28 August 2008

Update no.349A

Update from the Heartland
No.349A
28.8.08
Blog version: http://heartlandupdate.blogspot.com/
To all,
This special edition Update deals solely with Dignity in Death. If you do not want to think about or discuss this topic, please do not read farther. I imagine my words will be upsetting or even offensive to some who participate in this open forum, and for that, I am truly sorry. My intent is not to make anyone uncomfortable but only to encourage everyone to think. I share these particular words simply because I believe the law should change . . . for you, for me, for all of us, who shall reach the same point in our lives. I ask that you read my words, argue with me as you wish, and think about the issues involved. For those so inclined, I invite you to use my words however you may desire. I have chosen to petition my state government representatives, as it is state law that must change. You are free to use whatever finds resonance with you and tailor your statement to friends, to the Press, or to your state government as you see fit. The bottom line for me remains . . . it is time to change the law.

AN OPEN LETTER TO:
Governor Kathleen Sebelius
Senator Peggy Palmer
Representative Ty Masterson
Wichita Eagle

Simply and succinctly, I promised my recently deceased Mother I would do my best to seek change to the law, so that others might not suffer what she endured during her end of days. I ask for your support and advocacy for a refinement to the law, allowing a return of dignity and freedom to all citizens, including you and me, who will eventually face what my mother ‘endured.’
Life is terminal for every single one of us, no matter the station, net worth, political affiliation, religion, or social condition. The only remaining questions in each of our lives are when and how. We do not have a choice about our birth. Fortunately, as American citizens, we retain most of the Liberty that our forefathers sacrificed so much to establish from the oppression of the Crown. For the most part, we enjoy the Freedom to choose how we wish to live our lives, in our individual and personal pursuit of Happiness. Yet, for a myriad of perhaps well-intentioned reasons, the State has imposed its will, intruded upon our most private affairs, denied our choices for dignity in death, and We, the People, have acquiesced to these intrusions.
Kansas law appears quite clear. KSA Chap. 21 § 3406 establishes the criminality of assisted suicide, and KSA Chap. 60 § 4401 et al envelopes those peripheral citizens who might be involved in the defined felonious conduct. The Kansas statues are broad and all encompassing, and also quite indiscriminate. I seek finite, specific, limited and restricted modification of the existing law. To that end, perhaps we can learn from other states.
On 8.November.1994, the residents of Oregon passed Ballot Measure 16, which established the Oregon Death with Dignity Act (ODWDA) [ORS 127.800 – 995]. A voter initiative to repeal the new law failed the following year. The Bush Administration challenged the Oregon law before the Supreme Court in 2006. In Gonzales v. Oregon [546 U.S. 243 (2006); no. 04-623] [215], the United States Supreme Court fell short of an affirmation of the ODWDA law, when a 6-3 majority rejected the Federal Government’s invocation of the Controlled Substances Act of 1970 (CSA) [PL 91-513] in an attempt to suppress the will of the People of Oregon. Associate Justice Anthony Kennedy, writing for the Court’s plurality, concluded, “The Government, in the end, maintains that the prescription requirement delegates to a single Executive officer the power to effect a radical shift of authority from the States to the Federal Government to define general standards of medical practice in every locality. The text and structure of the CSA show that Congress did not have this far-reaching intent to alter the federal-state balance and the congressional role in maintaining it” – in essence, the states must decide without interference of the Federal government.
In Washington v. Glucksberg, [521 U.S. 702 (1997); no. 96-110] [304], the Court acknowledged the State’s interests with respect to the end of life question, including:
-- “prohibiting intentional killing and preserving human life;
-- “preventing the serious public health problem of suicide, especially among the young, the elderly, and those suffering from untreated pain or from depression or other mental disorders;
-- “protecting the medical profession's integrity and ethics and maintaining physicians' role as their patients' healers;
-- “protecting the poor, the elderly, disabled persons, the terminally ill, and persons in other vulnerable groups from indifference, prejudice, and psychological and financial pressure to end their lives; and avoiding a possible slide towards voluntary and perhaps even involuntary euthanasia.”
The growing body of law regarding the end of life issue including the cases cited above as well as Cruzan v. Director, Missouri Department of Health [497 U.S. 261 (1990); no. 88-1503] and Vacco v. Quill [521 U.S. 793 (1997); no. 95-1858] can be distilled down to a common denominator beyond Due Process, Equal Protection and other points of law. The Supreme Court of the United States of America has resisted passing judgment on the root question and explicitly stated in every case, while dealing with the particular constitutional arguments, that the issue of end-of-life, physician-assisted, death with dignity laws are a matter for the states to address via the legislative process, and the Constitution has room for this public intercourse.
It is in the context of the Court’s various related rulings that I have taken the liberty to include the text of the Oregon Death with Dignity Act as well as an Oregon State summary of their experience with the ODWDA (1998-2006).

