Physician-assisted suicide gaining favor

State Sen. Patricia Farley will not forget her stepmom's cracked, dry lips, or using a moistened sponge to swab tiny drops of relief into the dying woman's parched mouth.

"Our last memories of her do not resemble the woman she was in the 25 years of our lives," said Farley, a Las Vegas Republican.

"It was very hard for her knowing it was a month and a half of really just watching her waste away," Farley said. "That was probably one of the more surreal times. Watching her spirit disappear."

Beverly Halquist died in 2013 of cancer at the age of 74.

Two years later, Farley co-sponsored a right-to-die bill in the Nevada Legislature. It sought to allow physicians to prescribe life-ending drugs to mentally competent, terminally ill patients, but the measure, introduced by state Sen. David Parks, D-Las Vegas, never got a hearing.

State Sen. Joe Hardy, R-Boulder City, refused to consider the bill in committee. A physician and member of the Church of Jesus Christ of Latter-day Saints, Hardy said he supports hospice care and helping terminal patients manage pain, but not voluntarily ending life.

Parks said he'll try again in 2017.

Evolving public opinion

Public attitudes about the right to die have evolved in the decades since the issue was thrust into society's conscience by Jack Kevorkian, a Michigan doctor who claimed to have helped about 130 people die in the 1990s. Nicknamed Dr. Death, he was convicted of second-degree murder and spent eight years in prison. He died in 2011 at age 83.

"I'm trying to knock the medical profession into accepting its responsibilities, and those responsibilities include assisting their patients with death," Kevorkian told The New York Times after helping an Alzheimer's patient kill herself in 1990.

Four years later, Oregon became the first state to pass a "death with dignity" law when 51 percent of voters approved a ballot initiative allowing terminally ill patients to obtain lethal prescription drugs. Legal challenges delayed enactment until October 1997. One month later, 60 percent of voters opposed its repeal.

In 1995, Nevada lawmakers debated making it a felony to assist or solicit suicide.

"What is to stop Dr. Kevorkian from coming to Nevada?" one witness said during a hearing on the bill, adding that Nevada needed to stop the "death angel movement."

Criminal penalties were dropped because of concerns about liability if a dying person were to reject life-extending efforts, leaving only a statement that Nevada doesn't condone assisted suicide.

Washington state passed a measure similar to Oregon's in 2008. Montana's Supreme Court in 2009 extended protection to doctors who assist patients in ending their lives, but attempts to codify the ruling in statute have failed. In 2013, the Vermont Legislature approved the Patient Choice and Control at End of Life Act.

And just this month California Gov. Jerry Brown signed a bill legalizing voluntary death for the terminally ill.

The laws protect doctors and pharmacists who prescribe and dispense lethal medications. Statutes in Oregon, Washington, Vermont and California require patients to be 18, state residents and mentally competent. Two physicians must confirm a patient's terminal diagnosis, and a patient must make two verbal requests for the medication and a written request witnessed by two people, with required waiting periods between requests. The patient must self-administer the lethal dose.

Since the law took effect in Oregon, 1,327 people through 2014 received prescriptions and 859 died after ingesting life-ending drugs, according to the Oregon Public Health Division. Of those, 589 were at least 65 years old and 668 had cancer. Most, 810, died at home.

Confidentiality laws make it hard to know how many people may have moved to assisted-suicide states just to end their lives.

"We believe it does happen, but not often," said Peg Sandeen, executive director of the Death With Dignity National Center in Oregon. "Moving is so very hard that when you're terminally ill, it's almost impossible."

Critics Fear Consequences

Melissa Clement, president of Nevada Right to Life, fears hastening death by prescription would lead to a broadening of maladies for which suicide is deemed acceptable.

She points to Oregon, where 91 percent of patients cited loss of autonomy as an end-of-life concern. Eighty-nine percent said not being able to enjoy activities they once did is a factor. Perhaps most worrisome to Clement are the 40 percent who said they didn't want to be a burden on family and friends.

"We should be dealing with their pain, dealing with their depression," Clement said. "We should be dealing with things instead of just killing them."

Clement and advocates for the disabled worry the ill or frail may face pressure because of personal or financial reasons.

"When you've got an overburdened, overtaxed medical system, truly a lethal prescription is much cheaper than providing palliative care or comfort care," Clement said. "If you have a medical system or insurance system that has to choose between the two … that business motive is going to rear its ugly head."

But Brittany Maynard, 29, moved from California to Oregon after she was diagnosed with unstoppable brain cancer. She posted videos on YouTube and wrote of her decision on social media, saying she wanted to end life on her terms.

In a Facebook farewell, Maynard wrote, "Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me … but would have taken so much more."

She died Nov. 1, 2014 after ingesting a prescribed lethal drug.

Shift in Opinion

Maynard's story went global and reignited debate.

A Gallup Poll in May found that 68 percent of Americans think doctors should be allowed to assist terminally ill patients die, up 10 percentage points from the previous year. Right-to-die bills were introduced in 26 states and the District of Columbia this year, Sandeen said. Previously the average was two or three states a year.

The American Medical Association opposes doctor-assisted suicide. Its 1990 policy statement reads: "It is understandable, though tragic, that some patients in extreme duress — such as those suffering from a terminal, painful, debilitating illness — may come to decide that death is preferable to life. However, allowing physicians to participate in assisted suicide would cause more harm than good."

Yet doctor's attitudes are shifting.

Medscape, an online resource for health care providers, said in December that 54 percent of doctors it surveyed support aiding patients with incurable diseases in dying. The California Medical Association, which had opposed right-to-die legislation, recently changed its position to neutral, saying the decision should be left to patients and their doctors.

Major religions oppose assisted suicide, which a policy statement from the U.S. Conference of Catholic Bishops called a "threat to human dignity" and a "grave offense" that "breaks the bonds of love and solidarity with family, friends and God."

The Mormon church says much the same.

Farley understands the religious opposition and conflict. But the experience of seeing a loved one suffer changed her perspective.

"My family is deeply Catholic," Farley said, adding that even her father, now himself ill, has changed his opinion about the right to die. The choice, she said, is "really between an individual and ... God, not an individual and society.

"It's really nobody else's business."

Contact Sandra Chereb at schereb@reviewjournal.com or 775-687-3901. On Twitter: @SandraChereb