Thanks to Robert Trotman, Rabbi Ariel Stone, Bobbie Regan, Sam Friedenberg, former Governor Barbara Roberts, Reverend Catherine Nichols, Reverend Frank Moss, Betsy Moss DSW, Kirsten Leonard, Pete Reagan MD, Sue Porter, Peter Goodwin, MD.
Goodbye Peter Goodwin
Compassion & Choices of Oregon joins others all over the world today to grieve the death of Peter Goodwin, MD. He was a campaigner in the 1994 and 1997 ballot measures leading to Oregon’s Death with Dignity Act (ODWDA). On Sunday, March 11, Peter, who had a terminal illness, died after taking medication he obtained under the the Oregon law. He was surrounded by his four children and their spouses, and a Compassion & Choices of Oregon volunteer was with them as well. It took less than one-half hour after taking his medication for Peter to attain the peaceful death he sought.
“I was honored to call Peter Goodwin a compatriot and a friend,” said Barbara Coombs Lee, president of Compassion & Choices. “Our hearts are broken at this loss. The state of Oregon, medicine and the world have lost a great leader. Most of all, our sympathies are with his family, whom he dearly loved.”
In 2006, Peter was diagnosed with a rare, fatal brain disease, corticobasal degeneration. His doctors recently gave him a six-month prognosis.
Peter was a chief petitioner for the ballot measure that led to the ODWDA. Peter called his accomplishments as chair of the committee to pass the Oregon Death with Dignity Act in the mid 1990s “the most gratifying of my entire life.” He was instrumental in persuading the Oregon Medical Association to remain neutral on the measure. After the law passed, Dr. Goodwin helped launch Compassion & Choices of Oregon and was its first Medical Director.
Services for Peter will be Wednesday, March 14, at 5 p.m. at Cheatam Hall on the World Forestry Center Campus in Portland.
LISTEN – Assisted Dying Advocate Uses Law To End His Life, NPR
READ – Peter Goodwin, aid-in-dying advocate, ends life at 83, Washington Post
READ – Dr Peter Goodwin takes his own life after six-year battle with brain disease, Daily Telegraph (UK)
READ – Peter Goodwin’s life’s work, opinion editorial from The Oregonian
LISTEN – Remembering Peter Goodwin, OPB
READ – Peter Goodwin Is Dying: An Assisted Dying Doctor Invokes Law He Built, Daily Beast / Newsweek
READ – The Separation of Church and Medicine, Time
READ – ‘Death with Dignity’ doctor dies at 83, AP
READ – Dr. Peter Goodwin, Father of Oregon Law, Takes Own Life, ABC
READ – Peter Goodwin dies at 83, aided by Death With Dignity Act he championed, CBS
READ – Right-to-Die Advocate Ends His Life, Wall Street Journal
READ – Peter Goodwin Is No More, TopNews United Arab Emirates
READ – Peter Goodwin, doctor who pushed for Oregon’s Death with Dignity law, dies, Oregonian
READ – Dueling over death: Dr. Peter Goodwin crafted Oregon Death with Dignity Act; a 1997 interview, Oregonian
READ – Oregon physician behind Death With Dignity dies, USA Today
READ – Peter Arnold Goodwin, MD – obituary and memorial service announcement
READ – Oregon Doctor’s Death Highlights Right to Die with Dignity, commentary from Susan Graybeal, Yahoo News
Doctor who pushed for Oregon’s Death With Dignity Act intends to exercise the right
From The Oregonian, March 1, 2012
The doctor’s hands can suddenly knock a bowl of granola to the floor. The doctor’s hands put up a fight when he brushes his teeth. What’s really frustrating these days, though, is that the doctor’s hands won’t cooperate in pulling up the doctor’s pants.
“That is really a bummer,” says a jovial Peter Goodwin.
Goodwin, 83, has practiced family medicine for more than 50 years, at OHSU since 1985. But after his diagnosis, even he resorted to the Internet to learn about the rare, progressive brain disorder that would rob him of movement. There is no treatment and no cure for corticobasal ganglionic degeneration. Prognosis: six to eight years.
