アメリカの尊厳死。現在３州（ワシントン/オレゴン/モンタナ）が法的に医者の処方薬を許している。
Peter Goodwin: The Dying Doctor’s Last Interview
By Belinda Luscombe |March 14, 2012 |
Dr. Peter Goodwin, a family physician and right-to-die activist, took his own life on March 11, 2012, at age 83. He did it legally, with the blessing of his family and doctors, under the Oregon law allowing physician-assisted suicide — the first such law in the country — that Goodwin was instrumental in creating.
Dr. Goodwin granted TIME his last interview, four days before he died. (The full interview will be available online on Thursday and in print on Friday.) He did not look like a dying man; he was chirpy and alert and still had a mischievous twinkle in his eye. However, as a result of his fatal disease — a Parkinsons-like condition called coritcobasal degeneration — he could not use his right hand or do much reliably with his left. Walking was difficult for him and stairs were particularly treacherous. He did not want to die, but death was coming anyway, and he did not want to wait.
“I can no longer eat in public,” Goodwin said. “My balance is gradually deteriorating. My three doctors agree that I’m within six months of dying. My attending physician has given me a prescription for medication to end my life and I have had it filled.”
In Oregon, doctors may not administer injections to end a life, but they are allowed to write prescriptions for lethal drugs for mentally competent people who are able to take the medication without help and have less than six months to live. And yes, the prescriptions are covered by health insurance.
Dr. Goodwin took his life on Sunday not because he could not bear to live any more nor because he was in incredible pain, but because he wanted to die among family. He timed his death so that his four children and their spouses could be there, including his younger son, who is a Navy pilot in Korea. During our interview, he wept several times at the thought of no longer being involved in their lives.
Ever the activist — Goodwin was brought up in South Africa and his cousin was a defendant in the Rivonia trial alongside Nelson Mandela — the doctor wanted to make his death mean something. The moral question of whether doctors should be allowed to enable terminally ill people to kill themselves is not yet settled in the U.S. Currently physician-assisted suicide is permitted only in Oregon, Washington and Montana.
Oregon voters approved the Death With Dignity Act at the polls in 1994; it was enacted three years later, after they voted down legislation that would have repealed it. To date, 597 people have died under its provisions. Goodwin, who has himself helped three patients die under the legislation — and one patient even before the Death with Dignity Law — has fought tirelessly to change people’s attitudes about death, right up until his own.
Goodwin gave lectures and interviews as long as he was able about the importance of advance directives at the end of life as well as open and frank discussion with loved ones. He wanted the end of life to be as gentle as possible and within the patient’s control. He was also a big advocate of allowing dying people to receive hospice care early, rather than letting doctors continually try to cure them. “Physicians are taught to treat, and they often go on treating and treating and treating,” he said. “It’s very, very difficult because they have so much in their armamentarium — so many new ways of treating cancer, so many new ways of treating heart disease — it’s very difficult for physicians to give up.”
Goodwin passed, it seems, just as he wanted to: half an hour after taking the lethal dose of medication his doctor prescribed for him and surrounded by his children.
フェイスブックで自殺中継-台湾の女性
Woman's Facebook friends don't call for help as she commits suicide
The Taiwanese woman kills herself on her 31st birthday, posting photographs as her room fills with fumes.
Associated Press March 27, 2012, 2:55 p.m.
TAIPEI, Taiwan— A woman in Taiwan killed herself by inhaling poisonous fumes while chatting with friends on Facebook, and none of them alerted authorities, police said Tuesday.
Claire Lin killed herself on her 31st birthday, March 18, and family members who reported her suicide were unaware of the Facebook conversations that accompanied it, Taipei police officer Hsieh Ku-ming said.
Lin's last Facebook entries show her chatting with nine friends, alerting them to her gradual asphyxiation. One picture uploaded from her mobile phone depicts a charcoal barbecue burning next to two stuffed animals. Another shows the room filled with fumes.
One friend identified as Chung Hsin, told Lin, "Be calm, open the window, put out the charcoal fire, please, I beg you."
Lin replied: "The fumes are suffocating. They fill my eyes with tears. Don't write me anymore."
