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How to Die in Oregon

Distributed by Clearcut Productions Inc., 820 N River St, Suite 201, Portland, OR 97227
Producer n/a
Directed by Peter Richardson
DVD, color, 147 min.
Sr. High – General Adult
Health Sciences, Death and Dying, Sociology

Reviewed by Charles J. Greenberg, Cushing/Whitney Medical Library, Yale University

Highly Recommended  Highly Recommended   
Date Entered: 1/26/2012

While writing this review I decided to do a comparison. I searched Google for “right to live” and received a result of about 21,100,000 results. I then searched for “right to die” and was not surprised to receive only about 1,610,000 results, or about 8% of the former. Until now, there has been so much political confrontation between reproductive rights and the rights of the unborn in the context of right to life. There has not been very much public attention dedicated to the quality of the end of life, particularly when medicine cannot provide answers in confronting conditions such as brain cancer, amyotrophic lateral sclerosis (ALS), or idiopathic pulmonary fibrosis. Terminally-ill patients with only months to live nevertheless receive a barrage of medical interventions, often in the name of comfort and reducing pain. Patients also lose autonomy and control of both bodily functions and emotions during a period of distressing decline. Palliative care can ease pain but cannot provide or impose a means to end life when patients are eager for the end of both their suffering and the burdens they place on their families. People are seeking an end of life with dignity.

Oregon was the first state in America (after the countries of Switzerland and the Netherlands, according to the film) to provide a legal framework for the precedent-setting right to die with a physician-provided prescription. On October 27, 1997 Oregon enacted the Death with Dignity Act which allows terminally-ill Oregon residents to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. After more than a decade of legalized right to die, more than 500 persons have taken advantage of this law.

The award-winning film How to Die in Oregon manages to explore many of the complexities and frustrations of end-of-life medical care and the anxiety of real patients that want to confront the end of life with the absolute control that medicine cannot provide. Viewers also meet the volunteers who assist patients in asserting their autonomy, as well as a Washington State widow, Nancy Niedzielski, who wants to fulfill the promise she made to her dying husband to make death with dignity legal in that state. There are also medical professionals on camera that try to balance their ethical obligation to care while maintaining and even supporting their patient’s autonomy. In the presentation of the buildup to the 2008 public referendum in Washington State, the opinions of people adamantly against any form of physician-assisted end-of-life are heard on the streets and in the call-ins to talk-radio. Viewers will also spend time with a variety of family members who learn to support their lucid, irreverent, and engaged loved ones.

In the first scene of the film, the audience of How to Die in Oregon drops immediately into the home of Roger Sanger, the 343rd person to end their own life in that state, legally. Roger is surrounded by friends and family, as well as a “compassion and choices” volunteer, who confirms the voluntary step he is taking and predicts how bad the fatal cocktail will taste but that the whole amount must be consumed in 60-90 seconds. Roger does not hesitate at all, lies back while softly singing a tune, and then is silent. This is a documentary, and there is nothing inauthentic in this dramatic moment, including his last breath.

The other patient that is presented at different stages of the final months of life is Cody Curtis, a former health care worker who describes her own liver cancer diagnosis, surgery, difficult recovery, and cancer reoccurrence. Cody’s husband, oncologist, and grown children also describe coming around to the logic of the end-of-life alternative in an otherwise uncontrollable situation. Cody acquires the necessary drugs with her oncologist’s prescription, and then shares her uplifting spirit in having a sense of control and being able to enjoy aspects of normal life, no that the end is clearly in sight. Her son, an engineer, does not initially agree with non-intervention, but he articulates his own uncertainty and eventual support of her decision not seeking a little more time at the cost of increasing pain.

Many scenes with actual patients need no other soundtrack, and the dialogues between family members or between the patients and their “compassion and choices” volunteer are humorous and uplifting for their frankness and desire to defy the stereotype of their medical death sentence. Sometimes when a spouse like activist Nancy Niedzielski is describing her husband and her own desire to make good her promise, a soft, unobtrusive piano sets the tone of warm melancholy. Other types of soft music accompany narrative.

The actual day and evening of Election Day 2008 in Seattle, when the referendum to legalize Death with Dignity passes, shows Nancy Niedzielski at the moment of triumph, realizing that in fulfilling her husband’s dream she has truly just ended her marriage, and a new chapter in her own life finally begins. Her emotion is palpable.

Several different stories are successfully integrated and unified by a determination to put a final exclamation point on a life worth living by knowing when it is time to go. Cody’s final days with family, care-givers, and her own thoughts fill the final 30 minutes of the film. The final scene of her last night does share some family and volunteer preparation, yet the camera also provides her privacy by pulling back outside of the room and focusing on what she says in her final moments, not what has to be seen. There is no need for sensationalism at this sad moment for which we have all been waiting.

Effective documentary technique should demonstrate the sensitivity and trust the film director has earned to only go as far as a subject wants to in opening their life and legacy to the audience. Yet every patient portrayed in How to Die in Oregon has a story to tell and a point they want to make. Not one of the protagonists was alive for the debut of this film, but each of their stories will resonate with viewers for a long time. No doubt this carefully crafted documentary will be required viewing by activists in the 48 other states that have yet to legislate death with dignity.

How to Die in Oregon is highly recommended for all public, academic, and high school audiences.