On 11 Nov 07, Sarah-Kate Templeton, Health Editor of The Sunday Times of London reported that dozens admit aiding relatives commit suicide by helping them travel to Dignitas, a Swiss euthanasia.

Now, Debbie Purdy, 44, who suffers from a progressive form of multiple sclerosis, want a guarantee from the director of public prosecutions (DPP) that her husband does not risk prosecution and possible jail time of up to 14 years if his help to assist her travel constitutes an offence under the 1961 Suicide Act. Ms. Purdy reportedly said, “I want absolute clarity that my husband will not be prosecuted. If the DPP does not give this assurance, then I will need to go to Dignitas a long time before I want to die. I want to wait until the last possible moment, when I can no longer bear being alive, but I cannot do that while there is a chance my husband will be prosecuted.”

So her argument is that NOW she can travel alone, sparing her husband all risk. She would rather die earlier than put him at risk.

But I would add, that she would still have quality of life beyond the point where she is able to travel even with help, if she stayed at home and decided to wait until an even later last moment… when she could then Voluntarily Refuse Food & Fluid--a legal and peaceful way to hasten dying, provided adequate measures are taken to reduce the symptoms of thirst. Certainly, one can die this way in the comfort of home, beyond the point where they are capable of travel.

The mission of Caring Advocates and the strategy of the book, "The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life" is to promote a culture of extended quality of life. The book begins with this statement:

Life's greatest irony is that the freedom to control when we die, can— and often does—lead to choosing to live longer. In contrast, the greatest end-of-life tragedy is to believe that our only choices are to die illegally, violently, or prematurely—based on the fear that those in power will otherwise force us to endure months or years of unbearable pain and suffering, or to merely exist as our indignity and dependency increase.

Debby Purdy's personal interest in living longer, in protecting her husband's freedom, and making this liberty available to all by "as part of a test case to change the law" are all worthy causes. Hers is an example of PREMATURE dying. Again: Now she can travel alone; later, after enjoying more of life, she will not be able to. So the question becomes: Must she and others die prematurely to protect those who accompany them from prosecution?

The answer, even without a new ruling or law, is NO!

Her alternative, Voluntary Refusal of Food & Fluid, is a way to hasten dying that usually usually leads to death in 2 weeks or less, but the patient is often unconscious for the last few days. VRFF can be accomplished by a person whose physical state has deteriorated beyond the point where even "Husband-Assisted Travel" would be possible as it requires no physical capabilities other than the mental ability to say "No" to food and fluid when they are offered. Sometimes a psychiatric examination is necessary to establish decision-making capacity: see Terman SA. (2001a). Determining the decision- making capacity of a patient who refused food and water. J Palliat Med 15, 55 ‑60, [which happens to be a British journal] and Terman SA. (2001b). Evaluating decision-making capacity in a psychotic breast cancer patient. Primary Care Cancer 6(45‑ 8).

People who Voluntarily Refuse Food & Fluid do not experience hunger. They do experience thirst but this problem is solvable: see www.ThirstControl.com (a work in progress) or call 888 Thirst-0 (888-844 7780).

I have fasted twice, and learned how to control thirst from personal experience as well as from the literature. A new DVD explains how to deal with thirst.

The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life can be purchased on Amazon.com.

For further information, contact the author, Stanley A. Terman, Ph.D., M.D., 800 64 PEACE (800 647 3223), or DrTerman@CaringAdvocates.org (DrTerman@gmail.com).

We just posted two recent KPBS interviews on the audios page.

On February 19, 2007, KPBS "These Days" Host Tom Fudge interviewed California Assemblyman Lloyd Levine who co-introduced the Compassionate Care Bill, and Doctor Ted Mazer, M.D., who is president of the San Diego County Medical Society and trustee of the California Medical Society. The last five minutes of that interview is excerpted here.

This clip demonstrates several points. First: even a lawmaker who devoted four years to this issue seemed unaware of the huge difference between starvation and dehydration. Second: Dr. Mazer stated those who Voluntarily Refuse Food and Fluid die of dehydration and they can be made comfortable until they lose consciousness. Third, Dr. Mazer noted that "3 out of 38" people who used a prescription of lethal medication in Oregon (in 2005) had some problems—either unpleasant side effects or it did not work.

Another point is quite important—what was not discussed: Existing and proposed laws to legalize Physician-Assisted Suicide offer nothing for patients who are currently suffering from dementia, or will eventually suffer from dementia.

People are beginning "to get it": The incidence of Alzheimer's disease will increase three-fold. In addition, the relative number of potential caregivers will decline by about three. Anticipating the huge burden on their families, many are buying long-term-care insurance. It seems a reasonable alternative to going bankrupt, or to using a facility (if one will actually be available by that time) that Medicaid (MediCal) would pay for after they almost go bankrupt.

