Death With Dignity: One Oregon Story

From the farmer’s market on Saturday, I bought home fresh smoked fish, homegrown lamb, and a bundle of eucalyptus so fresh the oil gummied my hands as I threaded sprigs into vases. Soon the house filled with that sharp, redolent eucalypty smell, the crisp scent of truth.

As I unloaded these treasures, a text pinged—a friend I knew from a community group. I admired her wisdom and poise. We’d never met outside meetings, but when I noticed she stopped showing up and learned she had ALS, I reached out and visited a couple of times.

Still unprepared for her text, I sucked in my breath reading: “…I have an odd and last-minute question for you. Do you have any time this weekend to be a witness on my written request for Medical Aid in Dying form? You sign saying I am mentally fit, not coerced, etc. If you’re not around, it is OK, so no pressure—can ask someone else.”

***

Oregon’s Death with Dignity Act (DWDA) initially appeared on the ballot in 1994, passing by 51 percent. Opponents worked hard to prevent use of the Act, including a ballot initiative to repeal it in 1997. Voters rejected the repeal by 60 percent. I voted with the majority both times. Today, nine states plus the District of Columbia offer Medical Aid in Dying (MAiD) laws as an end-of-life option.

Requirements of the law include adulthood (≥18 years), capacity to make one’s own health care decisions, and life-limiting illness with a six-month prognosis. But there’s more. Patients have to request DWDA medication twice, at least 15 days apart (waiting periods can be exempted if they exceed a patient’s life expectancy). Patients need to make a written request with two witnesses (the forms my friend mentioned), and at least one witness cannot be a relative. Two physicians have to confirm the life-limiting diagnosis and the patient’s capacity to decide. If either physician feels the patient is impacted by, say, depression or pain management concerns, they must refer for psychological evaluation. The prescribing physician has to inform the patient of alternatives—e.g., comfort or hospice care, or pain control—although the patient may already be accessing those—and request (not require) the patient to inform “next-of-kin.” Finally, the patient must voluntarily self-administer MAiD medication, the timing of which can get a bit tricky with neurological diseases, like ALS.

The trend in Oregon for patients to access MAiD and receive a prescription but not use it has increased over time. Only 67 percent of those who received prescriptions have used them. Autonomy, quality of life, and dignity are the most often-stated explanations for accessing a MAiD prescription. Simply having the medication on hand offers security and independence, whether a patient chooses to utilize it or not. Just like my friend, they choose to have the option. Putting DWDA into context, few actually use it to die: In 2022, DWDA use accounted for only 0.8 percent of Oregon deaths.

***

At my friend’s house that afternoon, I joined her and her adult daughter and son. I felt honored and clasped her hand, telling her so. She squeezed—a weaker grasp than the last time I’d visited—and cried, apologizing for doing so. No need for apology, I insisted—this was an appropriate time to cry if ever there was one. We passed her tissues.

I read the form carefully and signed, followed by her daughter. Her son quietly looked on. My friend signed last, her once beautiful writing now wavy with weakness. She dropped the pen then, but her face brightened with palpable, visible relief.

More people access DWDA medication than use it, I told them (only 67 percent, as mentioned, actually take the prescription)—it’s about the independence and control in knowing you have options. And five percent of patients who ultimately use DWDA medication (and likely more who have a prescription but don’t use it) lived beyond their six-month prognosis before taking the medication. I wanted to empower her and her family with hope, knowledge, and healing. Not healing of ALS, obviously—but hope and healing—optimizing—of hearts and family relations, words that can be said, people seen, actions taken, in time left.

Source: Author photo

She and her kids kept thanking me, and I kept thanking them for the gift of helping honor her wishes in any way. I promised I’d be back in a couple weeks. Finally, her daughter offered me a bouquet of summer flowers in appreciation—so unneeded or expected, but so very kind.

Outside, warmed by a sunny Oregon day, I lay the bouquet in the car, pausing to breathe in the sanctity of this privilege I’d been invited to witness.

Then I noticed. Making her way daintily across a white, effulgent mum in the middle of the bouquet, there she was, a ladybug. A time-honored symbol of protection and healing; an emblem of positivity. Even transformation.

For PS, and all who love her.