Physician-Assisted Suicide
Price of Paradise · Hawaii Public Radio · aired 1995-12-17
Guests: S.Y. Tan (Professor, University of Hawaii John A. Burns School of Medicine); Norman Goldstein (Professor, University of Hawaii John A. Burns School of Medicine)
Duration: 1:00:03

[0:00:03] Randall Roth: Good morning. This is Randy Roth, host of Pop Radio. We're broadcast live each Sunday morning at 8 on KHPR 88.1 and KKUA 90.7, and then rebroadcast Sunday evenings at 8 on KIFO, that's 1380 AM. Everyone who helps bring the show to you is a volunteer. We do what we do because we enjoy doing it, and because we strongly believe in the importance of lively and informed dialogue. Our sponsor is the Hawaii Community Foundation, an organization that encourages grass-root efforts to build a sense of community, and that manages charitable funds with efficiency and compassion.
[0:00:38] Randall Roth: Our topic today revolves around something that many of us find uncomfortable to discuss or even to think about. And that is the inevitability of death. Some people might suggest that we not talk about it simply because it is inevitable. That is, no amount of discussion will prevent us or our loved ones from dying. But others say society's failure to really confront the inevitability of death has caused many people to die a slow and painful death and for society's precious resources to be wasted. My guests in the studio this morning to discuss this topic are Dr. Norman Goldstein and Dr. S. Y. Tan.
[0:01:14] Randall Roth: Norm is a clinical professor at the John A. Burns School of Medicine, editor of the Hawaii Medical Journal, and is in private practice specializing in diseases of the skin, hair, and nails. Dr. S. Y. Tan is professor of medicine at the John A. Burns School of Medicine, and chairs the ethics committee at the St. Francis Medical Center. He also is a licensed attorney.
[0:01:37] Randall Roth: Well, S. Y., um, first of all, do we have some, uh, some agreement on this issue of death and dying and the physician's role in in death and dying? And and I guess I I should start by by sharing a quote with our listeners. Uh on page B3 of this morning's advertiser, in addition to articles by you and and Norm, there's a column by Art Kaplan, and he starts it by saying, we've made a complete mess of dying, turning it into a lonely, isolated, painful, and expensive process. Um, do you agree with that?
[0:02:08] S.Y. Tan: Well, in large part, uh, Randy, that's true. Uh, it is, of course, an exaggeration because we do help the majority, the vast majority of of our patients die a peaceful and relatively painless and comfortable death. Mhm. Nonetheless, there are many instances where we as a healthcare profession can do a much better job uh, to be sure that we respect, uh, the dignity and comfort of our patients. Uh their wishes about dying naturally, uh about pain control, about gentle death as opposed to a wild death in the intensive care unit. Um
[0:02:43] Randall Roth: Let me stop you there and just see if if Norm agrees with everything so far, because I know based on your articles in this morning's paper that there is at least one issue that you disagree on, but Norm, do you agree with what S. Y. has said thus far?
[0:02:54] Norman Goldstein: Yes, Randy. In general, I agree with most of the things S. Y. has said over the years, not just right now. Uh, unfortunately, there are too many people who are dying in institutions. In fact, 80% of the people who died in 1985 died in institutions. 2 million people died in institutions, whereas just about 10 years ago, most of the people died at home.
[0:03:16] Randall Roth: And you would say that that's a problem that so many people are dying in institutions.
[0:03:19] Norman Goldstein: That's the major problem.
[0:03:21] Randall Roth: Why is it happening?
[0:03:22] Norman Goldstein: Well, physicians are trained because of the Hippocratic oath and their emotions, their training, to prolong life. And unfortunately, too many continue to prolong life way beyond the point when life should not be prolonged, not just for the patient, but for the family.
[0:03:38] Randall Roth: Okay, S. Y., are we still in basic agreement?
[0:03:40] S.Y. Tan: Still in basic agreement. One shouldn't forget that one reason why so many patients come to the hospital for their for their illnesses and for treatment, it's because uh, they choose to do so. Uh the doctors or the nurses and the hospitals don't go out there to drag them into the hospitals. Uh many of them go there because they need the support, they need the uh, treatment, and the family uh, is unsure how to handle uh, perhaps uh death or dying in in in in the home situation. Furthermore, some of these conditions, many of them, in fact, may be reversible. That's difficult for a lay person to know, whether or not uh, uh, to give up uh at at first glance. Having said that, however, I must I must say that uh, increasing numbers of individuals are staying home to die a peaceful death and uh, all to enroll in what we call a hospice, a setting where terminally ill patients live out their last uh weeks and months uh in relative peace and comfort without uh in uh medical interventions uh of the invasive sort. So these are all good moves.
[0:04:40] Randall Roth: And and you're a big supporter of of the hospice, and I know Saint St. Francis was a leader in setting up a hospice. Norm, are are you in agreement so far?
[0:04:47] Norman Goldstein: Very much. Thanks to Sister Maureen, who recently died and Bud Smiser, we have, I think it's eight hospice centers here in Hawaii, and we need more. It's not just the con- it's not just dying, it's the concept of a comfortable, pleasant way to go. We don't have to keep on keeping people alive.
[0:05:05] Randall Roth: And the hospice, as I understand it, is basically available to people who are who are terminally ill, which is typically defined as as someone who has given less than 6 months to live. S. Y., that is correct. Mhm. Okay. So both of you like the fact that we have um, more and more interest in in hospices and more and more hospice opportunities for people who are terminally ill. What about living wills? S. Y., can you give us a a brief explanation of what it is, where you stand, and then we'll see if Norm's in agreement.
[0:05:31] S.Y. Tan: Right, in 86, 1986, Hawaii enacted its first law on living wills. This is basically a legal mechanism where an ordinary person while able and alive and well, can put in writing his or her wishes about what they may not want when they are terminally ill. So they put on paper their wishes so that when they become terminally ill or comatose, irreversibly so, uh the physicians will respect their wishes.
[0:05:58] Randall Roth: So so they could actually say, don't give me nourishment, don't give me hydration, which which we know will eventually result in that person's death, and the physician has to honor that?
[0:06:06] S.Y. Tan: And the doctor has to honor them and they can decide to forego all forms of medical treatments, including artificial fluids and nutrition. And this was written into our our law in 1991. You don't have to be terminally ill now, all you have to be is to be irreversibly comatose, unconscious, um, with no permanently so with no hope of recovery. And the legal language is where you are unable to communicate meaningfully about medical decision making.
[0:06:30] Randall Roth: Are you a supporter of living wills?
