Rural Oregonians still face Death with Dignity barriers
Roadblocks abound in rural areas

By the time Tom Stanton’s cancer was diagnosed, it had already spread from his colon. It was in his stomach lining, blocking his bowel. Aggressive chemotherapy might add three months or so, the doctors offered. He declined.

He was in horrendous pain. But the thing that scared him more was having a stroke like his dad, and burdening his sister, Connie Saltos, with taking care of him. Their dad, expected to live two days, spent three months unconscious in a nursing home.

“He was worried to death about it,” Saltos recalls. “I told him, ‘Tom, we’re not going to put you anywhere. We’ll keep you here. If you have a stroke, you’re going to stay.’ But that really bugged him.”

Stanton was resolute in his decision to use Oregon’s Death with Dignity Act to obtain the medication to end his life. He told his sister as much when they got home from the hospital. The two had been best friends since childhood. They lived on the same dusty gravel road that winds up a hill just outside of downtown Prineville.

Without question, Saltos was going to help her big brother with this one last favor.

But it would involve travel. Pleading for help. And it would be months before Stanton would get the medication.

Terminally ill Oregonians have had the right to end their lives using medication for 20 years. There’s less overt campaigning against the law than in previous years, yet that resistance lingers today. Many doctors refuse to help patients, who are required to have two doctors approve them before they can get the medication.

The challenge is more evident in Central Oregon, where the region’s only hospital provider, St. Charles Health System, does not allow its doctors to sign for patients, citing religious objections. That leaves a small handful of doctors, most of whom don’t wish to be named, willing to sign for patients.

Oregon’s historic right-to-die law is almost elusive to those in rural areas. Of the 1,127 Oregonians who died using Death with Dignity medication between 1998 and 2016, 88 lived east of the Cascade Range, including in Central and Eastern Oregon.

In rural pockets of the state, there are no doctors willing to help within 100 miles, according to one advocacy group. Most prescriptions are written in the Portland area.

The effect of that is after being told they have six months or less to live, after making what could be the toughest choice of their lives, patients like Stanton are forced to spend their remaining weeks or months searching for doctors willing to help them use Death with Dignity.

Stanton grew sicker and sicker, and his 6-foot, 2-inch frame dwindled from 180 to 117 pounds. His sister loaded him into the car, lovingly stacked pillows around him and drove him to Portland, where she knew of a doctor who might help him end his life.

“He wasn’t complaining,” Saltos said. “He never complained. The point was we were on a mission, and he had to go.”

Lots of steps

The challenge of using Oregon’s Death with Dignity Act is partly by design. The hurdles force people to consider what they’re doing from every angle.

Andrea Sigetich helped her husband, Beryl Rullman, get the medications last year as he died of chronic obstructive pulmonary disease. She said there were lots of steps along the way.

“They really cause you to pause a number of times and say, ‘Is this what I really want to do? Do I want to go forward with this?’” Sigetich said.

It was also a learning process for Rullman’s doctor, who had agreed years earlier to help him end his life if he was terminally ill.

Before terminally ill patients can get lethal medication, two doctors must confirm their eligibility: six months or less to live, mentally capable of making health care decisions, at least 18 years old, Oregon resident and able to take medication without help. They have to ask twice verbally and once in writing, and they have to do it themselves.

Andrea Sigetich helped her husband of 30 years, Beryl Rullman, use Death with Dignity last year while he was terminally ill with chronic obstructive pulmonary disease. / Submitted photo

“This is not a casual thing,” said Tom Leach, a Bend-based volunteer for End of Life Choices Oregon, a group that formed in January solely to help families use Death with Dignity. “You’ve really got to think about it.”

The two doctors who help are called the prescribing and consulting doctors. The consulting doctor determines the patient has six months or less to live, fills out paperwork and gives it to the prescribing doctor, who confirms the prognosis and prescribes the medication.

The prescribing physician tends to be more involved in ushering the patient and family through the Death with Dignity process. Often, that doctor offers to be there when the patient takes the medication.

If either doctor is concerned about the patient’s mental state, they can have a psychiatrist weigh in.

Sigetich gets why the steps are there. Rullman knew exactly what he wanted — to avoid losing control and dying of suffocation — and his wife was determined to help.

The two had been married for 30 years. When they met, the connection was immediate. They were engaged in a few months.

