Patients suffering from terminal illness have always faced difficult decisions about end-of-life care: living wills, health-care proxies and funeral arrangements, to name a few.
But Glenn Elfman, a 62-year-old terminal-cancer patient from Pistol River, Oregon, struggled with an additional decision: whether or not to take his own life.
Oregon is the only state in America where physician-assisted suicide is legal, provided a patient has less than six months to live.
"It provides an option for me as a patient, a person suffering from a terminal illness when the medical profession has run out of all other options," Elfman said.
Even though the law was passed 10 years ago, opponents continue to protest.
Sue Williams, head of the local Right to Life Group, campaigned against the death-with-dignity law. She believes suicide is a desperate act.
"I don't think you can have a dignified death when you chose to kill yourself," Williams said. "If there is a law that says 'Yes, you can kill yourself,' that is a bad law."
According to Williams, people should be protected from harming themselves.
"We have protection against murder. We have protection against cigarette smoking right now. So why isn't there protection against people who can make this choice?"
Watching and Waiting
Elfman always attended medical appointments with his wife of 41 years, Linda. The cancer started in his prostate in 1996. Then, after a period of remission, it came back with a vengeance. Linda soon realized the disease might end their near-perfect partnership.
"We'd been so fortunate all our lives," she said. "Even to this day I keep thinking maybe it will go away and obviously it won't."
Without children, they've lived a rich and satisfying life, with a considerable amount of control. Elfman also wants to control the manner of his death, especially after seeing what happened to his dad, who also suffered from cancer. After several rounds of aggressive chemotherapy, he ended his days on a life-support machine. But Elfman said this wasn't his father's plan.
"His wishes were not in my view carried out and he was in no position to do anything about that," Elfman said. "My ability to continue to exercise control over my own life was really important to me."
Elfman decided to explore physician-assisted suicide because he had always led an active life as a home designer, musician and pilot.
"When those qualities of life you've always enjoyed are no longer there for you then that is the time to end it," he said.
The Elfman family pastor, Tim Brueckner of the Bethany Lutheran Church, disagrees. "Ultimately, God the creator owns the life. The life belongs to God and belongs to the community that God creates that life to be with," he said. Elfman's mother, a devout Lutheran, also disapproves of physician-assisted suicide.
Some doctors have suggested pride, not pain, drives patients to end their life.
"I can only tell you that for me personally … having the option available and knowing that it is there enables me to devote more energy to what I perceive as living," Elfman said. "I guess if that is pride so be it. I don't see it that way."
These theological and medical arguments have existed for decades, but for Elfman, time was running out. His latest CT scans indicated his cancer had spread. He and his wife now faced a radical choice.
"I hope I'm strong enough," she said. "I try not to think about the half that will be gone."
Eight months later his cancer had spread even more.
"My condition has deteriorated to the point where right now without medication I would be flat on my back in bed," he said.
Oregon's laws dictate he can now ask for the end-of-life drugs, but he needs two doctors to obtain the medication.
Dr. Gordon Metz, his radiation oncologist, agreed to be one of them.
Linda said she was trying to live in the moment. "Glenn is doing the looking ahead for me," she said.
Dr. Metz's role is to give Elfman a six-month prognosis, which will enable him to get the medication.
Elfman couldn't get the lethal dose immediately because there was a two-week waiting period, mandated by law, in case he reconsiders. During that waiting period, however, he received some shocking news: The cancer had spread to his lungs and his liver.
Finally, the drugs arrived.
"I've come to terms with it and I'm much at peace now as I've ever been in my life," Elfman said.
But at the critical moment, Linda wasn't ready to see him take his own life.
"I don't want to see him face any more of the really horrendous milestones," she said. "I've seen enough family members go through that, but there is a little part of me that goes hang on."
Elfman decided to hold on.
"And as long as that little part says hang on I'm going to do my best to do that," he said.
Elfman's condition worsened. He became bedridden and his pain medication increased. His breathing became more labored. Then, one morning in June, Linda awoke to the sound of rasping.
"I was horrified that his worst nightmare was being realized, that he was going to be suffering," she said. "That he was going to be lingering." She knew she couldn't give him the end-of-life drugs because he could not longer swallow.
At 7 a.m on June 3, the Elfman house was silent. In the end, though he had the tools to kill himself, he didn't do it. His wife felt he hung on in order to give his family more time to prepare.
Elfman's story is not uncommon. Requesting the drugs, in itself, is very different from taking them.
"Less than half of the people who have received the medication have taken it," said the executive director of Compassion in Dying of Oregon, George Eighmey. "I think in the end, Glenn said Linda is more important than ending a few days early."
Even the most carefully scripted departure can be changed by raw emotions. In truth, Elfman and Linda just couldn't let each other go.
Linda said she's glad her husband didn't have to take the end-of-life drugs. "I'm sure he preferred to go that way," she said.