Choosing death:a case study under Oregon's asst. suicide law

Saturday, August 20, 2005
Choosing death: a case study
By Tim Christie
The Oregon Register

The white electric clock perched atop the television ticks away the last minutes of Lucile Adamson's life, marking the time until she is ready to drink six ounces of a bitter clear liquid that will stop her heart.

Adamson, 78, has been fighting breast cancer for 10 years and now the cancer had won. It has spread throughout her body, and doctors have stopped treatment. She finds just getting around her sparsely furnished apartment to be a painful struggle.

Adamson, a retired biochemist, moved to Eugene five years ago from Los Osos, Calif., attracted by the climate, nearby hiking trails and the college-town atmosphere. Oregon's one-of-a-kind assisted-suicide law was in the back of her mind as well, as she knew that someday she might have cause to put the law to use.

Now that day has come.

On Aug. 10, at about 12:30 p.m., Adamson committed suicide with a lethal dose of barbiturates prescribed by a doctor, joining the ranks of about 225 Oregonians who have done so since the Death with Dignity Act took effect in 1998.

Adamson, who never married and had no children, was joined on her final day by two volunteers from Compassion in Dying of Oregon, a Portland-based group that helps dying patients navigate the law.

In an interview a week earlier, and in the last hour before she died, Adamson talked about her life, and about why she chose to end it on her own terms.

After her diagnosis, Adamson said that she was able to live a mostly satisfactory life for about nine years, but her health "suddenly started going downhill" as the cancer spread. With no appetite, she had lost 50 pounds in the past year. She wore an eye patch over her right eye, after radiation on a tumor behind her eye took her sight. She spent most of her time in bed or in a reclining chair.

"I saw no reason to continue since everything has become very difficult, from standing up to sitting down and everything in between," she said.

She said that she feared becoming incapacitated, and having to rely on others for daily living.

Adamson said that she's not a religious person, and did not expect an afterlife. She also said that she didn't think the federal government has any business interfering in Oregon's law or deciding whether someone chooses to end her life.

Supreme Court to rule

The U.S. Supreme Court is scheduled to hear arguments on a challenge to the Oregon law on Oct. 5 after a federal judge and the 9th U.S. Circuit Court of Appeals rejected efforts by former Attorney General John Ashcroft to block it.

Adamson grew up on a farm in Kansas, with no electricity and no running water. The nearest church was seven miles down a muddy road, and the family did not have a religious upbringing, said her older sister, Gail Sims of San Luis Obispo, Calif.

"Most of us are hard-headed realists," Sims said.

Adamson attended a one-room country grade school and graduated from Labette County Community High School in Altamont, Kan., in 1944. She went off to college, earning a bachelor's degree from Kansas State University and a master's at Iowa, and then a doctorate from the University of California, Berkeley, in biochemistry.

She spent much of her career exploring the mysteries of how chemical and biological processes work together in the body. She was in charge of the medical lab at a Harvard hospital, and worked as a researcher and professor at the University of Hawaii and the University of Missouri. She also taught in Australia on an exchange program. Later, she switched her focus to environmental health and helped start an ecology department at Howard University.

Her sister said she's not sure why Adamson never married, but she has an idea. "I suspect she was too smart for men in our age group to tolerate," Sims said.

When Adamson was well, she liked to hike and play bridge. When her body began to fail, books became her main companion.

Adamson made her initial contact with Compassion in Dying of Oregon in January 2003. In July, as her health worsened, she got back in touch with the group so that she could take the final steps spelled out in Oregon law to legally commit suicide. By this time, she also was getting hospice services from Cascade Hospice in Eugene.

She made two oral requests for a lethal prescription from her doctor, 15 days apart. She provided a written request to her doctor, signed in the presence of two witnesses. Her doctor and a consulting physician confirmed her diagnosis and her prognosis that she had less than six months to live and determined that she was capable of making such a decision. And her doctor informed her of alternatives to suicide, including comfort care, hospice care and pain control.

Finally, her doctor prescribed her 10 grams of liquid Nembutal, the brand name for a barbiturate called pentobarbitol.

On Friday, Aug. 5, a friend picked up the medication for her.

