FROM LEFT: JULIE, ELLEN, PEGGY, KATHLEEN, ANNE, AND RICHARD
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More Praise for Compassion in Dying: Stories
of Dignity and Choice
However you react to Oregon’s legal choice
for its terminally ill citizens, I hope you will withhold judgment
until you have read the moving and honest stories that fill the
pages of this unique book. Compassion in Dying offers you
a front row seat to caring scenes of death bravely shared by family
and loved ones. The author, Barbara Coombs Lee, is a leader of a
social movement whose time has come.
—Barbara Roberts, Governor and author, Death
Without Denial, Grief Without Apology
The job of our government is to protect the freedom
of religious choice. The Oregon law does exactly that, and this
book tells many deeply moving stories of why that is so very important.
— Reverend Jeremy Taylor, D.Min., author,
Where People Fly & Water Runs Up Hill
Barbara Coombs Lee and the organization, Compassion
in Dying, have greatly improved awareness of the needs for the terminally
ill, and this is a tremendous public service.
— Ron Wyden, U.S. Senator, Oregon
If Compassion in Dying did not exist,
then those of us who believe that it is the essence of tyranny for
government to insist on scripting not only the details of our lives
but the manner of our deaths would have had to invent it.
— Laurence H.Tribe, Professor of Law, Harvard
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The following is excerpted from Compassion
in Dying: Stories of Dignity and Choice (NewSage Press 2003).
This material is copyrighted by Barbara Coombs Lee and NewSage Press,
and may not be copied or excerpted without direct permission from
Margaret Peggy Haas Sutherland
Margaret Haas SutherlandPeggywas an
independent thinker. A graduate of Mount Holyoke College in philosophy
and psychology, she was considered smart and strong-willed. She
also placed a high value on self-sufficiency and encouraged this
in her five children. Those who knew Peggy say she was tolerant,
accepting, encouraging, and enthusiastic. She questioned authority,
and she believed people can do anything they set their minds to.
Peggy instilled a love of music in her family
and she loved to dance. She played the piano and especially enjoyed
classical music and opera, but her tastes encompassed jazz, gospel
hymns, Harry Belafonte, and the Irish Rovers.
Peggy was born in White Plains, New York in 1932,
and moved with her family to Pennsylvania when she was six years
old. After college she married Donald Sutherland, a physician, and
they had four girls and a boy. The family moved to Oregon in 1961
and Peggy immersed herself in community activity in addition to
caring for her growing family. Peggy was active on the boards of
the Portland Chamber Orchestra, Chamber Music Northwest, and the
Colonial Dames of America. She was a founding member of the Oregon
Psychoanalytic Association and a volunteer at Hopewell House, a
In January 2000 at age 67, Peggy found out she
had lung cancer. Nearly one year later, after two surgeries and
intensive cancer treatment, Peggy knew she was approaching death.
One of her lungs was removed and the cancer had eaten away a rib.
Peggy was coughing up blood, and the pain grew more intense despite
strong medication. She decided the time had come to determine when
she would die. For this, she turned to Compassion in Dying.
As required by Oregons Death with Dignity
Act, Peggy made two requests for medication to end her life. She
obtained statements from several physicians that she was mentally
capable of this decision and able to swallow on her own. Peggy was
Throughout Peggys process of choosing physician
assisted dying, her family was involved, learning everything they
could and talking with their mother. Peggys children supported
her wish to control her own death, but one of her children who is
a physician realized that she would not be willing to prescribe
medications for assisted dying to her own patients. However, she
did acknowledge and respect her mothers personal decision
to end her life.
Peggy Sutherland ingested the prescribed medicaton
on January 25, 2000. She was surrounded by family and friends, at
peace in her own home, looking out the window at the Willamette
River as it meandered through Portland. The following stories are
by four of Peggys children and one grandchild.
Daughter, homemaker, and mother of three children
My mother was so clear. It wasnt a process
of us deciding, it was her decision. It wasnt our choice to
make. She was a competent, intelligent woman. It was not for me
to tell her what to do. Besides, I supported her. I never once felt
that I shouldnt help her to do this; I dont think any
of my siblings did either. I remember a few conversations with my
siblings who are doctors, Dick and Kathy, about the Hippocratic
Oath. I remember them saying, This is something I always assumed
I would not do. But it was a complication, never a conflict.
