1 00:00:02,000 --> 00:00:07,000 Downloaded from YTS.MX 2 00:00:08,000 --> 00:00:13,000 Official YIFY movies site: YTS.MX 3 00:00:35,903 --> 00:00:38,372 What is death? 4 00:00:38,406 --> 00:00:40,874 How will my own life end? 5 00:00:41,675 --> 00:00:44,145 What options do I have, 6 00:00:44,178 --> 00:00:48,816 if any, as to what my death will be like? 7 00:00:50,484 --> 00:00:55,022 Artists, philosophers, writers, people like you 8 00:00:55,055 --> 00:01:00,194 and me have been considering questions like these for, well, 9 00:01:01,195 --> 00:01:05,299 for as long as there have been human beings. 10 00:01:05,333 --> 00:01:12,540 Today, some of us are willing to speak openly about such things, 11 00:01:12,573 --> 00:01:15,643 but many of us are not. 12 00:01:16,544 --> 00:01:18,946 We live in a, in a culture that seems 13 00:01:18,979 --> 00:01:21,182 to hide from mortality. 14 00:01:21,215 --> 00:01:23,317 This is the most difficult experience for 15 00:01:23,351 --> 00:01:25,586 a patient, and their families. 16 00:01:26,120 --> 00:01:28,088 Speaking about death and dying is 17 00:01:28,122 --> 00:01:29,623 complicated for people. 18 00:01:29,657 --> 00:01:33,194 And it takes a certain amount of willingness to be vulnerable. 19 00:01:34,628 --> 00:01:39,066 These conversations are not actually about dying. 20 00:01:40,334 --> 00:01:42,603 They're about the quality of our lives. 21 00:01:44,405 --> 00:01:47,441 Everybody's ideal is to die quickly in their sleep 22 00:01:47,475 --> 00:01:50,278 and not have any existential suffering. 23 00:01:50,311 --> 00:01:53,013 But that's not available to many of us. 24 00:01:54,515 --> 00:01:58,619 25% of people who die with chronic illness, 25 00:01:58,652 --> 00:02:00,888 die with uncontrolled pain. 26 00:02:01,855 --> 00:02:04,124 I'm going to die of breast cancer, right. 27 00:02:04,158 --> 00:02:06,627 One of the scariest things about that is, 28 00:02:06,660 --> 00:02:08,862 is that you have no control. 29 00:02:09,397 --> 00:02:12,733 But you can control the end of life. 30 00:02:12,766 --> 00:02:14,134 How I die. 31 00:02:14,168 --> 00:02:17,271 I can control how I die. 32 00:02:18,306 --> 00:02:22,109 Medical aid in dying is a medical treatment that enables 33 00:02:22,142 --> 00:02:27,114 a person who is dying, who has exhausted all hope for cure 34 00:02:27,147 --> 00:02:29,850 and is close to an imminent death; 35 00:02:29,883 --> 00:02:34,255 help them die in comfort, 36 00:02:34,288 --> 00:02:37,991 in peace and with reduced level of suffering. 37 00:02:40,428 --> 00:02:43,096 When somebody is thinking about aid in dying, 38 00:02:43,130 --> 00:02:46,133 they're not thinking about it casually. 39 00:02:46,166 --> 00:02:47,868 I think this is a very difficult debate for 40 00:02:47,901 --> 00:02:49,370 a lot of people. 41 00:02:49,403 --> 00:02:51,605 Some people don't feel it's an appropriate thing 42 00:02:51,639 --> 00:02:53,241 for a doctor to do. 43 00:02:53,274 --> 00:02:55,075 I don't know whether I would use it, 44 00:02:55,108 --> 00:02:58,212 but I know I'd like to have the choice. 45 00:02:59,447 --> 00:03:02,716 This is between an individual and her family 46 00:03:02,750 --> 00:03:03,951 and doctor. 47 00:03:03,984 --> 00:03:06,153 A good conversation goes... 48 00:03:06,186 --> 00:03:07,455 A long way. 49 00:03:07,488 --> 00:03:10,190 Right, but it's a hard one. 50 00:03:11,659 --> 00:03:15,596 Most people would rather not talk about death. 51 00:03:16,897 --> 00:03:20,234 They'd rather push it out of their minds. 52 00:03:20,268 --> 00:03:24,171 But I believe we must talk about it. 53 00:03:25,473 --> 00:03:31,412 For me, thinking about what I would like to have at 54 00:03:31,445 --> 00:03:35,148 the end of my life is very important. 55 00:03:36,717 --> 00:03:42,089 And sharing my wishes with my family, my friends, 56 00:03:43,257 --> 00:03:49,630 my physician, I believe will bring comfort to us all 57 00:03:49,663 --> 00:03:51,699 when my time comes. 58 00:04:04,312 --> 00:04:07,948 I want to tell you about John Rehm, 59 00:04:08,248 --> 00:04:11,985 my husband of 54 years. 60 00:04:12,019 --> 00:04:15,022 He was a fine man, self-confident, 61 00:04:16,089 --> 00:04:17,991 with a wonderful mind. 62 00:04:18,892 --> 00:04:23,397 He was knowledgeable about so many things and John 63 00:04:23,864 --> 00:04:26,133 was a born teacher. 64 00:04:27,701 --> 00:04:31,405 She hadn't been to college and she really went 65 00:04:31,439 --> 00:04:36,310 to the John Rehm graduate school and learned an awful lot. 66 00:04:37,010 --> 00:04:39,647 He was brilliant. 67 00:04:41,415 --> 00:04:45,419 John Rehm was thrilled with every step of Diane's career. 68 00:04:46,320 --> 00:04:50,223 He was just so supportive of everything she did. 69 00:04:51,158 --> 00:04:55,996 John Rehm retired at age 71, 70 00:04:56,797 --> 00:05:01,301 and he would wait for me to come home so we could 71 00:05:01,335 --> 00:05:04,438 go for a long walk around the neighborhood. 72 00:05:08,642 --> 00:05:11,845 It was in 2004, 73 00:05:13,581 --> 00:05:19,787 on those walks that I began to hear John Rehm shuffle. 74 00:05:21,489 --> 00:05:24,792 As the years went on, he became thinner and thinner 75 00:05:25,125 --> 00:05:28,228 and then his hands began to tremor. 76 00:05:29,029 --> 00:05:33,266 So he knew something was wrong. 77 00:05:34,368 --> 00:05:38,171 John was suffering from Parkinson's. 78 00:05:39,540 --> 00:05:44,044 Parkinson's Disease is a progressive disorder of 79 00:05:44,077 --> 00:05:46,079 the nervous system. 80 00:05:46,113 --> 00:05:48,682 And some people, like my husband, 81 00:05:48,716 --> 00:05:52,720 can develop complications that result in death. 82 00:05:54,955 --> 00:06:00,494 John and I began to talk about his declining health and 83 00:06:00,528 --> 00:06:06,400 the possibility that he would die much sooner than I would. 84 00:06:08,368 --> 00:06:10,170 Ready when you are. 85 00:06:10,538 --> 00:06:14,775 On my radio program, just as in my life, 86 00:06:15,142 --> 00:06:18,245 I never shied away from tough subjects 87 00:06:19,246 --> 00:06:22,149 and neither did John Rehm. 88 00:06:23,183 --> 00:06:27,888 On my mind this week, medical aid in dying. 89 00:06:28,656 --> 00:06:32,125 Some call it "death with dignity" 90 00:06:32,159 --> 00:06:35,829 or "physician assisted dying." 91 00:06:35,863 --> 00:06:38,899 It has different names. 92 00:06:38,932 --> 00:06:43,537 I had been aware of this movement in the U.S. and 93 00:06:43,571 --> 00:06:47,775 was favorably inclined toward it, generally speaking. 94 00:06:49,276 --> 00:06:55,516 My darling John died in 2014 and that experience 95 00:06:56,083 --> 00:06:59,587 made this issue very personal. 96 00:06:59,620 --> 00:07:02,923 I realized I still had a lot to learn. 97 00:07:06,326 --> 00:07:09,963 I decided I should do what I do best, 98 00:07:10,831 --> 00:07:15,435 investigate this subject and learn the facts. 99 00:07:17,404 --> 00:07:18,872 You can decide to stop chemotherapy, 100 00:07:18,906 --> 00:07:21,408 you can decide to have surgery on your aorta or not. 101 00:07:21,441 --> 00:07:26,013 One of the first experts I spoke with was 102 00:07:26,046 --> 00:07:32,185 Dr. Lonny Shavelson, a physician who has been focused 103 00:07:32,219 --> 00:07:36,423 on end of life care for over three decades. 104 00:07:37,991 --> 00:07:40,093 Probably one of the driving forces for me to become 105 00:07:40,127 --> 00:07:43,931 a doctor was, was dealing with the question of suffering, 106 00:07:43,964 --> 00:07:46,734 especially around the time of Jack Kevorkian 107 00:07:46,767 --> 00:07:48,602 in the early '90s, 108 00:07:48,636 --> 00:07:51,839 I think that people started really talking about this. 109 00:07:51,872 --> 00:07:54,207 He was a retired pathologist from Michigan who 110 00:07:54,241 --> 00:07:56,744 specialized in challenging authority. 