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Column One

Dying for a way out

It's an agonizing end for one man as rural doctors balk at a new

May 07, 2009|Kim Murphy

KENNEWICK, WASH. — Stephen Wallace had watched his wife die of cancer 22 years ago, using up the morphine as fast as they could put it into her and begging for more. No, he said then. I won't let this happen to me.

So when he was diagnosed with an advanced case of pancreatic cancer March 8, and given a few days to a few weeks to live, Wallace hoped to go quickly. He told his doctor and family that he wanted to take advantage of Washington state's new law allowing physicians to prescribe a fatal dose of barbiturates to terminal patients. His five children agreed, but his doctor balked, citing moral reservations.

The family appealed to the hospital, got nowhere, and called two other hospitals in towns nearby. None of the doctors in the area was willing to give Wallace, 76, the pills for his deadly sleep.

Cancer of the pancreas has a cruel reputation, delivering what some say is the most intense pain humans can imagine. It killed Wallace on April 8.

"It was very hard to watch my father die that way," said Tricia Crnkovich, who took turns with her brothers and sisters in Wallace's small bedroom as he shrank from 250 pounds to 60, losing most of the weight in the two months before he died. "I'll tell you, if I ever get cancer," she said, "I don't want to put my kids through that."

On March 5, Washington became the second state in the nation to allow physicians to help hasten the death of terminal patients. Oregon legalized a nearly identical "death with dignity" statute in 1997, and the courts in Montana have ruled that the right to privacy extends to patients seeking a doctor's help in ending their lives.

But outside the larger population centers around Seattle, Tacoma and Olympia, many physicians are unwilling. That leaves residents east of the Cascades who choose to utilize the statute with the same problem women seeking abortions in conservative rural communities have faced: It's legal, but health providers' moral qualms mean it's essentially unavailable.

"We knew that it would be harder to find attending and consulting physicians in more rural areas," said Robb Miller, executive director of the advocacy group Compassion & Choices of Washington. "It's going to take time to get people educated about the law . . . and build up trust and confidence among the physicians -- many of whom support the law and want to use it, but who might not be ready yet to make the leap."

Wallace raised his family here amid the arid farmland that spreads out from the confluence of the Columbia, Snake and Yakima rivers. The growing popularity of Washington's wines have lent a certain cachet to an otherwise bland expanse of fast-food restaurants, budget hotels and modest neighborhoods.

The area also is home to the Hanford nuclear reservation, where plutonium for the atomic bomb that was dropped on Nagasaki, Japan, in 1945, was manufactured. Hanford has since become a nightmare of leaky, poisonous tanks and a testament to the difficulty of cleaning up nuclear waste.

For most of his life, Wallace worked at Hanford. His job was one of the more dangerous ones, transferring the facility's perilous brews from tank to tank. His work there, Crnkovich and her siblings believe, led to his cancer.

From the moment he was diagnosed, the family said, Wallace refused even to go into hospice care. "When he retired in '94, he said, 'I bought this bed, and I will die in this bed,' " said his daughter-in-law, Ginny Wallace.

But Wallace's physician could not bring himself to assist, the family said. Dr. Idar Rommen, a family practitioner in Snohomish County -- another largely rural Washington area where most hospitals have refused to participate in the new law -- understands why.

"To me, personally, giving a patient a suicide pill is like abdicating my role," Rommen said. "I'm here to heal and to make better. And the other just doesn't seem like that's what I went into medicine to do."

The extent of the hurdles patients face in the Kennewick area became clear during a recent physicians' briefing that the Benton Franklin County Medical Society held here. The presentation on the new law, which allows a physician to prescribe a fatal dose of medication after a second qualified doctor also has certified that the patient is terminal, was met with silence.

"There was no feedback," said executive director Nicole Austin. "We're trying to walk a very neutral line. It's their decision as physicians if they choose to participate. I sense that it will be a challenge in this community."

Only about a third of Washington state hospitals have opted to allow their doctors to assist terminal patients under the law. Austin said many doctors are especially uncomfortable with the requirement under the law that physicians list the cause of death as the terminal illness, not suicide.

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