Unnecessary advocacy on the front page

dieWith wonderful medical advances, humans are able to survive cancer and diabetes diagnoses that would have meant certain death not that long ago. And while these same medical advances and general economic prosperity mean there's never been a better time to grow older, it also means that humans now have prolonged periods of demise that burden surviving family members. The average American lifespan has increased some 30 years since a century ago. Advanced age, dying and death are such huge issues but they don't exactly lend themselves to many news stories. So I love the idea behind the Los Angeles Times' Column One story on assisted suicide. And that's pretty much all I love.

The story, by reporter Kim Murphy, begins with this anecdote:

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. NoNo, 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."

Pancreatic cancer deserves its cruel reputation. My dear maternal grandmother Marjorie suffered and died from it. It's almost always a certain death sentence and a painful one at that. When my grandmother was diagnosed, she and her closest family made the decision against aggressive treatment such as surgery and in support of aggressive palliative care. We put a great deal of effort into managing her pain during the few months of time she had remaining and it really paid off. My grandmother was able to remain sentient and keep pain in control while she prepared for death. It also helped my family navigate questions of whether our views on sanctity of life meant prolonging it no matter what the diagnosis as well as how to respect the life she had remaining. There are no easy answers to these questions, although (if I may add) the process is helped by open and frank discussions and shared moral views.

Anyway, I have no problem with such an evocative story as Wallace's being the entree to a high-profile story on assisted suicide but it should be balanced out by equally heart-wrenching stories showing another perspective lest the reporter be accused of writing a press release for an assisted suicide foundation rather than an impartial exploration of a difficult topic.

Instead, the piece is filled with the euphemistic language of the "death with dignity" crowd. So Washington state, where this story takes place, allows physicians to "help hasten the death of terminal patients." And just to be clear about where you're being led by that opening anecdote, we're given this point of the piece:

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."

This breezy dismissal of moral concerns is woven throughout the piece, never engaged. Instead we get more background on the Wallace family. Here's the sum total of the "personal" response to reporter's lengthy Column One storytelling:

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."

In other words, the nameless doctor in question's actual views aren't given and we're not told why. We are told he couldn't bring himself to end the life of his patient but we learn this not from him but from the family who wanted otherwise. And then we get what has to be a fairly common medical objection but not a particularly engaging one from another doctor in a completely different part of the state. It's also not clear what hospitals' refusal to participate means. Does it mean that they're refusing to take part in it as a matter of principle or liability or what?

We learn that a presentation on the new law, which allows doctors "to prescribe a fatal dose of medication" was met with silence. But we're not told why there was no feedback. Were they horrified that they lived in a society where doctors would be given the right to do this or were they simply bored? I have no idea.

[Benton Franklin County Medical Society executive director Nicole] 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.

Again, a bit of an explanation is in order. Is it that they are appalled that they are given legal sanction to lie about the cause of death that troubles them? Or what? I have no idea:

Through 2008, 401 people in Oregon had opted for what Compassion & Choices prefers to call "death with dignity." So far, three Washington residents have obtained lethal prescriptions under the law.

Proponents characterize the laws as a means of allowing the terminally ill to have some say over how and when they will die.

Critics, including the American Medical Assn., contend that the better response is to offer patients adequate pain medication and reassurance.

If the American Medical Association opposes these physician-assisted suicide laws, it seems like their perspective deserves a bit more exploration than just that sentence above. The article does include a quote from an anti-suicide physician right at the end of the piece but it strikes me as way too little, too late.

The piece ends by claiming that nurses refused to manage Wallace's pain and goes on to describe his demise in detail.

Should the Los Angeles Times be interested in giving Column One coverage to those who don't think assisted suicide is as great as its proponents make it out to be, I'm sure there will be opportunities. I don't recall seeing a story hooked from that 2008 British Medical Journal study about the extent to which potentially treatable psychiatric disorders may influence a patient's decision to hasten death. Or where was that front-page expose last year of the Oregon woman who, when her lung cancer returned, was notified by the Oregon Health Plan that an oncologist-prescribed cancer drug that would extend her life wouldn't be covered -- but assisted suicide would be?

The debate over whether doctors should be forced -- or just encouraged -- to end the lives of their patients is an interesting one. But if you're going to cover the topic, go ahead and cover it fairly. And be sure to cover the other related problem areas in euthanasia laws as well.

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