111 00:07:56,777 --> 00:08:00,313 Dr. Jack Kevorkian ignited a national debate in the 1990s 112 00:08:01,148 --> 00:08:03,551 over physician assisted suicide, 113 00:08:03,584 --> 00:08:07,287 when he helped more than 130 patients kill themselves. 114 00:08:08,221 --> 00:08:09,389 Many doctors agree with me, 115 00:08:09,422 --> 00:08:10,891 but they're intimidated into silence. 116 00:08:10,924 --> 00:08:14,294 I am lucky to be in a position where I don't have to be silent. 117 00:08:14,895 --> 00:08:19,066 People weren't aware there was a problem until the 118 00:08:19,099 --> 00:08:23,403 extremity of his activities brought it to light, 119 00:08:24,237 --> 00:08:26,974 how desperate people were to prevent, 120 00:08:27,007 --> 00:08:29,376 avoid end of life suffering. 121 00:08:29,409 --> 00:08:32,212 It made me really realize that there was 122 00:08:32,245 --> 00:08:33,747 a bigger picture, 123 00:08:33,781 --> 00:08:36,149 that it was important for me to look into it, 124 00:08:36,183 --> 00:08:40,487 to understand it better and to really get into the idea of, 125 00:08:40,520 --> 00:08:45,258 in what was still then a hidden world of people asking 126 00:08:45,292 --> 00:08:46,994 to die because of illness and suffering. 127 00:08:49,029 --> 00:08:51,464 When John was dying, 128 00:08:51,498 --> 00:08:54,768 he could no longer walk on his own, 129 00:08:55,869 --> 00:08:58,906 he could no longer stand on his own, 130 00:08:59,807 --> 00:09:03,110 he could no longer feed himself. 131 00:09:03,143 --> 00:09:08,782 The doctor at the nursing home had said he was within 132 00:09:08,816 --> 00:09:13,520 six months of dying, because he had lost so much 133 00:09:14,622 --> 00:09:21,328 of his human capacity except the capacity to think. 134 00:09:22,562 --> 00:09:25,332 He could think very clearly. 135 00:09:25,365 --> 00:09:29,469 And John turned to the doctor and said, 136 00:09:29,502 --> 00:09:35,776 I am ready to die and I want you to help me. 137 00:09:36,877 --> 00:09:39,546 And the doctor said, 138 00:09:39,579 --> 00:09:43,316 here in the state of Maryland, 139 00:09:43,350 --> 00:09:47,554 I have not the legal authority, 140 00:09:47,587 --> 00:09:51,424 the moral authority or 141 00:09:51,458 --> 00:09:57,898 any other authority by which to help you die. 142 00:09:59,266 --> 00:10:02,435 The only way 143 00:10:03,003 --> 00:10:08,541 you can do this is to stop eating, 144 00:10:09,977 --> 00:10:14,648 stop drinking water, stop taking medication. 145 00:10:16,449 --> 00:10:20,587 And John, for the first time in a long time, 146 00:10:21,889 --> 00:10:24,658 became enraged. 147 00:10:26,994 --> 00:10:32,032 By the early 1990s, some people, patients, 148 00:10:32,966 --> 00:10:37,070 physicians and even some lawmakers, 149 00:10:37,104 --> 00:10:42,042 were beginning to look at what could be done legislatively 150 00:10:42,876 --> 00:10:47,114 to address end of life suffering in the United States. 151 00:10:49,717 --> 00:10:54,154 The state of Oregon was at the center of that movement. 152 00:10:56,189 --> 00:10:59,626 There had been multiple attempts in the legislatures 153 00:11:00,728 --> 00:11:02,863 of the nation to introduce a bill. 154 00:11:02,896 --> 00:11:05,598 None of those bills ever went anywhere. 155 00:11:05,632 --> 00:11:09,536 But we rolled up our sleeves and crafted a bill 156 00:11:10,403 --> 00:11:15,608 that we believed would satisfy people's concerns about safety, 157 00:11:16,977 --> 00:11:20,147 eligibility criteria that were crystal clear. 158 00:11:20,180 --> 00:11:22,883 These are for mentally capable, 159 00:11:22,916 --> 00:11:26,553 terminally ill adults who are well informed of all 160 00:11:26,586 --> 00:11:28,722 their end of life options. 161 00:11:28,756 --> 00:11:30,590 Because it's a medical procedure, 162 00:11:30,623 --> 00:11:33,193 it conforms to the standards of medical care. 163 00:11:33,226 --> 00:11:38,732 Now there are a great many people who point to 164 00:11:39,366 --> 00:11:43,636 Oregon's law as the standard by 165 00:11:43,670 --> 00:11:47,007 which all the others then followed. 166 00:11:47,941 --> 00:11:50,878 Oregon came online in November of 1997. 167 00:11:50,911 --> 00:11:52,345 Right. 168 00:11:52,379 --> 00:11:56,249 There was not another law passed until November of 2008. 169 00:11:56,283 --> 00:11:57,785 Oh, wow. 170 00:11:57,818 --> 00:12:01,154 We were having trouble making process in other states, 171 00:12:01,188 --> 00:12:05,292 until Brittany Maynard came on the scene in 172 00:12:05,325 --> 00:12:09,729 the waning days of 2014. 173 00:12:11,965 --> 00:12:15,035 Brittany was an adventurous spirit. 174 00:12:15,635 --> 00:12:17,805 She was a force of nature, 175 00:12:17,838 --> 00:12:20,573 would be a good way to describe her personality. 176 00:12:23,410 --> 00:12:27,848 Brittany and I, we got married in September of 2012. 177 00:12:28,782 --> 00:12:31,751 And a few months after our wedding, 178 00:12:31,785 --> 00:12:34,287 she started having headaches. 179 00:12:34,721 --> 00:12:36,623 They would wake her up in the middle of the night. 180 00:12:37,257 --> 00:12:41,728 Dan told me that by the summer they knew something 181 00:12:41,761 --> 00:12:44,264 was seriously wrong. 182 00:12:45,198 --> 00:12:48,235 I was told I had a grade two astrocytoma 183 00:12:48,268 --> 00:12:51,071 and was told anywhere from three, 184 00:12:51,104 --> 00:12:53,841 maybe five, up to ten years to live. 185 00:12:53,874 --> 00:12:55,708 I have to tell you, when you're 29 years old, 186 00:12:55,742 --> 00:12:58,145 being told you have that kind of timeline still 187 00:12:58,178 --> 00:13:00,580 feels like you're being told you're going to die tomorrow. 188 00:13:01,714 --> 00:13:04,251 70 days post-op, I went in for another MRI, 189 00:13:05,585 --> 00:13:07,921 and was told I had had a grade change. 190 00:13:07,955 --> 00:13:11,724 They were looking and saying it looks like grade four, 191 00:13:11,758 --> 00:13:14,661 which is the worst and most aggressive form of brain cancer. 192 00:13:15,562 --> 00:13:18,165 It's called a glioblastoma. 193 00:13:18,198 --> 00:13:22,102 So that was a major shock to my system and the system of my 194 00:13:22,135 --> 00:13:25,005 family because it went from having potentially years 195 00:13:25,038 --> 00:13:27,740 of time to being told I had like six months. 196 00:13:28,375 --> 00:13:30,410 Brittany told me, 197 00:13:30,443 --> 00:13:33,713 we will continue to fight this tumor, 198 00:13:33,746 --> 00:13:38,018 but if it gets bad, we're moving to Oregon. 199 00:13:39,652 --> 00:13:41,721 Oregon's Death with Dignity Program 200 00:13:41,754 --> 00:13:44,057 was something that she had come across. 201 00:13:46,894 --> 00:13:50,197 She decided that she would do what she could with 202 00:13:50,230 --> 00:13:54,767 the time she had remaining to pave the way so that other 203 00:13:54,801 --> 00:13:57,470 Californians wouldn't have to do what she did, 204 00:13:58,205 --> 00:14:01,041 and she was enormously effective. 205 00:14:01,074 --> 00:14:04,377 The freedom of this patient right is choice. 206 00:14:06,079 --> 00:14:09,116 100 million people worldwide had seen her, 207 00:14:09,149 --> 00:14:12,052 knew her name and knew what she stood for. 208 00:14:12,986 --> 00:14:14,821 And we have our own conversation now 209 00:14:14,854 --> 00:14:16,023 with Barbara Coombs Lee, 210 00:14:16,056 --> 00:14:18,025 president of Compassion and Choices, 211 00:14:18,058 --> 00:14:20,793 the group dedicated to expanding end of life options 212 00:14:20,827 --> 00:14:22,862 that's now working with Brittany Maynard. 213 00:14:22,896 --> 00:14:25,265 And Dr. Ira Byock is director of the 214 00:14:25,298 --> 00:14:26,900 Institute for Human Caring 215 00:14:26,934 --> 00:14:28,868 of Providence Health and Services, 216 00:14:28,902 --> 00:14:31,738 a palliative care physician and author of the book, 217 00:14:31,771 --> 00:14:33,473 "The Best Care Possible". 