Sigetich, who lived in Boston at the time, had a question she used to screen potential romantic candidates.

“I had this line: ‘I have this fantasy of putting my backpack in my car and driving west,’” she said. “Usually guys would go, ‘What? You want to do what?’ And Beryl said, ‘Great!’ I thought, ‘Oh, no. Am I in trouble.’”

No doc list

There’s no list of doctors willing to help, at least not one that’s publicly available. That’s understandable, as the people on such a list could be derided by patients and colleagues opposed to the law.

Saltos wishes that wasn’t the case. A list would make it a lot easier for families like hers.

“I think they don’t even stop to think that people are not finding it,” she said. “They’re not getting it.”

Neither the law’s supporters nor its opponents want to see a small handful of “doctor deaths” approving the majority of patients who use the medications. Rather, it’s better to have many doctors approving a few patients they deem appropriate candidates.

Ideally, patients’ own primary care physicians or the specialists who diagnosed them would help them use Death with Dignity rather than referring them elsewhere, said Matt Whitaker, Oregon director for Compassion & Choices, a nonprofit that advocates for Death with Dignity laws.

“The goal is not for there to be a specialized list of doctors in the state where everybody goes to them, but rather for this to be normalized and integrated into the medical standard of care,” he said.

In 2016, 106 doctors wrote 204 Death with Dignity prescriptions in Oregon, according to the Oregon Health Authority, which oversees the Death with Dignity Act and releases annual reports on the law’s use. Each doctor wrote as few as one and as many as 25 prescriptions.

Dr. Kenneth Stevens Jr., president and co-founder of Physicians for Compassionate Care Educational Foundation, a consortium of doctors and other health care professionals mostly in the Pacific Northwest that oppose the law, is concerned that a few doctors write too many prescriptions. That happens, he said, because after patients’ doctors decline to help, they go online and find groups like Compassion & Choices, who refer them to a specific group of doctors.

When there’s a small network of people participating in the law, Stevens said he’s concerned they wouldn’t expose abuses in the system, which he said there have been. The law’s opponents have highlighted two cases from 2008 in which Oregon’s Medicaid program denied coverage for cancer treatment because the patients’ odds of survival were too low, but permitted Death with Dignity medication. Stevens and others have also aired concern that the law could be used by people who have depression.

Most of the people involved with End of Life Choices Oregon, including its executive director, Sue Porter, left Compassion & Choices to form the new group. They’re hesitant to say much about the split on record but explain it as a desire to direct all their efforts on helping families, whereas Compassion & Choices focuses mostly on lobbying and advocacy.

End of Life Choices Oregon has volunteers posted around the state ready to help families struggling to find doctors. In Central Oregon, people are directed to Leach, who lives in Bend. Like most volunteers who help people use Death with Dignity, Leach was inspired by his own experience. He helped his wife use the law while she was dying of cancer in 2009.

For his wife and others, Leach said just holding the pill bottles — touching them and knowing where they’ll be stored — brings peace of mind. State data indicate the most common reason people use the law in Oregon is they fear a loss of independence.

“For those people who have that fear, they are suffering worrying about what’s going to happen and how the end might be, for them and their families,” he said. “Now, people get the prescriptions and they go, ‘OK, now I’ve got control over this.’”

Returning to practice

Dr. Dan Murphy’s first introduction to physician assisted death was in the mid-’80s, well before any laws were on the books. He was working in Merced, California, about 130 miles southeast of San Francisco.

It was the height of the AIDS epidemic, and men were returning home from the big city to die excruciating deaths. At a national AIDS conference in San Francisco, a doctor, who had AIDS himself, shared with the roughly 600 doctors in the audience the lethal recipe he prescribed for patients: 10 grams of seconal, 1 gram of morphine and a bottle of good red wine.

Dr. Dan McCarthy retired from St. Charles Family Care in Redmond but is returning to practice to help people use Death with Dignity. He is pictured at his home in Redmond on July 11, 2017. (Joe Kline/Bulletin photo)

“This was at a time when no state had it legal,” Murphy said. “I guess he figured since he had a fatal diagnosis in the first place that nobody was going to do anything to him anyway.”

Murphy moved his wife and kids to Redmond in 1995. Since so few doctors participated in Oregon’s Death with Dignity Act when it was implemented a couple years later, he became the go-to guy. For the next 20 years, he estimates he helped between two and three patients use the program every year, most of them referred by other doctors.

