My Turn: Death and dying a part of life
Burlington Free Press

January 27, 2007

In a recent editorial “Viewing death as a part of life” (Free Press, Jan. 7), Dr. Dudley M. Baker correctly wrote about the importance of bringing death and dying “out of the closet”, so to speak, to be freely and openly discussed as a part of life—to acknowledge the inevitability of dying, and in doing so provide, when the time comes, a better death; one which will supply a full measure of caring support and most importantly, respond to the wishes of the dying patient (the mantra of Hospice care).

To accomplish this requires first and foremost a reorientation of the thinking of many physicians. Many, if not most, physicians find it hard to accept the fact that, despite their greatest efforts, a patient under their care will die. When their treatments are no longer effective, they see this as failure on their part. They display the same, if not more, reticence to discuss the reality of dying as does the public at large. And as a consequence, they may not be fully responding to the needs and wishes of their dying patient.

Medical schools throughout the United States, including the University of Vermont College of Medicine, and throughout the industrial world recognize the significant changes in medical practice since Hippocrates’ time 2,500 years ago. So, with a rare exception, they either no longer administer any oath at all to their graduating students or in some cases provide a variety of statements supporting ethical care with emphasis on respecting patient autonomy and confidentiality, but not directing or limiting therapeutic options appropriate to the circumstances.

Patient Directed Dying legislation, which is being reintroduced in the Vermont Legislature, would provide the opportunity for terminally ill Vermonters to request medication which, under carefully defined requirements and safeguards will provide a shortening of the dying process. No physician is required to write such a prescription, but those who do will do so within the law and in concert with any statement of practice that they may have made upon being graduated from medical school.

One of the most important results of the similar Death with Dignity Act in Oregon, since the passage now eight years ago, has been a marked improvement in the frequency and depth of discussion of death and dying between patient and doctor. It has led to a high use of hospice services (among the highest in the country) as well as a commendable level of all aspects of palliative care. Vermonters, the vast majority of whom support this legislation, deserve no less.

Vermonters and lawmakers have thoughtfully discussed and carefully studied the patient directed bill for several years.We agree that this time for contemplation about serious end-of-life issues was productive and well spent.Lt. Gov. Barbara Snelling, Gov. Phil Hoff and Gov. Madeleine Kunin are right that the time has come to pass a law giving terminally ill Vermonters more choice and control at the end of life.

Diana Barnard, M.D., has a family practice in Middlebury.