After an event to celebrate and remember people who have died at JHC Hospice in Worcester, Massachusetts, Rev. John G. Pastor, reflected on changes he’s seen in Massachusetts hospice care since the narrow defeat of the proposed Death with Dignity initiative in 2012. In an interview with The Worcester Telegram & Gazette, he remarked the most notable change has been more and more people are talking about hospice in a positive light: “It’s good to have increased conversations, and even debates, about honoring wishes at end of life. Even though [the initiative] failed, it brought to light and affirmed our work in so many ways. There is really an awareness.”
Others at the hospice event, including some who opposed the bill, also acknowledged the Death with Dignity initiative broadened the public discussion about hospice care. JHC Hospice Director Ann Marie LeBoeuf noted, “In our society, people are not comfortable talking about death. It is dark. But now that it was a public issue, people do speak of it and talk about what they want.”
Improvements in End-of-Life Care Conversations
This has also been the case in states with Death with Dignity laws (Oregon, Washington, and just this year, Vermont). Prior to Oregon voters approving the Death with Dignity Act in 1994, many hospice workers expressed concern that the mere existence of the law would encourage people to request the medication rather than pursue other end-of-life options like hospice and palliative care. Unfortunately, this false dichotomy persists even today in states without Death with Dignity laws. In reality, shortly after the Oregon law went into effect in 1997, many doctors and other healthcare workers found conversations about end-of-life care improved.
Since the passage of Oregon’s law, the state has become a leader in many aspects of end-of-life care, and Oregonians tend to be more knowledgeable about hospice and palliative care than people in other areas of the country. Since the passage of the Washingtons Death with Dignity Act in 2008, awareness has increased there as well. According to a poll conducted by the National Journal and The Regence Foundation, overall knowledge of end-of-life options like hospice and palliative care is higher in states with Death with Dignity laws.
In our society, people are not comfortable talking about death. It is dark. But now that it was a public issue, people do speak of it and talk about what they want.
Not only do Death with Dignity laws provide a safeguarded framework to request the prescribed medication, they stipulate that the discussion must also include all feasible options including hospice and palliative care. People who exercised their rights under the Oregon and Washington Death with Dignity Acts utilized hospice at a higher rate than the national average. In 2012, 97% of people who requested the medication allowed under Oregon’s law and 92% of those who died in Washington were also enrolled in hospice.
The mere existence of the law creates a possibility for doctors and terminally ill patients to have an open and legal conversation about assisted death and all end-of-life options. This is what we strive for by promoting Death with Dignity laws based on our model legislation, the Oregon Death with Dignity Act. Our aim is twofold: to provide an option for dying individuals and to stimulate nationwide improvements in end-of-life care. Together we can make the difference.
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