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Tuesday, November 1, 2011

Watching Dr Oz 11/1/11: Montel Williams and the Euthanasia Debate

The Dr. Oz Show
Airdate: November 1, 2011
Montel Williams' Suicide Attempt

  • The euthanasia debate: should you have the right to die?

The most important health decision of your life that, if not prepared for, could tear your family apart. Should you have the right to die? Half the audience says yes and the other half says no.

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Montel Williams is an award-winning talk show host, actor, and author of many books. For 17 years he was doing three talk shows a day, every week. In 1989, Mr. Williams was diagnosed with Multiple Sclerosis and it tore him apart, emotionally and physically. Quickly the disease progressed to unbearable pain that would not respond to medication and doctors didn't know what to do for him. At that point he thought about killing himself.

As a former military man and gun enthusiast he has guns in his house and thought if he laid out all his guns to look like was cleaning them he could make his suicide look like an accident and no one would know. But he couldn't do it.

Then he tried jumping in front of a taxi cab and it changed his life. He realized that he couldn't put the people in his life through the experience of taking his life in that way instead he wanted the dignity to make the choice to be able to take his own life if, and when, he felt necessary.

Dr. Oz asked Montel, what is a doctor to do when what the patient asks violates the Hippocratic Oath? Montel wants doctors to stop rationalizing what harm is. He asks, is it rational to let someone go through excruciating, horrific pain? Montel would beg doctors to stop being psychic, to listen to the patient, and he feels that doctors should get out of the right-to-life argument completely because he believes there should not doctor assisted suicide, he believes people should be able to end their life on their own.

Do you have the right to end your own life?

[Now the heated debate begins. There was arguing, there was interrupting, there were personal beliefs shared and lots of disagreements. The Dr. Oz website has clips from today's show with bits that were not aired. The following is a simple summary of the general issues raised by guests and audience members.]

Keith Ablow, MD, psychologist, [author of several books including the psycholocial of Casey Anthony] and Fox News contributor, believes doctors have to be on the side of prolonging life no matter the degree of pain the patient is experiencing. People already have the right to end their life by refusing medical care. Dr. Ablow is against the medical profession taking part in ending a patients life, including discussing the issue with patients.

Dr. Ablow argues that in Sweeden, where euthanasia is legal, that most people end their lives due to depression and not a medical reason.

On the other side, Montel counters that in Oregon, where citizens have the right to take their own lives, most people who go through with suicide are doing so because of illness that has taken their chance of survival and their dignity – a word, he says, is defined by the individual.

Dana has faced this same question. An athlete, honor student, mom of two kids, active and happy she always thought she had a good future ahead of her. She began losing muscle control and could not hold or grab anything. In 2003 she was diagnosed with a neuro-muscular disease and was given 3-5 years to live. Almost 9 years later, the only thing she can do for herself is speak. She can't walk, roll over, scratch her own itch. She says she's depressed and tired of being alone. People tell her she could be worse and she's left stunned because she feels she's in hell.

Dana says she has a great family but there is no future. She can no longer run, or lay basketball with son or take her 17-year-old daughter shopping. Doctors say she's stable. She says: I'm not lucky, I'm existing.

Her son Anthony, he would like to see her here to see him progress in his life as she makes him stronger as a person. Her daughter who has been there from the beginning and seen her progress to now where she's bed bound. It hurts. She always had plans of doing things to do with her mother and she can't do those things. Her daughter says she know she's tired and she's had enough. She don't want her mother to suffer. Her daughter encourages her to take that cocktail and kill herself.

Dr. Oz asks Dana if she would take her own life and Dana replies “yes, I would.” She says she's failing inside. If there was something out there for her to take, she would take it.

In a nationwide poll, Dr. Oz asked his viewers if they believe doctors should help patients end their own lives and 54% said yes while 37% said no and the rest were undecided.

Another guest on the show was also diagnosed with MS almost 20 years ago. He said in the early stages of the disease he would have taken the option to end his life if but now he is grateful that he didn't. He says he wouldn't give up this life for anything and encourages Dana to come and be with the disabled community and find what he has found – strength, love and a desire to live.

Montel wanted to make it clear he felt pitting patient against patient isn't the way to discuss this issue, he loves the show, but feels this approach isn't the best way.

Dr. Oz interjected that his intent was not to pit patient against patient or person against person but to get people to talk about the issue.

Dr. Ablow stated concerned that Montel is speaking to people who are already on the edge of taking their own lives and that these people would be angered by the proposition of seeking out other alternatives and searching for more answers or support. He gives the example of the man who at one point wanted to take his life but who would have thought that someone in his place could find love of a great woman and would now be working to support the disabled community.

The audience provided varied and poignant views and stories.

One expressed her belief that life in any capacity is a gift from God and even if you only have a voice, it's God's voice.

Another told about her grandmother who had breast cancer and felt comforted to be in control of her own death. The granddaughter now works with compassionate people to let others know about suicide is an option and help the topic and the act to come out from under ground.

Gustin Reichback, New York Supreme Court justice living with pancreatic cancer shared that he is eager to live. Justice Reichback believes that this is an individual issue. He says he is realistic in the knowledge that at some point when therapies have been exhausted, he will have to face the reality that medicines will only prolong his dying instead of providing a meaningful life. Then he will consider if he's better off dead. To him, it's a question of rationality and morality. He explained that the state plays the role of rationality to make sure the decision is informed and that the patient is sound but the state does not have the right to tell him that his prolonged suffering is a moral duty.

