For a 31-year-old, Peter D. Richardson has spent an uncommon amount of time pondering—and filming—the end of life.
Last month, the Portland director's movie How to Die in Oregon was awarded the Grand Jury Prize for best documentary at the Sundance Film Festival in Park City, Utah. The film examines how physician-assisted suicide is practiced for terminally ill patients in this state, the first in the U.S. to legalize it, in 1994's Death With Dignity Act. But that's a clinical description of a painfully intimate project: To make the film, Richardson spent 10 months with Cody Curtis, a 54-year-old OHSU faculty member, as she, her husband Stan, and her two grown children grappled with her recurring liver cancer—and her decision, in 2009, whether to give herself a lethal dose of Seconal. How to Die in Oregon makes its local premiere this weekend at the Portland International Film Festival, and shows on HBO May 26.
Richardson spoke with WW last week from the Big Sky Documentary Film Festival in Montana—a state weighing whether it will join Oregon and Washington in legalizing physician-assisted suicide.
WW: If you faced a terminal illness, would you choose physician-assisted suicide?
Peter D. Richardson: I've thought about the question a lot, of course. I truly believe that it's impossible to know what you would do in that situation until you're actually confronted with it. There's a character in the film named Ray Carnay. He was a radio announcer and he's been a singer, an opera singer, and he's been diagnosed with throat cancer and the only treatment he can receive is to have his voice box removed. And of course, his voice is his identity, and so he chooses not to have it removed. I film with him going to a recording studio and he actually goes to record his own eulogy that's going to be played at his own funeral. Ray was someone who was very conservative politically and vehemently opposed to the law ever since Oregon enacted the law, and then once he received his terminal diagnosis he completely changed his mind. He said to me, "You know, Peter, you never know until you're confronted with this choice and an uncertain end how you might feel about having it." So I honestly really don't know. In fact, all of the people I've filmed with really didn't want to use the medication, and most didn't, actually. In fact, of the 16 people I filmed with, only three actually took the medication, and I think it was kind of a last resort for them.
Did you have any epiphanies in the making of this film that changed your mind?
I've lived most of my life in Oregon, and I was aware of the law but—I think like many Oregonians—it wasn't necessarily something I gave a lot of thought to. I maybe kind of assumed, "Well, this is purely an issue someone might decide on moral or religious grounds or maybe it's a little bit more black-and-white. And then, in making the film, I discovered it's an incredibly complex issue. I think what I learned and maybe what changed was just the understanding that this is not just some outlier issue that exists in this realm of Jack Kevorkian. How do we protect the rights of individuals in Oregon and where this practice is legal? How do you protect their personal freedom and choice while at the same time protecting the rights of other individuals who could potentially be negatively impacted by the law? There's a scene in the film that addresses that. It addresses one particularly famous case in 2008 where there were a number of individuals—but two that went public—who got these letters from an Oregon health plan notifying them that their health plan would not be able to pay for their cancer treatment, but they were eligible for a number of other care options—including Death With Dignity.
I used to work for an OB/GYN, and remember realizing there were a lot more shades to the practice of abortion than those available in the political debate. Can you describe to me one of the shadings on this issue that maybe doesn't get discussed politically?
A really great example is something that's called "the law of double effect" or "terminal sedation," and that's the practice of someone who has unmanageable pain, and the only way to manage that pain is to give them a high enough dosage of a painkiller, probably morphine, that will ultimately end their life. The primary intent of the administration of the medication is to stop their pain. But the secondary effect, the double effect, is that it ends a person's life. I wouldn't say it's a common practice, but it's [enough of] an accepted practice in the medical community that even organizations that are vehemently opposed to assisted suicide, like the Catholic Church, for instance, accept terminal sedation because of the intent at play. Even though in some places you could say terminal sedation is far more akin to active euthanasia than Death With Dignity is, because you're talking about, whose choice is it? Who's really the actor here? So I think that's one of those areas where you really get into the murkiness of some of these waters. There are researchers who argue that terminal sedation is a more objectionable or barbaric practice than physician-aided dying, because a lot of times when someone's in a situation [where] they are unconscious, they're not the ones making the decision. If that person had the option of Death With Dignity earlier in the process, they could've been the actors and they could've been the ones making this decision.
How well did you get to know Cody Curtis before you were there for her death?
I filmed with Cody and her family for 10 months. We first met in February of 2009 and then she took the medication Dec. 7 of 2009. So I got to know her and her family, I would say, very well over that time period, and I'm still keeping in close contact with them. They've been very supportive of the film and her story being told. When I first met Cody, she had this terminal diagnosis but she was given less than six months to live, and at the time I think she was skeptical she would even make it that long and she had set this date when she had planned to take the medication—Memorial Day, May 25—and then she outlived her prognosis. Basically, she kind of blew through that date and she was doing really well and she had really excellent palliative care through hospice, which is kind of one of these perverse realities I've learned about in this end of life discussion. Very often when people don't pursue a curative route, but rather a palliative care route, a lot of times not only is their quality of life better but they actually live longer, and I think that's probably true with Cody, that if she'd continued with chemotherapy or radiation or other curative therapies she probably wouldn't have lived as long as she ultimately did, and certainly her quality of life wouldn't have been as good by any objective measure. So I filmed with her for 10 months before she took the medication. And it was really uncertain up until the very end whether in fact Cody would take the medication. I think that she was like most of the people I'd filmed with. I think of all of the people I filmed with, she was really [most] reluctant to do it. In her own words in the film she says, "I'd rather just drift off...I'd rather let nature take its course." As her husband, Stan, says, she was prepared for that not to be an easy course, but then it became clear, I think, as her condition really took a turn for the worse, really dramatically, that she wasn't going to be able to drift off.
Over the course of editing a film like this, is it strange to watch, over and over, the death of someone you knew?
It's strange to watch all the footage, because I filmed the cinematography as well. Maybe not so much the death because of the way it was filmed: [I'm] not actually in the room when the person ingests the medication. But really at different times when I'm watching it, even now after having seen it so many times, different moments will sneak up on me emotionally. The last 10 months of Cody's life, I don't think her family would describe it as a sad or tragic time. It was a time when they were going to remember what life was about, and live every day in as meaningful a way as possible. They feel very firmly about that: That last 10 months was as much about living as it was about dying for them.
I understand you got one of the oncologists to go on film by showing her pictures of your cat. How did that work?
[Laughs.] Well I certainly would not say that Dr. [Katherine] Morris is someone who would make such a serious and important decision simply based on a shared affection for cats. I think that would be a discredit to her as a doctor and how seriously she weighed whether to participate in the film, but I did receive a tip that she was a lover of cats, as am I, and subtly worked that into one of our early interviews. It wasn't an easy decision for her to participate in the film, and it came in steps and stages. She'd never prescribed someone before Cody, and she was concerned about how participating in the film and speaking about this incredibly controversial topic would affect her practice, and how her other patients felt about her, and if she'd be able to provide any of them the care that she wanted to. So she thought long and hard about whether to be included in the film. I don't know how much the cats were a part of that, but I guess anything helps.
SEE IT: How to Die in Oregon screens at the NW Film Center's Whitsell Auditorium, 1219 SW Park Ave., at 5:30 pm Saturday, Feb. 19, and at Regal Broadway Cinemas, 1000 SW Broadway, at 9:30 am Sunday and 7:30 pm Monday, Feb. 20-21. Richardson will attend all three screenings.