Nobody argued that we should not do this. Its not that we
are a no-conflict family, but on this, it was Moms decision
and we all respected that. For Gods sake, the woman had just
been through hell for a year. How could we tell her she had no burdens?
It was obvious to me.
I get so upset when I hear people say, All
you need is a doctor who will take care of the pain. My mothers
final words when she took the drug were, I dont think
anyone has understood the pain I have been in. Shed
had two lung surgeries prior to the terminal diagnosis. Those are
really painful. They cut from your back through your nerves. She
had just recovered from one, then had to have another, and just
recovered from that and found she was terminally ill. It was really
about pain. She had been bedridden for six weeks. She had a morphine
pump in her spine, and we never got it to where she was stable enough
to get to the beach again. It became clear during those three weeks
in the hospital at Christmas of 2000 that she was going to die.
That was when the emphasis shifted from doing everything we could
to keep her alive to allowing her to die. She had made veiled references
to assisted suicide for several months, saying things like, Im
glad I live in Oregon.
Her decision to use the Death with Dignity Act
was never a secret. I went to every doctors appointment with
her. I was there constantly the last few weeks. The internist, oncologist,
radiation specialist, surgeons, and the pulmonalogist all knew.
We were lucky to be so medically sophisticated.
On January 25th she was in her own apartment,
looking out the window at the Willamette River. She had already
said goodbye to her bridge partners and old college classmates.
Her children and their spouses were with her, and her best friend,
her sister, and her nephew. She kissed us, and Dick read the Twenty-third
Psalmshe insisted on the King James Version. Then she took
the Seconal. In five minutes she was unconscious, and in fifteen
minutes she was dead.
I was so involved that right after she died I
was having flashbacks of all the terrible moments and I think it
really helped me progress in my grieving to be able to talk about
it. I feel lucky because I can talk about it now, two years later.
Its still there, and often I think of things she would enjoy,
I wish she could be here, I wish I could tell her. But I dont
carry a big, dark, ugly thing.
The Death with Dignity Act is all about choice.
My advice to a family in this situation is to respect the wishes
of the terminally ill. Its their issue. I think its
okay to express your opinion to the person, but respectfully. Let
your own beliefs be your own beliefs. My mother was very open that
she was dying. I think that made it easier for all of us. We were
all emotionally present in her dying. I would never presume to exert
my control over an intellectually competent person. We all are entitled
to our own decisions.
Daughter, pulmonary and critical care physician,
and mother of two children
I work in the medical community, and I have been
with patients when they died. I thought we could manage the end
of my mothers life with good pain control, hospice care, and
nursing care that she had the funds for. That was the place I was
coming from. I was not real keen on my mother using physician assisted
dying at the beginning, but I could definitely understand why she
wanted to. When it came down to it, I could see that my moms
quality of life was not going to be good for those last weeks of
her life, so I was okay with her decision.
As a doctor, I would never write a prescription
for this medication. It is not a service I want to provide for patients.
Do I believe that this service should be available? Yes. Am I willing
to refer my patients to another physician and a psychiatrist? Absolutely.
But it is not something I would do.
I thought the epidural catheter would work better
for her pain than it did and she would be able to go to the beach
for a few weeks before she died. My mom had periods when she was
better; we went to the Oregon Coast the week before Thanksgiving.
Then she got precipitously worse very quickly from Thanksgiving
I think she was very much at peace with dying.
Mom wanted to be in control of the moment she died, and she wanted
to be with all her children and the people who were important to
her. She had lost all hope. She did not feel there was anything
worth living for, because she had to be on so much pain medication
she could barely carry on a conversation. She didnt see any
point to staying alive that way for another six weeks. My mother
was a very strong-willed person and she wanted to be in control
during the time of her death; thats why this law was important
to her. To me that was more important than the daily pain issue.
I was with her and I think her pain was pretty well controlled by
the end. That was my perception. I cant speak as knowledgeably
about it; pain is a complicated thing.
The Death with Dignity Act is a good law, I could
see that. My mother was psychologically astute and medically sophisticated.
