: At Seattle Grace Hospital, patient Kim Allen ( Sara Gilbert) is suffering from stage IV (widespread) large cell lung cancer that has spread to her lymph nodes and her liver. She has had repeated pleural effusions (fluid has built up in her lungs, which she has had drained), and she continues to have difficulty breathing. She is in constant pain and is told that she has less than six months to live.

Allen has been offered hospice care with its attempts at pain relief and heavy sedation, but she is considering physician-assisted suicide instead. A psychologist has declared her mentally fit, and she asks her doctor, Dr. Teddy Altman (Kim Raver), to help her die. She seems open to the possibility, but in Washington state, according to the show, physician-assisted suicide is legal only if two physicians agree and the request is made by the patient twice, 15 days apart.

The second doctor who is asked to evaluate her, Dr. Owen Hunt (Kevin McKidd), is reluctant to approve her request. Finally, with both Altman and Hunt in agreement, Allen is sent home with a prescription for barbiturates, which Altman tells her will stop her breathing 45 minutes after she takes them.

The medical questions: Is stage IV large cell lung cancer usually terminal in less than six months or can it still be treated successfully with chemotherapy? Can a patient with extensive lung cancer be made comfortable with the help of sedation, pain medication and hospice care — without rendering her unconscious or stopping her breathing? Is physician-assisted suicide legal in Washington state provided that two physicians agree and the patient is mentally competent? Are barbiturates usually prescribed for use outside the hospital in such a case? Could a dose be determined that would predictably stop a patient's breathing in 45 minutes?

The reality: Chemotherapy can sometimes extend the survival of stage IV large cell lung cancer patients beyond six months, but it is often ineffective. The median time to death is eight months, says Dr. Joseph Lowy, medical director of the Palliative Care Service at NYU Langone Medical Center. Only 20% to 30% of patients are alive at one year, so the show's prediction of less than six months for Allen is fairly realistic.

Sedation, pain medication and hospice care can make such a patient comfortable, but shortness of breath can be a particularly difficult symptom to treat, says Dr. Timothy E. Quill, professor of medicine and psychiatry at the Center for Ethics, Humanities, and Palliative Care at the University of Rochester School of Medicine in New York. A patient might be suffering and not be able to report it because they are heavily sedated, Quill says.

In physician-assisted suicide, a physician generally evaluates the patient and then prescribes potentially lethal medication that the patient then takes (or not) by his or her own hand. It has been legal in Washington state since March 5, 2009, and yes, two physicians must agree on the prognosis (that the patient will die within six months), the competence of the patient and the voluntary nature of the request. "There must be no acceptable alternatives," Quill says.

Evaluation by a psychologist or psychiatrist is not required, says Dr. Shawn J. Skerrett, professor of pulmonary medicine at the University of Washington, adding that he's uncomfortable participating in physician-assisted suicide, in part because of "the lack of a requirement to exclude depression by a mental health professional."

Barbiturates are the most common medication prescribed for this use. Data from Oregon indicate that the drugs are consistently effective, but some research suggests that assessing the proper dose can be problematic. In 2009, for example, 36 patients took lethal doses of prescribed medication under the Washington state Death With Dignity Act. In six cases, death took more than 90 minutes.

New Angus Reid Poll on "Euthanasia."

From Seattle Post Intelligencer, a post today on a new poll by Angus Reid (a canadian firm I know very little about) on public opinion about "euthanasia." One problem with the poll is that it fails to make a number of distinctions about the definitions it uses, confusing death with dignity with assisted suicide with euthanasia. But for that reason, the poll most likely reflects the public's knowledge of the practice more than it's opinion about it. Here's the article - and don't miss the comments.

Incidentally, I'd love to know who commissioned the poll. Washington has had legal Death with Dignity since 2008. I smell more "pro-life" tampering with a democratically approved bill, even while they support the legitimacy of such a bill in California's prop 8 case....

Poll: Sharp divisions on euthanasia

A new Angus Reid poll find that 42 percent of American adults are in favor of making euthanasia legal in the United States, although 52 percent feel legalizing induced death would leave vulnerable people without sufficient legal protection.

The survey steered clear using such deliberately non-threatening terms as "Death With Dignity" favored by supporters of assisted suicide. In the 2008 election, by a 58 percent to 42 percent vote, Washington became the second U.S. state to legalize physician-assisted suicide.

In its poll of 1,001 American adults, taken Feb. 4 and 5, Reid asked:
"Generally speaking, do you support or oppose legalizing euthanasia in the United States?"

The results: 14 percent answered "Strongly Support," 28 percent "Moderately Support", 14 percent "Moderately Oppose," and 23 percent "Strongly Oppose." A total of 22 percent were not sure.

A near-majority of Democrats (47 percent) support euthanasia, while a bare majority of Republicans (51 percent) oppose it. A total of 47 percent of Independents backed legalized euthanasia.

Still, the public has reservations about induced and assisted death.

The poll asked if people felt that legalizing euthanasia "would leave vulnerable people without sufficient protection." Fifty-two percent agreed, 32 percent disagreed, 15 percent were unsure.

As well, Reid asked if legalizing euthanasia "would send the message that the lives of the sick or disabled are of less valued. The poll's respondents split down the middle, 44 percent in agreement, 44 percent disagreeing, with 12 percent unsure.

A contrasting opinion came when the pollster asked if legalizing euthanasia "would give people who are suffering an opportunity to ease their pain." Seventy percent agreed, only 19 percent disagreed.

The public seemed compassionate toward those making life-or-death choices.

"Do you think people who help a person to commit suicide should be prosecuted?" Reid asked.

Thirty-seven percent said "Yes," 34 percent answered "No," with 28 percent "Not Sure." Independent voters were strongest in saying those who assist suicide should not be prosecuted.

The poll put a related question more bluntly:

"If a parent is found guilty of assisting a terminally ill son or daughter to die, what do you think should be the appropriate punishment."

Just 6 percent opted for life imprisonment, and only 21 percent for any prison sentence, with 12 percent favoring a fine. Thirty-five percent opted for "No Penalty at All", while 26 percent were unsure.

Advocates of Washington's assisted suicide measure, led by former Gov. Booth Gardner, spent $4.8 million on their successful 2008 campaign.

The Washington vote gave momentum to a movement stalled for more than a decade after Oregon became the first state to legalize physician-assisted suicide.