218 00:14:34,074 --> 00:14:35,775 Well, Barbara Coombs Lee, let me start with you. 219 00:14:35,808 --> 00:14:38,511 Why do you think the case of Brittany Maynard 220 00:14:38,545 --> 00:14:40,480 is resonating with so many people? 221 00:14:40,513 --> 00:14:41,848 What's the key to this for you? 222 00:14:43,750 --> 00:14:47,120 The key is how Brittany has made dying real, 223 00:14:47,154 --> 00:14:49,656 made the tragedy of, of decline, 224 00:14:49,689 --> 00:14:51,491 the inhumanities that people 225 00:14:51,524 --> 00:14:54,694 suffer often before their disease takes their lives. 226 00:14:54,727 --> 00:14:57,830 Brittany is bringing that reality home to people. 227 00:14:57,864 --> 00:15:00,533 My heart goes out to Brittany Maynard. 228 00:15:00,567 --> 00:15:02,735 It's a heart wrenching story. 229 00:15:02,769 --> 00:15:05,238 But I want to assure the, our people watching that 230 00:15:05,272 --> 00:15:09,209 she could get excellent whole person care 231 00:15:09,242 --> 00:15:13,446 and be assured of dying gently in her bed, 232 00:15:13,480 --> 00:15:15,548 surrounded by her family. 233 00:15:15,582 --> 00:15:20,020 Giving doctors now authority to write lethal prescriptions fixes 234 00:15:20,053 --> 00:15:22,555 really nothing, none of the deficiencies in practice or 235 00:15:22,589 --> 00:15:26,426 medical training, it's really a socially dangerous thing to do. 236 00:15:26,926 --> 00:15:29,796 Barbara Coombs Lee, a socially dangerous thing to do? 237 00:15:29,829 --> 00:15:32,232 In other words, it might work in one individual case, 238 00:15:32,265 --> 00:15:34,334 for Brittany Maynard, but expanded, 239 00:15:34,367 --> 00:15:36,069 it doesn't make sense is the argument. 240 00:15:37,670 --> 00:15:41,241 It makes sense for a lot of people and I think that I agree 241 00:15:41,274 --> 00:15:43,276 with Dr. Byock and he knows that I do. 242 00:15:43,310 --> 00:15:46,146 Hospice and palliative care is the gold standard. 243 00:15:46,179 --> 00:15:49,049 It's wonderful. But it's not a miracle. 244 00:15:49,082 --> 00:15:53,953 And it cannot prevent the kind of relentless, dehumanizing, 245 00:15:53,987 --> 00:15:56,356 horrific decline that Brittany faces. 246 00:15:57,624 --> 00:16:01,528 Brittany Maynard was able to do that and she's in 247 00:16:01,561 --> 00:16:03,196 many ways, a role model. 248 00:16:03,230 --> 00:16:04,264 She's a... 249 00:16:04,297 --> 00:16:06,899 Moving from California to Oregon? 250 00:16:06,933 --> 00:16:08,668 To Oregon. 251 00:16:09,102 --> 00:16:13,873 It means that you have to have the wherewithal to uproot 252 00:16:13,906 --> 00:16:16,509 yourself and your family, your caregivers. 253 00:16:17,644 --> 00:16:21,314 So that takes it out of the option for many people. 254 00:16:25,552 --> 00:16:30,390 There are people who feel so strongly, as John did, 255 00:16:31,658 --> 00:16:40,367 that control is what they want as to when it ends, how it ends. 256 00:16:43,070 --> 00:16:48,208 But sadly, John was too ill to travel to Oregon, 257 00:16:49,209 --> 00:16:52,512 as Brittany Maynard had done. 258 00:16:55,948 --> 00:17:00,019 I came in with a photograph album. 259 00:17:00,820 --> 00:17:05,825 I sat on his bed and we looked at the photographs together. 260 00:17:07,994 --> 00:17:12,099 And he said, Diane, I have not had any food, 261 00:17:12,132 --> 00:17:17,070 I have not had any medication, I have not had any water. 262 00:17:19,539 --> 00:17:23,276 I have begun the journey. 263 00:17:23,576 --> 00:17:27,414 He had a smile on his face. 264 00:17:27,447 --> 00:17:34,487 And I believe it was because he had taken his life back into 265 00:17:34,521 --> 00:17:37,224 his own hands. 266 00:17:38,225 --> 00:17:40,827 Everyone dies at some point in time. 267 00:17:40,860 --> 00:17:43,896 But what is the enemy is terminal suffering. 268 00:17:44,864 --> 00:17:48,935 None of us want people who are about to die to suffer and we go 269 00:17:48,968 --> 00:17:51,738 about different ways in trying to take care of that. 270 00:17:52,205 --> 00:17:55,342 Language we use at end of life is so important that we... 271 00:17:55,375 --> 00:17:59,446 Dr. Grube speaks to medical students around the 272 00:17:59,479 --> 00:18:05,185 country about medical ethics and end of life care. 273 00:18:06,386 --> 00:18:09,956 Those weeks or days or months sometimes when a, 274 00:18:09,989 --> 00:18:12,192 a person who is going to die anyway 275 00:18:12,225 --> 00:18:14,561 has intolerable suffering, 276 00:18:14,594 --> 00:18:18,064 I am trying to persuade them to open their minds to the fact 277 00:18:18,097 --> 00:18:21,134 that this is something I think that's compassionate. 278 00:18:21,701 --> 00:18:24,504 Most people do not choose aid in dying because of 279 00:18:24,537 --> 00:18:26,173 lack of pain control. 280 00:18:27,607 --> 00:18:30,076 Everybody thinks well, gosh, it's they're having, 281 00:18:30,109 --> 00:18:32,011 oh the suffering is pain. 282 00:18:32,044 --> 00:18:34,547 Their suffering may be anhedonia, 283 00:18:35,682 --> 00:18:38,585 lack of joy or lack of pleasure, loss of autonomy, 284 00:18:39,952 --> 00:18:41,888 loss of dignity. 285 00:18:41,921 --> 00:18:43,623 We see the world differently. 286 00:18:43,656 --> 00:18:46,193 You know, I believe that the solution to suffering is to help 287 00:18:46,226 --> 00:18:47,860 the sufferer, to be with the sufferer, 288 00:18:47,894 --> 00:18:50,663 to be willing to suffer with the patient. 289 00:18:50,697 --> 00:18:53,400 That's what I dedicated my life to over these last 40 years 290 00:18:53,433 --> 00:18:54,601 as a doctor. 291 00:18:54,634 --> 00:18:56,803 We have to do a better job of allowing people to 292 00:18:56,836 --> 00:19:00,207 die with dignity, naturally at the end of their life. 293 00:19:00,240 --> 00:19:03,075 This is something that's been much discussed at our 294 00:19:03,109 --> 00:19:06,246 national meetings for geriatrics and for hospice 295 00:19:07,046 --> 00:19:09,081 and palliative medicine. 296 00:19:09,115 --> 00:19:12,252 So, it wasn't a new issue for any of us. 297 00:19:13,152 --> 00:19:15,455 There's a lot of genuine disagreement, 298 00:19:15,488 --> 00:19:19,192 there's respect on both sides, but some people don't feel it's 299 00:19:19,226 --> 00:19:21,528 an appropriate thing for a doctor to do. 300 00:19:22,161 --> 00:19:27,200 I wonder about the Hippocratic Oath, to do no harm. 301 00:19:28,134 --> 00:19:30,937 How does that work into your thinking? 302 00:19:31,638 --> 00:19:33,506 Do no harm. 303 00:19:33,540 --> 00:19:37,009 What is harm and who gets to define harm? 304 00:19:37,710 --> 00:19:40,747 The harm is defined by the patient and 305 00:19:40,780 --> 00:19:42,148 not by the doctor. 306 00:19:42,181 --> 00:19:45,585 And the suffering is defined by the patient. 307 00:19:45,618 --> 00:19:47,620 Yeah. 308 00:19:48,255 --> 00:19:50,557 Bodie and I, he loves to come with me. 309 00:19:50,590 --> 00:19:51,924 He loves to... 310 00:19:51,958 --> 00:19:56,763 Roger was diagnosed with incurable stage 4 311 00:19:56,796 --> 00:19:58,931 prostate cancer. 312 00:19:59,732 --> 00:20:03,536 He has since retired from practicing medicine, 313 00:20:04,704 --> 00:20:09,342 but he and his dog Bodie walk seven miles every day, 314 00:20:10,810 --> 00:20:12,679 no matter the weather. 315 00:20:13,980 --> 00:20:18,451 I always would tell my patients that just because 316 00:20:18,485 --> 00:20:22,589 you've got a terminal condition doesn't mean that 317 00:20:22,622 --> 00:20:25,191 you're dead yet. 318 00:20:25,224 --> 00:20:26,993 That you should go on, 319 00:20:27,026 --> 00:20:28,728 you should continue living your life, 320 00:20:28,761 --> 00:20:31,898 you should seek the beauty that's in it and the enjoyment 321 00:20:31,931 --> 00:20:33,600 that you can. 322 00:20:38,405 --> 00:20:43,743 John Rehm could have had such a peaceful death with his 323 00:20:43,776 --> 00:20:49,416 family around him, with all of us saying goodbye. 324 00:20:50,650 --> 00:20:53,420 Basically for two weeks, I listened every day, 325 00:20:53,453 --> 00:20:56,088 sometimes twice a day, to my mom get updates from my grandmother 326 00:20:56,122 --> 00:20:59,492 about how his condition was like slowly declining. 327 00:21:01,260 --> 00:21:04,797 It was just an excruciating time for 328 00:21:04,831 --> 00:21:07,367 all of them. 329 00:21:07,400 --> 00:21:11,971 And especially for Diane, to have to sit and just watch this 330 00:21:12,004 --> 00:21:14,341 over such a long period. 331 00:21:14,374 --> 00:21:19,245 On the ninth day, I stayed overnight, 332 00:21:20,513 --> 00:21:25,552 sleeping on two chairs, or trying to sleep on two chairs, 333 00:21:26,653 --> 00:21:29,756 watching this man suffer. 334 00:21:33,125 --> 00:21:36,629 And the next day, my dear John was gone. 335 00:21:41,468 --> 00:21:45,171 I spoke with Lori Wallace-Pushinaitis 336 00:21:45,204 --> 00:21:47,540 and her doctor. 337 00:21:48,408 --> 00:21:52,745 Lori followed the passage of the California law closely. 338 00:21:54,246 --> 00:21:55,782 I have had cancer for a little 339 00:21:55,815 --> 00:21:57,384 over seven years. 340 00:21:57,417 --> 00:22:00,387 I have known it's metastatic for a little over four years, 341 00:22:00,420 --> 00:22:03,390 and if it's metastatic, there is no cure. 342 00:22:03,423 --> 00:22:05,992 I'm going to die of breast cancer, right. 343 00:22:06,025 --> 00:22:09,362 So the minute I found out that there was legislation that was 344 00:22:09,396 --> 00:22:11,364 being considered that we would vote on, 345 00:22:11,398 --> 00:22:13,966 I started telling my oncologist immediately, okay, 346 00:22:14,000 --> 00:22:17,870 in today's notes, I want you to put that I want this option. 347 00:22:17,904 --> 00:22:20,172 And she's like, oh, but we don't, it's not even passed yet. 348 00:22:20,206 --> 00:22:21,708 I'm like I don't care. 349 00:22:21,741 --> 00:22:23,743 I want there to be as long a history in my medical records 350 00:22:23,776 --> 00:22:26,145 as possible. 351 00:22:28,381 --> 00:22:30,983 We met specifically around the issue 352 00:22:31,017 --> 00:22:35,221 of, of her interest in the option. 353 00:22:35,888 --> 00:22:36,956 Right. 354 00:22:36,989 --> 00:22:38,290 Not with a plan, 355 00:22:38,324 --> 00:22:41,160 but just the reassurance that if it were there, 356 00:22:41,193 --> 00:22:43,029 that that would be comforting to her. 357 00:22:43,062 --> 00:22:45,498 And I can't, I can't choose when, 358 00:22:45,532 --> 00:22:50,503 because if I would choose when, it would be when I'm 90, 359 00:22:50,537 --> 00:22:52,772 but that's not an option, right. 360 00:22:52,805 --> 00:22:56,242 Lori, if you had the medication, 361 00:22:56,275 --> 00:22:59,412 do you think you'd use it? 362 00:22:59,446 --> 00:23:01,681 I don't know. 363 00:23:01,714 --> 00:23:03,616 I mean I can't, I don't know how it's going to look 364 00:23:03,650 --> 00:23:04,917 when I'm dying. 365 00:23:04,951 --> 00:23:10,056 So, you know, I would love to fall asleep and then die 366 00:23:10,089 --> 00:23:11,257 in my sleep. 367 00:23:11,290 --> 00:23:13,493 That'd be great. I'd love to do that. 368 00:23:13,526 --> 00:23:18,030 But, if it gets to the point where I have no quality of life 369 00:23:18,064 --> 00:23:20,399 and I cannot have my pain maintained, 370 00:23:21,333 --> 00:23:22,735 I'm going to want to do something about that, 371 00:23:22,769 --> 00:23:25,738 not only for me, but also for my children. 372 00:23:25,772 --> 00:23:27,474 I have a 12-year old. 373 00:23:27,507 --> 00:23:30,810 He does not need to see his mother in misery. 374 00:23:31,744 --> 00:23:33,112 I understand. 375 00:23:33,145 --> 00:23:34,747 And I will do whatever I can to make sure 376 00:23:34,781 --> 00:23:37,950 that it is my choice and not someone making a choice for me. 377 00:23:39,151 --> 00:23:42,755 There's a strong belief that good palliative medicine 378 00:23:42,789 --> 00:23:46,859 can almost always relieve suffering adequately. 379 00:23:48,060 --> 00:23:50,062 Yet there are limits. 380 00:23:50,096 --> 00:23:53,165 And I think that everybody has to acknowledge that anything in 381 00:23:53,199 --> 00:23:55,868 medicine has a time when it doesn't work. 382 00:23:56,669 --> 00:23:58,104 In my experience, 383 00:23:58,137 --> 00:24:00,940 there's a subgroup of people for which nothing that we have 384 00:24:00,973 --> 00:24:05,211 treats, at the end of life, treats their suffering, nothing. 385 00:24:05,678 --> 00:24:09,448 25% of people who die with chronic illness, 386 00:24:09,482 --> 00:24:12,351 die with uncontrolled pain. 387 00:24:12,384 --> 00:24:14,987 And in the palliative world, 388 00:24:15,021 --> 00:24:19,592 we have a lot of experience with physicians being very reluctant 389 00:24:19,626 --> 00:24:23,896 to adequately treat pain because they worry about 390 00:24:23,930 --> 00:24:25,565 hastening death. 391 00:24:25,598 --> 00:24:28,167 But this is a tension that many physicians work with 392 00:24:28,200 --> 00:24:29,669 all the time, 393 00:24:29,702 --> 00:24:32,238 that they're actually afraid to adequately treat 394 00:24:32,271 --> 00:24:35,374 cancer pain or other kinds of pain, 395 00:24:35,407 --> 00:24:38,678 so doctors have struggled with this a lot. 396 00:24:40,379 --> 00:24:44,050 The more I learned about medical aid in dying, 397 00:24:44,917 --> 00:24:50,422 the more I came to appreciate how complex an issue it is. 398 00:24:51,791 --> 00:24:57,196 But for some patients, there can be barriers to care based on 399 00:24:57,997 --> 00:25:03,069 race or ethnicity, poverty, and other factors. 400 00:25:04,370 --> 00:25:07,106 So, Mrs. C, we're going to up and see her right after. 401 00:25:07,139 --> 00:25:11,711 To understand this better, I visited Highland Hospital 402 00:25:13,045 --> 00:25:19,752 where I met Dr. Jessica Zitter, an expert in palliative care. 403 00:25:21,153 --> 00:25:22,855 What's something interesting to me and very 404 00:25:22,889 --> 00:25:25,758 alarming as somebody who takes care of patients, 405 00:25:25,792 --> 00:25:28,460 a lot of African American patients, 406 00:25:28,494 --> 00:25:31,463 a lot of patients of color, people, you know, 407 00:25:31,497 --> 00:25:34,333 who don't speak English, is that there are many, many, 408 00:25:34,366 --> 00:25:38,370 many options that are not available. 409 00:25:39,305 --> 00:25:41,941 They don't tend to see or hear about hospice and palliative 410 00:25:41,974 --> 00:25:47,346 care as much as white patients do, or to access or to use it. 411 00:25:47,379 --> 00:25:48,648 It's a real problem. 412 00:25:48,681 --> 00:25:50,082 Isn't that interesting? - Yeah. 413 00:25:50,116 --> 00:25:53,753 Access to medical care is unevenly distributed in 414 00:25:53,786 --> 00:25:56,155 all aspects throughout our state. 415 00:25:56,188 --> 00:25:57,657 Throughout the country, indeed. 416 00:25:57,690 --> 00:25:59,491 Rich, throughout the county, rich people, 417 00:25:59,525 --> 00:26:01,193 poor people, insured people, non-insured people, 418 00:26:01,227 --> 00:26:04,330 black people, white people, Latino people, Asian people, 419 00:26:04,363 --> 00:26:09,936 there is no even distribution of access and there is the unequal 420 00:26:09,969 --> 00:26:13,239 access to aid in dying just like we see unequal access to 421 00:26:13,272 --> 00:26:14,641 everything else. 422 00:26:14,674 --> 00:26:17,109 It's more like ache than pain right now. 423 00:26:17,543 --> 00:26:18,645 Good. 424 00:26:18,678 --> 00:26:20,613 The pain is like, you know. 425 00:26:20,647 --> 00:26:22,715 Softened a little bit. 426 00:26:22,749 --> 00:26:28,621 So when do you reach that point when you say to the patient, 427 00:26:29,956 --> 00:26:34,160 maybe there's nothing more we should do? 428 00:26:35,261 --> 00:26:39,231 When do you do that, and how do you communicate that to them? 429 00:26:39,565 --> 00:26:41,267 Well, first, first of all, 430 00:26:41,300 --> 00:26:43,369 I would say those words are not the words that I would use, 431 00:26:43,402 --> 00:26:44,637 which is there's nothing more. 432 00:26:44,671 --> 00:26:46,939 There's always something more we can do, 433 00:26:46,973 --> 00:26:49,008 there's always something more we can do, right. 434 00:26:49,041 --> 00:26:50,276 But... 435 00:26:50,309 --> 00:26:51,778 Maybe we can't cure the disease. 436 00:26:51,811 --> 00:26:54,413 Maybe our treatments can't stop this disease from progressing. 437 00:26:54,446 --> 00:26:56,215 But there's lots of other successes we can have. 438 00:26:56,248 --> 00:26:57,583 That's right. 439 00:26:57,616 --> 00:26:59,151 I'm so sorry. - Yeah, that's sore. 440 00:26:59,185 --> 00:27:00,619 I'm sorry. Okay. You know what I'm going to do? 441 00:27:00,653 --> 00:27:01,854 I'm going to go call the team. 442 00:27:01,888 --> 00:27:03,022 We're going to go find out what's going on. 443 00:27:03,055 --> 00:27:04,691 Okay. 444 00:27:04,724 --> 00:27:06,726 There are definitely families I've encountered that 445 00:27:06,759 --> 00:27:09,128 feel like saying that we're not going to intubate your 446 00:27:09,161 --> 00:27:11,163 loved one, saying that I don't think it's a good idea, 447 00:27:11,197 --> 00:27:12,965 they perceive as... 448 00:27:12,999 --> 00:27:14,200 An abandonment? 449 00:27:14,233 --> 00:27:16,602 As sort of harmful or an abandonment, right. 450 00:27:16,969 --> 00:27:19,171 Hello. 451 00:27:19,205 --> 00:27:21,007 How are you today? 452 00:27:21,040 --> 00:27:22,308 How are you feeling? 453 00:27:22,341 --> 00:27:23,910 One of the things in, you know, 454 00:27:23,943 --> 00:27:27,013 that's a factor in my practice is I'm so afraid to think that 455 00:27:27,046 --> 00:27:30,049 someone would think that I was depriving them of something, 456 00:27:30,082 --> 00:27:33,252 on a racial basis or because they were less educated. 457 00:27:33,652 --> 00:27:35,922 That's a terrifying thought for me. 458 00:27:35,955 --> 00:27:39,025 So you can imagine the impulse to that would be to say well, 459 00:27:39,058 --> 00:27:41,260 let's just do everything, let's just keep going, we'll trach, 460 00:27:41,293 --> 00:27:42,729 we'll peg, we'll do everything. 461 00:27:42,762 --> 00:27:45,497 And I think that what I've learned from the palliative care 462 00:27:45,531 --> 00:27:51,170 movement is to stop and to, to, to try and tolerate the feeling 463 00:27:51,203 --> 00:27:53,873 of discomfort in myself, the feeling of discomfort in the 464 00:27:53,906 --> 00:27:58,044 loved one or the patient and stay in the conversation. 465 00:27:59,678 --> 00:28:02,048 Oh, gracious Lord, we pause for just a moment from a place 466 00:28:02,081 --> 00:28:04,951 of thanksgiving and gratitude, just knowing that you are right 467 00:28:04,984 --> 00:28:08,520 here in the presence with each of... 468 00:28:09,722 --> 00:28:12,591 I love Washington, DC. 469 00:28:13,492 --> 00:28:15,995 It's been my home all of my life, 470 00:28:17,163 --> 00:28:20,666 and I've never wanted to live anywhere else. 471 00:28:22,935 --> 00:28:28,540 Over the decades, I've seen tremendous changes happen here. 472 00:28:32,111 --> 00:28:37,716 Finally, after a long battle, the District of Columbia has 473 00:28:38,650 --> 00:28:43,522 approved the right to medical aid in dying. 474 00:28:44,991 --> 00:28:49,896 Tell me a little about how difficult it was to get 475 00:28:50,462 --> 00:28:52,298 this law passed. 476 00:28:52,331 --> 00:28:54,867 Well, it was not easy. 477 00:28:54,901 --> 00:28:58,370 People need time to adapt to changing social circumstances, 478 00:28:58,404 --> 00:29:01,140 especially big issues like this. 479 00:29:06,779 --> 00:29:10,749 Diane, the reason I opposed the law was the deep 480 00:29:10,783 --> 00:29:15,254 history of malfeasance when it comes to the United States of 481 00:29:15,287 --> 00:29:19,792 America and the medical establishment's commitment to 482 00:29:19,826 --> 00:29:23,362 caring equally for bodies that are not white. 483 00:29:24,030 --> 00:29:31,237 I understand the law, I support what the law makes available, 484 00:29:32,771 --> 00:29:38,577 but I do not trust the government and establishment 485 00:29:38,610 --> 00:29:41,013 to be fair. 486 00:29:46,152 --> 00:29:48,387 Put your hands together, everybody, welcome! 487 00:29:52,358 --> 00:29:55,261 Would you reach your neighbors this morning in a spirit 488 00:29:55,294 --> 00:29:56,428 of love, peace and joy? 489 00:29:56,996 --> 00:29:59,465 There was a good deal of concern, skepticism, 490 00:29:59,498 --> 00:30:03,002 perhaps even suspicion on the part of African Americans about 491 00:30:03,035 --> 00:30:05,771 some of these medical things because in the past, we've had, 492 00:30:05,804 --> 00:30:08,374 we have a terrible history of taking advantage 493 00:30:08,407 --> 00:30:10,642 of African Americans. 494 00:30:10,676 --> 00:30:11,743 Of course. 495 00:30:11,777 --> 00:30:13,312 I got more opposition from, 496 00:30:13,345 --> 00:30:15,714 from religion than I did from African American communities. 497 00:30:16,415 --> 00:30:18,584 The Catholics were the ones that are the most opposed, 498 00:30:18,617 --> 00:30:20,552 in my opinion and were during this debate. 499 00:30:21,620 --> 00:30:24,390 And I was raised Catholic, so I kind of knew their arguments 500 00:30:24,423 --> 00:30:25,791 before they came in. 501 00:30:25,824 --> 00:30:27,393 But it was important to listen. 502 00:30:27,426 --> 00:30:28,961 This is a choice. 503 00:30:28,995 --> 00:30:30,262 No one has to participate. 504 00:30:30,296 --> 00:30:33,199 No doctor, no pharmacy, no provider, no person. 505 00:30:33,232 --> 00:30:34,800 No one. 506 00:30:34,833 --> 00:30:38,104 If somebody is a person of faith and they feel that their faith 507 00:30:38,137 --> 00:30:41,273 prevents them from doing this, they're completely entitled to 508 00:30:41,307 --> 00:30:43,375 not act on it. 509 00:30:43,409 --> 00:30:48,280 Or if there's a hospital that's religiously affiliated and they 510 00:30:48,314 --> 00:30:52,184 feel that their hospital should participate in this whatsoever, 511 00:30:52,218 --> 00:30:54,720 that's their choice. 512 00:30:55,187 --> 00:30:58,891 While many religions disagree with these laws, 513 00:30:59,858 --> 00:31:04,563 the Catholic Church is the most outspoken and 514 00:31:04,596 --> 00:31:07,599 best funded opponent. 515 00:31:08,534 --> 00:31:14,440 Please tell us what the Roman Catholic's Church's position is 516 00:31:14,473 --> 00:31:17,343 on medical aid in dying. 517 00:31:18,144 --> 00:31:20,346 We have a creator who creates life, 518 00:31:20,379 --> 00:31:24,183 but part of that created order is there is a natural way that 519 00:31:24,216 --> 00:31:26,352 we die, and return to our creator. 520 00:31:27,053 --> 00:31:28,955 We shouldn't take control over that, 521 00:31:28,988 --> 00:31:31,323 but to let it unfold as nature would have it. 522 00:31:34,260 --> 00:31:37,997 I know you are a devout Roman Catholic. 523 00:31:39,598 --> 00:31:41,033 Striving to be. 524 00:31:41,067 --> 00:31:45,972 How much does your religious belief 525 00:31:46,005 --> 00:31:48,407 motivate your thinking? 526 00:31:48,774 --> 00:31:50,276 It's in sync with my thinking. 527 00:31:50,309 --> 00:31:52,411 I say all human life is inherently valuable. 528 00:31:52,444 --> 00:31:54,313 There's a million doctors in the country, Diane. 529 00:31:54,346 --> 00:31:57,783 And they all don't have the same sense of reverence for life in 530 00:31:57,816 --> 00:31:59,551 all the stages, the beauty. 531 00:31:59,585 --> 00:32:01,120 So in the Catholic tradition, 532 00:32:01,153 --> 00:32:03,822 we would say that as your quality of life diminishes, 533 00:32:03,855 --> 00:32:08,727 your obligation to pursue and maintain life diminishes 534 00:32:08,760 --> 00:32:10,096 as well. 535 00:32:10,129 --> 00:32:11,863 When we're just maintaining life, 536 00:32:11,897 --> 00:32:14,366 that is not living the fullness of life, 537 00:32:15,334 --> 00:32:18,704 so we're allowed to say no to medical interventions that would 538 00:32:18,737 --> 00:32:20,806 prolong that life. 539 00:32:20,839 --> 00:32:25,044 But what about medical aid in dying? 540 00:32:25,544 --> 00:32:27,146 Right. 541 00:32:27,179 --> 00:32:29,315 Since death is a part of life, we would say it's one thing to 542 00:32:29,348 --> 00:32:31,750 say, you know, my quality of life is diminishing, 543 00:32:31,783 --> 00:32:33,552 I don't want to pursue this, that. 544 00:32:33,585 --> 00:32:36,788 It's another thing to step in and to take over the process. 545 00:32:40,926 --> 00:32:46,398 If I had a magic wand that would ensure that no person 546 00:32:47,433 --> 00:32:50,636 at all, no matter who they are, would be discriminated against, 547 00:32:50,669 --> 00:32:54,873 and that they would be treated fairly and honorably and if this 548 00:32:54,906 --> 00:32:57,943 was that person's decision, then I would support it. 549 00:32:59,645 --> 00:33:02,014 Maryland is just one of the 550 00:33:02,048 --> 00:33:06,818 many states that have considered medical aid in dying 551 00:33:07,886 --> 00:33:11,090 over the past several years. 552 00:33:12,358 --> 00:33:16,062 The opponents of the bill that contacted me over the 553 00:33:16,095 --> 00:33:18,030 course of the last couple of years have, 554 00:33:18,064 --> 00:33:21,567 have largely focused on religious arguments, 555 00:33:21,967 --> 00:33:23,469 moral arguments. 556 00:33:23,502 --> 00:33:28,540 It's always been an issue that I've struggled with, and, 557 00:33:28,574 --> 00:33:30,809 you know, it's been in the legislature for a number of 558 00:33:30,842 --> 00:33:33,512 years now, and I was originally opposed. 559 00:33:33,545 --> 00:33:36,248 And I was worried that it would normalize suicide. 560 00:33:36,282 --> 00:33:40,352 I was worried that it was, it was a first step on a, 561 00:33:40,386 --> 00:33:42,288 a slippery slope. 562 00:33:42,321 --> 00:33:45,957 Do you consider medical aid in dying suicide? 563 00:33:47,593 --> 00:33:48,827 No. 564 00:33:48,860 --> 00:33:51,397 The person is on the threshold of dying. 565 00:33:51,430 --> 00:33:55,667 We're just choosing how, in that little window that they have 566 00:33:55,701 --> 00:33:58,270 left, how they choose to die. 567 00:33:59,205 --> 00:34:02,208 People who are going to suicide have the choice to 568 00:34:02,241 --> 00:34:04,543 live and choose to end their life. 569 00:34:06,245 --> 00:34:09,481 People who are doing aid in dying don't have the 570 00:34:09,515 --> 00:34:10,949 choice to live. 571 00:34:10,982 --> 00:34:14,120 Tell me, if you can, 572 00:34:14,153 --> 00:34:17,523 what happened to change your thinking. 573 00:34:19,024 --> 00:34:22,461 It changed with the death of my mother. 574 00:34:23,229 --> 00:34:28,467 She contracted esophageal cancer in 2014. 575 00:34:30,902 --> 00:34:32,504 You know, the doctors did their best to try to 576 00:34:32,538 --> 00:34:33,872 make her comfortable. 577 00:34:33,905 --> 00:34:37,909 She was obviously in pretty extreme pain, 578 00:34:37,943 --> 00:34:41,046 even with all the palliative care she was getting. 579 00:34:41,079 --> 00:34:45,117 A few days before she died, she went into the kitchen and 580 00:34:45,151 --> 00:34:47,286 got the bottle of liquid morphine that she'd been 581 00:34:47,319 --> 00:34:49,688 prescribed for the pain and tried to drink it, 582 00:34:49,721 --> 00:34:52,224 tried to commit suicide. 583 00:34:59,398 --> 00:35:02,801 Thinking about my mother and what she went through and I 584 00:35:02,834 --> 00:35:09,941 began to question whether I had the right as an elected official 585 00:35:11,243 --> 00:35:17,616 or even as her next of kin to make that decision for her. 586 00:35:21,620 --> 00:35:26,625 Delegate Luedtke's story reminded me of something another 587 00:35:26,658 --> 00:35:33,499 legislator told me, that each of us is just one bad death away 588 00:35:35,100 --> 00:35:38,904 from supporting these laws. 589 00:35:44,310 --> 00:35:48,647 Bill Roberts and I have been friends since high school when 590 00:35:48,680 --> 00:35:54,353 we were voted "cutest couple" in the graduating class. 591 00:35:54,953 --> 00:36:02,694 But in 2018, he was diagnosed with stage 4 prostate cancer and 592 00:36:03,762 --> 00:36:06,498 congestive heart failure. 593 00:36:07,466 --> 00:36:11,637 As happened with John Rehm and myself, 594 00:36:11,670 --> 00:36:16,275 Irene and Bill had to face their own mortality. 595 00:36:18,544 --> 00:36:21,647 And we have discussed end of life because 596 00:36:21,680 --> 00:36:23,249 friends have died. 597 00:36:23,282 --> 00:36:26,818 You know, and sometimes terrible things have happened to people 598 00:36:26,852 --> 00:36:32,391 we've loved so much and it was, it was happening to us. 599 00:36:32,424 --> 00:36:34,926 You know, when you get to be in your 80s, 600 00:36:34,960 --> 00:36:38,297 you know no one gets out alive. 601 00:36:39,465 --> 00:36:42,601 I guess there's a bet going with the doctors at the 602 00:36:42,634 --> 00:36:46,672 hospital as to what'll get me first, the, 603 00:36:46,705 --> 00:36:48,774 the heart failure or the cancer. 604 00:36:49,808 --> 00:36:55,614 You live in Colorado where medical aid in dying 605 00:36:55,647 --> 00:36:57,683 is permitted. 606 00:36:57,716 --> 00:37:01,052 I feel very lucky in, in living in Colorado and 607 00:37:01,086 --> 00:37:02,688 having this option. 608 00:37:02,721 --> 00:37:08,727 It will be a gentle easing into whatever comes next. 609 00:37:09,861 --> 00:37:15,133 I, I, I have no great anticipation for the next life, 610 00:37:16,302 --> 00:37:20,672 but I'll tell you what, I'll, I'll find out and I'll try to 611 00:37:20,706 --> 00:37:22,073 let you know. 612 00:37:22,107 --> 00:37:26,077 That conversation was bittersweet for me. 613 00:37:27,479 --> 00:37:32,217 I knew that my old friend would die soon, 614 00:37:32,250 --> 00:37:37,389 but I took comfort in knowing that he, unlike my husband, 615 00:37:38,757 --> 00:37:43,762 would have the option of medical aid in dying. 616 00:37:49,768 --> 00:37:52,270 I want to say thank you to everyone who is here. 617 00:37:52,304 --> 00:37:54,473 I want to say to the proponents, 618 00:37:54,506 --> 00:37:56,475 the people who are here in favor of the bill, 619 00:37:56,508 --> 00:37:58,777 thank you so much for all your efforts and I'm so 620 00:37:58,810 --> 00:38:00,312 grateful to have you here. 621 00:38:00,346 --> 00:38:02,481 And I want to say to the opponents, 622 00:38:02,514 --> 00:38:05,150 thank you for taking your time to be here... 623 00:38:05,617 --> 00:38:08,987 And so, when the Maryland legislature took up 624 00:38:09,020 --> 00:38:10,756 the matter again. 625 00:38:10,789 --> 00:38:12,324 We're going to call House Bill 3. 626 00:38:12,358 --> 00:38:15,461 And I was asked to testify, 627 00:38:15,494 --> 00:38:20,699 both Bill Roberts and John Rehm were very much 628 00:38:20,732 --> 00:38:22,501 on my mind. 629 00:38:22,534 --> 00:38:24,603 The Maryland legislation that is before 630 00:38:24,636 --> 00:38:27,639 you today has been modeled after the Oregon 631 00:38:27,673 --> 00:38:30,241 Death with Dignity Act. 632 00:38:30,275 --> 00:38:33,445 And it's been implemented in eight other jurisdictions for a 633 00:38:33,479 --> 00:38:35,614 combined 40 years of experience. 634 00:38:36,615 --> 00:38:39,518 And I hope that this time around that we can bring this 635 00:38:39,551 --> 00:38:41,887 compassionate and much needed option to the 636 00:38:41,920 --> 00:38:44,790 residents of Maryland. 637 00:38:45,491 --> 00:38:48,527 Good afternoon, I'm Diane Rehm. 638 00:38:49,961 --> 00:38:55,467 The legislation you are considering might have permitted 639 00:38:55,501 --> 00:39:02,641 John Rehm to have the measure of autonomy that he wanted over 640 00:39:02,674 --> 00:39:05,176 his own death. 641 00:39:06,512 --> 00:39:12,418 By this time, what I had heard from patients, family members, 642 00:39:12,451 --> 00:39:16,121 physicians and others had taught me a lot. 643 00:39:17,956 --> 00:39:23,061 This end of life option provokes strong feelings in people, 644 00:39:23,094 --> 00:39:25,597 as it should, 645 00:39:25,631 --> 00:39:30,335 and as the concerns of the Maryland lawmakers demonstrated. 646 00:39:31,937 --> 00:39:33,238 Delegate Watson. 647 00:39:33,271 --> 00:39:34,940 Thank you, Mr. Chair, 648 00:39:34,973 --> 00:39:36,241 and thank you all for coming out. 649 00:39:36,274 --> 00:39:37,409 I really appreciate it. 650 00:39:37,443 --> 00:39:38,644 This has answered a lot of questions, 651 00:39:38,677 --> 00:39:40,446 but I still have one or two remaining. 652 00:39:40,479 --> 00:39:43,114 We had had a very emotionally wrought debate on 653 00:39:43,148 --> 00:39:44,750 the bill when it came to the House floor. 654 00:39:44,783 --> 00:39:47,553 It was a very difficult conversation to have. 655 00:39:48,420 --> 00:39:50,889 My concern is based around the financial capability 656 00:39:50,922 --> 00:39:54,760 and dwindling resources as we age, of certain demographics. 657 00:39:55,794 --> 00:39:57,863 The concern from my constituents is like 658 00:39:57,896 --> 00:40:00,499 a lot of them, they have a concern about fear, 659 00:40:00,532 --> 00:40:03,101 economic situation, vulnerable community. 660 00:40:03,869 --> 00:40:05,771 I mean what if, at the end of the day, 661 00:40:05,804 --> 00:40:08,540 a health insurance company looks at it strictly as any business 662 00:40:08,574 --> 00:40:12,778 to maximize revenue, and they say instead of paying for 663 00:40:12,811 --> 00:40:16,181 someone to take chemo over an extended period of time when 664 00:40:16,214 --> 00:40:17,883 they're going to pass away anyway, 665 00:40:17,916 --> 00:40:20,819 let's save money and give them this one option. 666 00:40:21,787 --> 00:40:24,055 The, the folks that maybe don't have the best 667 00:40:24,089 --> 00:40:26,858 insurance to get the best treatment, 668 00:40:26,892 --> 00:40:28,894 are going to be kind of if they're in pain, 669 00:40:28,927 --> 00:40:30,328 this may be their only option? 670 00:40:30,361 --> 00:40:31,963 And what the fact is in the health care 671 00:40:31,997 --> 00:40:33,632 insurance industry, 672 00:40:33,665 --> 00:40:36,835 a dead person is the most cost effective person of all. 673 00:40:37,569 --> 00:40:41,473 What's the difference between this medical aid in 674 00:40:41,507 --> 00:40:43,675 dying medication and the morphine? 675 00:40:43,709 --> 00:40:46,645 What happens if the medication isn't administered 676 00:40:46,678 --> 00:40:49,548 properly or if it doesn't work as intended? 677 00:40:50,281 --> 00:40:52,551 Can you explain, very briefly, 678 00:40:52,584 --> 00:40:56,087 what a physician looks to to determine mental capacity? 679 00:40:56,121 --> 00:41:01,660 How do you respond to folks who feel very strongly 680 00:41:01,693 --> 00:41:07,933 that aid in dying would increase the risk of death for truly 681 00:41:07,966 --> 00:41:09,801 vulnerable people? 682 00:41:09,835 --> 00:41:12,938 That is those who are disabled in some way. 683 00:41:13,905 --> 00:41:17,342 Amyotrophic lateral sclerosis, for example, ALS... 684 00:41:17,375 --> 00:41:19,144 These laws that we've passed, 685 00:41:19,177 --> 00:41:20,746 the law here and in other jurisdictions, 686 00:41:20,779 --> 00:41:23,815 requires that somebody meet certain criteria. 687 00:41:23,849 --> 00:41:27,085 That means that people who are not able to self-administer 688 00:41:27,118 --> 00:41:29,387 cannot avail themselves of this law. 689 00:41:30,221 --> 00:41:32,190 And there was an interesting divide in the 690 00:41:32,223 --> 00:41:33,692 disabled community. 691 00:41:33,725 --> 00:41:36,061 There were those who were worried that this would be a 692 00:41:36,094 --> 00:41:38,830 step toward euthanasia and people who were disabled would, 693 00:41:38,864 --> 00:41:42,433 you know, be at risk, you know, in the future. 694 00:41:42,467 --> 00:41:44,870 But there are others in the disabled community who were 695 00:41:44,903 --> 00:41:48,740 disappointed in the legislation because they said what if we 696 00:41:48,774 --> 00:41:52,043 have a disability that prevents us from self-administering. 697 00:41:52,077 --> 00:41:56,314 And I said, you know, it's not a flaw in the legislation so much 698 00:41:56,347 --> 00:41:59,217 it is an understanding of what we could accomplish 699 00:41:59,250 --> 00:42:00,552 at this time. 700 00:42:01,252 --> 00:42:03,855 So you have to keep in mind you've got this legislation 701 00:42:03,889 --> 00:42:06,324 and its protections, but you also have an entire practice of 702 00:42:06,357 --> 00:42:09,127 medicine where doctors are licensed and education 703 00:42:09,160 --> 00:42:10,829 and certification. 704 00:42:10,862 --> 00:42:13,398 Those practices and rules also govern this practice. 705 00:42:14,332 --> 00:42:17,736 I think that we make a lot of rash and bad decisions 706 00:42:17,769 --> 00:42:19,537 sometimes when we're in pain, because all... 707 00:42:19,571 --> 00:42:24,743 The legislators expressed very understandable concerns. 708 00:42:25,310 --> 00:42:29,047 But in states where laws have been implemented, 709 00:42:29,748 --> 00:42:34,419 evidence shows the protections written into them have worked. 710 00:42:35,687 --> 00:42:40,959 Knowing that lets me focus on what is so important to me, 711 00:42:42,393 --> 00:42:44,095 individual autonomy. 712 00:42:45,230 --> 00:42:52,938 My philosophy in this matter is to respect that singularly 713 00:42:53,639 --> 00:42:56,808 personal moment for each of us. 714 00:42:58,443 --> 00:43:04,683 If you believe that only God should be the decider, 715 00:43:06,284 --> 00:43:10,956 I support you 100%. 716 00:43:12,523 --> 00:43:19,330 If you wish to have every single option that 717 00:43:19,364 --> 00:43:21,967 medical science can provide, 718 00:43:22,934 --> 00:43:27,072 I support you 100%. 719 00:43:29,174 --> 00:43:33,712 And if you believe, as I do, 720 00:43:35,413 --> 00:43:41,987 that you want the right to end your suffering 721 00:43:42,020 --> 00:43:49,527 at a time you choose, I support you 100%. 722 00:43:50,228 --> 00:43:52,263 The bill went over to the Senate and I think I lot of 723 00:43:52,297 --> 00:43:54,733 the senators were struggling with the issue in the same way 724 00:43:54,766 --> 00:43:56,367 that a lot of them members of the House were. 725 00:43:56,401 --> 00:44:00,538 It did end up tying, one vote short of what it needed to pass. 726 00:44:00,571 --> 00:44:02,307 I was disappointed when the bill failed. 727 00:44:02,340 --> 00:44:05,543 So was I. 728 00:44:05,576 --> 00:44:09,881 But I expect the bill will come up again, 729 00:44:09,915 --> 00:44:13,752 and I hope it will pass next time. 730 00:44:16,087 --> 00:44:21,927 Washington, D.C.'s Death with Dignity Law went into effect in 731 00:44:21,960 --> 00:44:31,136 June of 2017, but no terminally ill patient actually used the 732 00:44:31,169 --> 00:44:33,839 law for over a year. 733 00:44:36,641 --> 00:44:42,480 One of the first patients to do so was journalist and artist 734 00:44:43,081 --> 00:44:45,817 Mary Klein. 735 00:44:48,386 --> 00:44:55,093 Stella Dawson was Mary's wife and life partner for more than 736 00:44:55,126 --> 00:44:57,528 37 years. 737 00:44:58,864 --> 00:45:02,300 Mary was complaining of stomach pains and of digestive 738 00:45:02,333 --> 00:45:06,838 problems, she said Stella, I'm really, really tired. 739 00:45:06,872 --> 00:45:12,310 I came back from work and Mary took my hand and took me 740 00:45:12,343 --> 00:45:16,081 into the living room and we sat down, 741 00:45:16,114 --> 00:45:21,386 and she said, "Stella, I think I have cancer." 742 00:45:21,887 --> 00:45:25,791 And so we spent the weekend researching doctors and got an 743 00:45:25,824 --> 00:45:30,962 appointment and sure enough, it was advanced ovarian cancer. 