I see no reason to view palliative care and death with dignity as an "either-or" situation.

Nora Miller's husband was diagnosed with terminal lung cancer in 1999, and died peacefully after exercising his right to Death with Dignity under Oregon's law. Her mother and sister were not so fortunate.

These contrasting experiences have motivated Miller to do what she can to promote the enactment of Death with Dignity laws in all states, to encourage medical personnel to learn about and embrace the benefits of the law for their patients, and to challenge misrepresentations of the facts about Death with Dignity wherever possible.

Nora's letter to the editor below was published in the recent issue of Neurology Today in response to an opinion piece.

I very much appreciated Dr. Lynne Taylor's Viewpoint article on Death with Dignity in Neurology Today. I have a personal interest in the education of doctors on this particular issue. Palliative care makes a huge difference in the daily lives of the dying, but it cannot address all issues. I see no reason to view palliative care and death with dignity as an "either-or" situation. The experience in Oregon shows that these two practices work hand in hand to ease the symptoms of an inevitable death while still accommodating the occasional patient who would rather go out smiling and aware.

There's no need to view death with dignity as some kind of defeat — indeed, for those who request it, it amounts to a kindness beyond value. My husband exercised his option under Oregon's Death with Dignity law in 1999. Losing him was the hardest thing I've ever experienced, but I supported his choice completely. He chose to die a few weeks earlier than he would have otherwise, in exchange for the ability to die while still physically and cognitively functional. That mattered very much to him. Athough he very much did not want to die, he was not depressed. Indeed he would have very happily gone back to his life and his family if he could have survived his metastatic lung cancer. But he did not have that choice; he was going to die, no matter what. His pain was well-managed, but pain was not the problem for him. It mattered to him, deeply, that he have the ability to control the timing and circumstances of that death.

Palliative care focuses on minimizing the pain, anxiety, and discomfort of death, but palliative care would not prevent him from eventually becoming incoherent, incontinent, and uncommunicative. Brain tumors do that to you, and increasing doses of medication simply speed up the transition into oblivion. For many patients, that is just fine, a welcome darkness before their endless night. For those few who would prefer to leave the lights on, death with dignity provides a solace that no palliative care can. With palliative care training, doctors learn to view death as the inevitable completion of life. With training in death with dignity, they can learn to recognize the exquisitely personal nature of death, and by doing so, they can learn to respond to the needs of all their patients, even those few of their patients who seek a different way of dying.