“I found it a privilege to work with people in the last days of their lives,” said Murphy, who speaks softly and appears to consider each word before saying it. “It’s a deeply moving experience to talk with people that are at the end of their lives to hear what they have to say.”

They were without exception interesting people, he said. Independent people, too. People who had made their own decisions from early on. Nearly half the people who received prescriptions have bachelor’s degrees or higher, according to state health authority data.

The difficulty of finding doctors was apparent even then. Murphy would get calls from as far east as Baker City and John Day, or as far west as cities along the Oregon coast. One person he helped, a nurse from California dying of breast cancer, had moved to Central Oregon from California specifically to use the law.

Murphy retired in December 2015. He’s since met with Leach and learned about the continued struggles local families face in using Death with Dignity. The 64-year-old doctor plans to return to practice solely to help families use the law. His state medical license is still active, and he’s renewing the federal license that lets him prescribe controlled substances.

He plans to use an Oregon law that lets medical providers forgo malpractice insurance as long as they don’t charge for their services.

Leach attributes the low use in Central Oregon in part to a lack of support from Compassion & Choices over the years.

“Probably right now it could be more difficult here than other places,” he said, “and we’re working really hard to change that.”

It’s also due to hospital rules that align with the Catholic church, Leach said.

The Stanton family. Connie Saltos, far left, helped her brother, Tom Stanton, far right, use Death with Dignity last year. To Connie's right is her sister-in-law, Sunny Stanton, her brother, Don Stanton and their mother, Letha Stanton. The family is pictured at Don and Sunny's wedding in 2000.
(Submitted photo)

Religious objections

Some health systems, St. Charles included, don’t let their doctors sign for patients because of their ties with the Catholic church. That’s the case for Providence Health & Services, which operates a number of hospitals in the Portland area, as well as in Medford, Hood River and Seaside. It’s also true for PeaceHealth, which has hospitals in the Eugene area.

The church formally severed its relationship with St. Charles in 2010 because the health system performed tubal ligation, a form of female sterilization. Regardless, St. Charles officials have said they still adhere to the church’s ethical and religious directives, a set of rules that govern health care, including bans on elective abortions and euthanasia.

“There are certain things that we elect not to do because of those directives,” St. Charles spokeswoman Lisa Goodman said.

Some people interviewed for this article said St. Charles physicians have signed Death with Dignity forms. For the last five years of his practice, Murphy’s clinic in Redmond was owned by St. Charles Family Care. He didn’t hide the fact that he helped patients use Death with Dignity and said administrators were well aware.

Dr. Charles Blanke, an oncologist with Oregon Health & Science University, said the problem of finding doctors — while intensified in rural parts of the state — is universal throughout Oregon.

Blanke agrees there should be a public list of doctors willing to help patients use the program. In June, he took a call from a patient who had been searching for a doctor for months. He’s gotten requests from patients in Central Oregon after their doctors at St. Charles turned them down. He’s even driven to their homes.

“It’s a huge problem,” Blanke said.

After her brother’s diagnosis, Saltos called St. Charles to see if the doctor who worked with Stanton would sign his Death with Dignity approval.

“They told me, ‘Well, you can’t talk to him. He’s a contract doctor,’” she said. “I said, ‘Well, would he sign?’ ‘No.’”

She was frustrated that St. Charles wouldn’t help her find a different doctor. Her brother’s hospice agency wouldn’t help, either. Most hospice agencies — who care for nine in 10 of the patients who use Death with Dignity, according to the OHA — don’t let their doctors approve patients.

Saltos scoured the Internet for help, posting on various Facebook pages and getting accused of shirking her duties as a loved one. She didn’t know where else to turn. Finally, a friend told her about OHSU’s Blanke, who agreed to meet with them in Portland. Saltos said Blanke agreed to help Tom but wasn’t able to find a second doctor. Luckily, she learned about another doctor in Bend, who agreed to help. That doctor asked not to be identified.

Not long after, the medication arrived in the mail.

Ethical questions

Leach, the End of Life Choices Oregon volunteer in Bend, initially struggled with his wife’s decision to use Death with Dignity. They lived in the Corvallis area at the time.

He earned his master’s degree in religious studies from a seminary and worked as a chaplain for hospitals and a hospice agency. Leach places himself on the liberal end of Christianity.

