Living in pain is easy; dying with dignity is hard -- a review of How to Die in Oregon

By Edward Copeland

In 1994, Oregon became the first state to allow doctors to prescribe lethal doses of medication to the terminally ill so they wouldn't have to endure all sorts of crippling pain and the assorted loss of functions and powers that turned lives into something that could hardly be called living anymore. Tonight, HBO premieres the great documentary How to Die in Oregon, which personalizes the law, telling the stories of several Oregonians who weigh the option of whether or not to end their suffering. It's a powerful, emotional film that hits particularly close to home for me. It's also something everyone should see, especially in a time when compassion and rationality on a wide variety of issues seem to be in short supply.

Sometimes it's difficult when reviewing a movie — narrative or documentary — such as How to Die in Oregon that you know will deal with issues that are important to you. It makes critical distance harder to have. On the other hand, if you feel the film (or play or TV show for that matter) botches the presentation, you're liable to be harsher than you would be otherwise. Thankfully, that's not the case with How to Die in Oregon.

The documentary opens with a home movie of Roger Sagner, who became the 343rd person to have his suffering ended legally after the passage of Oregon's law. As his lethal dose of Seconal gets mixed for him, his volunteer from Compassion and Choices, the advocacy group that helps most people with their final act, asks him the two questions that they are required to: "Do you know you have the right to change your mind? and "What will this (drink) do to you?"

Sagner answers very quickly, "It will kill me and make me happy." He then gives his last words, first of love to his gathered family members, and then his final statement:

I thank the wisdom of the voters of the state of the Oregon for allowing me the honor of doing myself in on my own volition to solve my own problems.

What I wouldn't give if the wisdom of Oregon voters could somehow be bottled and slipped into the entire country's water supply, since we have a short supply of rational-thinking adults. Oregon also legalized medical marijuana, which has shown great progress in easing the pain for people such as myself who have multiple sclerosis, but then again 15 other states and the District of Columbia have joined Oregon on that law. Unfortunately, I'm stuck in a state which has a governor and legislature doing its damnedest to drag us back to the 19th century, prior to its and which on the last General Election ballot had as a priority a state question making sure that no state judge used Sharia law in making rulings.

When Oregon voters approved its Death With Dignity law, only the countries of Switzerland and the Netherlands had legalized the practice. Since then, forward-thinking voters in Washington state and Montana also have approved such laws. Worldwide, Luxembourg is the only country to legalize it since. Worldwide, debates go on everywhere, but they always run into the same opposition, usually from churches and the religious, who most of all should watch How to Die in Oregon and maybe they'd understand this is about compassion — and isn't compassion a basic tenet of most religions?

The film was directed, produced and photographed by Peter D. Richardson and won the Grand Jury Prize for Documentaries at this year's Sundance Film Festival. I don't know its competition, but How to Die in Oregon definitely proves award-worthy. Richardson establishes an amazingly intimate rapport with the film's interview subjects. His main focus stays with a 54-year-old woman named Cody Curtis who successfully beats liver cancer once only to have it return stronger and with a six-month death sentence attached, making Curtis face the idea of taking the lethal dose when the cancer returns.

Given an expiration date and knowing what kind of pain she faces, Cody decides that she won't let cancer and doctors control what remains of her life and she sets a date to take the lethal dose, which gives her an unexpected sort of freedom, even though her entire family isn't happy about it, especially her son Thomas, who asks his mom if she won't struggle for herself, can't she struggle a little for him?

Thomas moves past that, but that's what prevents laws such as Oregon's from being the law everywhere — friends and family, partly out of love but out of selfishness as well — can't bring themselves to accept the idea of their parent or child or whomever choosing to die, even when they witness the amount of pain that person goes through for long periods of time and know deep inside that it only get worse and that person's life will not end well under any scenario.

Before we meet Cody, the film introduces us to Sue Potter, a seven-year volunteer for Compassion and Choices and one of the group's most active. We see her make one of her first stops to a man lying in be, obviously having a particularly bad day. Potter explains to him that she's there to talk with him because he's contacted the group about ending his life.

"End my life? I'm already in life," he tells her. "I've already ended life. I want to exit life."

Potter explains what it's like for people who get to these conditions. "These people have lost so much control and they'll tell us repeatedly that they want the medicine for control."

The actual process requires filling out a form with the extremely long title REQUEST FOR MEDICINE TO END MY LIFE IN A HUMANE AND DIGNIFIED MATTER. It requires the signatures of two witnesses attesting that the person seeking the lethal dose is of sound mind.

As Cody Curtis says at one point in the documentary about having the lethal prescription in her house, should she need it:

It's very comforting to know they're here. I don't have to go through any more bureaucracy... They're here when I decide... It's not like when I'm in the hospital and they tell you, "You have to have another CAT Scan" or "We're taking you down for another procedure." It's my choice when to take them and whether to take them. My volunteer has told me I'll know and I'll just have to trust her on that. I'll know when my life isn't worth living anymore.