I dont think the law would have been abused or misinterpreted
in our family setting. We were fortunate that our mother was already
seeing a psychiatrist before she got her illness, so we were able
to use his evaluation, along with the other referring physicians,
to say that she was not clinically depressed. I thought the law
worked very well for our family. We all had a very close relationship
with my mom and we didnt have any conflict or debate about
whether Mom should do this or not; she was in charge.
My sister Ann is a pretty highly functioning mentally
retarded person, meaning that her IQ is in the high 70s-80s range,
and so she could process all this. She understood that Mom had cancer,
she knew that Mom was going to die. She had long talks with Mom
about it. I dont recall having a conversation with Ann where
she expressed any concern about this choice. Ann wanted facts: whats
going to happen, how soon will she die, when will we know shes
dead. She would cry.
I really didnt want my mother to die. I
was very close to her and I loved her very much. I valued my time
with her. I went through all the stages of anger and grief, and
I was able to come around to getting comfortable with it when I
realized this was going to happen whether I liked it or notmy
mother was going to die.
It was really that process of being there a lot,
spending so much time with my mother at the end of her life, that
let me understand why she wanted to do this. If I had not done that
I probably would have always been uncomfortable with it. If I were
to counsel a family in this situation I would say it would be very
important for each child to spend enough time with the person who
wanted to use the law, talking to them and learning as much about
the law and the process as possible. That was the most valuable
thing for me.
Everyone should be in charge of their own life,
and they should get to die in a way that is comfortable for them.
Mom was a unique person. She died honorably in the way she wanted
to die. It was the right thing for her.
Daughter, social worker, and mother of two
We live in a society that tells us to not talk
about dying: just care-take and say all is well, and dont
ask direct questions. But my mother was incredibly direct. She always
told us, When things get uncomfortable or difficult you talk
about it. In our family we talked. To not talk about her dying
would have been weird. After Mom got a terminal diagnosis, months
ahead of her death I felt we could talk about her dying. We would
ask questions like, So what are you going to do with the time
before you die? How are you going to live to your fullest? How are
we going to make you the most comfortable?
We told her, When you get to the point that
you feel you no longer have control, were going to make sure
we have a prescription for you so you dont have to live in
misery. I wish we had done it sooner, to be honest. I wish
we had gotten the prescription a month earlier, filled it, and had
it there. Mom should have taken it days before. I think it would
have prevented the suffering she had. People can say it was only
a couple of days she suffered badly, but it was awful. She suffered.
Mom talked about the frustration she felt that no one would ever
under- stand the degree of pain she had been in. I was there, and
I slept on the floor next to her bed the night she died. She was
waking up in these weird morphine states, half awake and half asleep,
crying out, having bowel movements. Nobody should have to live like
that, especially a woman with such incredible class. It takes away
all sense of dignity. My mother was a classy and dignified woman.
Mom believed problems in life were challenges
for us to master and face directly, even simple difficulties like
a broken window shade or TV cord. Bigger life issues, like facing
her own mortality, her sisters death, or her divorce, she
addressed openlyno matter how painfulwith emotion and
I suspected from the start that my mother would
probably choose assisted dying. She was a very decisive person who
was never afraid to face and discuss difficult issues. Moms
attitude was, This is how I feel about dying. This feels awful,
I dont want to die that way, I want to get the prescription
She also talked about other details, such as when to die, how she
saw her death happening, what she wanted read at her funeral. It
was more than just the assisted dying, it was the process of death,
too. When you feel like you have choice, then you feel like everything
isnt out of control, or worried every second that you could
die at any moment. This way, it feels like you can be comforted
in the process.
I have always supported the Death with Dignity
law and believe it is an individuals right to have that choice
at the end of their life.
My brother and sister, both doctors, had a discussion
on how to help someone die when youre a physician. It goes
against the oath you take, but we werent battling this. There
was no conflict among the siblings; it was our own personal how
do you get around it? For me it would be a good choice if
I knew I were going to die. I want to live, I want to be with the
people I love as long as I can. But if I were in pain I would choose
the assisted dying law. Thats what my mother chose.
There was a lot of love for my mom, unconditional
love. The weaknesses, the little things that bugged me about my
mom became totally irrelevant towards the end of her life because
I knew I only had a little more time with her, so I just loved her.
My attitude became, What do you need, Mom? What can I do for
My mother gave me many gifts throughout her life.
