Follow Calif. on right-to-die laws?

By John C. Goodman

Have you ever thought about how you're going to die? If you're lucky, it'll be quick and relatively painless. A sudden heart attack, for example.

Most of us aren't that fortunate; we have a much better chance of dying slowly while connected to a half-dozen tubes in a hospital intensive-care unit.

Nearly 70 percent of all deaths in the United States occur in hospitals, nursing homes, and hospice facilities.

One doctor, who blogs under the pseudonym Scott Alexander at the website Slate Star Codex, describes how many of his patients leave the world: "Old, limbless, bedridden, ulcerated, in a puddle of waste, gasping for breath, loopy on morphine, hopelessly demented in a sterile hospital room."

He gives some specifics - and be forewarned, this gets gruesome: "You will become bedridden, unable to walk or even to turn yourself over. You will become completely dependent on nurse assistants to intermittently shift your position to avoid pressure ulcers. When they inevitably slip up, your skin develops huge incurable sores that can sometimes erode all the way to the bone, and which are perpetually infected with foul-smelling bacteria. Your limbs will become practically vestigial organs, like the appendix, and when your vascular disease gets too bad, one or more will be amputated, sacrifices to save the host. Urinary and fecal continence disappear somewhere in the process, so you're either connected to catheters or else spend a while every day lying in a puddle of your own wastes until the nurses can help you out."

Most doctors, meanwhile, choose to die quickly and with very limited intervention from the health system.

In "How Doctors Die," Dr. Ken Murray wrote: "I cannot count the number of times fellow physicians have told me, in words that vary only slightly, 'Promise me if you find me like this that you'll kill me.' They mean it."

California Gov. Jerry Brown just signed legislation creating a right to physician-assisted suicide. Similar laws already are on the books in the states of Montana, Oregon, Vermont, and Washington. New Mexico's proposal is caught up in the courts.

I have no problem with such laws, but they're really only half-measures. For every patient who might request physician-assisted suicide, there are thousands more whose lives are being prolonged unnecessarily by hospital bureaucracies. They need our compassion and attention as well.

Imagine you're in a restaurant and a woman at the next table stops breathing or her heart stops beating. You would immediately give her CPR, right? And if you don't know how, you would frantically search for someone nearby who does.

The idea of denying the woman CPR would be monstrous. It might even be described as murder. Yet for patients near the end of life, the ethical choices are often reversed. Thousands of patients both verbally and in writing request "do not resuscitate" designations. Basically, this means, "If I am in pain, have no quality of life, and am incapable of communicating intelligently with you, don't keep me alive by hooking me up to a respirator, feeding me through a tube, or breaking my ribs with CPR so that I continue in that condition."

Yet hospitals systematically deny such requests if even one relative objects. The relative may be someone the patient hasn't seen in years. She may be someone the patient doesn't even like.

This needs to end. And our attitude toward death needs to change.

Most families wouldn't think of allowing their dog or cat to suffer needlessly. Why can't we be just as compassionate to our mothers, fathers, brothers, and sisters?

John C. Goodman, author of the recent book "A Better Choice: Healthcare Solutions for America," is a senior fellow at the Independent Institute in Oakland, Calif., and president of the Goodman Institute for Public Policy Research (www.goodmaninstitute.org).