Doctor presents on “aid in dying”

POLSON — Death is often something people avoid speaking about at all costs. But for others, it is a stark reality, something that is coming sooner rather than later. For the latter, deemed terminally ill, a choice in how to spend their last days is of utmost importance, said Dr. Thomas Preston, who visited Polson and St. Ignatius last Wednesday to discuss the issue.

Preston, a retired cardiologist who practiced in Seattle, immediately made clear to attendees that the purpose of the presentation was purely informational, though he did admit he was an advocate of “death with dignity” for terminally ill patients, defined in the medical community as persons having six months or less to live.

Aid in dying, in which a physician prescribes a terminally ill patient a strong sleep aid to bring about death, is only legal by voter initiative in two states: Oregon and Washington. Oregon passed the measure 12 years ago while Washington has had such a law since 2008. The state of Montana could be on track to have a similar measure after 2009’s monumental Baxter v. Montana decision, in which the state Supreme Court determined physician-assisted suicide was not a violation of the state’s constitution.

“In conclusion…we find nothing in Montana Supreme Court precedent or Montana statutes indicating that physician-assisted dying is against public policy,” the decision read.

Preston said the ruling virtually allows the assisted dying, though two bills, one for and one against, will be put into play during Montana’s legislative session next year.

“If any prosecutor went after a physician, it would probably be a pretty frivolous lawsuit” as long as nothing illegal was done, Preston said. “The Montana mindset is that it is a decision between the patient and their doctor.”

Montana could have stringent rules on the act, similar to what has been put into place in Washington. Requirements for the drug include, above all, the choice being a competent, terminally ill patient’s own, they must be over 18 years old and they must be making a voluntary request for the drug.

“A physician will tell the patient about alternatives, and if they chose to take it, they must administer the life-ending medication themselves,” Preston said. “It is illegal for anyone else to administer the medication.”

Using statistics from last year in Washington, Preston found that 53 different physicians dispersed the medication to 63 patients. Of the 63 patients, 47 died, 36 after taking the medication, seven without taking it, four whose status is unknown and 16 who were still alive at the end of the year.

“This points out that what’s really important to these people is having this as a backup plan,” he said. “As soon as they got the medication, they had much more peace of mind.”

The reason, Preston said, is the suffering terminal ill patients endure. As a practicing cardiologist in the 1980s, Preston recalled the story of an 86-year-old patient he had known for 15 years that had trouble breathing. One day, Preston came in to learn the patient had experienced cardiac arrest the night before but had been revived. “I wish they hadn’t done it,” the man wheezed to Preston. Taken aback, Preston spoke to the man about his condition and life outlook. When the patient experienced cardiac arrest the next night and again was revived, he looked at Preston and asked, “Why did you do this?”

Preston said that medical advances have helped prolong life, but often times for someone who is prepared for death and who is at peace.

“It made me understand because what was most important was I had contributed to this condition, his life was prolonged medically,” he said. “All my upbringing and training is to be concerned about suffering. Prolonging life can only sometimes prolong suffering.”

One of the benefits of aid in dying is the ability for a person to pass away at home, in comfort, generally surrounded by family. For more than 2,500 years people have thought about aid in dying, Preston said, mentioning in his presentation a quote from a work by Sophocles.

“I ask you to be my healer, the only physician who can cure my suffering,” Heracles asks of his son in the famous passage.

Yet Preston said people are against aid in dying for a variety of reasons. Professional concerns, such as the Hippocratic Oath, which doctors recite as an ode to ethical practices, as well as cultural and religious issues make the subject murky for many people. The will of God for others is something man should not be involved with, Preston said.

“A frequent case is that families get blinded by love,” he said. “By pulling the plug on a ventilator, did I kill that man? We, with our medical practices, have set the conditions for that person’s death.”

When people really get desperate, Preston said many could turn to traditional suicide, a proposition which is the worst of all possible remedies. A murder-suicide in Libby earlier this year, a case where a man killed his wife who had been suffering from cerebral palsy before killing himself, only highlighted the direst of such scenarios.

“You could never do a double-blind study but undoubtedly, death with dignity has prevented violent deaths,” Preston said.

The responses Preston has received while making presentations sponsored by the Helena-based Compassion & Choices, a plaintiff in the Baxter case, have been overwhelmingly positive, he said. In the 12 years Oregon has had the measure, Preston said there have been no reports of abuse of the law. But ultimately, the decision could come down to voters of Montana, who may have to decide whether they agree or disagree with physician assisted dying.