[0:06:33] Norman Goldstein: Very much so, a staunch supporter of living wills. And it is a very powerful argument why we should hold a line just at this point and not just go down the road a slippery slope further. What I mean here is uh we have living wills, we have a legal mechanism and yet only a small minority of the population has living wills. When we looked at hospital admissions over the past 1 year at a major hospital in town, only 8% of the patients had living wills.
[0:06:56] Randall Roth: Okay. And and so I have the terminology straight, as I understand it when we talk about a living will that gives instructions to uh to not provide hydration and nourishment at certain point in time, knowing that that will cause death, that that's a form of what some people call passive euthanasia?
[0:07:12] S.Y. Tan: Passive euthanasia is one phrase used to describe this.
[0:07:15] Randall Roth: Okay. And so when it comes to passive euthanasia and and living wills, you're a staunch supporter.
[0:07:19] S.Y. Tan: That's correct.
[0:07:20] Randall Roth: Norm?
[0:07:21] Norman Goldstein: I am without also. I go a step further. Some patients do need more active support. Not necessarily Kevorkian's type support, putting the bag over the face or, you know, aggressive things like that. But the patient could be given the opportunity to do this themselves. I I have to give you a personal uh interjection at this point. For about 20 years, I carried a card in my wallet that said under any circumstances, keep me alive.
[0:08:00] Randall Roth: Whatever you have to do, my physician, you keep me alive. And this was 20 for 20 years. About the 8 or 10 years ago, I took that out of my wallet, and I now have a living will and I don't want to be kept alive because I realize what's going to happen to my family, my loved ones left over. Death should be remembered by the family as a pleasant situation. And the living will situation, uh the agreement we have, the legal thing we have now S. Y. is great. I just wish more people had it.
[0:08:12] Randall Roth: Okay. Now, so far, the two of you have have agreed basically on on everything we've talked about, but the name Kevorkian was just raised, and this is the fellow that some people call Doctor Death. Uh Norm, can you describe just a real quickly what Dr. Kevorkian has been doing and what your opinion is on those actions?
[0:08:29] Norman Goldstein: Dr. Kevorkian has been uh assisting, physically, actively assisting people to end their lives, either with injections, uh with various medications, massive medications, where they are terminal. Uh there was one recent case where it may not have been terminal, but in most cases, these people were going to die, they requested assistance with their suicide. The problem is in all states right now, this is illegal. Dr. Kevorkian has been in jail for short times, and right now he's out. We have a minister here in Hawaii from uh Michigan, uh who has been the only minister working with Dr. Kevorkian, and unfortunately, he couldn't be uh around right now, but he's been very, very supportive of what Dr. Kevorkian is doing, and I personally feel the same way. I as a dermatologist, could not inject the patient, I could not put the gas mask over the patient. And there are other ways to do it and other physicians should be more actively involved with helping their patients at those last few days.
[0:09:26] Randall Roth: And is it accurate to call this a form of of active euthanasia or a form of of mercy killing, or physician-assisted suicide?
[0:09:34] Norman Goldstein: Uh yes it is. It's all three. The Hemlock Society, as most of the audience know, uh is involved with passive assistance, but we're also interested in more active assistance when it's called for.
[0:09:46] Randall Roth: Okay. S. Y., I assume this is where uh the roads diverge.
[0:09:51] S.Y. Tan: Yeah, Randy. Look, um, a couple of points. Uh, just to finish up on the living will uh legislation and why so few of our population uh indeed uh has such a living will and such a uh what we call it advanced directive. One reason is because uh of the suspicion of medical institutions and their fear that doctors and others will do them in prematurely. So they don't want to sign this form which says, don't treat me or don't over treat me when I'm at death's door. Uh they're they're they're they're nervous. If we were to legalize active uh um euthanasia, mercy killing, it will just be another reason why many more people will not execute a living will. And that would uh set us back in our educational efforts to tell our population the true and real and genuine advantages of living wills.
[0:10:37] Randall Roth: So one positive step, the living will, uh is hurt, you would say, by anything that would support the next step, which is active euthanasia or mercy killing.
[0:10:46] S.Y. Tan: Yes, we should hold a line right here at a living will level and we still have ways to go yet to to educate and inform our public about how useful such a document is.
[0:10:54] Randall Roth: Okay. And I know you've got other reasons to say you disagree with Norm, and I want to get Norm's reaction to that, and then I'll come back to you S. Y.
[0:10:59] Norman Goldstein: This is very important that's why, physicians are not active enough in getting permission from their patients for not only living wills, but getting autopsy permission. As an intern, I had the trouble and most of our physicians have, they're embarrassed to ask, they're awkward, it's just uncomfortable to ask for autopsy permission from relatives or from the person before they die. Physicians are not trained properly, we at the UH are trying to do this, we're making a very uh great stride in doing this, but we still have troubles.
[0:11:28] Randall Roth: So there needs to be more and better communication between physician and patient not just about their condition today but about the inevitability of death and the consequences of that.
[0:11:37] S.Y. Tan: Right, much more. In fact, this would be the most uh important step we can take to to alleviate this this situation.
[0:11:43] Randall Roth: And we've just diverted back into agreement, and I want to make sure that I really understand where it is that the two of you disagree, and Norm has talked about Dr. Kevorkian and said he basically agrees with this notion of physician-assisted suicide, and S. Y., you have given us one reason why you're in disagreement, give us a couple of more, and then we're going to start inviting some calls.
[0:12:02] S.Y. Tan: Sure, we have a, we have five or six reasons why, why uh mercy killing is, is, is wrong, and these have been identified in, in an article in, in today's papers, but just to summarize the two or three of the key articles. Of course, one is that life is uh is is sacred. It's the sanctity of life uh religious argument, but we have other arguments. Uh, one of the most important is the fact that uh we have effective pain control and comfort care and that most patients who request uh to be put to death, uh in fact, rescind such a request, the experience in Netherlands uh proved this. About 90% of patients who initially request death uh in fact, uh withdraw such a request.
[0:12:37] Randall Roth: And and in the Netherlands, they have allowed mercy killings for some time or condone them.
[0:12:41] S.Y. Tan: That is right. There's another argument, and and this is I think by far the most powerful argument, and this is the fear of abuse, the slippery slope argument. What this means is that initially, you will allow active mercy killing when the patient who is competent requests, and may active mercy killing. Um when this happens, shortly thereafter, uh the patient may not be fully competent and fully requesting this. Uh the patient may be depressed uh and uh, then shortly thereafter we may be talking about encouragement to request death, for earlier death to to save, to conserve society's resources. And so, that we go down this little slope and before too long we'll have people who will be euthanized, who will be put to death, who who have not requested or or or consented to the to the process. And in the Netherlands, this has happened, about a thousand people have in fact been put to death uh who have never requested uh explicitly or consented to the procedure.
