The Role of the Doctor in Transforming End-of-Life Choice and Care
By Kim Callinan, Compassion & Choices CEO
Today marks the 20th anniversary of a doctor writing the first prescription medication under Oregon’s medical aid in dying law. That courageous doctor was Pete Reagan. I recently had the pleasure of meeting with Pete and his wife, Bonnie, in their beautiful Portland home.
Several weeks after visiting with Pete and Bonnie, I met with another early visionary for expanding end-of-life care options, Dr. Timothy Quill. Tim was the lead plaintiff in a 1997 Supreme Court case, Vacco v. Quill, which sought to establish the right to medical aid in dying under the U.S. Constitution’s equal protection clause. While the U.S. Supreme Court declined to recognize the right, the case affirmed palliative sedation as a medical practice by recognizing that dying patients have a constitutional right to receive as much pain medication as necessary, even if it advances the time of death, as long as the physician’s intention was not to cause death.
Through these discussions, I realized just how important the early pioneer doctors have been in advancing end-of-life care options. These physicians were trained to cure and save lives, yet their patients needed support about how they die. These physicians did not have a roadmap for how to respond to their patients’ requests for help. Quite the contrary, they worked under a standard of medical care that suggested needless suffering was preferable. These doctors — and many others — had to wrestle with their own personal and moral beliefs. They went against conventional wisdom, and sometimes challenged their peers, to create a new definition of what it means to support a patient at the end of life. They are heroes.
These doctors weren’t setting out to be pioneers — quite the contrary, in fact. They merely sought to provide the best care possible for their dying patients. These physicians recognized that for some of their patients, the best care possible meant giving them autonomy and allowing them to relieve their suffering by ingesting prescription medication to die peacefully in their sleep. They were committed to ensuring that medicine allowed for this compassionate, end-of-life care option to be a recognized as a legitimate medical practice.
We frequently talk about expanding end-of-life care options as a consumer movement — that consumers are the ones driving the change. And we are. The change is happening because we are expressing our wishes and values to the medical establisment and public policymakers and they are adapting. What is also true is that this change has come in partnership with some very honorable and heroic doctors. These doctors recognized that a key element to patient-directed care is respecting and honoring their patients’ values and priorities, even if they differed from their own.
So on March 23, the day the first medical aid-in-dying prescription was written, I’d like honor the many doctor advocates who have championed end-of-life care autonomy. They include Dr. Reagan, Dr. Quill, three other early doctors who publicly advocated for passage of the law — Dr. Peter Goodwin, Dr. Peter Rasmussen and Dr. Nancy Crumpacker — all of the many doctors who advance end-of-life choice through our Doctors for Dignity and Doc2Doc programs, and many, many others. I, for one, am profoundly grateful for their courage and leadership. They are a critical part of the movement for patient-directed, end-of-life care and autonomy. Their efforts have paved the way for a healthcare system that recognizes medical aid in dying as a legitimate form of palliative care. And they are changing the way Americans die, for the better. We are all so thankful.