While the film keeps Curtis as its center, it has plenty of time for sidetrips to other dying people, interview subjects such as Derek Humphry, author of the once controversial book Final Exit, as well as Seattle's Nancy Niedzielski who leads the campaign for a similar law in Washington.

Niedzielski's story really illustrates the need for such laws. Her husband Randy was diagnosed with brain cancer. Nothing doctors could give him would alleviate the pain and the condition got so bad sometimes his eyes would literally pop out of their sockets. Randy finally decided to end treatment, since none of it was going to save his life or ease his pain. He went to a hospice and asked if they could help him do what they could to end his life quickly, but the hospice workers said they couldn't because that was illegal in the state of Washington. Randy told them that he would move to Oregon so he could take advantage of the Death With Dignity law, only he was told that he was so weak and near death by then that he wouldn't survive long enough to establish Oregon residency, a requirement of the law. His last request was that his wife change Washington's law and she helped lead the campaign for two years until its passage in 2008.

You get to see the usual opposition as when Nancy serves on a phone bank and gets an opponent of the law's passage and actually challenges the caller on what so many people don't seem to understand on any issue: They are free to think it's wrong, but why do they think their belief should be imposed on everyone else? Why is the idea of choice (and I'm not using it in terms of the abortion debate here) so revolting to them? You also see Nancy interviewed for a radio program where the host calls what she is seeking "assisted suicide," a term which offends Nancy and most others who support Death With Dignity. Nancy tells him that suicide is when someone who is otherwise healthy and would live for many more years decides to end his or her life because he or she is clinically depressed. Unfortunately, in the 47 states that don't have this law, that's how they treat people who are in chronic pain: as if they are just depressed and need shrinks and medication, like a teenage boy whose girlfriend just dumped him.

It also has something to do with what you hear in passing in a segment that plays excepts of the Washington debate on talk radio where a man talks about having to be placed in long-term care and how it's eating up his inheritance. Not that I ever had a fortune in savings, but I've watched it evaporate thanks to my medical costs. It doesn't help that my sole income is Social Security Disability Insurance and for two years running, Social Security recipients have been denied cost-of-living increases under the argument that the rate of inflation hasn't been high enough to justify it. Of course, this hasn't prevented Congress from giving themselves cost-of-living hikes to their six-figure salaries both of those years.

Then there is Medicare. Part A the "hospital part" is free, but if I wanted Part B, I would have to pay a premium which would be deducted from my meager Social Security check. On top of that, one of my doctors won't take Medicare patients and others are threatening not to because of talk that their fees might be reduced. Therefore, I didn't take Part B, staying on the health insurance that was funded by my employer who still considers me an employee on long-term disability, even though I receive no salary. The government tries to blackmail you into taking Part B, telling you that for each year you don't sign up, the premium will increase a certain percentage for every year you didn't. As far the increasing number of doctors who refuse Medicare patients, Lawrence O'Donnell pointed out last week that in 1960, before Medicare, the average family doctor's salary was $10,000. Just four years after Medicare's enactment, that average had increased to $24,000. Today, that average is something around $130,000 a year. For specialists, it's about $333,000 a year. And these poor babies fear cuts. By the way, Part A, the "hospital part" only covers you if you are admitted to a hospital. If you have outpatient procedures at a hospital or are taken to an emergency room at a hospital, that doesn't count. That's Part B.

The entire health-care industry, with the government as co-conspirators, opposes laws such as Death With Dignity because they want to bleed everyone dry first. The system for people who are chronically ill but not terminal actually is set up so that you really can't get financial help unless you are broke first. That's what they want: It's how the system is set up. Pardon my digression. I'm writing this to praise a wonderful documentary on an important topic.

Oregon isn't immune from this either. How to Die in Oregon also tells the infuriating story of Randy Stroup, a 53-year-old uninsured man diagnosed with prostate cancer who had to depend on the Oregon Health Plan. After his first treatment, his doctor recommended stronger chemotherapy and the health plan sent him a letter denying the treatment, but giving him a list of other options, including the Death With Dignity Act. This was a man who wasn't terminal and could be saved.

"To think they'd put a price tag on my life," Stroup said, "by saying they'd pay to kill me but they wouldn't pay to help me." Sounds very reminiscent of when Arizona recently cut their program for people awaiting transplants. One way or the other, it all comes down to money in the end.

