November 13, 1997

I had a sick feeling when I heard that, as predicted, Oregon voters decided not to repeal a 1994 statute on assisted suicide. They were saying, as they said then, that they want physicians to be able to prescribe fatal doses of barbiturates to terminally ill patients.

Suffering and desperation are fairly widespread in health care. I remember some of my own patients, like the 75-year-old man on tube feedings for weeks, unable to talk after massive head and neck surgery for cancer. There was the 39-year-old mother of two, in the late stages of ovarian cancer, worried about how her family would pay their 20 percent of the hospital bill. There was the 50-year-old man on a respirator for weeks, stuck in ICU isolation after massive surgery to try to get his arms and legs working after an accident. Every one of these patients told me they wanted to die. Physicians and other staff on these cases felt the situation was virtually hopeless. Yet these patients were discharged with more time to live and maybe some new measure of hope.

It’s these real-life stories that make me opposed to assisted suicide. Nurses and physicians have to be committed to minimizing pain, controlling symptoms, alleviating suffering, and providing supportive care to the dying. Without an unswerving loyalty to the preservation of life, the slope is so slippery, it’s frightening.

Let’s take the case of the 39-year-old woman with ovarian cancer. What if, when she asked me if there were a way to end her life quickly, I had said something like, "Absolutely. You qualify because you’re terminal, and all you need to do is talk with your doctor. It’s your right." She would have died without those last weeks at home with her children. She would have died without hearing how her church had rallied together to donate money to help pay the hospital bill. Her family, on some very significant level, would have been forced to deal with her own act of suicide, in addition to her tragic death. What if the woman had asked me to help her crush the pills? Then I, as a nurse, would have played a role in her suicide, even though my fingerprints would never have been on the barbiturates themselves.

I’m also worried about the subtle pressures society can apply once the way is cleared. Imagine that you have been lying in bed for months on end, your pain controlled most of the time, but aware that you will soon be dying from cancer or heart failure or something else. Imagining that your family has been coming to visit you day after day, tired, frazzled, grief-stricken. Would you wonder if you should put them out of their misery? If they almost wanted it over? What if your physician kept saying, "There’s really nothing more we can do for you"? What if finances were an issue? What if friends and neighbors were asking the family, "Why doesn’t she just put an end to it?"

I can hear the television ads now:

"Sometimes death is the right decision.
Call (800) JUST DIE ."

We all fear death and suffering on some level. For all the challenges, pain, and suffering nurses witness, I’ll bet most of us can testify to amazing, moving things that have happened in the lives of patients and families facing death. Turning those death experiences into suicides won’t—in the end—make the process any easier. What do you think?

Barbara Bronson Gray, MN, RN
Editor in Chief

Oregon’s assisted-suicide initiative upheld in court