The very public suicide this week of a Placerville, Calif. man suffering from severe emphysema raises prickly medical and ethical questions that many would prefer not to mull.
Most pointedly: How bad does the suffering have to get before a patient says, enough, and takes his life? And, how can a patient and medical provider manage terminal illness so that people aren’t driven to take their own lives?
For Allan Leo Peters II, 64, those answers weren’t forthcoming. He hanged himself Wednesday from a local bridge after delivering a note to a local newspaper, calling his condition unbearable.
“My life has been drastically altered in the past few years,” he wrote, “and I believe in euthanasia.”
Euthanasia has been widely debated in the country for decades. Only Oregon and Washington have passed physician-assisted suicide laws; in California, it is a criminal offence. But advocates say it is one answer for people desperate from the suffering and poor quality of life due to illness.
“One of the reasons why the people of Oregon approved the Death With Dignity law is because it does act to prevent these types of violent and tragic suicides like this (Placerville) man,” said Peg Sandeen, executive director of the Death With Dignity National Center in Portland, Ore.
“Advanced emphysema is incredibly debilitating and painful and it’s very difficult to continue to live with.”
Even those on opposite sides of the contentious assisted-suicide debate would agree that Peters’ death constitutes a tragedy.
One answer for end-of-life care, according to Dr. Robert McCarron, medical director of the University of California, Davis Internal Medicine and Psychiatry Clinic, is for physicians, patients and family members to talk openly about what lies ahead.
McCarron said he was unfamiliar with the circumstances surrounding Peters’ death or his physical or mental health history. But he recommends, generally, that physicians be as open as possible with patients.
“You need to talk only with the patient about any thoughts of suicide or euthanasia,” McCarron said.
“Stories like this raises red flags for physicians,” he said.
“Almost half the people who end up killing themselves in this country have actually seen their primary-care provider within one month of doing so. Screening for depression and asking about it is paramount. Don’t passively assume that someone’s not going to suicide.”
Managing pain is a key to a humane handling of a long-term illness, experts say.
“We really believe uncontrolled pain is a medical emergency, not a reason (to end life),” Sandeen said.
Pain medication can be used for late-stage emphysema patients, according to Dr. Fred Herskowitz, a Bay Area pulmonary disease specialist and member of the American Lung Association of California board.
“There are a lot of medications available for the shortness of breath and, in the end stage, we do use opiates, powerful narcotics, for the dual purpose of relieving pain and to reduce the feeling of shortness of breath,” he said.
No matter the illness, patients need to advocate for themselves for pain management, McCarron said.
“It’s not OK for people to live with tremendous amount of pain,” he said.
Peters’ suicide note, delivered to the Mountain Democrat newspaper office Tuesday night, details a life made unbearable by emphysema, a lung disease that results in obstruction -- and eventually -- destruction of the airways, which causes the lungs to transfer less oxygen to the bloodstream.
Many advanced emphysema patients are forced to use oxygen tanks to increase breathing volume.
According to figures compiled by the American Lung Association, there are 25,402 emphysema patients in the 2,109,832-resident four-county (Sacramento, El Dorado, Placer and Yolo) area where Peters died.
“I really cannot convey to you how very hard it was even to try to take a very deep breath,” Peters wrote.
As debilitating as pain can be, Sandeen said her organization’s figures show it is not the leading reason why terminal patients seek assisted suicide.