They include the gift of acceptance of others and love for divergent
thinking. She gave us opportunities to stretch. By the age of eight
or nine all of us children were doing our own laundry, a lesson
toward self-sufficiency. By the time we went to college we each
knew that Mom expected us to take care of ourselves and face any
personal challenges. She expected that we would be successful and
today we are.
She encouraged our friends to speak openly about
difficult and controversial subjects. I loved it when my friends
would get into debates and heart-to-hearts with my mom, and so did
she. She loved those who did not fit the mold. I felt accepted.
Mom also gave me the gift of music. When we traveled to the beach
as a family, Mom would teach us songs and harmonies. Each of my
sisters and brother would take a part. Even in the last years of
Moms life her appreciation for music did not dwindle. She
went to concerts, performances of Chamber Music Northwest, the opera,
jazz, and gospel music. She played music, she sang, and she encouraged
her family to include music in their lives.I felt very close to
Mom in those last few months and I am very grateful to God that
I had the time to share with her all that I needed to before she
died. When the day came and everyone who adored her was with her,
I was full of love and acceptance for what she was doing. I could
see in her face the relief she felt in being able to finally end
the suffering. It was a beautiful thing, people were very open.
I remember feeling surprised at how clear-minded
Mom seemed the morning of her death, lucid and happy. Different
passages were read from the Bible, Shakespeare, and a poet she liked.
I watched her take it in, seeming so relaxed and ready. I remember
feeling like we needed to take care of my sister Ann, who is retarded,
to make sure she was okay. Mom reassured Ann. After Mom drank the
medicine she fell asleep almost immediately. We watched her as we
cried and comforted Ann. The doctor checked her pulse, and again
later, and stated the time of death. People began to leave, going
downstairs. I did not want to leave the room until they took her
body. I did not want Mom to ever have to be alone, even though I
knew intellectually she was gone. I felt she needed someone to stay
with her body until it was out of her home. Mom deserved to be protected
until the last possible moment. When they put her body in the van
and drove away, I felt like my job of caring for her physically
was finally over. It is hard to put into words how powerful the
experience is, watching someone you need and adore die, and yet
be glad. My love is without boundaries and unconditional. I wanted
my mom to be given comfort and to be free from pain even if it meant
she was no longer in my life.
I would advise people in this situation to get
the prescription early. People dont want to use it until they
absolutely have to, they want to live. And if they know they have
that choice, than they want to live every moment that they can.
Son, physician, and father of two children
I was totally in favor of my mothers decision.
There was never a question in my mind; I was always comfortable
with it. I have always believed in the value of assisted dying,
but my personal beliefs about it have little if anything to do with
the decisions of an intelligent, competent person who is in pain
and dying. Any questions I might have if I were put in that situation
are irrelevant. The only potential problem would have been if a
new drug or procedure were discovered that would have definitely
cured her cancer, and she chose to take the barbiturate instead.
The only concern my sisters and I had was whether
one of us should object to her decision, just to see if she was
unsure of it and not telling us. We wondered if maybe she was seeing
if anyone would give her support if she wanted to change her mind.
None of us, that I know of, objected to her decision, but it was
a way to check if she had doubts. But when she was confronted on
the days when she could talk because she withheld her morphine,
she was clearly confident of her decision.
What I would tell a family in our situation is
that life isnt fair. At some point a terrible thing occurs,
which rips someone from you. Realize that, and move on to the next
phase of helping that person cope with the tragedy. This is about
the person, not you. As mad or angry or afraid as you are, the real
focus is on the dying individual.
Assisted suicide may or may not be the best way.
There may be other ways to bring emotional comfort and relief to
the person. When everything is over and done and your loved one
has passed on, the family will cope best by knowing they did everything
they could to comfort, love, and help the individual in need.
Assisted suicide is an action; you are taking
your own life and should be clear why and when that should, if ever,
occur. Many people are incapable of that action. No one can create,
teach, or produce this feeling in an individual. Many people who
know they are dying from a malignancy and what that means and entails,
still choose, rightly, not to act. It is their decision. But if
your loved one does not want to be bedridden with severe pain and
fogged mentally from narcotics, having their feces cleaned by family
members as daily occurrences with no hope of change until they die
in that very room, then assisted suicide is potentially a very good
My mother was a very insightful and intelligent
person when it came to the psychological and emotional make-up of
people and what makes one tick. There is simply not another person
in my life whom I can talk to like I could with her. The mumbo
jumbo of psychoanalysis was a fluid language with her, and
I miss those discussions.