[0:13:40] Randall Roth: So when so when I try to get the terminology straight and I'm listening to various ways of describing the same thing, you're suggesting I think that maybe accelerated inheritance is another way of describing, mercy killing? At least that's a fear, right?
[0:13:52] S.Y. Tan: It's a fear.
[0:13:53] Randall Roth: Okay. Recognize that uh America is currently squeezed by rising healthcare costs, and we are plagued by violence and family rupture uh and and the secularization of the medical profession into a business. In this climate, active mercy killing, the legalization of it uh raises very, very serious concern for a more dangerous and a more uncaring society.
[0:14:15] Randall Roth: Okay. Well, I want to remind listeners that this is Pop Radio. My name is Randy Roth. We're talking about the physician's role in death and dying and my guests are Dr. Norman Goldstein and Dr. S. Y. Tan. Both are professors at the John A. Burns School of Medicine, Norm is the editor of the Hawaii Medical Journal and is in private practice specializing in the diseases of skin, hair, and nails and S. Y. chairs the Ethics Committee at the Saint Francis Medical Center, he also is a licensed attorney.
[0:14:42] Randall Roth: If you would like to ask a question or make a brief comment, just call us at 9558821. You'll find on the other end of the line either our trusty producer Susie Roth or our assistant this morning, John Roth. That number again is 9558821 and as always neighbor islanders are invited to call us collect. Well, Norm, I'm curious, what is a dermatologist doing here in the studio talking about this particular issue?
[0:15:08] Norman Goldstein: Well, Randy, it's not just that I'm interested in the skin and the outside, I'm interested in the whole person, and I always have been for my entire professional life. In an average week, now, some people would ask the same question of me, but in an average week, I get two people asking me about information about death with dignity. I don't do this, you know, I don't get involved with the terminal stages of a person's life, but I refer them to the Hemlock Society or I say get yourself another physician. If your physician does not agree with what you're saying about how you feel about death with dignity, ask for a second opinion. We do in other fields, ask for this also.
[0:15:47] Randall Roth: Okay. Well, we have a treat, uh someone who just called in and and I confess I encouraged him to do so. Uh Bud Smiser is a fellow who's probably done more to get people I think to to think about this particular uh set of issues and and to talk constructively about what to do about these issues than than anyone else that I know of. I think everyone realizes that Bud is a columnist for the Star Bulletin, used to be editor of the Star Bulletin. Bud, are you there?
[0:16:13] Bud Smiser: Can you hear me, Bud? Hi, yes, how are you, Randy? I'm just fine. Bud, I know that uh that you could speak a a long time about this topic. I- I think you probably have been the most uh articulate and passionate voice on the issue uh at least here in in Hawaii and I think everybody knows that you're on on Norm's side of uh the issue so far as physician-assisted suicide is concerned. But I'm really interested in hearing any thoughts that you might- might want to share briefly with us either building on what you've already heard or adding some things to the conversation.
[0:16:44] Bud Smiser: I'd like to add just one thing. And I've I've been interested in this movement for 20-25 years now, maybe even 30. And I've become convinced that it's terribly important for families to do what you're doing now, or what you're encouraging now, talk this over before there's any need, before there's any crisis because it's very hard to talk about in a time of crisis and people ought to ought to get the heads sorted out on this and they ought to let their friends and relatives know where they stand and then, I think it will be much easier to handle crisis times because in the crisis times, there's just so much pressure as a recent study by uh, as recent national studies showed to go ahead with unnecessary life saving methods just because it seems somehow wrong not to when actually it it's wrong to go ahead with them.
[0:17:28] Randall Roth: So when Norm and S. Y. are S. Y. are saying we need more and better communication between the patient and the physician, you're taking it another step and saying that patient really ought to be talking to loved ones about all of this?
[0:17:39] Bud Smiser: Yes, and the sooner the better. Don't wait for a crisis.
[0:17:42] Randall Roth: Okay. Uh let me get a reaction from S. Y. or Norm and then I'll come back to you, Bud. Excellent suggestion, Bud. Okay. I agree completely, Bud. Thank you. Okay. Bud, anything else? No, that's it and thanks very much. Thank you, Bud. We really appreciate your calling in. Uh let's see, we have Evie Char. Evie, are you there?
[0:17:58] Evie Char: I'm here.
[0:17:59] Randall Roth: Evie, what what is your title?
[0:18:01] Evie Char: Oh, I'm a clinical nurse specialist, uh and I do counseling and I work a lot with people who are dying or seriously ill.
[0:18:08] Randall Roth: Well, I- I knew that part. I just what and what institution are you associated with?
[0:18:12] Evie Char: I'm in private practice. I'm I'm a consultant to Saint Francis Hospice, but that is as a volunteer.
[0:18:17] Randall Roth: Okay, I see. Well Evie, we also invited or encourage you to call in and share your experiences, your thoughts about this topic. What can you either add to what's been said or or to kind of uh elaborate on it?
[0:18:29] Evie Char: Well, I certainly would like to underline what has been said today, and I think this is a topic that is very difficult to discuss and as we said earlier, families and physicians need to talk about it earlier. But it is such a difficult thing to do. Uh, I'm wondering, how can we teach and encourage both our physicians and our families to do this earlier while someone is healthy and can make such decisions.
[0:18:53] Randall Roth: You know, I- I really like that question, and stay on the line Evie because I want to come back and get your thoughts on it, as I ask S. Y. and Norm to respond.
[0:19:00] Randall Roth: respond to that. I I want to add that Dr. Max Botticelli, who's a a colleague of of SY and Norm at the Johnny Burns School of Medicine, he had an article a few months ago in the newspaper where he ended up making a number of recommendations and one was that we need to make physicians aware of their responsibility to dying patients. And I thought to myself, this is coming from a professor at the medical school and I've got two other professors from the medical school here, and yet I'm not sure that there is complete agreement on just what that responsibility is. Um, but at any rate, whatever it is needs to be communicated to the physician and then there needs to be communication with the patient and I'm going to talk to Evie in a moment about the communication between family members. What's your reaction what you're listening to, Norm?
[0:19:41] Norman Goldstein: the first step is physicians must be taught just like they're taught anatomy and physiology. They must be taught about what's happening with death and what the family, how the family is involved with death. And this is just, it is a course. It's not emphasized enough. The next thing we have to
[0:19:56] Randall Roth: Let me let me let me ask, is there a bottom line here's the right thing to say, or do the professors disagree as to what specifically should be said, but they all agree that that physicians to be need to think about this and then need to establish good lines of communication.
