Growing Older / Liz Taylor
Why physician-assisted suicide isn't an option for Alzheimer's

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Q: My question is precipitated by former President Reagan's long, drawn-out death from Alzheimer's. Thinking about him and others living 10 years with the disease is appalling. If I were ever diagnosed with dementia, I'd want to investigate suicide. Does one need to move to Oregon? Not only is the caretaking taxing, the emotional aspect draining, but the financial requirements are just crushing. What are our choices?

A: You're brave to ask, and I'm probably brave to answer, because the question of suicide among older people is fraught with politics, political correctness, religion and deeply felt beliefs about one's right to choose whether to live or die. As the boomers age, we're going to hear a lot more about this issue. My prediction: The debate will make the abortion-rights fight look like a walk in the park.

In 1997, Oregon voters passed the Death with Dignity Act, becoming the only state in the country to permit physicians to prescribe lethal medications to qualifying terminally ill residents, as long as they're self-administered. This makes it an unlikely option for someone diagnosed with Alzheimer's.

First, the person must be terminal within six months of their suicide, and most people with Alzheimer's live five to 10 years after diagnosis.

Second, the person must be mentally competent, fully understanding the consequences of what they're doing and capable of administering the medications. By definition, Alzheimer's robs its victims of good judgment — of the capacity to understand consequences — and ultimately the ability to carry out their own deaths.

In Washington, as in many other states, it's a felony to assist in a suicide, either by providing a drug or administering it.

The plain fact is, it's extremely hard for a person with Alzheimer's or other dementing illness to end his or her life legally (Dr. Kevorkian's first client was a 54-year old woman from Oregon with early-onset Alzheimer's).

"I don't see the laws changing soon," says Midge Levy, of Washington's End of Life Choices chapter (formerly the Hemlock Society). "Although we advocate for the right of terminally ill, mentally competent adults to hasten death, it's not likely the law will permit mentally incapacitated people to do it — or others to make that decision for them. It becomes the 'slippery slope' of euthanasia."

Robb Miller, executive director of Compassion in Dying of Seattle, an organization that provides advocacy, counseling and emotional support to individuals who desire a peaceful, humane death, agrees.
 
However, there are steps you can take to protect yourself as much as possible. First, make very clear in your Directive to Physician and Durable Power of Attorney that you do not want your life prolonged unnecessarily and that, at the first opportunity, your wish is to avoid any life-sustaining treatment. Talk to the people you've named as your substitute decision-makers to make sure they understand your wishes and agree to carry them out.

For example, many people with Alzheimer's eventually develop pneumonia or other infections, or they stop eating. Without antibiotics, tube feeding or other medical interventions, and with palliative (comfort) care, the person usually dies relatively quickly and peacefully. If this is your wish, be sure to express it clearly.

(Indeed, the North Carolina Medical Society has published an excellent paper at www.ncmedsoc.org/non_members/longterm_feedingtube_physician.pdf, outlining why tube feeding can be medically harmful for people with advanced dementia.)

Levy and Miller's organizations can guide families about decisions to not prolong the lives of people with dementing illnesses. You can reach Levy at 206-624-2158 (or see www.endoflifechoices.org), Miller at 206-256-1636 or toll free at 877-222-2816 (or see www.compassionindying.org/wa.

For readers wanting more information on the topic, read "Final Exit," by Derek Humphry ($14, Dell Publishing).

Q: I don't have access to the Internet but would appreciate your sending me copies of the documents you mentioned in your May 31 column.

A: I receive many letters from readers similar to this via "snail-mail," asking me to send materials I've referenced in my columns. Unfortunately, I'm not able to do this.

Because I'm a freelancer, not an employee of The Seattle Times, I work from my own office and don't have access to the copy machines and mailing options of the newspaper. As often as I can, I include a telephone number where readers can obtain information I discuss. This isn't ideal, but there truly is no substitute for the amazing ability of the Internet to provider readers with almost any document I mention — free, fast, and in their home.

As an alternative, I want to toot the horn of our country's public-library system. In almost every library in this country, there are computers for public use. Says Craig Kyte, manager of General Reference Services at the Seattle Public Library, patrons here have access to the Internet, and Microsoft Word and Excel, as well as the library's online catalog and Web site (www.spl.org) via these machines.

Don't know how to use them? A librarian will readily show you how, and the downtown branch has free classes, including some for older people. For reservations, call 206-386-4636.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist on aging and long-term care, she consults with individuals and teaches workshops on how to plan for one's aging — and aging parents. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.