PORTLAND, Ore. — Even after he got sick, even after he'd been fighting the cancer for years longer than doctors expected, Mark Kobayashi didn't think about dying. He always tried to control his body with his mind. Shortly after having a third of his colon cut out, he was sitting up in bed like a king. I have to put all my energy down into my stomach so I'm healing, he declared. He didn't want to have bad thoughts. He didn't even want his wife, Joan, to have bad thoughts. Stop that, he'd tell her, you'll weaken me.
Now, though, he was lying in an Oregon hospital bed, barely conscious, wracked by pain, drained by hours of vomiting. It was early this year. His planned two-day stay in the hospital for a catheter implant had stretched to six. His body had gone into shock. They couldn't get the medications right. They couldn't stop the vomiting. Tumors filled Mark's lungs and spread along his spine; the most unbearable clenched his hip near the sciatic nerve. Peering up from his bed, he could see a young doctor standing over him, making small talk to a nurse.
Mark was 67, a retired elementary school teacher revered by his students. Friends knew him to be calm, centered, unafraid of making decisions, gloriously free of baggage. His wife of 34 years thought him that rarity, a truly happy man.
He'd lost the battle, he saw that now. He was closer to the end than he'd thought. It was nearly time to go.
You deal with things when they come up, not before. That's what he always told his wife. Dying had finally come up.
"I'm not going to go through this again," Mark told those gathered around his bed. "I want to talk about a legal way out."
For a moment, the hospital nurse didn't understand. A legal way out of this procedure? she asked.
No, Mark's son, John, explained. He means a legal way out of life.
So began--for patient, relatives, doctors, nurses and counselors alike--one more pioneering encounter with Oregon's unprecedented Death With Dignity Act.
Oregon is the only place on Earth that has a law offering patients the option of physician-assisted suicide. When Mark Kobayashi first spoke from his hospital bed about "a legal way out," the statute had been on the books for just 15 months and had been in use for less than a year. During that time, 15 people had invoked the law, dying after taking lethal medications prescribed by a doctor.
Those deaths have done little to diminish the furor over the Oregon statute. After three years of court battles and two election-day victories, physician-assisted suicide continues to provoke highly charged ethical, legal and medical debates. Across the country, the notion of doctors legally helping patients die has generated as much divisiveness as any societal issue in recent decades. It has been called everything from "the abortion issue of the next century" to "this century's civil war." It has enraged the American Medical Assn., the Roman Catholic Church and the U.S. Congress. It has galvanized priests, lawyers, pundits, legislators, professors, regulators. Most recently, it has inspired a powerful counterattack: On Oct. 27, the House of Representatives passed a bill that would effectively overturn the Oregon law.
Yet--as Mark Kobayashi demonstrated--physician-assisted suicide in Oregon is no longer a matter mainly for abstract debate. Now the matter rests chiefly in the hands of patients and families, doctors and nurses, hospices and pharmacists.
Those asked to implement Oregon's statute are still feeling their way. Although legal, the process of helping someone die has the covert feel of the underground. The advocacy group Compassion in Dying operates out of an unmarked Portland office rather than the address on its letterhead. Those few hospice nurses who attend their patient's death do so secretly, not as professionals but as family friends. Many doctors are unwilling to participate in any way. Of the handful who do, only three have publicly acknowledged assisting a suicide.
Such hesitancy and confusion is not hard to fathom. Oregon's Death With Dignity Act has dragged onto the public stage a complex, ambiguous, intensely personal matter that for centuries has been handled privately between doctors and patients. It has first politicized, then codified, one of the most basic and enigmatic of human concerns. It has required Oregonians to forge their way through an ethical wilderness. It has asked a state to regulate what approaches the incalculable.
Yet it has done something else as well: It has empowered patients.
I want to talk about a legal way out. Talk Mark Kobayashi did. Soon enough, lying in his hospital room, he was listing those whom he wanted with him when he took his lethal dose.
His nurse from Mt. Hood Hospice, Margaret Ann Stochosky, agonized over her inclusion: Her hospice--committed to caregiving, pledged to "neither prolong nor hasten death"--didn't allow such participation.
His son, John, winced: He didn't want his dad to die that way. He didn't like the whole idea.