[0:20:12] Norman Goldstein: I mean the perfect proof is that why and and I are disagreeing on some of the points, but the basic point of communication with the family members and the dying person is most important. And the sooner the better.
[0:20:23] Randall Roth: After we do this, we have to get together with the attorneys. We have to get together with the legislators. We have to get together with the press people. We have to have a symposium, not just what SY is planning in the near in the next two months, but many symposia like this, to get the word out to people. Okay. Yes. Why a reaction to either what I've just said, Norm said or what Eevee
[0:20:44] S.Y. Tan: Sure. Just a quick note. I think we need to educate our healthcare professionals, doctors, nurses, and the like. I think we need to do this early so that the place to teach would in fact be in medical school, not after physicians have gone into private practice. Uh I think we may still uh search for the best curriculum, the best way to teach the information. But one thing is clear. So long as we equate
[0:21:06] S.Y. Tan: clinical death with clinical defeat, doctors will continue to keep treating and keep treating when treatment is to no avail. Right. And we have to get away from this mindset. So this is educational and educational goal that we need to keep focus on.
[0:21:20] Randall Roth: So in the past, keeping the patient alive, no matter what was victory, having the patient die was defeat. We have to get away from that mode. Okay. Well, Evy, please share with us, how do you get people to to talk to their loved ones about these issues? How do you do it? Because I know that this is part of of your practice.
[0:21:39] Evy: Well, it's a difficult thing as both the gentleman have said, and I think it goes right along with what SY said about society's values as well as physicians, that keeping someone alive is victory. I think most families look as at death as defeat also or having lost, and I think we need to look at the whole issue of life and death as a part of life and that it is a natural occurrence. Going back to the old ways as we used to look at it, and the acceptance of death. And um also the options. I think families don't know where to begin to discuss this, much as a a young child's family doesn't know about immunizations that are available, how good they can be, what they're used for, what is available. Families don't know that in terms of options for dying, a ways to die.
[0:22:25] Randall Roth: It it sounds like the medical school is is really making great strides in this area. How about the school of nursing? Do you know is there an active attempt to get nurses sensitized to these issues and to equip them with the skills to to get the kind of conversation going that that we're assuming?
[0:23:05] Evy: Yeah, it's it's a tough area. I know when when my mother was dying, I the last thing I wanted to raise was the fact that she was dying and and eventually she's the one that raised it, and once she did it just was real, real clear to me that she wanted very badly to talk about the fact that she was dying and the consequences of that.
[0:23:23] Evy: And families have a great deal of difficulty doing that. Um, all sorts of things, you know, fall into place here. Even gosh, if I mention this, they might think I'm after her money. And so they're reluctant to do that and I think I don't mean to put the whole burden on the physicians. I think the physician could be the leader in initiating and then say to the family, this is something to talk about early on.
[0:23:44] Randall Roth: Evy, thank you. We we really appreciate your sharing that with us this morning. Norm, I think you have a reaction to that?
[0:23:49] Norman Goldstein: I I agree. Uh I feel the nurses are a very important part of the medical team. The doctor is not king. Uh he may be king and the nurse can be queen or vice versa. But we really do have a team effort here. Let me interject one brief personal story here again. My father died when he was 88 years of age, in Hawaii. He had prostate cancer, lung cancer and spread to his bones. We had, fortunately, we had a gerontologist who helped take care of him and we had a pain pill, a long-lasting pain pill. So we gave him one pill twice a day for the last year and a half of his life. He was alert, he was astute, he went to sleep after our family got together and spoke with him, and he had no pain whatsoever for the last year and a half of his life. We have to push the pain pills.
[0:24:35] Randall Roth: SY, I get the impression that while modern technology isn't going to prevent us from dying, we're going to die, that great strides have been taken in terms of of being able to medicate a dying person so that they are relatively pain-free. Is that accurate?
[0:24:51] S.Y. Tan: That is very accurate. Push the pain pill, push the comfort care. Uh even if in our zeal to conquer pain and discomfort, we may even hasten uh death. That is okay. We call this the double effect in in in in in ethics. Uh because your intent here is to relieve suffering, not to terminate life. Thank you.
[0:25:13] Randall Roth: Okay. Well, as you our lines are are filled and so we're going to start moving through uh our calls as quickly as we can. Let's go first to Ralph and Kailua. Good morning, Ralph.
[0:25:21] Ralph: Good morning. Uh I have a uh article here from the uh December 4th uh Newsweek that I thought was the best one that I've seen in a long time. Terminal care too painful, too prolonged. Uh Hazel Welch was 82, severely disabled and living in a Connecticut nursing home when I perforated the stomach ulcer. Landed her in the emergency room at Yale New Haven Hospital. The physician on call, Dr. Sherman Newland, proposed emergency surgery to repair her exploded digestive tract. To his surprise, she refused, explaining that she had already outlived her friends and relatives, and that at 92 years on this planet was quite long enough anyway. Her odds of surviving the operation were just one in three, but as Newland accounts in his book uh How We Die, we need to intervene, uh seemed obvious. So he pressured her. She gave in and he operated. She survived for a few painful weeks and then died of a massive stroke. Unfortunately, this this goes on too frequently. Uh doctors pressure their patients to uh go for one more operation and it just goes on and on and on.
[0:26:32] Randall Roth: Ralph, let me let me get a a quick reaction. And and I think SY said something along these lines earlier. A quick reaction from SY and Norm. Okay.
[0:26:40] S.Y. Tan: Doctors should always respect uh patient's autonomy uh so long as patients have full cognizance about the facts uh of all the indications and uh uh competent to decide uh uh uh uh appropriately and properly.
[0:26:53] Norman Goldstein: I agree. Yes. Why? By the way, Nolan's book is an excellent book. The Hemlock Society has more information on how to get it.
[0:26:59] Randall Roth: Okay. Ralph, is that it?
[0:27:01] Ralph: Yes, that's it.
[0:27:02] Randall Roth: Thank you. We really appreciate your call. Thank you. We have Betty from Kaimuki. Good morning, Betty.