Religious objections to Death with Dignity tend to come from conservative Christians who adhere strictly to the Bible, which prohibits taking one’s own life. Opponents call Death with Dignity assisted suicide.

Here’s the difference, in Leach’s mind: People who kill themselves could live but choose not to. People who use Death with Dignity want to live, but can’t.

“They’re dying,” Leach said. “The only choice they have is how and when am I going to die?”

Some doctors believe Death with Dignity contradicts the Hippocratic Oath, an ancient Greek medical text that outlines ethical standards. It directs doctors not to give lethal drugs or perform abortions and to protect patients from harm.

Blanke said he thinks Death with Dignity ends suffering, which the oath encourages.

For some doctors, it’s not ethical or religious opposition that keeps them from participating, it’s intimidation around helping a patient end his or her life. Plus there are a number of forms and rules.

“If you don’t do this every day or every week or even every month, it can be a little challenging,” Blanke said, “and of course people are very worried they’ll do the wrong thing and put their license at risk.”

Both Compassion & Choices and End of Life Choices Oregon operate physician help lines that walk doctors through the steps. Compassion & Choices launched its phone line, Doc2Doc, in 2015. Doctors who call are connected with peers who have years of experience with the process.

Between 2014 and 2015, the number of prescriptions written went up 40 percent, according to Oregon Health Authority. Whitaker attributes the spike in Death with Dignity use in 2015 in part to the phone line.

In other cases, misinformation keeps doctors from approving patients for Death with Dignity. Whitaker has heard doctors say they aren’t certified to participate. There is no certification. Others say they aren’t Compassion & Choices physicians. Compassion & Choices is not a medical provider.

There’s also the fact that doctors just aren’t very good at estimating life expectancy, Blanke said. There’s pressure to get it right when a person could end his or her life based on the projection.

“You have to question, ‘Holy cow, I might have allowed somebody with a longer life expectancy to claim their life,’ and that’s really a catastrophe,” Blanke said.

Stevens, who is opposed to Death with Dignity, said doctors make mistakes. They’re not always right when they say a patient is dying. Sometimes they make the wrong diagnoses.

“Many times people think of this situation, ‘A person is dying; let’s just get it over with,’ but you are not necessarily dying,” said Stevens, a professor emeritus and former chair of radiation oncology at OHSU.

Even doctors like Blanke, who believe wholeheartedly in Death with Dignity, face ethical dilemmas.

What about patients with curable illnesses who still choose Death with Dignity? The law says a person is eligible if their illness will kill them within six months, but doesn’t specify whether they would survive with treatment.

Blanke’s toughest case yet was a young patient with Hodgkin lymphoma and a more than 90 percent chance of survival with treatment. She did not believe in chemotherapy and feared its toxicity, despite Blanke’s efforts to convince her otherwise.

Blanke referred the patient to a psychiatrist for an evaluation. Once she was cleared, he approved her for Death with Dignity, holding firm to his belief that doctors should not force patients to receive treatment.

He declined to say whether the patient used the medication.

“That was a very, very challenging situation,” he said. “You have to ask yourself, ‘Why doesn’t that patient want to take relatively non-toxic treatment and live for another seven decades?’”

Hiding the meds

A Father’s Day heart attack and double bypass surgery forced Jim Schweigart to retire in 2006. He’d been an officer with the Pendleton Police Department for 36 years.

By hunting season, he started to feel sick again. It was different this time. A doctor at St. Anthony Hospital, the city’s only hospital, said he had advanced cancer and three to six months to live.

Jim Schweigart pictured in his Pendleton Police Department uniform. His hospice agency threatened to withdraw care if he used Death with Dignity in 2007 while he was terminally ill with cancer, according to his daughter.
(Submitted photo)

Schweigart was the one who cared for his own father as he died of pancreatic cancer in 1978. Patients couldn’t get morphine at home at the time, so he’d bring his father back and forth to the hospital every few days so they could give him morphine and fluids.

“Dad decided he didn’t want to suffer like his dad did,” said Lisa Schweigart, Jim Schweigart’s daughter, who lives in Pendleton.

Lisa Schweigart, 45, had always been close with her father, so when he told her he wanted to use Death with Dignity, she took charge. Jim Schweigart’s primary care doctor declined to help, but with some prodding from his daughter — who said she can be real pushy — that doctor referred him to a doctor in La Grande, who agreed to help.

