The End in
Two Acts
Oregon is one of the nation’s leaders in hospice care, at-home (versus hospital) deaths and pain management. More than three-quarters of all Oregonians die with an advance directive or physicians orders in place (specific instructions about what they want and do not want at the end of life), the result of a well-funded and energetic statewide (pre-Terri Shiavo) campaign spearheaded by OHSU’s Center for Ethics in Health Care. Clearly, the state is paying more — not less — attention to end-of-life issues. And that, say many in the health care community, is a direct result of the extensive public discussion that has surrounded Oregon’s death with dignity legislation, as well as the existence of the Act itself, which has challenged stalwart opponents (including the Catholic hospitals) to enhance end-of-life care.
Sitting in room 4203 in the California state capitol, Tom McDonald didn’t know much about the Oregon law. What he knew, as he testified before the Senate Judiciary Committee, was that he was dying. He was dying, and he didn’t want to die in pain.
Pain — the very idea of pain — was a big deal for Tom. He vividly remembered his mother’s death more than 40 years before. She was at home, in bed, dying of cancer. These were the days before hospice, before palliative care, before physicians had become sophisticated about pain management. A shelf in the kitchen refrigerator was stacked with little bottles of liquid morphine.