A few of the Facebook friends chatting with her tried to stop her and track her down on their own, but none called police. Chung did not respond to attempts to reach him for comment.
Lin's last words, in Chinese, were: "Too late. My room is filled with fumes. I just posted another picture. Even while I'm dying, I still want FB (Facebook). Must be FB poison. Haha."
Lin's Facebook postings indicated she was unhappy because her boyfriend was ignoring her, and had failed to return home to be with her on her birthday. Her boyfriend found her body the next morning and alerted her family, Hsieh said.
Hsieh said he regretted that none of her friends called police to help her during the 67-minute episode, but he added it may have been difficult for them to know her whereabouts because of the nature of social media.
"It could be true that it would be hard to track down a Facebook friend without her address or phone contact," Hsieh said.
Chai Ben-rei, a sociologist at Taiwan's Feng Chia University, said the incident reflected social isolation in the Internet age.
"People may have doubts about what they see on the Internet because of its virtual nature, and fail to take action on it," he said.
In a statement, Facebook said the company is deeply saddened by Lin's death and that the case serves as a "painful reminder of how people can help others who are in distress or need assistance."
Facebook's help page has links to suicide prevention hotlines in about 20 countries, including Taiwan, where the Taiwan Suicide Prevention Center's phone number and website are listed.
In the case of an emergency, however, Facebook urges users to call authorities immediately.
ベビーブーム世代の尊厳死殺人−アメリカの場合
Ohio hospital shooting: Mercy killing or murder?
Aug 12, 5:48 PM EDT
By THOMAS J. SHEERAN and JOHN SEEWER Associated Press
CLEVELAND (AP) -- John Wise watched a tear roll down his wife's face as he stood alongside her bed in the intensive care unit. She'd been unable to speak after suffering a stroke and seemed to be blinking to acknowledge him, Wise confided to a friend who had driven him to the hospital.
The couple had been married 45 years and Wise told his friend that they had agreed long ago they didn't want to live out their years bedridden and disabled.
So a week after Barbara Wise's stroke, investigators say, her husband fired a single round into her head. She died the next day, leading prosecutors to charge the 66-year-old man with aggravated murder Wednesday in what police suspect was a mercy killing.
The shooting leaves authorities in a dilemma some experts say will happen with greater frequency as the baby boom generation ages - what is the appropriate punishment when a relative kills a loved one to end their suffering?
More often than not, a husband who kills an ailing wife never goes to trial and lands a plea deal with a sentence that carries no more than a few years in prison, research has shown. In some instances, there are no charges.
"It's a tragedy all around that the law really isn't designed to address," said Mike Benza, who teaches law at Case Western Reserve University in Cleveland.
A New York man in March was sentenced to six months in jail after suffocating his 98-year-old disabled mother and slitting his own wrists. He told authorities he had just been told he had cancer and believed he was going to die soon, and feared no one would care for his mom. A Washington state man accused of shooting his terminally ill wife this year told investigators she had begged him to kill her; he is free on bail while prosecutors weigh charges.
Almost always, there are deeper issues involved with the accused, including depression, their own health problems and the stress of taking care of a dying spouse, said Donna Cohen, head of the Violence and Injury Prevention Program at the University of South Florida.
Seeing a dying or disabled spouse suffering can be enough to push someone over the edge, said Cohen, who is writing a book called "Caregivers Who Kill."
"Men will hit a wall when they can't do anything else," she said. "That's usually a trigger."
She worries this will happen more often with longer life expectancies and a continuing shortage of mental health services for older people.
In the early 2000s, testifying a Florida legislative committee, Cohen cited research showing that two in five homicide-suicides in the state involved people 55 and older. The number of cases grew among older people while staying the same with those under 55.
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Police say Wise took a taxi from his home in Massillon, calmly walked into his 65-year-old wife's room on Aug. 4 at Akron General Medical Center without drawing any attention, and shot her.
Juries are often sympathetic to those who kill a spouse out of what is portrayed to be love and compassion, but the message that sends is unclear, said Wesley J. Smith, a California lawyer who wrote a 2006 book "Forced Exit: Euthanasia, Assisted Suicide and the New Duty to Die."
