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Kathryn L. Tucker, JD
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From Legal Affairs, Compassion and Choices, Denver, CO; and Loyola Law School.

Correspondence to: Kathryn L. Tucker, JD, Legal Affairs, Compassion & Choices, PO Box 101810, Denver, CO 80250; e-mail: ktucker@compassionandchoices.org


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):279-280. doi:10.1378/chest.12-2264
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To the Editor:

Dr Van Mol misunderstands the reference to the consensus statement regarding deactivation of cardiovascular implantable electronic devices in my recent article in CHEST.1 The statement is cited not to suggest device deactivation is aid in dying, but as an example of how medical practice in an evolving arena benefits when such a statement or clinical practice guidelines are promulgated, offering guidance on an emerging practice. It is timely for guidelines to emerge regarding the practice of aid in dying, which has been openly available for 15 years in Oregon and more recently in Washington, Montana, and Hawaii. It is likely to become more widely available nationwide as the consensus grows that the option harms no one, galvanizes improved communication and care for all terminally ill patients, and offers a peaceful death to the relatively few patients who choose it. The consensus is based on evidence. Health professionals who embrace evidence-based medicine, including the American Public Health Association, have carefully examined evidence from Oregon and have concluded that the availability of aid in dying poses no danger and offers a desired choice for some patients; accordingly, the association adopted policy supportive of aid in dying.2 Other national medical organizations have also done so.3 Physicians willing to provide this compassionate option to patients experiencing a dying process they find unbearable, despite excellent pain and symptom management, will welcome guidelines that offer advice on handling requests for aid in dying and setting forth best practices. Physicians who opt not to provide it cannot be compelled to do so, although it would be appropriate to refer a patient to a willing colleague, as is the case with device deactivation.

The intent of a physician caring for a terminally ill patient ought to be to support his or her patient in making an informed, reasoned decision that allows the patient to achieve death in the manner most consistent with his or her values, beliefs, and desires. How one dies may be greatly significant. As one philosopher noted, “We live our whole lives in the shadow of death, we die in the shadow of our whole lives.…We worry about the effect of life’s last stage on the character of life as a whole, as we might worry about the effect of a play’s last scene or a poem’s last stanza on the entire creative work.”4

References

Tucker KL. Aid in dying: guidance for an emerging end-of-life practice. Chest. 2012;142(1):218-224. [CrossRef] [PubMed]
 
American Public Health Association. Policy statement database: patients’ right to self-determination at the end of life. American Public Health Association website.http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1372. Accessed September 13, 2012.
 
American Medical Women’s Association. American Medical Women’s Association Position Paper on Aid in Dying. American Medical Women’s Association website.http://www.amwa-doc.org/cms_files/original/Aid_in_Dying1.pdf. Accessed September 13, 2012.
 
Dworkin R. Life’s Dominion. New York, NY: Alfred A. Knopf; 1993:199.
 

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References

Tucker KL. Aid in dying: guidance for an emerging end-of-life practice. Chest. 2012;142(1):218-224. [CrossRef] [PubMed]
 
American Public Health Association. Policy statement database: patients’ right to self-determination at the end of life. American Public Health Association website.http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1372. Accessed September 13, 2012.
 
American Medical Women’s Association. American Medical Women’s Association Position Paper on Aid in Dying. American Medical Women’s Association website.http://www.amwa-doc.org/cms_files/original/Aid_in_Dying1.pdf. Accessed September 13, 2012.
 
Dworkin R. Life’s Dominion. New York, NY: Alfred A. Knopf; 1993:199.
 
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