When the Death with Dignity medication arrived in the mail, Jim Schweigart told his daughter to lock it in his gun safe downstairs. The St. Anthony Hospital’s hospice agency staff, who was caring for Jim Schweigart in his home, had threatened to withdraw their services if he used Death with Dignity, Lisa Schweigart said.

Hospice staff were relentless. Lisa Schweigart said they waited until she wasn’t home, then searched through the kitchen cupboards, the refrigerator and the bags her dad kept his medication in.

St. Anthony Hospital spokesman Larry Blanke said he did not know the hospice agency’s policy on Death with Dignity, including whether the staff would stop caring for patients who had the medication. He said he would find more information, but did not follow up, nor did he return several calls seeking comment.

St. Anthony Hospital is owned by Catholic Health Initiatives, a nonprofit health system formed in 1996 through the consolidation of four Catholic health systems. In the initial call, Blanke said hospital officials consider dying naturally to be “death with dignity.”

“As a Catholic Hospital, we don’t believe in euthanasia, of course,” he said. “We can’t just intentionally kill someone.”

Lisa Schweigart recalls her dad being very angry.

“He said, ‘It’s my right. I fought for my country in Vietnam,’” she said. “‘I worked on the streets and patrolled the streets of this town to keep these people safe in the middle of the night and they have the audacity to tell me that I have to stay here and be miserable until my body says, ‘Sorry, I’m tired. See you later’?”

Hospice perspectives

Barb Hansen, CEO of the Oregon Hospice & Palliative Care Association, said she’s “pretty confident” no hospice agency in Oregon today would drop patients for having Death with Dignity medication. She couldn’t say whether that was true in the past.

It’s rare for physicians who work for hospice agencies in Oregon to sign patients’ Death with Dignity approval forms.

Hansen doesn’t track hospice policies on the subject. When patients ask hospice providers about using Death with Dignity, some help them find doctors who can help, others won’t.

Agency policies also differ on where staff can be when patients take the medication. Some agencies make their staff leave the room. Others make them leave the home. Regardless, they’ll manage the patient’s symptoms and comfort the family all the same, Hansen said.

Death with Dignity is a sensitive subject for hospice agencies, who have spent years battling the public perception that they hasten people’s deaths.

“There has been the connotation from the public that hospices are death panels, and all we do is give people high doses of morphine and put them out, which is far from the truth, of course,” said Dr. Jennifer Blechman, palliative care director for Partners in Care, a Bend-based hospice and home health agency.

That’s why many agencies, Partners in Care included, do not let their physicians approve patients for Death with Dignity. Partners in Care continues to support patients who use the program, but it won’t help them take the medication and its providers leave the room when they do so, she said. Sharon Strohecker, the director of St. Charles Hospice, said her agency’s policy is the same.

But while Blechman said she helps connect patients with local doctors who can help them, Strohecker said St. Charles Hospice does not.

“It’s the patient’s work that they need to do,” Strohecker said.

Near the end, Jim Schweigart described to his daughter how his body ached all over. His stomach. Under his arms. He could only eat through a feeding tube and couldn’t get up to use the bathroom.

Ultimately, though, Jim Schweigart never took his Death with Dignity medication, and instead died naturally. Through the end of 2016, only 64 percent of the 1,749 people who received prescriptions took the medication, according to the OHA.

Lisa Schweigart gets worked up easily reflecting on how her local medical providers treated her family throughout the ordeal. No one talks about Death with Dignity in Eastern Oregon, she said. Even her father’s former colleagues on the police force disagreed with his decision.

Oregon’s Death with Dignity Act does not require any providers to participate if they choose not to. Lisa Schweigart doesn’t think it should be that way.

“If you’re here and you’re the only hospital, I don’t think you should be dictating your religion over to everyone else,” she said. “I think you need to do your health care.”

Ask early

Some people wait weeks before taking the medication. Others never take it.

Rullman — Sigetich’s husband, who suffered from chronic obstructive pulmonary disease — was not one of those people. FedEx delivered his Death with Dignity medication at 2 p.m. and he took it at 8:30 p.m. the same day in April 2016, Sigetich said.

Rullman was diagnosed with COPD — a group of lung diseases that cause irreversible damage, making it increasingly difficult to breathe — about seven years before his death. He was on oxygen for five years. For the first year or so, he could still hike, then that was out of the question. Eventually he couldn’t kayak either.

