Managing Life’s End

By Bob Buddemeier

Let me put this as delicately as possible.  You are going to die.  If you are like most people you don’t know when, where, or how, BUT you have some definite positive or negative preferences about the answers to those questions.

A recent presentation by Jan Rowe, RN (ret) and Athera Brockbank, Clinical Manager for Providence Hospital hospice, laid out the choices to be made and actions taken in anticipation of life’s end – both well in advance and when the end draws near.  Their presentation addressed primarily medical issues, with an admonition to also take care of the paperwork and other advance arrangements: will, trust, designating a health care representative, powers of attorney, mortuary arrangements, etc.

This article is a summary of the key points of the presentation, including guidance on where to find further information. A video of the presentation is available for viewing on MyRVM (Go to MyRVM>Staff Departments & Services>Health Services>Educational Resources>End of Life Presentation 2025.

Record of Preferences:  The do-it-in-advance items are preparation of an Advance Directive (AD) and a POLST (Portable Orders for Life Sustaining Treatment) form – and discussion of the contents with your medical provider and your Health Care Representative, who should be willing to support your choices. These are the places to record preferences such as “do not resuscitate” or “do not intubate,” for example.

The POLST is primarily oriented toward emergency personnel and first responders; it needs to be signed by your Principal Care Provider, and should be posted on your refrigerator door.  The AD is also known as a living will but it does not need to be drawn up by a lawyer or notarized; it must be witnessed by two people. It is a flexible document – although standard forms are available, this can be drawn up in any way you want.  Copies should be given to your medical providers and family or friends who may be looking after you or your interests.

Treatment Options: There are two treatment options to be considered in case of serious or terminal illness, palliative care and hospice.  Both require referral by a doctor. Palliative care is for those who are seriously ill and need special care (e.g., for pain management).  The Providence Hospital palliative care operates though their home health care program, for people who can’t conveniently get to a hospital or provider’s office. It can be combined with a medical treatment program.

Hospice is for those with a prognosis of death within six months. It cannot be combined with medical disease treatment, but it does not need to meet home health care requirements. It is focused on the relief of distress and symptoms and attends to the individual’s emotional as well as physical needs during the final stages of life.

Death Management:  In Oregon, the terminally ill patient who wishes to control the circumstances of their death has two recognized options:  Voluntarily stopping eating and drinking (VSED), and Medical Aid in Dying (MAID), enabled by Oregon’s Death with Dignity (DWD) Act.

VSED results in a natural death, is usually painless, and requires no permission or authorization.  However, one’s doctor should be notified, and the process does require determination and may require 24-hour care.  The official cause of death is recorded as either the underlying disease or dehydration.

MAID is described as follows – Oregon’s Death With Dignity Act provides an end-of-life option that allows a terminally ill, qualified person to legally request and obtain a medication from their physician to hasten their inevitable death in a peaceful, humane and dignified manner at a time and place of their choosing.  To be “qualified,” people must be over 18, competent to make decisions, and able to administer the medication themselves.  They must make two separate oral requests and one written request to the  MD or DO who will write the prescription, and have a second doctor confirm that life expectancy is six months or less.  Death is recorded as caused by the underlying condition.

Information and advice: Jan Rowe and Prathiba Eastwood are End of Life Choices Oregon (EOLCOR) volunteers at RVM.  EOLCOR is a 501(C)(3) non-profit that performs the following services free of charge,

• Make home visits to educate clients and loved ones about all of their choices
• Offer emotional support, especially to those without family or caregivers who agree with their choice
• Work closely with hospice personnel
• Help find supportive doctors and pharmacies
• Offer guidance through the MAID process and info about VSED
• Assistance and presence at planned deaths, if requested

RVM permits MAID and VSED in all living situations except the Memory Support Center.  For information on RVM policy and potential support, see Melissa Preston, Aaron Williams, Fr. Joel, or Linda Bellinson.

The RVM library has an information binder entitled “Resources in the RVM Library and Beyond on Death and Preparing for It.”

Offsite Organizations

END OF LIFE CHOICES OREGON                       503-922-1132
www.eolcoregon.org

VSED Resources Northwest                                   360-919-6363
VSEDresources.com

Oregon Health Authority
Oregon.gov/oha
Search “Death with Dignity Act”

Death with Dignity National Center                    503-228-4415
Deathwithdignity.org

Compassion and Choices                                        800-247-7421
compassionandchoices.org