The good part of dying

by Jason Renaud of Portland, Oregon. Jason is the Executive Director of Compassion & Choices of Oregon.

What does a “good death” mean? In Oregon we’ve debated the question for years. As part of the ongoing discussion, Oregonians voted in 1994 for the right for eligible adults to use life-ending medicine with a doctor’s prescription.

Opponents claimed Oregon would be a suicide tour stop. They said the indigent and people with disabilities would be euthanized. Families would coerce “burdensome” loved ones to take poison. Children would be demoralized. Persons with mental illness would use the law to commit suicide. The number of people who used the law would rise exponentially each year.

None of these concerns came true. None. But what stewards of the law could never quite illustrate was the good part of dying.

A good part? What could be good about dying?

The good part is laid out in Peter Richardson’s ‘How to Die in Oregon’ which plays for the first time tonight on HBO. What the documentary film shows is dying persons with a calm peace of mind, relief and sincere gladness. With the protection of the Oregon Death with Dignity Act they know they will not be in pain, they will not suffer, they will not be humiliated, they will be in control.

Richardson’s cinematic style is calm. His listening lens captures a gallery of dying persons and their family members. We are his shadow. But when elegant and buoyant Cody Curtis has a hard bite of gut pain, together we see her sudden grimace. Richardson’s camera drops and his voice intrudes, “are you alright?” No, she’s not alright, she’s dying. The pretense of filmmaker and subject evaporate and together we walk with Cody as she carefully weighs her her decision.

Richardson gently moves us through Cody’s decision process. She’s already a survivor of liver cancer, a wife and mother, elegant and eloquent. How much pain must one suffer? How many surgeries, how many pills, how much is sufficient? When is it okay to say goodbye to your children? When have you loved your husband enough?

Since 1994, volunteers for Compassion & Choices of Oregon have talked with thousands of persons like Cody Curtis, on the most intimate terms, about how they would die. These conversations are a frank discussion between adults, armed with the facts about Oregon’s Law.

Eligibility includes diagnosis of a terminal illness; typically cancer. Our clients have already heard the bad news from their physician. Their tears are dry. Our task, illustrated in Richardson’s film, is to help them, step by step, to understand and to use the law.

Sometimes they arrive fully decided - like Gordon Greene, a grizzled character who knows his clock is ticking down. They plan to use the law to die. Others, like Cody, come with questions and concerns of their own.

The conversation about good care at the end of life flows around and beyond Death with Dignity (ODWDA). Everyone one of us, either in our own lives or because we live with and love others, will face this decision. The evidence - both of years of implementation of ODWDA and from ‘How to Die in Oregon’ - is utterly persuasive and irrefutable. We have the right choose - and Oregon pilots this idea for the world.

After a recent HBO screening a woman stood up and introduced herself as an oncologist - a doctor who routinely works with patients in the dying process. She said, “Over the years I’ve discouraged many patients from using the Oregon law - but after seeing this film I will reconsider what I tell my patients.”

The beauty and grace captured in ‘How to Die in Oregon’ is the well-planned efforts of those approaching life’s end intentionally. We watch as Cody spends her final hours with her children, husband and friends, on her own terms.

‘How to Die in Oregon’ captures what the many years of ethics-based arguments cannot: the human experience of a peaceful and dignified death. This good part shows how Oregon’s Death with Dignity law has eased the experience of dying. But as Cody Curtis shows us is that dying isn’t the hardest part. That’s reserved for saying goodbye.

May 26, 2011