That was six years ago. Today, he has less than six months. So sometime soon, the disease permitting, the doctor’s hands will perform a final task: to bring a glass to his lips and administer the drug that will cause his death.
This is the right that Goodwin fought for years to establish with his long campaign for the Death With Dignity Act, which Oregon enacted in 1997. He was one of the few doctors willing to speak publicly in favor of the controversial proposal.
During the campaign to bring the act to the ballot, Goodwin said publicly that were he to receive a terminal diagnosis, “I don’t want to go out with a whimper. I want to say good-bye to my kids and my wife with dignity. And I would end it. Damn right.”
Peter Goodwin, a family medicine doctor at OHSU for years, laughs as he talks in his Terwilliger Plaza apartment about his failing health. He suffers from a rare and incurable neurological disorder and has been given less than six months to live. When he feels the time has come, he will exercise his right under Oregon's Death With Dignity Act, which he campaigned for through the 1990s.
Goodwin calls the measure his most significant legacy. Beyond the right to obtain aid in dying, he says, the law’s passage spurred medicine to focus attention on the needs of the dying, with more palliative care and hospice. In 2010 under the Death With Dignity law, 65 people died, the highest number since enactment.
But debates and politics are long behind him. Goodwin now parcels his precious hours for good-byes with friends and colleagues. On Friday morning, with Mount Hood gleaming in the distance from his Terwilliger Plaza window, he sat down with The Oregonian and talked for 90 minutes about a life of standing face to face with death … of others, and of his own.
“We just haven’t come to terms with the fact that we’re going to die, all of us, and to make concessions to that is really giving up hope.” On the contrary, he says; when at death’s door, “the situation needs thought, it doesn’t need hope. It needs planning, it doesn’t need hope. Hope is too ephemeral at that time.”
Born and educated in South Africa, Goodwin “started off as many physicians do, an arrogant know-it-all.”
Yet he puzzled over his inability to connect with patients “well enough for me to be satisfied and for many of them to be satisfied.” He took a year of study at the Medical College of South Carolina. There, a friend who was a psychologist listened to Goodwin wonder aloud how one patient would take advice to quit smoking, but another wouldn’t.
The friend simply asked why Goodwin wanted patients to stop smoking.
A ridiculous question, it would seem. “I thought to myself, oh, that silly idiot.”
Then with a shock he realized that his friend was pointing out the power imbalance between doctor and patient, which led Goodwin to question his motives in practicing medicine, which he says made him a better doctor.
“Why am I lording it over them? What am I doing to them when I talk to them about stopping smoking?” Goodwin says. “That is what he wanted me to think about.” His eyes have tears. “It was touching, really.”
He learned more from his mistakes than from his triumphs. “But it took me a long time to recognize my failures.”
He remembers a patient in the rural South African burg of Queenstown, a woman who had been in a car accident that broke her legs. “I pinned and used plates in both fractures, and neither of them got infected, which was an absolute miracle. She recovered, and she was eternally grateful to me.”
But larger to Goodwin than her gratitude was his mistake: “One leg, one foot was straight ahead, the other was off at an angle of about 30 degrees because I had pinned and plated that leg in the wrong orientation. She could never forget what I had done for her. When I looked at her legs, all I could say to myself was, ‘Good gracious, Peter, is that the best you could do?’”
“The fact that patients love you doesn’t mean everything.”
Goodwin’s wife of 50 years, Erica, was “my adviser, my guide,” a sensitive listener, “which is why our children grew up so well. It was lovely to be together, but losing her was a disaster.”
That great heartbreak came in October 2008. His wife suffered a massive stroke. Goodwin confronted a choice.
“She had said that she never wanted to die as an invalid. So I called her doctor, and he came to the house. I said, look she’s really stroked out. Let’s wait and see until the morning,” he says.
