The chronicle of a lonely do-gooder family doctor who survived.

Monday, November 3, 2008

Washington State Proposition 1000

Washington State Proposition 1000, the Right-to-Die initiative. Modeled after Oregon's generally successful Physician-Assisted-Suicide law.

Initiative Measure No. 1000 concerns allowing certain terminally ill competent adults to obtain lethal prescriptions.

This measure would permit terminally ill, competent, adult Washington residents, who are medically predicted to have six months or less to live, to request and self-administer lethal medication prescribed by a physician.

Should this measure be enacted into law?

Yes [ ] No [ ]

I voted no.

Yes, I am a bad liberal. Yes, I am another fascist physician trying to foist my personal ethical beliefs on my patients.

Actually, I am neither and I have really mixed feelings about this, something that is rare in this age of divided politics. I won't be heartbroken if it passes and I am pretty sure I signed a petition to get this on the ballot.

Here is my thinking. My day is divided into 15 minute blocks of time that I spend with patients. 2 minutes is spent with the nurse, checking in the patient and taking vital signs. 6 minutes is spent on documentation and insurance paperwork. 2 minutes is spent on the acute medical issue that I insist we deal with, which the patient could care less about: the blood pressure of 235/115 or the psychosis or the 50 pounds of weight loss since I last saw them. That leaves about 5 minutes, on a good day where I'm not behind from the previous 10 visits that looked like this.

Pain and suffering during a terminal illness is a Really Important Thing to discuss, certainly one of the most important conversations you could have with your physician. I absolutely believe that a rationally thinking person might choose to end their life, on their own terms as a logical and even morally correct thing to do. I just don't see how the current health care system is set up to do this the right way, granting enough time for consideration and safeguards that actively ending life deserves.

To be clear, the current system is so broken that we cut corners on hundreds of other important conversations: the new diagnosis of cancer, the decision to begin hospice care, whether grandma should be moved into a nursing home. Proposition 1000 is just where I have finally decided to draw my own personal line.

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