http://oregon.gov/DHS/ph/pas/index.shtml.
I think you can readily see the extraordinary care, protection and precision incorporated into the ODWDA. Further, the Oregon law directly addresses the State’s proper interests as outlined by the Court in Glucksberg. The fact that the Oregon Court chose to address only the Government’s use of the CSA against the ODWDA without judging the validity of the law at question, strongly suggests the Court’s desire for the public debate to continue regarding Death with Dignity laws and for the answers to be achieved via legislative rather than judicial action. Thus, I seek your support for the proper legislative process to modify the existing law.
Senator Sam Brownback’s aversion to and legislative efforts against specifically the ODWDA as well as all other state efforts is well known. I laud his passion and concern for each and every life. Yet, among his words, I cannot find a logical rationale for imposing the State’s will upon the most private affairs of every citizen. Taking the lofty moral ground that all life is precious carries the air of moral superiority and universal, sanctimonious omniscience. Such dictum ignores a horrific reality.
The Kansas congressional delegation voted for Federal Assisted Suicide Funding Restriction Act of 1997 [PL 105-12], to prevent the expenditure of public funds on any activity related to assisted suicide, which includes and encompasses Death with Dignity laws like ODWDA. I would strongly encourage any subsequent, related, state legislation include a comparable prohibition on the use of public funds for such activities. Death with Dignity is a very personal, private action, and most definitely not a matter of public interest beyond the protection of individual rights.
I recognize and acknowledge the religious basis for our laws regarding suicide. Our cherishment of life has always been and will always be a hallmark of this Grand Republic. Further, I acknowledge the State’s interest in protecting the life of every citizen. I do not seek alteration of those protective laws, other than to segregate a very narrow, distinct and unique portion of those laws with only one purpose – allow every citizen the dignity to end their days by their free choice within defined constraints, at the time and manner of their choosing. As with all choice, those like Sam Brownback can and will freely choose to endure the rigors of a slow and lingering death. However, as in Oregon, some small number of citizens will choose to end their days in a dignified, respectful way. And, judging from Oregon’s experience with the ODWDA law since becoming effective, a very small percentage of eligible residents / citizens actually choose to avail themselves of the option, but at least it remains an option. We are denied that option in Kansas. I, for one, want the option legally available when my time comes. I have had a Living Will for 25 years. We have talked to our now-adult children about our wishes as well as the legal documents necessary to protect our intentions. Yet, the best legal documents available to us under the current law do not allow us dignity in our death.
The evolution of medical technology enables artificial continuation of critical physiological functions to sustain a body for comparatively long durations with no brain function whatsoever. Because we can, does not mean we should in all circumstances. The mounting popularity of Living Wills and trusted family members or agents to protect an individual’s wishes given incapacitation or incompetence reflect the blossoming drive to control our private lives as we see fit, not as someone else or group of someones wishes us to exist.
My Father died suddenly of congestive heart failure at 26.November.2003; his death was quick and without protracted suffering. My 85-year-old Mother suffered a prolonged, lingering death, fraught with uncertainty, loss of control, ambiguity and apprehension.
In late 2004, my Mother was diagnosed with pulmonary squamous cell carcinoma. After multiple consultations regarding an array of treatment options, she chose not to take aggressive action in light of her age, her quality of life, and the probability of success given the variables in her life. The various medical challenges of her age and disease added complication to her life; those challenges were either overcome or tolerated, and did not materially affect the quality of her life. While she endured the inevitable physiological decline of advancing age, she enjoyed her final years in a peaceful, comfortable life with family around her. In late June of this year, a few days before her 85th birthday, she stopped eating. She told us she was no longer hungry, no longer found any satisfaction in food. We tried repeatedly to convince her, to help her, find some sustenance that was acceptable to her. I recognized the consequence and sought the counsel of our family physician who confirmed the tell-tale signs of her end of days. We engaged a professional hospice care provider to ensure her last days were as comfortable as possible. My sister was able to leave her family and job in California to attend our Mother, and help with the logistics of the moment. Within a few weeks, Mom lost her remaining mobility and control of bodily functions, but remained lucid, aware and engaging, although bed-ridden. All forms of water had a metallic taste to her, no matter what we did to make water more tolerable to her. Ice chips became her only intake, other than medication. Mom repeatedly asked me why the process (meaning death) was taking so long. She knew life was at an end, and she worried about being a burden on so many people and about what was to come. A week prior to her death, she began to hallucinate, seeing snowflakes, drifting flowers and odd colors. She