In the last two weeks of his life, it was “crystal clear” that Rullman was ready, said Sigetich, who lives in the home they shared on a rural stretch of property on the southeast outskirts of Bend. By then, he relied on his wife and hospice nurse to use the bathroom and shower. He would have used the medications then if he had them, she said.

“I’m walking him to the bathroom and he said, ‘This is supposed to be Death with Dignity and I don’t have any more dignity,’” Sigetich said. “That was the point at which he felt it was done for him.”

Fear of losing autonomy is the most common reason Oregonians use Death with Dignity. Between 1998 and 2016, 91 percent of people who used the program named that as being among their chief end-of-life concerns. A slightly smaller proportion cited not being able to do activities that make life enjoyable.

Only about 26 percent of users cited a fear of inadequate pain control. That could be because 90 percent were enrolled in hospice programs, which specialize in controlling symptoms like pain.

After Gene Kozowski was diagnosed with amyotrophic lateral sclerosis in July 2015, he was clear with his family: He wanted to use Death with Dignity. ALS is a progressive, incurable condition that eventually renders people unable to move, speak or breathe.

His daughter, Andie Edmonds, thinks she would make the same choice, but that didn’t make it easy.

“Knowing my dad’s personality, to think of him confined to a wheelchair, to think of him like people I’ve seen with ALS, he’d be so mad,” said Edmonds, 50. “He’d just be pissed.”

After the diagnosis, Edmonds and her husband bought a wheelchair accessible home within the Tetherow resort on Bend’s westside — a single-level with widened doorways, ramps and grab bars in the bathroom. Edmonds hoped it would encourage her dad to stick around longer. He lived with the family for six months before he died in February.

Edmonds believes her father could have lived longer comfortably, but he worried constantly about losing the ability to swallow, which he believed would have rendered him unable to take the medication. In order to use Death with Dignity, patients must be able to take the medication themselves, whether orally or by putting it in their feeding tube.

Kozowski told Edmonds he was afraid of becoming a burden to the family. That’s a concern cited by 42 percent of Oregonians who used the program, according to the Oregon Health Authority.

“My dad would say that all the time,” Edmonds said.

Unlike others in Central Oregon, neither Kozowski nor Rullman had trouble getting approved for Death with Dignity.

Rullman told his doctor years before his COPD diagnosis he wanted to use the law if he was terminally ill. She agreed. Sigetich sees the same doctor, but declined to identify her. Rullman was the first Death with Dignity patient his doctor approved. She had her partner serve as Rullman’s second signer.

Sigetich said she recommends people ask their doctors whether they would help them use Death with Dignity in the event they became terminally ill. It wouldn’t involve paperwork, but would be helpful to know their attitudes.

“Especially because if that person isn’t going to support you, you might want to know that 10 or 15 or 20 years before you die,” she said. “That might just be useful information.”

Planning the right death

Sigetich was the only person Rullman wanted to be there when he took the medication.

She asked a hospice nurse and a good friend to stand by in the kitchen for support. She mixed the medication — packets of powdered phenobarbital and morphine into a liquid binder — and poured it into her husband’s crystal scotch glass.

Rullman drank it sitting on the living room couch. Even at his sickest, the 78-year-old was never in bed unless he was sleeping. Afterward, he was conscious for about 10 minutes.

“He said some things he wanted to say and I said some things I wanted to say,” Sigetich said.

After he lost consciousness, the nurse helped Sigetich lay him down. He lived for another hour.

“It was so peaceful,” Sigetich recalled. “I was really kind of surprised by that.”

Peaceful is a word that comes up a lot when family members describe loved ones’ deaths using Death with Dignity. Everyone has said what they need to, and everything is planned just so: when it happens, who is there, what music is playing.

Kozowski drank the medicine sitting in his favorite chair. Afterward, Edmonds laid her head on his chest surrounded by her husband and brother.

“That, to me, was a gift,” she said.

Murphy is at the bedside for roughly 90 percent of his patients’ deaths. He always reminds them they can change their minds. Some throw parties. One watched her favorite movie, “Finding Nemo.” One told him it felt like he was going on a trip to somewhere he’d never been. One, an outspoken atheist, jokingly held a tiny Jesus statue. “It’s just insurance, Murph. It’s just insurance,” she’d told him.

