(The Tennesseean, Dave Boucher – writer)

Death isn’t a choice. But there are options, and Marian Ziebell has a plan.

She knows how she wants to die.

Turning 82 in June, Ziebell lives in the Uplands Retirement Village in Pleasant Hill Tennessee in western Cumberland County. She suffers from the early stages of Alzheimer’s disease.

Ziebell doesn’t want to see the late stages of the disease.

“Both my sister and my cousin spent many years in total care with Alzheimer’s disease. They were not living satisfying lives, and the sadness, stress and cost to others is considerable,” Ziebell told The Tennessean in an email.

“I am planning on assisted suicide.”

If she goes through with the plan in Tennessee, there’s a chance someone will have broken the law. Killing oneself isn’t illegal, but the act of helping someone commit suicide is a felony. That could mean up to 12 years in prison, if convicted.

Ziebell didn’t discuss the specifics of her plan. She did say her oldest son knows about her wishes and “agreed to be with me when I take the planned action.”

She doesn’t want to break the law. But she’s done the research and can still remember her sister and her cousin. Ziebell wants to have the right to have a say in how she dies.

Debating death

Tennessee lawmakers are set to discuss changing state law Tuesday so that some terminally ill patients believed to have less than six months to live could legally participate in assisted suicide.

It’s a heated issue that’s remained in the public discourse for decades. Oregon approved the nation’s first assisted suicide law in 1997, but only Washington state and Vermont have followed with their own laws in the nearly 18 years since the first “Death with Dignity Act.”

Controversial physician Jack Kevorkian, known to many as “Dr. Death,” drew considerable ire and attention for his role in assisted suicides and subsequent conviction in 1999. More recently, the 2014 assisted suicide of 29-year-old advocate Brittany Maynard, who suffered from terminal brain cancer, received considerable national attention.

In Tennessee longtime political activist John Jay Hooker is the face of the movement. He and other advocates prefer terms such as “death with dignity,” “right to die” or “physician-assisted death” to assisted suicide, arguing the term stirs up negative connotations.

Facing his own terminal illness, Hooker wants the ability to end his own life on his own terms. Depriving anyone of that ability, he argues, violates the spirit of the U.S. Constitution and “the American dream.”

He also argues the state is ready for legalization: The latest edition of the Vanderbilt Poll shows 55 percent of registered voters support physician-assisted suicide, compared with 38 percent who oppose it.

“The time has come in America when assisted dying, dying with dignity, is going to happen on a nationwide basis,” Hooker said Monday. “I think it’s just a question of time, and I’m hopeful Tennessee will take a major position.”

Lawmakers in 17 states — not including Tennessee — introduced at least 31 bills related to some form of assisted suicide this year, according to the National Conference of State Legislatures. Most failed or stalled, but there was recent action in California, where the state Senate approved an assisted suicide bill last week.

The move comes on the heels of the California Medical Association officially changing its stance on assisted suicide, dropping its opposition and taking a neutral stance on the concept. A spokesman from the Tennessee Medical Association didn’t respond to a request for comment.

There’s no indication Tennessee lawmakers are ready to push forward with any law change. The bill made no progress in the General Assembly this year before being shipped to a summer study session, a move used at times to bog down legislation.

Treating pain vs. ending life

In May 1992, Donald Ruane walked up to Donald Willis at a Nashville bar and shot Willis in the neck.

Willis was rushed to the hospital, where he was placed on life support, according to court records. Paralyzed from the neck down, Willis communicated with eye movements and nods that he wanted to be taken off life support.

A Davidson County court ruled Willis had the right to refuse treatment that would save his life. He was taken off the ventilator and died shortly thereafter.

It’s one of many cases where a patient was given legal approval to end his or her life. Those patients are kept alive through ventilators, feeding tubes or some other artificial means. But there are people who want to avoid the tenuous trek down the treatment road that many times can only lead to life support.

Terry Jackson, who spent 11 of his 50 years as a registered nurse in an emergency room, believes cases where these patients are allowed to refuse treatment serve as precedence for Tennesseans who want to die before they must rely on life support.

“In order to remove the ventilator, I can assure you that (the doctor in Willis’ case) administered an intravenous sedative to make the patient unconscious. Otherwise, it would have been an agonizing and painful event. This was active euthanasia and not passive,” Jackson recently said in an email to The Tennessean.

Citing several studies, Jackson said there are medical steps taken when a person asks to be taken off a ventilator, in order to avoid pain and ease passage. He argues that process might lead to something that mimics a natural death, but in reality it assists a person in dying.

Hooker agrees such care is essentially assisted suicide.

“What’s the difference between the doctor taking you off the essential ingredients to live and giving you some medicine that will speed up your death?” asked Hooker, who argues assisted suicide is the “ultimate civil right.”

That difference is everything, in the view of attorney Mark Fulks. Fulks — who worked for the Tennessee Attorney General for more than 12 years before joining Baker, Donelson, Bearman, Caldwell & Berkowitz PC — notes the U.S. Supreme Court already rejected the right to assisted suicide in 1997.

In Tennessee state lawmakers have drawn the line between refusing treatment and medication that hastens death. Patients are already allowed to have a “living will” that outlines their desires to refuse treatment. But medical assistance is a step too far under current law, where Fulks said it’s clearly defined as a crime.

“It comes down to what many may consider a quibbling over semantics: Doctors can give a patient medicine at a therapeutic dose right up to the point that the medicine becomes lethal,” Fulks wrote in an email.

“But once the prescribed dose or the medicine’s intended use becomes lethal, it becomes a crime.”

Hooker has filed a lawsuit arguing, in various ways, assisted suicide should be legal. His assertion the state’s law against assisted suicide is unconstitutional is “the only potentially viable argument that he has,” Fulks wrote in an email, before again pointing to the U.S. Supreme Court and courts in Alaska, California, Florida and Michigan rejecting similar arguments.

The question is better suited for the General Assembly, Fulks said. Jackson and Hooker and optimistic lawmakers might be amicable to a change in law.

Ziebell hopes that they decide to allow assisted suicide. She knows why she’s made her own decision as to how she’ll die.

“There are kind and helpful alternatives. There are legal ways to take one’s own life. It can be planned with support and agreement of people close to you. It can be done without pain or discomfort,” Ziebell wrote in an email.

“Many people choose this pathway of ‘Death With Dignity.’ You can be grateful to have time to plan your departure from life, last wishes, gratitude to others.”

Tennessee lawmakers discuss assisted suicide

Tennessee state senators are set to discuss issues surrounding the legality of assisted suicide in Tennessee. Right now it’s a felony in the state, but advocates argue people should have the ability to legally end their lives if they are suffering from a terminal illness.

The state Senate committee hearing begins at 1 p.m. in legislative plaza, with the proceedings also streamed online at the Tennessee General Assembly website.

The ability to die in Oregon

Assisted suicide was first legalized in Oregon in 1997. Here’s a look at implementation of the law since it took effect:

Number of people prescribed life-ending medication: 1,327

Number who used the medication to end their lives: 859 (65 percent)

Median age for those who used medication: 71

Most common underlying disease: cancer — 78 percent; ALS (Lou Gehrig’s disease) — 8.3 percent

Reason cited for wanting to die: losing autonomy — 91.5 percent; less able to engage in activities making life enjoyable — 88.7 percent; loss of dignity — 79.3 percent