Devon Webster MD, an oncologist living with MS, was hospitalized extensively as a teen, was in a wheelchair and on a respirator. Dr. Webster wants people to consider the death with dignity act. She feels it's her duty as a medical professional to talk with patients about end of life decisions. Technology has proven able at prolong life without regard for quality of life and she doesn't believe that is always the right choice. Dr. Webster says she is an expert in talking about end of life discussions and Dr. Ablow feels she should not share his profession with that belief.

Dr. Ablow is concern that we don't know what is around the corner, what the next day will hold for us, and that taking a life, your own life, will take away an opportunity that could be life saving.
Further the opposing side, Montel expressed that to him, it's not not fair for Dana to be around only to motivate people with concern for her quality of life or her well being.

Barbara Coombs Lee of Compassion and Choices, based in Denver, Colorado explained that the aid in dying act in Oregon is not for people who are giving up life due to reasons such as depression but it is for people with no other treatable options to terminal, medical conditions for which the only option is to find out what is life going to look like with a terminal disease.

Dr. Oz said we are faced with a public health crisis about how to die and we end up not doing it right in America. 

Ira Byock, MD, president of the American Academy of Hospice and Palliative Medicine [and author of the book Dying Well.] believes that Dana could have been allowed to die with dignity from her multiple bouts with pneumonia by refusing care. She and her family say that was never explained to them as an option. He cites the example that we treat our pets better in this country by not allowing them to suffer through life ending illness, not putting them on respirators or machines because we understand that it's not an option to allow them suffering.

Number One Thing to Do Today
What should we be talking about with regard to end of life discussions? The vast majority of people die because of their illness and have not had a discussion with their loved ones about how to handle a life-threating illness.

Dr. Ken Prager, MD at Columbia University Medical Center encourages everyone to make arrangements for a proxy – a trusted person who will represent your choices when you are unable to communicate.

Dr. Prager recommends beginning the discussion with a doctor at regular health visit and request the form. Dr. Oz disagrees stating that from his experience people don't see their doctor regularly enough and they don't bring up the subject when they have an appointment.

Dr. Oz says it's important to discuss those hard questions of how you want your life to end, under what circumstances would you want your life prolonged and when would not want your life prolonged. Go through the “what if's” and think about what is important to you then, discuss it your family or trusted people and put the decisions in writing – they can be changed at any time.

Dr. Oz stated seriously and frankly: “[Doctors] have the incredible ability to torture you if that information is not available”

It's an extremely difficult circumstance for loved ones to make those decisions and he would rather that we not put that responsibility onto others. Dr. Oz says it's your duty, today. to print and complete both an Advanced Directive and a living will. Make the decisions on who will take charge of your care when you are unable.

What is Dr. Oz's stand on this issue. He stated specifically that he believes in the case of terminal illness when people can no longer enjoy a quality of life then their doctor should be able to pharmaceuticals to help their patient end their life. He believes that doctors should help people in desperate situations and encourages everyone to talk freely and openly about death with their family.

Click here to download your state-specific Advanced Directive and outline the care you do and do not want. Advanced Directives are valid only in the state for which they are created.

[I think the basic take-away from this episode is that it's OK and encouraged to discuss death and how it can and will be handled but that the decisions are intensely personal and unique to every person and situation. I believe there is no all encompassing right answer but that there are many right answers for each person and the challenge is to find the answer that fits. From hearing Dr. Ablow speak and respond to audience members, I came away with the impression that the feels doctors should not be included in the discussions of end of life options and I feel would leave out a potentially vital resource.

It's personal, it's hard and it's not something we want to think about: death. But life comes with a built in ending: death. To me, it makes more sense to be prepared rather than ignore.

Years ago, the father of a co-worker who was in the early stages of MS shot himself, he said in a note, rather than allowing his family to take on the burden of his care. He left a wife and four children. It seemed to be the easy way out and at the same time, it seemed too soon. He was functioning in life, but, I can only guess and speculate, he may have already felt a loss of his life. I think he took his life as a way to allow his family to have, what he saw, a better future.

Five years ago tomorrow, my family and I turned off life-support for my father and he passed away after suffering a massive heart attack days before and in the throws of multiple organ failure. We knew what choice my father would make and, as a family, we discussed it and talked with every doctor and nurse involved in his care. Honestly, the nurses were more helpful, upfront and informative than the doctors and each of the nurses had spent more time with my father than the doctors, in my experience.

Words can be so lacking. Losing is a parent, a loved one, is devastating even under “ideal” circumstances. But knowing that, when faced with death and unable to speak, my father was able to have the experience he would have wanted is absolutely precious. We were fortunate – see, stamped with lacking - that in knowing what he wanted, we were confident in our decision and we made the decision as family with the singular goal of what was best for him. We all agreed to put aside our own wishes and focus on his choices. My father passed, peacefully, on his own terms, surrounded by his family. It's still hard...but it was a beautiful passing that I will hold with me...]

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  1. what if you are in an emotional coma ? and all else has faild.

  2. I would say keep trying. There are as many options for treatment out there as people on the planet. If you've tried a counselor and that didn't work keep looking for one until you find someone who you connect with. The world may seem dark during these times but there are so many ways to find help. Don't give up. Keep asking questions until the answer resonates with you.