The center of How to Die in Oregon and much of its power belongs to Cody Curtis' story. After setting a date to take the medication, she find a happiness and freedom. Instead of everything revolving around her impending death, it becomes about life again and she ends up not taking it on the date she set and actually living beyond the six months she was told and with few signs of the pain she feared. It's as if she's been given a gift and gets more time with her husband and children, but eventually the cancer does kick in with its pain and complications. As she had said before after her brush with the disease, it's a relief to know the medication already is there in her house when she needs it and it's up to her to choose when that time is. Director Richardson's choice in filming the conclusion of Cody's story proves both perfect for the documentary and for Cody as well.

From beginning to end, Richardson's compelling documentary takes you on an emotional roller coaster. It would have been easy to turn How to Die in Oregon into a propaganda piece supporting Death With Dignity laws, but he just lets his subjects talk and the audience has the experience. No embellishment is necessary.

How to Die in Oregon premieres on HBO tonight at 8 p.m. Eastern/Pacific and 7 p.m. Central. Truly, it should not be missed. 

(Cross-posted at Edward Copeland on Film.)

The amazing recovery of Gabrielle Giffords

By Michael J.W. Stickings

We've been focusing a great deal on the shooting and on what was behind it, that is, the larger socio-political context, but, lest we forget, the most amazing part of the story is happening at a hospital in Tuscon:

Rep. Gabrielle Giffords is able to breathe on her own, doctors said Tuesday.

Giffords remains on a ventilator to help her recovery, said neurosurgeon G. Michael Lemole Jr.

Giffords now has a "101 percent chance" of surviving Saturday's shot to the head, said trauma surgeon Peter Rhee.

"She will not die—she does not have that permission from me," he said.

Monday, Rhee said the congresswoman's chances of survival were 100 percent.

Giffords remains in critical condition in the intensive care unit, they said.

"It's going to happen on her timeline, not ours," Lemole said.

"She has no right to look as good as she does, but we all have to be patient," said Lemole, noting that recovery from a shot through the brain can take a long time.

"She's on her own schedule," he said. "It's a week to week, month to month" healing process."

Doctors have been able to "back off" the sedation the congresswoman is receiving, Lemole said.

Giffords is responding to commands by moving on both sides of her body, Rhee said.

Some tests involve testing responses to pain, he said.

"We do a test called a sternal rub," he said, by pushing down hard on the breastbone to cause a response.

"We say, 'Gabby, show me your thumb' and push down," he said.

She now responds to the request by giving a thumbs up to avoid the push, he said. "She's doing it on her own."

Truly amazing. And wonderful news.

Of course, Giffords is receiving excellent medical care, including from two military doctors (who were brought in because her husband, an astronaut, is in the Navy.

All Americans should have access to such care, and the vote Giffords cast for health-care reform helped last year helped move the country towards a fairer and more just system for all. Consider what she herself wrote in August 2009:

We are as great nation. We deserve the best health care in the world. How we get it is the real question.

We need reform that puts patients first. It is not right and not fair that insurance companies can deny coverage because of pre-existing conditions, or impose lifetime limits on service.

I support reform that allows Americans to keep their current health care program, keep their doctors and keep their hospitals.

I support reform that creates competition through a strong public option that lowers everyone's costs and competes with private insurers.

I support reform that allows Arizonans who lose their jobs to afford insurance so they can get back on their feet without fear of getting sick without medical care.

I support reform that will slow the growth of health care costs and does not impose new taxes or burdens on our nation's most valuable economic contributors, small businesses.

Last month, this nation observed the 40th anniversary of our arrival on the moon – one of the most awesome accomplishments in the history of mankind. Now our generation has our own opportunity to make history.

A nation that can leave footprints on another celestial body is up to this challenge.

Providing Americans with health care that gives them lifetime security and peace of mind must be America's next great accomplishment.

And there is still work to be done -- at the moment, to reject Republican attempts to repeal the Affordable Care Act.

Of course, we must remember that Giffords wasn't the only victim of Saturday's shooting. Six people died and 14 others, including Giffords, were wounded -- six of the wounded are still at University Medical Center, and, two, including Giffords, are still in critical condition.

We wish them all the best health care available. And we wish them all well.

Craziest Republican of the Day: Steve King

By Michael J.W. Stickings

Certifiable GOP wacko Rep. Steve King (R-IA) -- who's been our CRD several times before (see here, here, here, and here, not to mention here) -- yesterday made what TPM's Rachel Slajda graciously called "an original argument... for why health care reform is unconstitutional."

Responding to Rep. Jared Polis (D-CO), who made the sensible and oft-made case that "health insurance counts as interstate commerce and therefore falls under the Congress's constitutional powers, King argued that there are people who never even use health care -- and therefore a law requiring them to buy insurance is unconstitutional." And just who are these people? "There have always been and likely will always be, babies that were born, lived and died within the jurisdictions of the individual states," he said, "who never cross a state line, access no health care and therefore do not impact interstate commerce."

Wait... what? Polis was confused, too. Just who are these people who as babies don't receive any health care at all? This is priceless in its craziness:

I hate to tell you but they show up in garbage cans around this country, sir,

said King.