[0:27:06] Betty: Good morning. Thank you. Uh there was a program on at 6 a.m. this morning. Uh that was very disheartening to me because there was the head of the Heart Association of Hawaii who spoke of uh lives being extended to uh age 100. Now in my family, there are three and this is um um different uh three, they're all in males. One lived to be 100, one 93, another 93 and so on. And I think that 80 80 years old is enough. Now maybe what percentage of the population are like me and they have osteoarthritis and poor very bad circulation and um uh uh I don't know what else, but but 80 years is enough. Now um this goodness of extending life is what bothers me more than anything else be
[0:27:57] Randall Roth: Chuck mentioned uh you know, Joe Moore and I like I like Joe. His shenanigans get front page coverage, but who's it written by? The show business reporter. Uh but nobody's taking a look at what is the quality of news that we're getting now that we have four TV news stations. What's the quality of news we're getting? What about the approach that uh uh channel 13 or news 8 is is taking now? Is it a legitimate approach uh uh to the news? We don't look at it that way. We only look at television as as show business. We don't uh even during uh newspaper guild and uh uh negotiations. It hardly gets any ink uh in the newspaper whereas during Carpenters or HGEA or other union other unions, uh there's all kinds of ink uh spilled over those negotiations. So I agree. I think there should be a lot more self-coverage, and I I'll point again to the Saturday uh bulletin commentaries from the editors. I think that's a good start, but it's shouldn't be where we stop.
[0:28:57] Chuck: Yeah, and I and I just wanted to point out, I'm sure that the advertiser editor was late this morning because he was out there delivering those Sunday papers.
[0:29:07] Randall Roth: Okay. Thank you. Thank you, Chuck. Uh, you know, Jim, listening to Tom just now, he mentioned about um the union or union contracts coming up. Uh, and I think even mentioned the word paranoia at one point in a different context. Maybe it's paranoia, but there's a rumor that it's not just a coincidence that you're coming from the Detroit Free Press where there is a a strike.
[0:30:29] S.Y. Tan: terminal state do not wish uh there's not wish such an extension fine. But I think we can coral with medical progress. Okay but but has to be in terminal state and shouldn't be with the assistance of the physician. Correct but uh but uh but the physician should should respect the wishes of the patient by going one step beyond and giving an injection of a lethal drug, or putting a plastic bag over the patient's face, especially when done by a healthcare professional. Yeah just brings up. What about there's a law in in Oregon that I guess is on hold right now because of of litigation but Oregon passed a law recently saying that physicians could legally give a prescription that by design would cause death. Do you consider that physician-assisted suicide that has crossed the line that you refuse to cross, or is that still on this side of that line? No, that has clearly crossed the line. Here, we have a active act by a physician, a prescription for death, uh for to actively assist a patient die. And that's the keyword active, if it's passive, if it's just a matter of the physician not doing something to prolong life, you support. Passive who allowed death to occur naturally, quite different. In the appropriate situation, I think that's perfectly okay. There's nothing magic about dying at 80, or 90, or a hundred. Age itself should not be the determinant uh for when you go. Okay. Um well, let's uh Betty, thank you for your call. We really appreciate that. I think we we lost Betty. I hear the the sound in the background. Let's go to Howard from Manoa. Good morning, Howard.
[0:31:56] Howard: Good morning. I'd like to make one point. Uh as far as the living will goes, I feel it's very important to state that if you have a long-term illness with very little chance of recovering, that no one should feed you if you can't ask to be fed. And that's the deal we my wife and I have and I'd like the panel to comment on that. because there are a lot of people in nursing homes that are really dead. If people would see them. Yeah. Howard, do you have? Do you and your wife have a living will? Yes. Okay, cuz I think SY and Norm, you've both said that that you agree completely with with Howard. But SY, I think you also mentioned that relatively few people like Howard and his wife have a living will. What happens if a person's in the hospital, uh they're terminally ill, their heart stops beating, they haven't executed a living will. SY, what's that physician going to do? The physician will speak to family members usually, to advise them or to uh seek their input on what the patient might want. And that family member is probably, I think we're being realistic when we say probably going to say save this person. The last thing they're going to want to do is to lose this person. They're to a low point mentally, physically, psychologically, emotionally, etc. Isn't that the problem? Absolutely. They're guilty, they're uncertain, they have etc. And that's why we come back to what you two were saying earlier, I think that people really, at least people who feel like uh Howard, really need to go to the trouble of executing a living will. Yes, absolutely. Okay, Norm, you're Oh yeah. Yes. Yeah. Once the patient is in the hospital just about to leave, it's too late. Okay. And and you don't need to go to a lawyer necessarily, certainly a lawyer can help explain it and can can customize the form to fit your situation. But uh SY, you're you're the lawyer. I I I know I am too. But you're a grimacing just a little bit. Do you think that people should go to lawyers every time an a living wills to be executed? No, it's very easy to to execute a living will. You do not need a lawyer. Uh all you have to do is to get a form from any number of hospitals, physicians offices, uh office of aging, and so on. Or the University of Hawaii Elder Law Program, absolutely. Uh the the Memorial Society of Hawaii, there are lots of programs out there that are perfectly happy to help somebody get a living worm well form. I'm not an attorney, but I have the forms in my office. Okay. Howard, thank you for your call. We really appreciate uh your your calling us. Let's go to Debbie on the Big Island. Good morning, Debbie.
[0:34:18] Debbie: Yes, good morning. I I have a brief comment. I agree with a lot of what's being said this morning, but I do believe that the education really belongs with the young people and not only with the medical professions. I was astounded when we had our first child, that there's no parenting classes given in in all of our 12 years of mandatory education. There's no relationship classes. There's no classes on death and dying. And these I believe should not be limited to people in the profession but we should be learning about life as we are children in school if we're not getting it from our family and our society.