"Where's the stopping point?" he said. "There almost comes to become a cultural acceptance that certain people are better off dead than alive."
Those who kill a loved one to end the suffering are acting out of their interests, he said. "We're really putting Grandpa out of our misery," Smith said.
Wise's lawyer has said that he was a good man who was devoted to his wife.
"I am absolutely confident that everything that he's ever done for his wife has been done out of deep love, including the events that just recently transpired," said attorney Paul Adamson.
The former welder also suffered from nerve damage that made his hands and feet numb, survived bladder cancer and had diabetes, said Terry Henderson, a 30-year steel plant co-worker.
Those issues could help his case if it goes to trial. "The facts surrounding her death are sympathetic and may actually foster a plea before trial," said Jeff Laybourne, a prominent Akron defense attorney.
But just because his wife may have been suffering isn't a valid defense under the law, Laybourne said.
Other factors that could determine whether the case goes to trial include the timing of the shooting and that it happened in such a public place.
Henderson thinks Wise may have snapped under the weight of both of their health concerns. "He never dreamed, given his history of medical problems, that this would happen to her before he'd go," Henderson said.
That kind of situation can be deeply depressing for a person dependent on the care of a spouse who suddenly is disabled, said Dr. Peter DeGolia, a physician specializing in care for the aging at University Hospitals Case Medical Center in Cleveland.
"If this man was dependent on his wife for care and basic well-being, and suddenly she's gone, he's going to feel very vulnerable, highly at risk," he said. "Older white males are the highest risk group for carrying out suicide plans."
It's a scenario that DeGolia said can be defused with help from social workers and hospice care for the dying.
"There are lots of options," he said, "aside from going and shooting them."
----
Seewer reported from Toledo.
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Hollywood filmmaker Tony Scott jumps to death
LOS ANGELES | Mon Aug 20, 2012 12:47am EDT
LOS ANGELES (Reuters) - Hollywood filmmaker Tony Scott, director of such big-screen action hits as "Top Gun" and "Crimson Tide," jumped to his death on Sunday from a bridge over Los Angeles Harbor, the Los Angeles County Coroner's Office said.
Scott, who was 68, was seen parking his car on the Vincent Thomas Bridge and jumping into the water below at about 12:30 p.m. local time, and his body was recovered by law enforcement from the harbor shortly before 3 p.m., said Lieutenant Joe Bale, a watch commander for the coroner's office.
Bale said there was no immediate evidence leading investigators to believe that Scott's death was anything but a suicide. He said an autopsy had not yet been performed.
(Reporting and writing by Steve Gorman; Editing by Doina Chiacu)
精神科医が語るうつ病による自殺者への思い。
Psychiatrist: I hate suicide but also understand it
By Charles Raison, Special to CNN
11:40 AM EDT, Tue August 21, 2012
(CNN) -- I got a terrible shock when I heard the news that the famous director Tony Scott had apparently committed suicide by jumping off the Vincent Thomas Bridge in San Pedro, California.
Not because I knew Scott, and certainly not because it is a rare thing for people who seem to "have it all" nonetheless to kill themselves.
No, I got a shock because I knew the bridge.
For the better part of a decade, I trained and then worked as a psychiatrist in Los Angeles. For several of those years, I did psychotherapy with a young woman who drove over that same bridge every day. The bridge became almost a third person in our work together, because she talked about it constantly.
Every morning and then again every evening she faced huge anxiety as she approached its yawning span because it was all she could do not to stop her car and throw herself off it. Just seeing that bridge made all her pain and despair intensify, and it came to represent everything that was wrong with her life.
On the other hand, it's a beautiful structure, in an industrial sort of way, and it also seemed beautiful to her because it was always there, silently waiting, always offering an easy out. When things were really bad, she'd drive 20 miles out of her way just to avoid that bridge and the terrible temptation to jump or crash her car off the side.
Fortunately, my patient avoided Scott's fate. She came to grips with a history of abuse and her depression eased. She married and left Los Angeles. I also left Los Angeles, but a few years ago, I returned to the San Pedro area to give a talk and crossed that bridge with a mixture of relief and distress.