Now for the bad news, as reported By Charles Duhigg in the New York Times on March 26, 2007. (The specific link to The Times is given at the end of this article.)

According to The Times, some insurances companies have sold policies and taken the insured’s premiums for years, and then, when the patients became qualified to receive the benefits they had paid for, gave them a bureaucratic run around designed to frustrate them until they either died or gave up. For the “aged and frail,” especially those who have no one else to fight for them, giving up or dying are likely outcomes. Even those with younger adult children doing the fighting have had to sell family assets in the meantime, while the tactics were being played. (See the Times article for specific stories.)

The Times interviewed former employees of insurance companies who revealed such strategies as mailing beneficiaries the wrong forms to the wrong addresses... and then after a long delay, they denied the claim since the policy holder either filled out the wrong form or waited too long to respond. Other reasons to deny claims included the irrelevant fact that facility was not approved; the patient was “not sufficiently infirm” despite a doctor’s orders; or the policy conditions were not met. The Times noted that many times, these conditions were not mentioned in the original contract.

Of course, not all insurance companies are guilty. But with the number of claims undoubtedly destined to rise dramatically over the next few decades, one should purchase long-term-care policies prudently. One company had one complaint for every 383 policy holders compared to another company which had only one in over 12 thousand. The New York Times article stated, “In California alone, nearly one in every four long-term-care claims was denied in 2005.” The Times quoted Glenn R. Kantor, a California lawyer who has represented policyholders, as saying, “These companies have essentially turned their bureaucracies into profit centers.” Alleging restrictions on insurance company employees from making phone calls to expedite requests for missing records, and other tactics, one could say that their motto seems to be, “To delay is to increase profits.”

Click here for the complete article, entitled, “Aged, Frail and Denied Care by Their Insurers”.

According to the British Medical Journal, more than 2000 doctors, nurses, and other health workers have published a petition in a French news magazine admitting to having assisted the deaths of terminally ill patients at some time in their careers (Le Nouvel Observateur 2007 March 8:98 Click here for the full article).

The petition was published four days before a trial opened in Perigueux, in south west France, of a doctor and a nurse accused of killing a 65 year old patient who was terminally ill with pancreatic cancer by administering a lethal dose of potassium in August 2003. If they are found guilty, the two risk up to 30 years in prison.

Consider this headline:
Euthanasia doctor cleared by Italian medical panel


In fact, the courageous doctor, by a unanimous decision of a MEDICAL panel, was cleared of any wrong doing in Rome. He "switched off the life support of a paralysed man at the centre of a battle over euthanasia." (I must ask, Why did it take a month to decide?)

The article reports how the sides lined up:

"Supporters see Riccio as a hero for ignoring a court ruling that rejected Welby's request to have his respirator removed. Opponents said Riccio was a criminal who should go to jail."... "Welby, 60, an eloquent advocate of euthanasia was denied a Catholic funeral because he had asked to die, and Pope Benedict entered the debate by saying life was sacred until its 'natural sunset'. Riccio, who removed the respirator after giving Welby sedatives, denied he had performed euthanasia, which is illegal in Italy and carries a 10-15 year jail term. Former Italian President Francesco Cossiga formally demanded magistrates consider Riccio a murder suspect last month but Riccio said on Thursday he had still not been named as a suspect in the investigation into Welby's death.'There is also no hypothesis of a crime ... as far as I know,' he said. 'We'll have to wait for the judiciary.'

The Sydney Morning Herald report on 29 January 2007, in an article entitled, Violent end only option for many sick old people, quoted Marshall Perron, a former chief minister of Australian's Northern Territory, on the Bureau of Statistics: Three people aged over 75 committed suicide every week. "Most of them hang themselves," Perron said. Others shot or drowned themselves, used drugs, gas or electricity, or jumped off buildings or in front of trains. "Most of them die alone because they are afraid to implicate friends and family."

Lea Nikki Bacharach, the only daughter of composer Burt Bacharach and actress Angie Dickinson, committed suicide by using a plastic bag and helium gas in her home in Thousand Oaks, which is north of Los Angeles, on January 4. She suffered from Asperger's syndrome, a form of autism, and poor eye sight, which prevented from pursuing a career in Geology. She was 40 years old.

This method of dying was popularized by the latest edition of Derek Humphry's book and DVD, Final Exit.

After a person dies in such a way, some people will always wonder if she would have taken her life if she had not known about this method to commit suicide.

People who are terminally ill or who have devastating chronic illnesses such as Lou Gehrig's disease (ALS), who decide to end their lives by Voluntarily Refusing Food & Fluid, often change their minds after a few days of fasting, and can then continue to find further meaning in living.