[0:35:10] Randall Roth: That's uh that's a very interesting point. I do have to add I I had a teacher in here some time ago who was telling me about a class at her school where they would give these young uh high school kids, I think it was a a a 10 lb bag of flour, something like that that they had to carry around for a day to get a feel for uh having a child. But uh SY, what do you think of of Debbie's suggestion that maybe in the schools, kids ought to be thinking about talking about the inevitability of death and the various issues that we're discussing this morning? No, I think it's an excellent suggestion. Norm? I I agree. I think we should get physicians and attorneys to do many seminars in in the schools. It's an excellent idea. We we learned more, the people participating in this panel learn probably more than the people listening. This is one example that I've learned a great deal with that comment. We'll open up a lot of possibilities. I I just question, what good is American history if we don't know about life, you know. Right. Yeah. I think your point is a a is an extremely good one, Debbie. We really appreciate it. Very much. You know, I know Norm mentioned earlier that there is a a conference coming up that SY is involved in and I guess to say you're involved in it SY is a little bit of an understatement. Uh this is kind of your baby. It's called the Bioethics Conference and this is the one for 1996. It's not the first, but the title is A Future of Dignity, Confronting Ethical Dilemmas of the Elderly. And just glancing at the program, you have a who's who of of people who have written in this area, people on both sides of the various controversial issues. Uh the topics just look fascinating to me. This is uh February 15th and 16th, it's going to be held at the Sheraton down in Waikiki. And SY, I assume the the public is an I assume most people who attend will be physicians and attorney, but nurses, but the public is invited? The public is definitely invited and the tuition fee is very low, and in fact most of the audience will not be physicians and lawyers judging from our first experience. They are in fact lay people, nurses, social workers, etc. I think it will be an excellent conference. Uh those who are interested can just call in and request a brochure or application. And a lot of our listeners I think will get a kick out of this, SY and I think you're the only person that I know of who's done this. You have um the registration fee is double for lawyers and physicians. So the non-lawyers, non-physicians, you get in for half of what the others are paying. Ability to pay. The means test. Okay. Um and and I guess that is sponsored by St. Francis Medical Center so anyone wanting more information could call out there. Thank you, Randy. Okay. Well let's uh remind our listeners that this is Pop Radio. My name is Randy Roth. We're talking about the physician's role in death and dying. In the studio is Dr. Norman Goldstein and Dr. SY Tan. Both are professors at the University of Hawaii School of Medicine. If you'd like to ask a question or make a brief comment, just call us at 955-8821. I think we have one open line and so um uh somebody quick, grab that phone and call us and you can get in. Let's go to Tony from Kailua. Good morning, Tony.
[0:37:45] Tony: Good morning, Randy. Um my question is this, the great majority of people who die both in Hawaii and elsewhere are dying in hospitals. I would like to know if your panelists feel that hospitals should develop some policies
[0:38:00] Speaker 1: with regard to care of dying patients and I especially say this in relation to the fact that the commission which accredits hospitals now has a requirement that hospitals do have some form of uh of policy with regard to dying.
[0:38:16] Norman Goldstein: Okay. Norm? I agree, Tony. I think it's an excellent idea. Uh how we do this? I'm not quite sure, but you've brought it up and we will start doing it. Uh one of the problems is getting hospitals to agree, like uh St. Francis may not agree with Queens, but each individual hospital should have their own policy. And if you feel like uh the St. Francis uh uh feeling is what you want, that's the hospital the physician you're uh going to would be attending. And other hospitals uh likewise. Uh we should be doing this. Thank you.
[0:38:47] S.Y. Tan: Tony, you're right. The uh joint commission uh requires uh hospitals uh to do a number of things uh to respect what they call patient rights. Isn't that specific chapter in their regulation book? And uh all hospitals are required to do uh a certain number of things for for for its for the patients. This includes uh informing them upon admission about their rights regarding living wills and advance directives uh and so on. Uh most hospitals have uh very active uh committees on pain control. Uh we have uh ethics committees, uh we have seminar sessions uh aimed at educating health care professionals and others on uh on on care of the dying, on patients autonomy, uh on living wills, and so on. Uh slow uh but definite and steady uh uh progress. Thank you.
[0:39:31] Speaker 1: Tony, does that respond to your comment? Uh yes, although I would hope that uh we can get some discussion on further policy development beyond the things that SY has just talked about.
[0:39:42] Speaker 2: Okay. Well, I'm sure they will in the two day bioethics or three day bioethics conference, but we're going to do everything we can in in the next 19 minutes as well. Thank you, Tony. Appreciate your call. We're going to jump to uh uh Kenneth is it Fifer? Fifer Fifer who is a minister in Ann Arbor, Michigan, which is where Dr. Kavorkian is is located in the state of Michigan. Um, Mr. Fifer, are you there?
[0:40:04] Kenneth Fifer: Yes. Yes, I'm here.
[0:40:06] Speaker 2: Um, I believe you're a friend of of Norm Goldstein's.
[0:40:09] Kenneth Fifer: Uh, yes, uh we we have actually never met in person, but we've exchanged correspondence in regard to a special issue of the Hawaii Medical Journal that he's going to be putting out.
[0:40:17] Speaker 2: Okay. And and and you're calling because I I think Norm told you that we were going to be having this show this morning?
[0:40:22] Kenneth Fifer: Yes, and I have a Hawaii connection. My parents live in retirement at uh Poihainani and I once lived in the islands in the mid-sixties and was a teacher at Mid-Pacific Institute.
[0:40:32] Speaker 2: Okay. Well, great. Uh, what can you share with us this morning on this topic?
[0:40:36] Kenneth Fifer: Well, I want to share from the perspective of a minister who has worked with several people, one very publicly, Marion Frederick uh who had called on the services of Jack Kavorkian. Marion had asked uh several physicians to be of assistance to her and she had been unsatisfied with their answers and eventually decided that she wanted to seek Jack's help and did. And I was present at the time that that Marion took her life uh with his assistance. One of the things that I have learned from this is that they're it's not just pain that is at issue, there is a level of suffering that goes beyond pain. Marion was terrified of what was happening to her. She had Lou Gehrig's disease, she was within a very short time, I I don't know specific days or weeks, but she was rapidly losing the capacity to write, and that was the only way she had of communicating. She hadn't spoken in 18 months because of the Lou Gehrig's disease, and she was terrified of having a good mind, her mind was fine, trapped in a ruined body. And the way she saw to get out of this was to choose her own dying before time, and she was unable because of her physical debilitation to take her own life, and therefore she needed the assistance of a competent person. I can assure you that she was in the best spirit that she could be in and had been since her diagnosis once she learned the moment when she would have to suffer no more and she spent a week with her family that was I think a a beautiful week for her.
[0:42:04] Speaker 2: Kenneth, stay on the line. Uh I know that SY Tan disagrees very strongly um with the suggestions that the the suggestion that physician assisted suicide is a as a good thing. SY, why don't you respond to what Kenneth has said and then we'll give him a a chance to close.
[0:42:19] S.Y. Tan: We face uh rarely and fortunately so such tragic cases and these are difficult cases. I I do not mean to to downplay the importance or the seriousness of of of uh of feelings of of such individuals. But uh uh and when we when we recognize that loss of control and loss of self-esteem and suffering are very important components uh in addition to pain and discomfort, I I I couldn't agree with you more. However, having said all that, uh one can uh um quickly respond uh by pointing out to uh a wider danger uh when we uh legalize mercy killing just across the board because I think the more vulnerable in society, the poor, the aged, and uh uh the elderly will will become unwilling victims. And if we talk about seeking the care of someone competent, I think Kavorkian would be a horrible example because what he shows um what emerges looking at the cases, the 26 or 27 cases that he's done uh uh uh conjure an image of uh of of uh of uh someone who's uh interested in sensationalism, um someone who's very defiant. Uh who is he's actually promised not to do any more such acts and uh and I think this will be a horrible way to to have uh to have a patient die. This is not mercy killing.