Normally, death involves a great deal of discomfort and uncertainty, especially in the last 72 hours, Murphy said. If family lives far away, it’s unclear when they should come. Much of it is waiting.

The reality, some family members say, is that people who are determined to take their lives rather than losing control of their bodily functions or other consequences of their illness will find a way to do so. And they might do it in a way that’s disturbing to family members.

Lisa Schwiegart said she knew her dad could unhook his tubes in the middle of the night, go downstairs, take his gun from the safe and shoot himself.

“If there is a better way to do it so people don’t have to clean up the mess, so he can say goodbye and choose his time, perfect,” she said. “You don’t want somebody to feel that’s their only way out when they’re dying anyway.”

Kozowski was clear with his family: If he had any trouble using Death with Dignity, he would find a different way to take his own life. Edmonds said she and her family are strong supporters of the Second Amendment, and pleaded with him not to shoot himself.

After her father died, Edmonds found a mask and other equipment among his things — tools for killing himself. He would have driven somewhere — out on the woods maybe — and connected the mask to his exhaust tank.

“That sounds just absolutely horrific to me,” she said. “To think about my dad being alone in that process, it just kills me. … People who have these terminal diseases will find a way. They will.”

‘The most peaceful thing’

When Stanton’s doctor diagnosed his cancer, he said it had been growing in his colon for at least 7 years.

He’d never had a colonoscopy, especially not after what happened to Saltos’ husband, Jerry. The laxative his doctor told him to drink the day before the procedure in 2009 made him so dehydrated, he went into cardiac arrest.

“I heard a noise and his arms shot out and he was purple,” Saltos said, pointing to the other end of her couch where her husband had been watching TV. She performed CPR on him for 15 minutes, likely saving her husband’s life.

Connie Saltos sits by the woodpile her brother, Tom Stanton, cut and split outside the shop where Stanton worked near Saltos' home in Prineville. Connie helped Stanton use Death with Dignity as he was dying from cancer last year. (Joe Kline/Bulletin photo)

Saltos describes her brother as gruff. Outspoken. Opinionated. People either loved him or didn’t like him at all.

He and their younger brother, Don — who they always joked was their mom’s favorite — owned a trucking company. They hauled tar to build roads. Traveled a lot with their buddies.

“They had a heck of a deal going,” Saltos said.

Don had to give up the business after he had a heart attack. His doctor told him he couldn’t drive trucks any more.

Stanton loved to chop wood, and his wood pile is still on the property. Saltos said he chopped until the day he was diagnosed.

In the weeks before Stanton took the medication, he stayed with his sister.

“It gave us time,” Saltos said. “Not that we hadn’t had time all of our lives, but he was my best friend since I was little.”

They cried often. But they’d laugh, too. Stanton and Saltos loved to pick on their younger brother, Don.

“Little blue-eyed, blond-haired baby — that’s her favorite,” Saltos said.

Near the end, Stanton had lost so much weight that his arms were throwing him off balance. He took several hard falls around the house.

“It was just heart breaking,” Saltos said. “I was glad we didn’t have to watch him do that again.”

Stanton told Saltos he wanted crab for dinner one night. Her son brought some from California, where he lives.

“We had King crab legs coming out of our eyes,” Saltos said. “Jerry was cracking it and dipping it in garlic butter and Tom ate it all. I don’t know how he did it, but he was such a good eater.”

That was a Monday. It would be Stanton’s last meal. Friday morning, he decided, was when he’d die.

On Friday morning, Saltos and her husband laid out the materials for Stanton. He mixed it himself. The instructions said to drink it all within 2 minutes. He told them to tell his friends he loved them and would miss them. Then he started to drink.

Then he stopped.

“And you take care of my baby sista!” he said to Jerry.

“Tom! Drink! It says don’t stop!” Saltos screamed.

He drank the rest.

“We told each other how much we loved each other and he set the cup down and just as he did, he started to go like this,” Saltos said, imitating the motion of curling into a ball.

The doctors warned there could be seizures, vomiting, but there was none of that. Tom just looked like he was sleeping. He didn’t move again.

Saltos wiped away a tear that had fallen onto her cheek. Like so many before her, she said, “It was the most peaceful thing.” •

(Editor’s note: This article has been corrected. A quote regarding St. Charles was misattributed to Tom Leach. The Bulletin regrets the error.)

This image is copyrighted.

Comment on this story

This image is copyrighted.