The final day

The following Monday Adamson made final arrangements with Compassion in Dying: Two volunteers are scheduled to come to her apartment at 11:30 a.m. Wednesday. At the appointed time, Dr. Nancy Krumpacker, a retired oncologist from Portland, and another volunteer arrive at Adamson's apartment, and find her sitting in her easy chair.

In keeping with Compassion in Dying's protocol, Krumpacker asks Adamson: Are you sure you want to do this?

Without hesitation or elaboration, Adamson responds emphatically: Yes.

At 11:28 a.m., Adamson takes some anti-nausea medicine to ensure that she can keep the barbiturates down, and then waits for the stipulated one hour before she can take her lethal dose of medicine. On the floor next to her chair is the morning paper; a well-worn 1932 edition of "The Complete Short Stories of Somerset Maugham, Vol. 1"; and a denim Winnie the Pooh ball cap.

In the kitchen, Krumpacker uses a pair of needle-nose pliers to peel the metal tops off four 2.5 gram bottles of Nembutal. When she is done, she pours the six ounces of liquid into a drinking glass, filling it not quite half full.

Adamson, wearing a striped shirt, blue slacks and slippers, says she is doing fine, and isn't nervous about dying ?- just ready.

"It's the thing to do," she says. "I feel I'm escaping all sorts of worse fates."

The room is momentarily quiet, the ticking clock the only sound, the shades drawn against a bright August day. Adamson elicits nervous laughter by asking, "Should we play bridge until it's time for the end?"

Krumpacker asks, "What do you think is going to happen after you swallow the medicine?"

Adamson, the scientist, responds, "I'll go to sleep. ... You're not asking me about the afterlife, are you?"

"I'm just curious about what you think," Krumpacker says.

"Nothing," Adamson replies.

They talk about environmental degradation in the world until finally Adamson says, "I don't know if I want to spend my last minutes talking about this."

So instead she talks fondly about the cats she used to have.

At 12:25 p.m., Adamson says, "Almost there ?- three minutes."

At 12:27 p.m., one minute shy of an hour, she says, "Why not do it?"

Krumpacker hands her the glass of Nembutal, and warns her that it's a bitter drink. "You might go to sleep very quickly; you want to drink it quickly, but not in big gulps."

At 12:28 p.m., Adamson takes her first swallow. "It's bitter," she says.

She takes a second draft, and a third. Krumpacker and the other volunteer kneel on either side of her chair. She keeps drinking ?- four, five, six, seven swallows, pausing between each ?- then coughs three times. Then she drinks down the rest, and hands the glass to Krumpacker. It all takes about a minute.

A moment passes, and Adamson says: "The bird is on the wing."

She's explains that it's a line from Omar Khayyam's "Rubaiyat":

The Bird of Time has but a little way
To Fly and Lo! the Bird is on the Wing.

Adamson coughs again and rests her head in her right hand. Her eyes are closed now.

At 12:32 p.m., Krumpacker asks, "Are you still with us?"

"Yes," she responds, without opening her eyes.

At 12:34 p.m., her hand drops, and her head tilts back.

"Lucile?" Krumpacker says.

There is no response.

Adamson has fallen into a coma. The barbiturate is shutting down her respiratory system and her brain function, and slowing her heart. Her head lolls to the right, and her mouth is slightly agape.

At 12:53 p.m., about 25 minutes after Adamson drank the Nembutal, Krumpacker places a stethoscope on her chest and listens for a heartbeat. She hears none.

"She's gone," Krumpacker says.

She pats Adamson's arm and leg, and buttons her shirt. She calls Cascade Hospice and says, "This is Dr. Krumpacker here with Lucile Adamson, and she's just died."

Hospice officials will call the funeral home, and the funeral home will come to get Adamson and arrange for her to be cremated. Krumpacker calls Adamson's attorney, and asks him to call Sims in California with the news.

Later, Krumpacker talks with Adamson's attending physician, filling him in on the details of the suicide, so that he in turn can report the case to the state Department of Human Services, which compiles the information into an annual report.

Sims says her son will collect his aunt's remains.

"I suspect that he'll go out on some Oregon trails where we have all hiked and scatter her ashes," Sims says. "What she liked was hiking in the woods."