[0:43:27] Speaker 2: Okay. And and we are lines are full as usual so I need to to move on very quickly, but but Kenneth, I want to give you just a few seconds to to respond to that.
[0:43:33] Kenneth Fifer: Um, my response is that Marion sought the help of physicians who would not help her and Jack Kavorkian was not her first choice but was her only choice for avoiding a suffering a living hell and I think that while I recognize Dr. Tan's point that there are dangers involved in the legalization of physician-assisted suicide, there are suffering people right now, and my concern is to try to help them, and I appreciate your hearing from a voice from Ann Arbor and I'm sorry I couldn't hear more of your program.
[0:44:24] Speaker 2: Okay. Well, I think uh Norm Goldstein wants to say hi to you. Ken, thank you very much. I wish we had more time. We will get you in to our special issue. And incidentally, SY Tan will be on our special issue dealing with this also. Thanks again, Ken.
[0:44:36] Norman Goldstein: Okay. Thank you, Norm.
[0:44:38] Speaker 2: Thank you, bye bye now. Thank you. Let's go to uh Joe from downtown. Good morning, Joe.
[0:44:42] Joe: Good morning.
[0:44:43] Joe: Uh my remark is about the living will. If you have a living will, make sure you have someone who can ramrod it after you've written it. Because I had a friend who was recently uh died, she had a living will. Uh she also had been on dialysis for three years. Uh when she went into the hospital, the doctor had talked her because her extremities were dying. She was losing circulation, gangrene, her doctor talked her into having one of her legs amputated. After it was amputated, in rehab, she had a stroke. She was no longer compos mentis, um they put her back in the hospital and there was no way to ramrod it. Nobody, she had no friends, no children,
[0:45:22] Speaker 2: So the living will is more or less ignored.
[0:45:24] Joe: That's exactly right, they cut another leg off.
[0:45:26] Speaker 2: Okay. Joe, let let me get some responses to this because, again, SY and Norm have have wonderful articles in this morning's advertiser in the focus section, page B3, right below their articles is a column by Art Caplan, and part of his article is describing the results of something that's called the support study. And the thing that alarmed me about that support study and and those results, is along the lines of what what Joe is mentioning, and that is not only are there a lot of people who don't have a living will, in a shockingly high percentage of the cases, the physicians who should be aware of that living will and whose action should be directed by it, are unaware of it. SY?
[0:46:06] S.Y. Tan: So true, and thank you uh Joe for bringing up this case. Uh, physicians out there, please uh please take note. Uh living will is a a legal documentation of a patient's wishes. If uh correctly executed, one needs to adhere to the wishes and it will be both uh morally and legally wrong to uh violate uh the patient's wishes.
[0:46:26] Norman Goldstein: That's that's a good very good point, Norm. Many charts and hospitals here in Hawaii say there's a sticker that says, do not resuscitate but too all too many of them do not say living will inside. Mhm. Mhm.
[0:46:37] Joe: Uh well, bottom line, I think is money. Okay. That's where it all is. That's I mean, it's very high-minded that the doctors think of the patient service, but as long as there's a body in a bed, there'll be money coming in.
[0:46:49] Speaker 2: Well, fee fee for service, I think you're suggesting gives the wrong incentive on this and and SY, I know some people have the opposite concern and that is, as the health system is is changed to where you give the incentive to the provider to stop providing services because they're receiving a flat fee and so they'd rather provide less services. I think your concern that that incentive would would give us the opposite just as bad result.
[0:47:15] S.Y. Tan: Right. I don't think doctors keep patients uh far too long because because they stand to earn extra dollars. I I think that's too simplistic uh notion. I I I think they do so because they're awkward, they have not been trained, they they don't communicate terribly well. Uh they are fearful of the law because they may be accused of of of of of of of homicide. And um and I think with increasing education we can solve this uh this problem.
[0:47:38] Norman Goldstein: I agree.
[0:47:39] Speaker 2: Joe, you've you've raised a a really important aspect of this issue and I I appreciate it a lot. Thank you for calling. Let's go to, well, before we go to the rest of our our callers and and again, our our lines are full and and we really appreciate the interest that that the listeners are showing in this topic. Let's jump over to Andy from Kailua. Uh Andy, I believe is with the Hemlock Society.
[0:47:58] Andy: Yes, that's right, Randy. I'm the vice uh vice-president and also membership chair.
[0:48:02] Speaker 2: Can you give us a real quick description of what the Hemlock Society is and then make your comment?
[0:48:08] Andy: We're a society that's across the United States. Uh we there are also other societies that believe as we do. We believe in good life and a dignified death. We get calls every day from people who are asking how they can terminate their lives. They don't necessarily have to be persons who are terminally ill. Got one lady who's 94 years old, she's blind, she's incontinent, her quality of life is gone. And as some of our previous uh uh speakers have said, Lou Gehrig's disease, AIDS, rheumatoid arthritis, there are a lot of reasons why people want to terminate their lives and when I hear people speak about the slippery slope, I just really don't understand it because we are not doing to others what they don't want to do. We have people coming to us asking how they can help themselves. And the living will which Derek Humphry uh instituted for us because he had watched his mother in a persistent vegetative state for years and was un was not allowed to die, uh is a very good legal document. However, it only protects the physician.
[0:49:09] Speaker 2: Okay. Andy, let me ask you, does the Hemlock Society, when you hear from somebody who feels the quality of their life is is over and and they are are looking forward to death, what does the Hemlock Society do? Do you tell them specifically how they can end their lives or or or just how do you deal with that?
[0:49:27] Andy: Currently with the laws as they are, we can only educate. We can educate by uh showing them the final exit book. We can go through the final exit book with them. And that has instructions on how they can commit suicide in a in a relatively and I don't even know what word to use because I don't think there's there's any way that doesn't have some really negative elements to it. Um, Norm, I I I think this is something you've written a little bit about. Right. There's no guarantee in suicide. Some people don't die when they're supposed to with the appropriate dose, but the information Hemlock has is is the best source.
[0:50:04] Speaker 2: Or it or it's I think you wrote something or somebody that that I've read recently had written that it can be just terrible on family members to find someone with the bag over their head and various apparatus that Right, in some cases are suggested as ways of committing suicide.