I have other thoughts, emotions, and reflections
that come and go as I think of my mothers death. They are
all good because I know she passed away in a manner that made her
happy, surrounded by her family who loved her. She wasnt happy
she had cancer, she wasnt happy to be denied life and playing
with her grandchildren. But again, life isnt always fair.
Make the best of your situation. She did.
Granddaughter, 13, wrote this story one year
after her grandmothers death. She is Ellens daughter.
QUESTIONING ANOTHER DEATH
My Grandma Peggy used to smoke. A lot. Shed
do that thing where you smoke a cigarette and then when its
almost out you light a new one with the burning end of the butt.
Chain-smoking. Shed smoke all day when my mom and my moms
siblings were little, smoke all day inside the house and read novels
and put together puzzles. Then she got lung cancer. It was before
I was born, before my parents wedding, and she stopped smoking.
She had to have a big part of one lung removed, but she lived and
the cancer was gone. Then, years later when I was about eleven,
we learned that the cancer had come back. She hadnt had a
cigarette for fifteen years, but she went to have her lungs checked
out and there was the telltale black spot. Big and ugly, dark like
a grave. I remember we were at an Italian restaurant a little while
after my mom found out, and in the middle of dinner my mom started
to cry. Grandma has cancer, she said. My mother
has lung cancer again, and Im afraid.
We were all afraid. Grandma was getting thinner
and paler all the time. At first we hoped that the cancer could
be destroyed. The doctors tried chemotherapy, and all of Grandmas
amazing naturally dark hair started to fall out. They removed all
of one lung, so she was left with half the air a person should be
able to breathe and had to have one of those scary oxygen tanks.
A year went by, and she was not getting better. Time after time
we got a phone call from the hospital or from one of my aunts saying
that Grandma Peggy had to be readmitted.
My thirteenth Christmas was spent at St. Vincents
Hospital. The hospital is a very scary place with its cold hallways
and strange smells. It is even scarier when your grandmother, who
you love very much, is lying in front of you, all white and bony
like a skeleton with tubes plugged into her. Grandma was only half-conscious,
her eyes fluttering open and closed. While we sat in uncomfortable
teal leather-upholstered chairs, staring at the dully wallpapered
walls, she gave us our Christmas gifts. My brother had a huge bag
of gold dollar coins. He was ecstatic. She gave me money, too, but
I also got a pretty little velvet box. Inside it was a dried rose
and a tiny birds nest. There was also a figurine of a sitting
fairy. Grandma couldnt walk anymore, so I knew that she must
have seen this fairy awhile ago while shopping and thought of me.
In that funny smelling little hospital room, I finally realized
that my grandmother, Grandma Peggy, who loved me and knew everything
about the world, was going to die soon.
Grandma was in pain and everyone knew it. She
told her children that she knew she was going to die and didnt
want to suffer any longer. She was prescribed a fatal dose of barbiturates,
which she took on January 25, 2001, exactly a month after Christmas.
She said goodbye to her four daughters and one son, fell asleep,
and died peacefully.
Her death was a controversial one. Assisted suicide
is a big deal right now. My mother and aunts are still being interviewed
about it, over a year after Grandmas death. Theyve been
in numerous newspapers and this week they will be on ABC News. We
are all constantly being reminded that shes gone. I guess
its good for us, but sometimes it hurts. Its been hard
for them without Grandma, I can tell, and its been hard for
me too. Last Christmas there was something missing. There was no
one with colorful, flowing skirts and sophisticated perfume. There
was no one to talk to about opera, no one around who I could ask
any question in the world to and receive an answer like an encyclopedia
Grandma loved to see me act. Sometimes onstage
or during rehearsals I wonder if she can watch my plays from where
she is. I think she would have wanted the way she died to spark
interest. I bet she likes that people are still talking about her,
that she made them think and question what they believe. Grandma
Peggy liked to stimulate peoples minds, and shes still
good at it.