“That was, of course, really in a sense, going against all these sort of information that I knew was appropriate for a stroke patient. But she died the following morning, early. And I have no regrets about that. … I say good night to her every night.”
In the 2011 documentary “How to Die in Oregon” about the Death With Dignity Act, patients said they would know when the time would come to exercise their right. Goodwin can already see the window closing; he’s fallen a few times, and while he hasn’t been injured, he knows that he will not be as lucky as time passes.
When his doctors gave him less than six months, he obtained the drugs to end his life. “It’s given me a sense of relief.” The law requires a patient to give himself the drug, so Goodwin’s hands have never been more important to him.
He can still raise his right arm to shoulder level, but the right hand “is almost totally, ridiculously useless.” His left hand retains some function, although “sometimes it takes two rotations of my Sonicare toothbrush to get all my teeth.” The struggle to do up his pants again can take four or five minutes.
“I use four-letter words quite freely, and at times, I giggle because sometimes it’s really laughable what happens. Even when I knock things to the floor, I sort of think to myself: I did that twice before, but the last two times, I did it a lot better.”
He glances out the window, at shining Mount Hood. He has spent many a dusk watching the light play across the mountain.
“I may be the first person to have come up with this observation, but I don’t think so because I think other people have been unfortunate in the past, and so I think: Life is unfair. There you are.”
To treat that condition, the doctor offers his prescription:
“Be fulfilled. In other words, be happy with yourself. Recognize achievements and be proud of them then go on to further achievements. Know what you want to do and do it. Be happy. Know good friends. Be in love.”
Missourians should follow Oregon’s lead and have a right to die
By Sandy Davidson, an attorney who lives in Boone County Missouri; published in the Columbia Daily Tribune.
Oregon law provides a framework for initiative.
Peter Richardson’s movie “How to Die in Oregon,” screened at Ragtag Cinema, should have carried a warning: “Don’t wear mascara while viewing.”
This beautiful film last year won the Grand Jury Prize for documentaries at the Sundance Film Festival. It primarily tells the story of a terminally ill woman who chose to use Oregon’s voter-approved right-to-die law.
The film raises the question of why people in Oregon should have the right to choose to die when people in Missouri do not. After all, Missouri sent the first right-to-die case to the U.S. Supreme Court in 1990. The Nancy Cruzan case started with the 25-year-old Mount Vernon resident’s tragic car accident that left her in what the law calls a “persistent vegetative state.” The court ruled, 5-4, in favor of Cruzan’s right to die.
More specifically, the court said “yes” to Cruzan’s right to die by the removal of her feeding tubes but also said the state had the right to require “clear and convincing” evidence she would want to have the tubes removed. The high court remanded her case back to the Missouri trial court for more evidence, and the trial court then received what it considered “clear and sufficient” evidence that Cruzan herself would want the tubes removed. Cruzan’s medical team received the legal green flag to remove the tubes and thus end her ordeal.
In the wake of the Cruzan case, living wills became popular, stipulating what types of care a person would want in case of accident or illness. Advanced medical directives could not, however, direct a physician to engage in euthanasia.
In 2006, in Gonzales v. Oregon, the U.S. Supreme Court reviewed Oregon’s law and ruled, 6-3, in favor of physician-assisted death. The question posed to the court was whether the federal law on controlled substances gave the U.S. attorney general the power, in effect, to quash Oregon’s law that permitted physicians to write prescriptions for lethal drugs for terminally ill patients who chose death. The court ruled against the U.S. attorney general and in favor of states’ rights.
So the high court, in a narrow decision involving Cruzan, ruled in favor of withdrawing treatment that kept her in the limbo of a “persistent vegetative state” and later told the U.S. attorney general to butt out of states’ decisions permitting prescriptions for life-ending drugs for terminally ill people.
Oregon’s law has many safeguards. For example, two physicians must agree the patient is terminally ill and will die within six months, and the physician can only prescribe and cannot administer the lethal drugs.
Washington state voters also adopted a statute much like Oregon’s. Montana courts recognize assisted death as a right. Vermont’s Legislature has been considering a right-to-die bill, and Massachusetts voters might soon give themselves the right to die. And Missourians?
The importance of laws such as those in Oregon and Washington was driven home to me two decades ago.
My stepfather, Pops, lay dying at University Hospital from cancer that had grotesquely swelled his stomach. He told his physicians he wanted to go to sleep, and they thought he was requesting a sleeping aid. But then he got through to them: No, he wanted a drug to make him sleep permanently. His physicians told him they couldn’t do what he wanted. He protested, saying, “Ask my daughter. She’ll tell you. She’s a lawyer.”
Pops’ last coherent words to me were “shoot me”— and he meant it.
People in Oregon and Washington have the right to die via a prescription written by a physician. People in Missouri do not. Terminally ill Missourians must eke out the last bit of pain, whether they wish to do so or, like my Pops, do not.
I cried during Richardson’s film on dying in Oregon. I cried afterward, too, in part for the suffering Pops was forced to endure because of state law.
Isn’t it time for an initiative petition in Missouri for a right to die for terminally ill people who want their suffering to end?
‘How to Die in Oregon’ is now available at Amazon, Netflicks, Barnes & Noble, and on HBOGO.
Oregon POLST headlines national journal
Oregon’s groundbreaking Physician Orders for Life Sustaining Treatment program (POLST) is featured in the latest edition of the Journal of The American Medical Association. The program, which was created by health care professionals two decades ago in an effort to ensure the wishes of those with advanced illness are followed, has now spread to 34 states around the country.
READ – POLST Registry Do-Not-Resuscitate Orders and Other Patient Treatment Preferences (excerpt)
The program’s key component is an order form that provides clear instruction about the patient’s health care preferences to health professionals, such as paramedics and emergency room physicians, when a patient cannot communicate these wishes themselves. The form allows patients to request that they receive or refrain from certain measures such as CPR or intensive care. In addition, Oregon’s program includes a registry that offers 24-hour access to emergency workers when the printed form cannot be located.
The JAMA article highlights the latest research to gauge the impacts of the program. That data revealed:
- 25,142 people were enrolled in Oregon’s registry during the first year of operation.
- 86 percent of patients in the POLST program are 65 or older.
- 28 percent wished to receive CPR if needed.
- 72 percent had a “Do Not Resuscitate” order.
- 50 percent of patients who had a DNR order wanted to be hospitalized.
“Our study shows that resuscitation is not the most important question for people with advanced illness and frailty,” said Susan Tolle, M.D., director of the Center for Ethics in Health Care at Oregon Health & Science University and senior author on the study. OHSU administers both the program and the registry. “Not only is CPR unlikely to be successful in patients with advanced illness, but knowing that the patient has a DNR order does not predict what other treatments they want or do not want. Half of patients with a DNR order wanted to return to the hospital and half did not. POLST orders for scope of treatment clarify which patients want to be hospitalized and whether they would want intensive care in a time of crisis.”
“The POLST program creates a system that has been shown to have advantages over traditional advance directives and do-not-resuscitate orders by providing a more comprehensive set of medical orders based on patient preferences and ensuring that patients receive the medical treatment they want with a high degree of accuracy,” added Alvin H. Moss, M.D., director of the West Virginia Center for End-of-Life Care, which oversees the Physician Orders for Scope of Treatment (POLST) program, a program comparable to Oregon’s POLST program, and the WV e-Directive Registry. “The Oregon POLST registry is the final step in completing the system and makes those orders available to treating health care providers in an emergency.”
One of the important aspects of the POLST program is its ability to launch important discussions among patients, their loved ones and health care professionals. When these discussions occur in the early stages of advanced illness for frailty, patients can share their wishes in case they are unable to communicate in a time of crisis. In addition, the program offers families some peace of mind because when a patient fills out a POLST form, the burden of family members who previously could only speculate on their loved one’s wishes, need not do so anymore.
“One of my colleagues, a rural doctor, taught me not to start my conversations about goals of care with code status,” explained study author Erik Fromme M.D., a palliative care specialist at OHSU. “Instead, he said, it should be the last question you talk about. Too often in health care the conversation begins and ends with resuscitation, when it would be much more helpful to know what kind of care a patient wants before they arrest. Our data, and programs like Oregon’s support the wisdom of this approach.”
READ – Study: Oregonians Who Have Registered Their Wishes Don’t Want Resuscitation, OPB.org
READ – An Oregon study points to better end-of-life care planning, Oregonian.com
Accomplishments of 2011 – a report to our supporters
Dear Friend of Compassion & Choices of Oregon,
We are pleased to tell you 2011 brought exciting growth and change to Compassion & Choices of Oregon – almost too many accomplishments to list.
As a dear friend, you already know our work is based on three key pillars: Support, Educate and Advocate. So I’ll share some of the more important highlights each of those areas.
Support for our clients seeking relief through the Oregon Death with Dignity Act was delivered with compassion, sensitivity, expertise and professionalism.
• More than 40 dedicated Client Support Team volunteers responded to 286 people who inquired about the Act, helped more than 85 persons receive a legal prescription, and supported 51 to use the medication. Aid in dying in Oregon remains safe, rare and protected.
• Those volunteers enlarged our client service across the state. Our largest number of clients (57 percent) come from the Portland metro and North Coast area. Other clients can be found in Eugene and Central Coast (21 percent), Southern Oregon and South Coast (11 percent), and Central and Eastern Oregon (11 percent).
• A team of medical directors began to provide peer-to-peer information for prospective prescribing doctors January. By anticipating doctor concerns, Compassion & Choices of Oregon helps avoid patient problems and assures patient access to the law.
• Our new client database collects, collates and reports relevant information about our services. These measurements enable accurate reporting and quick retrieval of data and benchmarks for management decisions.
• We recruited and trained new volunteers in Portland and Eugene and launched a new Client Support Team in Southern Oregon. Today, more than 70 volunteers from every corner of the state help assure choice is protected for all Oregonians.
• Compassion’s clients are well-served by Oregon’s great hospices – more than 85% are with hospice at time of death. Education about aid in dying remains our everyday work, and the word continues to spread across Oregon and the country.
• We launched this newly designed and rebuilt website in January; it provides doctors, pharmacists, hospices, patients, loved ones and others with easy access to vital information.
• We launched a Facebook page in March, and as of this writing, 430 people have ‘friended’ us. How about you?
• Millions watched the award-winning documentary ‘How to Die in Oregon,’ when it premiered on HBO in June. The film takes viewers inside the lives of patients, doctors, family members, Compassion & Choices volunteers and others as they confront the law and experience its impact on their individual stories. Advocates were rallied in March to stop a dangerous legislative assault in the Oregon House.
• Opponents put forward Oregon House Bill 2016 last March, which took the pejorative (and insulting) position that dying patients interested in accessing the Oregon law are mentally incapable and in need of counseling. The measure would have created unconscionable hurdles to citizen access to the law. A statewide communication effort stopped it in its tracks. Citizens from across the state signed petitions, wrote letters, made phone calls and sent emails to let lawmakers know that our rights to Death with Dignity are not to be tampered with or abridged.
Several leading Oregon foundations came forward with financial support for our work, including the Kinsman Foundation, Spirit Mountain Community Fund, PacificSource Charitable Foundation and Holzman Family Fund.
A joint operating agreement with the national office of Compassion & Choices makes our work in Oregon more efficient and your gifts more effective. We now share office space, information technology and back-office functions, significantly decreasing our overhead. This single, combined annual report exemplifies that partnership. Our cost to honor your gifts in this report was significantly less than previous years.
Liberty is on the march in Oregon. Our mission to be a comprehensive resource for Oregonians at the end of life is more secure than ever before, largely because you gave freely of your personal resources. We hope you will continue to support us in the future.
Gratefully,
Jason Renaud
Executive Director
