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Good life, ‘good death’

Thoughts on the defeat of Question 2

Massachusetts ballot Question 2 that would have legalized physician-assisted suicide for the terminally ill was defeated 51 percent to 49 percent on Election Day with 96 percent of precincts counted and was the closest of the three questions on the Massachusetts ballot.

There were, of course, impassioned voices for and against the ballot question including religious, medical and disability rights groups who fought the measure, saying it’s open to manipulation and relies on diagnoses that could be wrong.

I find it curious that some or many in the medical community were against the measure because “most doctors die differently than their patients.” So wrote Dr. Ken Murray, retired clinical assistant professor of family medicine at the University of Southern California, in a Feb. 25 Wall Street Journal article.

“It’s not something that we like to talk about,” Dr. Murray wrote, “but doctors die, too. What’s unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.”

A 2003 survey of 765 doctors found that 64 percent had created an advanced directive — specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20 percent for the general public.

“Why such a large gap between the decisions of doctors and patients?” Murray asks. “The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75 percent of the cases and that 67 percent of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8 percent of patients survived for more than one month. Of these, only about 3 percent could lead a mostly normal life.”

“Unlike previous eras,” Murray wrote, “when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients’ wishes, but when patients ask ‘What would you do,’ we often avoid answering. We don’t want to impose our views on the vulnerable.”

“The result,” Murray says, “is that more people receive futile “lifesaving” care, and fewer people die at home than did, say, 60 years ago.”

Murray cites an article by nursing professor Karen Kehl titled “Moving Toward Peace: An Analysis of the Concept of a Good Death,” which ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. “Hospitals today,” in Murray’s view, “provide few of these qualities.”

Doctors, on the other hand, “want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).”

The states of Oregon and Washington have legalized physician-assisted suicide. Perhaps as more and more baby boomers approach the inevitable cessation of life as we know it, the ballot measure will pass the next time around.

Cardinal Sean O’Malley called the defeat of the ballot measure the best outcome for the ‘‘common good.’’ ‘‘It is my hope and prayer that the defeat of Question 2 will help all people to understand that for our brothers and sisters confronted with terminal illness we can do better than offering them the means to end their lives,’’ O’Malley said in a statement.

I don’t know what the better options are that Cardinal O’Malley is referring to. I also don’t understand how a patient’s own decision to end insufferable pain and agony can be in conflict with whatever better options the Cardinal may have to offer.

I am reminded of Steve Job’s last words as reported by his sister in an article; He said “Oh wow! Oh wow! Oh wow!”

If I have any say in the matter when my time in this sphere is ending, I could live and die with those words.

John Bos lives in Shelburne Falls, is a hospice volunteer and a founder of the Eventide Hospice choir.

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