It is that strange mixture of relief and distress that characterizes many of the responses to Scott's apparent suicide that have been posted on CNN.com.
Many comments come from family members of people who have committed suicide, some defending the loved one's decision, others decrying it as the ultimate selfish act. Although I've spent my life battling suicide, I find myself empathizing with both points of view.
Perhaps the first thing to say about suicide is that people make suicide attempts for all sorts of reasons. Sometimes people want to die, or half want to die.
But just as often in my experience, suicide attempts are a cry for help, or a way to punish people they are upset with, or a means of controlling a situation. I've known more than a few married people who kept a husband or wife from walking out on them, at least for a while, by making a suicide gesture.
On the other hand, people really only kill themselves for three reasons.
Occasionally people will commit suicide because they are facing some incurable condition that promises a brief future filled with nothing but pain.
Although many mental health clinicians will disagree vociferously with me, I have seen suicides that I felt were in this sense justified. For example, I knew a grand old fellow who, in the midst of unbearable physical pain from inoperable cancer, took his life when he had a life expectancy of two to three months.
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Occasionally people will commit suicide because they are psychotic and believe they must die for some reason that makes no sense to anyone else. I had a patient once who made a very serious suicide attempt because she believed that if she died, the mysterious private investigators who were stalking her would leave her family alone.
These types of suicides are heartbreaking, because they are so futile and can often be prevented by appropriate treatment.
The vast majority of people who choose methods of suicide that are almost guaranteed to succeed -- like a gun to the head or a plunge from a high bridge -- do so because of they are losing a battle against major depression. These are the suicides that haunt and hurt worst of all, and that almost to a person are the most tragic.
I hate suicide.
I've been fortunate that suicide does not run in my family. But it runs in lots and lots of families and I've known -- and known of -- more people who have killed themselves than I can easily count.
There was the shy kid who shot himself in high school, the young punk who drove his car off a particularly bad curve, the wonderful hard-working father of the class valedictorian, and various in-laws across a couple of marriages.
And those are just people from my personal life. Like any psychiatrist who deals with the severely mentally ill, my life is littered with memories of folks who threw themselves off high buildings, hanged themselves in dark closets or slit their throats in dusky gardens.
But as much as I hate suicide, I also understand it. One of the things people have repeatedly posted in comments responding to Scott's death is that you can't weigh in on why someone might commit suicide unless you've really had your life torn apart by an episode of major depression.
I agree.
Severe major depression is probably the most unbearable pain a human being can withstand for any protracted period of time. Many people who died of cancer have written eloquently about how the crushing pain from their tumors paled in comparison to the pain they felt when depressed.
With all other pain, most people can maintain some sense of separation between themselves and the pain. As horrible as it is, the pain is in their arm, or leg, or belly or head. But there is still a "them" that is separate from the misery.
Depression is different. Because it is at its essence a perceptual disorder, it causes one to see the entire world as pain. It feels painful inside, but it also feels painful outside.
When a person is depressed, the entire world is disturbed and distressed, so there is nowhere to escape. And it is this fact that makes suicide so seductive, because it seems to offer the one available escape option.
There are at least two reasons why suicide in response to major depression is so horrible and so tragic. First, although our treatments for depression are far from perfect, they are nonetheless effective enough to help the vast majority of depressed people feel well enough to forgo killing themselves.
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And even when treatment is not particularly effective, depression often passes on its own accord. It is not an incurable cancer that offers a guaranteed foreshortened future of unbearable pain. Because of this, depressed people kill themselves over something that would have lifted had they just been able to hang in there.
The other reason depression-driven suicides are so tragic and terrible is because they cast such long shadows on families and other loved ones.
Children especially suffer. They grow up wondering why, and whether they could have done something, and whether they'll have to struggle with the same urges.
I think of people I have known in this situation, and I have to think of something else to keep from tearing up as I write this. More than once I've "guilted" acutely suicidal patients into not killing themselves for the sake of their children and have done so with a clear conscience.