[0:50:21] Speaker 2: Okay. Well, Andy, uh Randy, I want to thank Dr. Tan and and Dr. Goldstein for coming out because education is the name of the game. And we have found that if people can go to their physicians and get the necessary pills to terminate their life when they want to, 80% of them never use it. They only want to be able to be in control of them their own destiny. Okay. Andy, I need to move on because our lines are full and we're running out of time, but I really appreciate you calling in this morning.
[0:50:49] Andy: Thank you very much.
[0:50:50] Speaker 2: Okay. Very quickly, let's go to Tom in Mililani. Good morning, Tom.
[0:50:53] Tom: Uh good morning. Uh I have just a uh quick comment. I'm an internist actually uh practicing in Honolulu uh helping to care for terminally ill patients, it's part of my practice. And I would like to really acknowledge Dr. SY Tan's uh position as he expresses it in his letter uh in this morning's Honolulu Advertiser. Uh and and he says that doctors should not help patients end their lives. Um, and he does mention in that in that uh letter that hospice uh is a compassionate response uh to the terminally ill. And I really agree with him that there uh there isn't effective pain control available for for us to use uh taking care of such patients uh which allow us doctors to effectively preserve human dignity, I think.
[0:51:39] Speaker 2: Okay.
[0:51:40] Tom: And so there's just no need for us to get onto this slippery slope uh and if we uh where I think uh we will open ourselves up to the possibility of abuse.
[0:51:49] Speaker 2: Okay. And I I just real briefly, I participated I think in that recent poll of Hawaii's physicians which Dr. SY Tan alludes to at the end of his letter. Uh and I think it shows by far that most of Hawaii's actually practicing physicians uh would probably agree with him.
[0:52:06] Speaker 2: Okay. Tom, I really appreciate your calling in this morning. You know, and Tom brought up again the notion of of hospice care and I know SY and Norm, you're both big supporters of that. I would just add that I didn't know much about it until my mother was terminally ill and I don't think anyone who has come into contact with the hospice people could have anything but uh just the strongest aloha imaginable for what they're doing. Let's move on to Susan in Honolulu. Good morning, Susan.
[0:52:32] Susan: Good morning, Randy. First of all, I want to thank you for for uh providing all these wonderful resources to the residents of Honolulu and and the whole state. We have uh great organizations that are barely knowing just because sometimes things are a well kept secret and one of those is the Memorial Society of Hawaii. And uh I would like to encourage people to seek that out and find out uh more about it that they can be more in control of them their own destiny.
[0:53:01] Speaker 2: Okay. And I I assume the Memorial Society is is in the phone book.
[0:53:05] Susan: Yes it is.
[0:53:05] Speaker 2: Okay. Great and I mentioned earlier in the show that I know among other things they do provide living will forms.
[0:53:10] Susan: They do, and they get those notarized at their annual meeting in February.
[0:53:14] Speaker 2: It can be a lot of trouble to get the whole thing completed properly and to help have the help of the Memorial Society and and the University of Hawaii Law School's Elderly Law Program and the various other organizations can be very very beneficial, I think. Thank you, Susan.
[0:53:27] Susan: Thank you, Randy.
[0:53:28] Speaker 2: Uh again, we just have a couple minutes left, so we're going to try to move quickly. Let's go to Norman in Kapa'hulu. Good morning, Norman.
[0:53:33] Norman Goldstein: Hi, um I just have a comment on just a see what your speakers have to say about it. Uh I'm in the health care profession and I've seen many cases where um terminally ill or, you know, people come in to the hospital, and um, you know, they can't speak for themselves. Let's put it that way. I'm kind of nervous right now.
[0:53:51] Speaker 2: Mhm.
[0:53:52] Norman Goldstein: But um, and the family they have a living will and the family decides, well, you know, we want to override this and we want everything done for Dad or Grandpa. And I just wanted to see what your the the speakers' opinions are.
[0:54:04] Speaker 2: Okay, good question. SY, I'm sure this happens from time to time.
[0:54:07] S.Y. Tan: It happens commonly. Family members, understandably would want things done for perhaps their loved one, but uh it is the doctor's uh responsibility and duty to uh uh tell the family members that indeed the uh situation is a terminal and that indeed the patient has expressed his or her wishes uh legally and that in fact we are obligated to go along with those wishes, and that the decision actually is the patient's, uh has been made by the patient, therefore taking the burden away from the family's need to interject or to second guess.
[0:54:35] Speaker 2: And I guess you emphasized earlier that that obligation the physician has to be directed by the living will as opposed to the relatives of the patient is both moral and legal. Both moral and legal and it should be the doctor who should be taking the lead.
[0:54:49] Norman Goldstein: Respect the patient. Pure and simple. Respect the patient.
[0:54:51] Speaker 2: Okay. Norm, Norman, thank you for calling. We got we have time for one more caller if we go quickly. Let's go to Gwen on Maui. Good morning, Gwen.
[0:54:57] Gwen: Yes, hi. Very quickly, I just wanted to to tell you that more than a living will is needed. Um, paramedics revived my 82-year-old mother-in-law and she became brain damaged. The family knew of her living will desire and her doctor knew, but the paramedics were uninformed and said they were just doing their job. Now she is brain damaged. And those and she's still alive against her will. I was wondering why not wear a necklace stating the person's wishes and re and saying that this could be backed up by the threat of litigation if their wishes are not followed.
[0:55:26] Norman Goldstein: Yeah, that's available now. There are bracelets and necklaces just like the MedAlert. Let's state this.
[0:55:31] Speaker 2: Okay.
[0:55:32] Susan: I think that's an excellent idea because she is now living a very very very limited life.
[0:55:36] Speaker 2: Gwen, I I really appreciate your call. We're we're just down to the last few seconds. Excellent Excellent program this morning. Thank you. Uh, I want to give SY Tan and Norman Goldstein, both professors at the John A. Burns School of Medicine, 10 seconds each to wrap it up.
[0:55:50] S.Y. Tan: Death with dignity is paramount. It is important. It is achievable with the laws we have now, with living wills, with much, much more intense education for doctors, for healthcare professionals regarding pain control, and so on. We do not need to move beyond the line. We do not need to get involved with active euthanasia and peril society as a result.
[0:56:10] Norman Goldstein: With your physicians. Get a second opinion if necessary. Tell your legislators how you feel. Talk to your attorney about a living will and comfort care only. And above all, of course, uh contact the Hemlock Society at 735-7146.
[0:56:25] Speaker 2: Okay. I want to thank uh doctors Norman Goldstein and SY Tan. Our producer is Susie Roth, our Director of Operations, Jeff Alardi. Our phone bank was handled by John Roth this morning. You've been listening to Pop Radio. I'm Randy Roth. Aloha.
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