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As Americans Live Longer, Attitudes Toward Death Change



Los Angeles Times
Friday, August 05, 2016
Los Angeles — When doctors told Robert Stone last year that he had terminal cancer, he didn’t feel afraid.

Stone said he’d come to accept death as a natural part of life. What he did fear was having too little energy or too much pain to enjoy his remaining days.

So last month, Stone, 69, became one of the first people in California to obtain lethal medications under a new state law that allows doctors to write prescriptions for terminally ill patients to kill themselves.

Stone said he won’t take the pills until the growing fatigue caused by his bone marrow cancer becomes debilitating.

“I’ll know that by how I feel,” he said. “It gives me some comfort in having control over what the end of my life will be like.”

Americans are planning for the possibility of living into their 80s or 90s, said Len Fishman, director of the Gerontology Institute at the University of Massachusetts, Boston.

“They also know that that can mean living with serious physical and cognitive disease, and it’s making them think about what choices they would want to make if they were in that situation,” he said.

That’s led to more patients refusing intensive medical treatments just to prolong their lives, because there might be “some things worse than death,” Fishman said.

More controversially, it’s also contributed to a recent surge in the number of states looking into legalizing physician-assisted suicide — seen as either a humane option for the sick or the beginning of a dangerous trend in medicine.

Generally, attitudes toward death are changing in part because baby boomers — the oldest of whom reached retirement age five years ago — were the first generation to see many of their parents live into their 80s, Fishman said. They probably saw health conditions they wouldn’t want for themselves.

Stone recalled his mother’s last months with a grimace.

He remembers that when she was hospitalized for congestive heart failure in 1992, her hands were strapped to a hospital bed, a tube down her throat. She eventually ended up in a coma before dying weeks later at age 80.

Stone said his mother, father and uncle endured “excruciatingly painful” situations before they died.

“If they’d had a choice, I don’t think they would’ve done so,” he said.

In October, Stone’s doctors told him that his chemotherapy had stopped working and that he probably had one to two years left to live.

But unlike his mother’s, Stone’s last months will be peaceful, he said.

Since his diagnosis, he’s traveled to Vietnam and Japan, two countries he’d always wanted to visit. He recently read through stacks of letters written as long ago as 1962, fondly remembering old friends.

And for these happy final months, “I’m very thankful,” he said.

Since November 2014, legislators in more than 25 states have introduced bills that would legalize physician-assisted suicide — a fivefold increase from 2013, according to data collected by Compassion & Choices, an organization that advocates such laws.

California is the fifth state — after Oregon, Washington, Montana and Vermont — to allow the practice. When Gov. Jerry Brown signed the End of Life Option Act into law in October, he wrote that he believed it would be a comfort to have this option if he were “dying in prolonged and excruciating pain.”

In part, states are looking into physician-assisted death because of Brittany Maynard, a 29-year-old Californian with terminal brain cancer who decided to move to Oregon in 2014 to take advantage of that state’s aid-in-dying law.

Jessica Grennan, national field and political director for Compassion & Choices, said she thinks the widespread attention Maynard received — she ended up on the cover of People magazine — and the subsequent passage of California’s law pushed physician-assisted suicide into the national dialogue.

“I was at a bachelorette party and everyone was asking me questions about this,” she said.

A Gallup poll last year found that 68 percent of Americans thought doctors should be allowed to help terminally ill patients commit suicide — a 10 percent increase from the previous year.

Such laws face heavy opposition from some quarters.

Opponents say they fear these laws could be the beginning of a societal shift in which some people’s lives are deemed less valuable.

“It’s a very utilitarian attitude toward human life,” said Camille Giglio, head of the anti-abortion advocacy group California Right to Life. “To say simply because you’ve got an illness or you’ve got a disability ... you should do the right thing and take yourself out of the world.”

Many doctors have historically been opposed to such laws, saying they go against their oath to save lives. A group of physicians in California has sued to overturn the state’s law.

In Oregon, Dr. Kenneth Stevens, an oncologist, has been fighting physician-assisted suicide since Oregon became the first state to legalize it in 1998. “It’s changing what doctors do, what hospitals do,” he said. “I can’t fathom why a doctor would do this.”

In 2000, a terminally ill woman with inoperable cancer who refused treatment asked Stevens for a prescription for lethal medications.

He encouraged her to try chemotherapy and radiation instead and fight for the chance to see her son graduate from the police academy and perhaps see him get married.

She agreed and is still alive 16 years later.

“Killing someone is not a medical procedure,” Stevens said.

Because many doctors are wary of helping patients die, participation in California’s law is completely voluntary. Physicians don’t have to prescribe such medications if asked or refer patients to colleagues who will.

But public acceptance of the practice has influenced doctors as well.

Last year, the California Medical Association, which represents doctors, switched its stance from opposed to neutral, which many credit with the bill’s ability to gain sufficient support in the state Legislature.

In Colorado, where there’s a campaign to get a similar measure on the state’s November ballot, the Colorado Medical Society is re-evaluating its opposition to the practice.

“The times are changing rapidly in terms of national acceptance of the concept of this within the medical arena,” Dr. Catherine Sonquist Forest, a family medicine doctor and professor at Stanford University, said in a webinar about the new law for California physicians.

For Stone, obtaining the pills has given him confidence that he will be able to live each remaining day “fully, thankfully and joyfully.”

“I’ve looked back on my life to see how fortunate I’ve been,” he said.

He recounted attending the University of California, Berkeley, during the Free Speech Movement, working in the Peace Corps in the Philippines and enjoying a career dedicated to helping the homeless.

Since his diagnosis, Stone has been making his way through a bucket list.

He had long wanted to photograph every state capitol. When he found out he had cancer, he had done 44. He took a photo of West Virginia’s building in Charleston, the 50th, in March.

Also on the list is learning how to play “Lady of Spain” on the accordion, an instrument he gave up when he was 11.

He starts lessons in a few weeks.