Life, from its beginning, is a terminal condition, yet it is a gift that brings both joy and suffering. House Bill 54 (short title "Terminally ill: ending life option") aims to hasten death and belittles the value that a person with a terminal disease has to offer. Toward the end of life, patients may fear death, pain, suffering and aloneness. We as a community, both medical professionals and caring friends and family, need to support and accompany such patients on their unpredictable end of life journey.
I am a medical oncologist, a physician caring for patients with cancer. I have been in this specialty for 27 years, including the last 17 years in Anchorage. Alaska state legislators need to let HB 54 die a natural death and not pass it into law.
Here are some problems with the bill:
1. HB 54 states that a patient must have an "…irreversible disease that has been medically confirmed and that will, within reasonable medical judgment, produce death within six months." Doctors are notoriously poor at assessing survival duration. Unless a patient is imminently dying, within hours to days, we cannot predict a survival of less than six months.
When a patient is imminently dying there are many appropriate treatment options: oxygen, morphine, benzodiazepines, and loving support of family, friends and medical personnel. When a physician tries to predict a "less than 6 month" survival, they are relying on published data collected years ago which are not relevant to today's practices and current treatment options.
2. HB 54 implies patients with life-threatening or life-ending diseases do not have alternative options. Advances in management of cancer and other diseases have increased dramatically in recent years. Many patients in Alaska are alive much longer than previously predicted due to new targeted therapies. Chronic leukemia and multiple myeloma are examples with survival rates of 10 years, compared to previous 2-3 years. A patient who lives 1 more year with a new drug, has the potential to receive another new therapy in the future.
HB 54 capitalizes on Alaskans' fear of suffering and abandonment, particularly in our elders. When given treatments to control pain, shortness of breath, anxiety, and depression that do not hasten death, patients then have improved quality of life leading to life-giving experiences. Experts in supportive care are available in Alaska, including palliative care specialists, pain specialists, counselors and support groups, and the No One Dies Alone (NODA) program.
Two patient examples offer hope:
David Wight had stage IV bladder cancer and exhausted all known standard treatments in 2014. I predicted a survival of less than six months. He chose to enroll on a clinical trial with a novel drug (now standard of care) and is alive on treatment with no evidence of cancer, more than three years later. This example speaks to success and unpredictability of new treatments.
Donald Dunkleberger had stage IV lymphoma, which did not respond to standard chemotherapy. Specialists in Seattle declined to offer a life-saving bone marrow transplant due to the unresponsiveness of his cancer. In 2016, I expected a survival of less than six months. Without any further treatment, he is alive two years later without active lymphoma. This example speaks to the inability of expert physicians to predict prognosis.
Unintended consequences of the bill:
1. Alaskans are well aware of our "culture of death." Alaska has among the highest rate of suicide per capita in the country. HB 54 fosters this low regard of life. We need to support and accompany patients with terminal diseases and not offer them the option to commit suicide.
2. Alaskans are all well aware of the financial toxicity of medical care. Several columns by Charles Wohlforth in the ADN have discussed this problem. There is increasing risk of financial bankruptcy for patients treated for cancer. HB 54 will put implicit pressure on patients with terminal diseases to hasten death in order to decrease financial burden on their surviving family members.
We need to turn the culture in Alaska to value and care for our ill and elderly. As caring Alaskans, we can help people without harming them. If this bill is of concern to you, contact your state legislators.
Dr. Jeanne E. Anderson is an oncologist who practices in Anchorage.