Yes, that's right, the interstate commerce argument doesn't apply because of all those babies in garbage cans who manage to live and die without ever accessing health care.

"Polis was more or less speechless," notes Slajda. Can you blame him? This is just the sort of unsubstantiated claim, just the sort of insanity with a straight face, Republicans pass off as rational argument on a regular basis -- not just with respect to health-care reform but with respect to pretty much everything.

I realize that Republicans oppose the very idea of factual evidence, but here's the video:

Ayn't She Sweet

by Distributorcap

The 112th Congress opened today - and it isn't taking long for teabag insanity to rear its ugly head straight from the rectum of an colic elephant. Led by the orange Oompah-Loompah from Ohio and his band of mirthmakers, the next two years are guaranteed to supply a plethora of fodder to the comics, photoshoppers and intelligentsia of this country. Sadly it will also be two of the most pathetic, tragic and regressive years for the America people.

In honor of this new and improved form of psychosis known as the House of Representatives, we announce the creation of the Randbag Award. This award, named in honor of the Queen of Insensitivity herself - Ayn Rand - will be given on a regular basis to a most deserving member of the In-crowd - the teabagger that shows the most insensitivity, insanity, intolerance and/or inappropriate behavior. With the land inside-the-beltway now polluted by an overabundance of dirt-teabags - this is sure to be a very, very competitive award.

First up - Diane Black - freshman Congressteabag from 6th district of Tennessee

One of the early signs for the onset of GOP dementia will be the parade of teabaggers demanding the repeal of the Affordable Health Care Act - the watered-down and insurance company-friendly health care bill that took all the oxygen out of Washington to pass last year.

Ms. Black has stated her case for repeal - and it meets all the earmarks of a Randbag.

There is a mandate there that insurance companies must insure children up to the age of 24, and what we have found is that there are a lot of insurance companies that are just saying we’re not going to be in this business any longer, because we know that we can’t survive if that’s what we’re going to do.

And the second piece of that was to insure children regardless of their health care history, and as a result of that, I know several health care insurance agents in my district who have said we’re just dropping any insurance for children whatsoever.

Those damn sick kids - they are just medical terrorists! Better for them to die than to force insurance companies and agents out of business. After all, it is just too expensive to pay claims to those sick people who paid premiums.

Ms. Black (a registered nurse!) couldn't be more clear - she is more concerned about the bottom line of insurance companies than the health and well-being of children. But then again she is a teabagger who campaigned on the nasty things liberals want to do to ruin America - so this should come as no surprise to her constituents.

Ms. Black thinks the provision in the law that allows parent to keep their children on their policies to age 26 (not 24 as she states - it is amazing how many teabaggers in government don't even bother to get the facts straight while they are criticizing) is just too burdensome for the poor burdened insurance companies. She also thinks that requiring insurance companies to insure sick kids is just another form of cadillac-driving welfare - and that this is just too anti-capitalist.To put this simply,  Representative Diane Black of Tennessee looks forward to watching the ailing children of America drop dead - it is good for the bottom line.

Diane Black describes herself a champion of long-term health care for the disabled - and of course like all good teabaggers - she is for strong family values.  Values like the ones that let families watch their children get turned down for insurance because they have diabetes, cancer, muscular dystrophy or some other illness. Values that will force families to choose between food and medical care for their kids.  I can guarantee you that Diane, her three children and six grandchildren all have good health policies. While she attends Community Church in Hendersonville, I am sure Ms. Black pats the heads of all the healthy children in the pews.

Diane Black believes that access to health care -even for kids - should be based on the ability to pay, not on any moral obligation or need. Diane Black is also saying that it is okay for insurance companies to drop you - and kids - once you get sick, that they are not required to deliver services even after you pay. Diane Black cares more about the viability of insurance companies than she does not care about Americans - or her own constituents.   Or rather Diane Black cares more about receiving her campaign donations from insurance companies, agents and brokers than she does about affordable health care for kids.

Let's give her some credit - Ms. Black is right in one respect - it is time to get insurance companies out of the health insurance business and have universal coverage - so no family has to stress out wondering how they will pay for an ill child.  Only Diane Black is right for all the wrong reasons and Diane Black will NEVER vote for universal coverage.

As another worshipping teabagger at the Temple of AynRand,  Diane Black thinks health care is a privilege - for those rich white folks in Tennessee. For the poor - well that is too bad, have the community take up a collection. In addition, Diane Black was on-board with the hate-the-Islamic-Center crowd. She is a true teabagger through-and-throuh - the hate oozes out of her pores.

For showing insensitivity and idiocy early on - Diane Black is the first recipient of the Randbag.

Bachmann Parrots GOP Talking Points on Health Care

Bachmann on Fox: