ROBERT SIEGEL, HOST:
Physician-assisted suicide is illegal in most states of the U.S. There are gray areas where doctors can help suffering patients hasten their death, but no one can talk about those directly. From KQED in San Francisco, April Dembosky has this story of one woman's isolation and fear when her husband was dying.
APRIL DEMBOSKY, BYLINE: Hope Arnold remembers the day her husband was discharged from the hospital. He had stomach cancer, and treatments were no longer working for him. So Hope finalized plans with the local hospice. She dropped off some paperwork at a medical office and bumped into one of her husband's doctors.
HOPE ARNOLD: And he hugged me and asked me how I was holding up. And then he handed me a bottle of liquid morphine. And he said, you might need it.
DEMBOSKY: Hope handed the bottle back. She said the hospice was going to take charge of her husband's pain medication.
ARNOLD: And he looked at me and he held my gaze for a second. And he put it back in my hand, and he said, you might need it.
DEMBOSKY: She slipped the vial in her purse.
ARNOLD: When I got home, it hit me like a ton of bricks. I said to J.D., I think he may have given this to me so I can give you an overdose. And he said, maybe. And then we didn't talk about it anymore.
DEMBOSKY: J.D. Falk deteriorated quickly. Hope worried that he was in a lot of pain, but she couldn't tell.
ARNOLD: And I couldn't ask the nurse that.
DEMBOSKY: She was afraid that if she asked, it would betray the thoughts she was starting to have about that extra vial of morphine.
ARNOLD: I couldn't ask anybody anything because then I would've tipped my hand.
DEMBOSKY: Just over 3 percent of U.S. doctors say they have written a prescription for life-ending medication. Almost 5 percent of doctors reported giving a patient a lethal injection. Barbara Coombs Lee is president for the advocacy group Compassion and Choices.
BARBARA COOMBS LEE: Those practices are undercover. They are covert to the degree that patients are part of the decision making. It is by winks and nods.
DEMBOSKY: Her organization actually guides dying patients on how to get around the law.
COOMBS LEE: We talk with people about how they might broach the subject with their physician, and quite frankly, how to play the wink-and-nod game.
DEMBOSKY: It's a game Hope found herself entangled in during her husband's last days - a game where she didn't know the rules. Hope felt like she couldn't think straight.
ARNOLD: It's just like this foggy, like, dream state.
DEMBOSKY: Should she do it?
ARNOLD: I wasn't sleeping right.
DEMBOSKY: When should she do it?
ARNOLD: I was beyond stressed.
DEMBOSKY: What if she did it wrong?
DEMBOSKY: Medical experts say this kind of situation is a symptom of a much bigger problem. Stanford ethicist David Magnus says doctors are just plain bad at communicating about death.
DAVID MAGNUS: Across the board with end-of-life care clinical interactions, they're full of misunderstandings.
DEMBOSKY: He suggests what some people interpret as hints on how to hasten someone's death, maybe aren't.
MAGNUS: That may be how the family perceived it.
DEMBOSKY: On the flip side, Magnus says what some people believe is assisted suicide actually isn't. It's legal for people to take or give large doses of narcotics to relieve pain, even if a known side effect is that it may hasten death.
MAGNUS: The difference there really has to do with intent, and that's a tricky thing 'cause that has to do with what's going on in the mind.
DEMBOSKY: Hope wondered what was going on in her husband's mind. He never actually said he wanted her to give him an overdose. Hope thinks that's because he didn't want to ask her to commit a crime.
ARNOLD: He didn't want to put me in that position.
DEMBOSKY: In the end, she didn't do it. Her husband died under hospice care just a couple days after he got home. Hope left the morphine vile untouched.
ARNOLD: I don't know whether or not he wanted that. That's not the point. The point was nobody could talk about it.
DEMBOSKY: Not her husband, not the doctors - everyone was speaking in code at a time when she was desperate for clarity. For NPR News, I'm April Dembosky in San Francisco.
SIEGEL: That story is part of a reporting partnership of NPR, KQED and Kaiser Health News.
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