We may or may never know why Scott apparently killed himself, but we can be sure that his family and friends will spend many years wondering what they might have done to have protected him. This is part of the painful legacy left by suicide, and my heart goes out to them.
In fact, even psychiatrists have a difficult time predicting when someone is at heightened risk for suicide. In part, this comes from the fact that many people who really want to kill themselves keep their mouths shut about it and just go do it. In part, it comes from the fact that suicide is often an impulsive act driven by acute and unpredictable increases in anxiety and despair that one cannot predict in advance.
For families and friends worried about the suicidal potential of a loved one, there are a few useful pieces of advice I can offer from the research literature, such as it is.
First, older men are more likely by far than other people to kill themselves.
Second, people who kill themselves often will tell someone ahead of time. Any such communications should be taken with utmost seriousness, and all efforts should be made to keep the person safe and get him or her to appropriate treatment immediately.
Third, even over the suicidal person's objections, the means for committing suicide should be removed from the environment. Guns should be taken out of the house. Pain pills should be taken elsewhere.
Fourth, studies conducted over the last 20 years suggest that the biggest short-term risk for depressed people to kill themselves is the development of unbearable anxiety. If a loved one with depression begins to pace the floors or do other things suggesting that they are becoming consumed with terror, panic or dread, the risk for suicide shoots up.
Finally, it is not true that talking about suicide increases the likelihood it will happen. In fact, studies suggest the opposite.
So if you have a loved one with depression who is struggling with the will to live, one of the best things you can do -- over and above getting them immediate health care -- is to check in with them regularly and honestly and act if their drive to die intensifies.
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凡人もこの範疇に入る。
*****
上記への読者のコメント
Paul W
22minutes ago
I would like to posit to you an additional cause for suicide - chronic unworkability. Some people whose lives never work out, whose lives are metered by failure, breakdowns, mishaps, accidents, illness, loss, loneliness. People who cannot make or keep friends, who cannot find love or who find love and loses it repeatedly. People whose lives suffer an incessant string of improbable setbacks in their careers, relationships, health. When something has a 95% chance to succeed, but fail due to a chain of improbable 5% events.
If you call it luck, it's aberrational luck. But it's not obvious, it's not like a circus elephant falling from the sky on your dog, it's when a complete stranger who serves everybody else in explicably forgets you, or your cellphone running dry when you really need to reach someone and you do not have their phone number written down anywhere. It's a numbers game, it's by degrees, but it's pervasive.
And people have no grip on why that happens. There is nothing in Religion that explains it except for Job, but this Job-like existence is filled with mundane mishaps. Most people don't know about unworkability, and have no way of communicating it to others in their lives. How do you explain to your siblings who have families and successful careers that nothing ever seems to work without getting the inevitable pep talk about taking responsibility, working hard, getting your act together, dropping bad habits or basically - look at me, I have everything, I worked for it, you don't because you're too lazy (or fill in the bad habit).
I know this from personal experience. From a probablistic point of view, my life is full of improbable mishaps and near misses, things tend to break down. I live with the pain, the dread of a life that has not worked out, and am starting into old age that offers very little to look forward to. But I recognize that my mishaps as aberrant, and plan for them. I spend a lot of time and energy proactively planning everything I do, and double-checking everything and too often finding a mishap waiting to spring had I not done so.
I had made a decision to not commit suicide, it also helps that though I think of it often, at core, I am not suicidal. But absolutely I understand it, and can only offer a partial relief that you can make your life at least marginally workable if you recognize the problem and what types of things typically go wrong beforehand. But I offer to you unworkability as a factor in people taking their lives.
Japan minister Matsushita found dead at home in possible suicide: police
Monday, Sep. 10, 2012 Japan Times
Japanese financial services minister Tadahiro Matsushita was found dead at his residence in Tokyo on Monday, police said, adding they suspect the country's top financial regulator committed suicide.
The police have yet to disclose details about the death of Matsushita, 73.
A member of the People's New Party, the coalition partner of the ruling Democratic Party of Japan, Matsushita served concurrently as postal privatization minister.
Matsushita was a five-term member of the House of Representatives from Kagoshima Prefecture.