744 00:45:33,999 --> 00:45:39,104 She did five series of chemo because she was, 745 00:45:39,137 --> 00:45:44,175 she wanted to live and she wanted that opportunity 746 00:45:44,209 --> 00:45:47,678 to enjoy her life. 747 00:45:47,712 --> 00:45:51,917 So she did all that she could for as long as she could. 748 00:45:55,320 --> 00:45:57,122 Nothing was working. 749 00:45:58,723 --> 00:46:04,095 Mary's diagnosis came before medical aid in dying was 750 00:46:04,129 --> 00:46:07,933 legal in Washington, D.C. 751 00:46:08,399 --> 00:46:11,970 But as her disease progressed, 752 00:46:12,003 --> 00:46:16,307 she learned the City Council would be voting on a bill. 753 00:46:18,476 --> 00:46:20,211 Mary said to me, 754 00:46:20,245 --> 00:46:23,214 "Stella, there's a chance that we can get 755 00:46:23,248 --> 00:46:25,884 medical aid in dying here in the District." 756 00:46:25,917 --> 00:46:31,990 so we both hit the telephones, started writing letters. 757 00:46:34,292 --> 00:46:38,296 And Mary Cheh was the first person who responded. 758 00:46:39,697 --> 00:46:42,233 She was very, very brave. 759 00:46:42,267 --> 00:46:43,701 She was quite ill too. 760 00:46:43,734 --> 00:46:44,970 I know. 761 00:46:45,003 --> 00:46:46,938 And she would come and she would testify. 762 00:46:46,972 --> 00:46:49,340 She was not even sure that the law would be in place 763 00:46:49,374 --> 00:46:51,877 before she passed away. 764 00:46:51,910 --> 00:46:55,013 And so I remember her saying, "This is what I'm trying to do 765 00:46:55,046 --> 00:46:57,916 with my end of life is give somebody in the future the 766 00:46:57,949 --> 00:47:01,519 freedom to make this decision and not have to go through what 767 00:47:01,552 --> 00:47:02,720 I've gone through." 768 00:47:03,021 --> 00:47:04,856 And let me just say, 769 00:47:04,890 --> 00:47:07,025 these are difficult conversations to have 770 00:47:07,058 --> 00:47:08,693 with your doctor. 771 00:47:08,726 --> 00:47:11,262 Mary spoke out at a 772 00:47:11,296 --> 00:47:13,798 public meeting saying, 773 00:47:14,699 --> 00:47:16,902 "I can't find a doctor 774 00:47:16,935 --> 00:47:21,139 who is willing to participate with me." 775 00:47:22,207 --> 00:47:26,644 So how difficult was it to find that doctor? 776 00:47:27,979 --> 00:47:29,881 It was very stressful. 777 00:47:29,915 --> 00:47:32,250 Mary Klein was referred to you? 778 00:47:33,184 --> 00:47:34,485 She told me 779 00:47:34,519 --> 00:47:36,287 as soon as we met 780 00:47:36,321 --> 00:47:38,223 that she was looking for a physician to help her. 781 00:47:39,357 --> 00:47:41,626 And she said, "I've never done this. 782 00:47:41,659 --> 00:47:44,029 If you're willing to on this journey with me, 783 00:47:44,062 --> 00:47:46,097 I'm willing to go on it with you." 784 00:47:46,131 --> 00:47:47,698 Wow. 785 00:47:49,034 --> 00:47:53,204 Mary saw this as part of a continuum of care 786 00:47:54,172 --> 00:47:58,343 and she was enrolled in hospice and was very pleased with the 787 00:47:58,376 --> 00:47:59,544 hospice care she got. 788 00:47:59,577 --> 00:48:00,946 Good. 789 00:48:00,979 --> 00:48:03,648 But she was waiting as long as she could 790 00:48:03,681 --> 00:48:05,951 with the medications that we had that she could 791 00:48:05,984 --> 00:48:08,386 manage and they weren't working anymore. 792 00:48:09,921 --> 00:48:11,489 They weren't working. 793 00:48:11,522 --> 00:48:14,459 At the very end, I said you know I could give you enough 794 00:48:14,492 --> 00:48:19,564 medicine so that you just would sleep for the rest of the time 795 00:48:19,597 --> 00:48:22,333 you have, and she said I don't want that. 796 00:48:25,170 --> 00:48:30,008 She did not want to be in a coma or a semi coma 797 00:48:30,041 --> 00:48:31,909 at the end of her life. 798 00:48:31,943 --> 00:48:34,946 She wanted to be present, 799 00:48:34,980 --> 00:48:38,749 she wanted to be with me and the dogs. 800 00:48:40,818 --> 00:48:42,620 She wanted to be able to say goodbye. 801 00:48:42,653 --> 00:48:44,956 Of course. 802 00:48:44,990 --> 00:48:47,692 And it was that night she said to me, 803 00:48:47,725 --> 00:48:50,895 Stella it's time. 804 00:48:52,263 --> 00:48:56,701 You don't know it's going to be the end, do you? 805 00:48:56,734 --> 00:48:57,868 No. 806 00:48:57,902 --> 00:48:59,037 You don't. 807 00:48:59,070 --> 00:49:01,006 You don't, you don't. 808 00:49:01,039 --> 00:49:03,274 You know, even though, even though she said something 809 00:49:03,308 --> 00:49:07,945 like that, I still thought she had several weeks. 810 00:49:07,979 --> 00:49:12,683 I visited her four days before she died and then again 811 00:49:12,717 --> 00:49:14,252 on the day that she died. 812 00:49:14,285 --> 00:49:15,753 Oh, I'm so glad. 813 00:49:15,786 --> 00:49:18,856 And Mary was dying, that last time I saw her. 814 00:49:18,889 --> 00:49:22,027 I, she died from ovarian cancer. 815 00:49:22,060 --> 00:49:26,397 She did not die from the potion that she drank, 816 00:49:26,964 --> 00:49:29,834 that just affected the time she died. 817 00:49:29,867 --> 00:49:32,470 But she was already dying. 818 00:49:32,503 --> 00:49:38,576 She just laid back and went into a very deep sleep. 819 00:49:39,010 --> 00:49:43,014 And you were right there with her. 820 00:49:43,048 --> 00:49:45,650 It was about two and a half hours before 821 00:49:45,683 --> 00:49:48,386 she passed away. 822 00:49:48,419 --> 00:49:51,356 And she died in my arms. 823 00:49:53,124 --> 00:49:54,759 That's what she wanted. 824 00:49:54,792 --> 00:49:59,397 That's exactly, it's what she fought so very, very hard for. 825 00:49:59,430 --> 00:50:03,468 It's a peaceful death. 826 00:50:03,501 --> 00:50:08,073 And it's a loving death. 827 00:50:14,779 --> 00:50:17,548 I think that's all I can say. 828 00:50:26,491 --> 00:50:31,596 In 2020, humanity began a long struggle with the 829 00:50:31,629 --> 00:50:34,232 COVID-19 pandemic, 830 00:50:34,265 --> 00:50:38,669 tens of millions became infected and many, 831 00:50:38,703 --> 00:50:41,572 many deaths were reported each day. 832 00:50:42,707 --> 00:50:48,179 In this country, I think this has led more of us to recognize 833 00:50:48,213 --> 00:50:54,352 the importance of making our end of life wishes known to those 834 00:50:54,385 --> 00:50:56,154 close to us. 835 00:50:58,356 --> 00:51:01,025 Then would you be good enough to take the phone 836 00:51:01,058 --> 00:51:04,595 out of your pocket and video this? 837 00:51:04,629 --> 00:51:06,197 Okay. 838 00:51:06,231 --> 00:51:11,169 Because I would very much like your mother, your father, 839 00:51:11,202 --> 00:51:18,943 uncle Dave, Aunt Nancy, everybody to know exactly how I 840 00:51:18,976 --> 00:51:22,747 feel about what I'd like at the end of life. 841 00:51:23,314 --> 00:51:24,515 Do you want me to record it? 842 00:51:24,549 --> 00:51:25,883 Please. 843 00:51:25,916 --> 00:51:30,054 To my family, my physician and any hospital... 844 00:51:31,356 --> 00:51:36,194 I believe that the more we learn to talk openly about death, 845 00:51:37,395 --> 00:51:39,063 the better. 846 00:51:39,096 --> 00:51:45,336 It's been such a taboo subject for many of us for too long, 847 00:51:46,337 --> 00:51:51,376 but if we can discuss what we want with our friends, 848 00:51:51,409 --> 00:51:58,483 our doctors, our families, if we can make our own wishes known to 849 00:51:58,516 --> 00:52:03,988 those who care about us, everyone will be more prepared, 850 00:52:05,523 --> 00:52:11,929 and the end of life will be less stressful and could be more 851 00:52:11,962 --> 00:52:14,432 joyous for us all. 852 00:52:16,367 --> 00:52:22,440 As for me, in my early 80s, I'm living life to the fullest. 853 00:52:24,242 --> 00:52:29,914 I'm still working, I've remarried, I travel, 854 00:52:30,881 --> 00:52:33,751 I have a new puppy. 855 00:52:33,784 --> 00:52:36,854 Life is wonderful. 856 00:52:37,788 --> 00:52:44,762 But, I have also prepared for what will eventually come 857 00:52:44,795 --> 00:52:49,967 for all of us, and I'll be ready 858 00:52:51,202 --> 00:52:54,171 when my time comes.