The Day I Die by Anita Hannig

Author:Anita Hannig
Language: eng
Format: epub
Publisher: Sourcebooks
Published: 2022-05-15T00:00:00+00:00

Six months might seem like an arbitrary threshold for saying that someone with a terminal illness is close to death. Why does a patient who is within six months qualify for an assisted death but not someone who is seven months or a year away?

When the Oregon Right to Die committee drafted the original bill, they narrowed in on the six-month requirement as a cutoff point because it overlapped with the admission criteria for hospice. A patient must be within six months of the end of their life to be admitted to a hospice service funded by Medicare. There’s one big difference: if a physician refers someone to hospice and they outlive their prognosis, there are no consequences. A small minority of patients are on hospice for years. As long as they show continuous decline, they will remain enrolled. But if a physician underestimates the time an assisted dying patient has left, they may cut short a life.

Prescribing physicians like Blanke know that some primary care physicians play it fast and loose with the six-month benchmark for hospice—especially when dealing with an elderly patient with multi-system failure who expresses an interest in hospice.

“The six-month requirement for hospice is the softest requirement you’ve ever seen,” Blanke explained. “I’ve never seen anybody turned down for hospice, and it’s not unusual for somebody to live for eight months, or twelve months, or eighteen months on hospice. And then you say, ‘Oh well, I was wrong.’ But the problem is, assisted dying is irrevocable. So those six months, they are real. You really have to believe that someone is imminently dying.”

For that reason, prescribing physicians cannot rely on existing prognoses for hospice. Besides, even if a patient is already on hospice, they may not have received a specific time frame from their provider. Prescribing physicians must therefore apply their own metrics and criteria to determine if a patient with a serious illness is likely to die within six months. And making that kind of prediction can be daunting—it introduces the possibility for uncertainty and error.

Elizabeth Steiner Hayward, a physician and state senator in Oregon, knows how heavily the responsibility for making a correct prognosis weighs on prescribing physicians and how difficult it is to get it right. She says it sometimes keeps her up at night.

“One of the biggest challenges of any physician is to predict when someone’s going to die,” she told me. “We’re not God.”

Steiner Hayward remembered vividly a case from her private clinical practice, when she diagnosed a male patient with stage-four lung cancer. The patient declined treatment, which put him at a life expectancy of three to four months, according to available statistics. His oncologist concurred. But the patient was adamant about walking his daughter down the aisle the following summer. Nine months later, he did, and he died a month after that.

If Steiner Hayward had been asked to assist with his death, she would have determined that he had less than six months to live—when in fact he had ten.

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