had periods of lucidity between the hallucinations and was aware of our concern. By Sunday the 27th, her hallucinations took on an ominous character; she saw strange men, large spiders and other objects that raised her level of anxiety and literally scared her. She no longer asked for or perhaps could not ask for ice chips. My sister and I spent the night with her. Mom was quite fitful and restless, with short periods of sleep; she reached for and tried to fend off imaginary objects she saw in her mind’s eye. On Monday, we altered her medications to give her some rest and peaceful moments. By that afternoon, I was able to have several extended conversations with her about a variety of subjects but mostly about family. I felt sufficiently confident that she had rebounded for a period that I returned to work on Tuesday. That evening, we had a short chat among her hallucinations, and she actually took a few ice chips. By early Wednesday morning the 30th, Mom was non-responsive. I arrived shortly after the nurse’s call. Her heart and labored breathing continued; however, virtually every test of neuro-muscular response was vacant. Numerous, repeated attempts at communication left me feeling she was aware of what was happening, but she was in essence, totally paralyzed. She did not recover and passed away that evening.
My Mother and I talked through the preparations, to ensure her affairs were in order, to understand her wishes after her passing, and to discuss the process. Four years ago, she created a Living Will and signed both Legal and Medical Powers of Attorney. She did everything possible under the law to define her end-of-days. She had the necessary ‘clear and convincing’ evidentiary documentation [as defined in Cruzan] regarding her wishes. We talked about what could be done and could not be done under Kansas law. We also discussed the Oregon law as a point of reference. My Mother qualified under the technical criteria of the ODWDA, except for residency. In fact, she was well beyond the median age of Oregon applicants. I never pressed her for an answer, so I do not know what she would have done if Kansas had had an equivalent ODWDA law, and the matter is moot for her, but not for our family and not for you and me. The advantage of the ODWDA is the availability of a humane, respectful, dignified set of choices for each and every citizen to choose how they wish to conduct their end of days, and they remain in control of their most private and personal affairs. Yet, despite all that preparation and taking advantage of all remedies under the law, I could not help her attain what she sought – a quick, dignified death.
My Mother cannot speak for herself, and her voice falls to me – her first born. By this ponderous letter, I trust that I have at least fulfilled my promise to her. I prostrate myself before you and beseech you to help us pass reasonable, responsible and respectful legislation to amend the law, and provide means for humane choice and recognition of the freedom we all seek to enjoy. I do not seek reformation of our common law regarding suicide or subjugation of our Judeo-Christian moral values that form the bedrock foundation of our laws. Rather, I seek specific delineation to and amendment of very unique, discreet sections under the broader umbrella of the law, to provide precise criteria for qualification and application of legal means within a very small, defined population, so that each of us might have the option to control our private affairs during our inevitable end-of-days.
To assuage whatever concerns you may have, I suggest a phased implementation of an ODWDA-like amendment to the law in Kansas that would allow broader experience and public debate regarding the safeguards and appropriateness of legal protection. Perhaps a proper initial condition, to establish Cruzan’s ‘clear and convincing’ evidentiary documentation, might involve a written statement by the individual, invoking the privilege, validated by an immediate family member, along with a medical diagnosis and prognosis from a licensed physician, and an independent and private affirmation by a non-medical, officer of the court. Once Kansas develops a body of experience like Oregon has, we could gradually expand the window of qualification or criteria for application. For example, initial implementation might encompass only the direct, competent, voluntary application by the individual. Perhaps, as positive experience grows, the application criterion might expand to a witnessed document like a Living Will, or even later a properly empowered agent with the individual’s medical power of attorney. As the old proverb goes, long journeys begin with small step. Let us begin the journey toward returning freedom of choice to those citizens about to enter their end-of-days.
If you have not witnessed the lingering death of a loved one or family member, I respectfully suggest that absorbing and relating to the trauma of this particular path to death will remain beyond your reach. For a small portion of the population, the law should respect the expressed wishes of the individual, who is terminally ill, passed any productive condition, and desirous of controlling their death on their terms. This is NOT a matter of public popularity, but one of very personal and private choice.
Thank you very much for your time and consideration. I stand ready to assist you in any manner to amend the law and allow us all to have the choice of death with dignity.

Very respectfully submitted,


Cap Parlier
Citizen of the United States of America
Resident of Kansas
LtCol USMCR (Ret.)
USNA 70
Devoted Son, Husband, Father, Grandfather


My very best wishes to all. Take care of yourselves and each other.
Cheers,
Cap :-)

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