While Lori Conners asked her husband, Kevin, to hold a revolver to her head while she pulled the trigger, as police have reported, a question remains about the way she chose to die: Was she aware of the choices available to manage her pain and depression?

Kevin Conners of Break Neck Hill Road in Westbrook has been charged with second-degree manslaughter for “aiding another person to commit suicide” on Sept. 6, 2018. He turned himself in June 20 after state police issued a warrant for his arrest.

The arrest warrant affidavit describes in detail Kevin Conners’ account of how he helped his wife die, how he agreed to hold the gun so Lori Conners wouldn’t “flinch” as she pulled the trigger. It describes her physical pain from cancer and Lyme disease and her depression. But it does not mention whether or not she was given counseling about palliative care, which might have eased her symptoms.

According to state police, Kevin Conners “stated that Lori watched how cancer ate away at her father’s body and the pain he went through before passing away in Hospice. He stated that Lori always spoke about how she didn’t want to suffer like her father and end up dying in Hospice.” Her father, Hubert Hedges, died in October 2016; it is unclear whether he died at Connecticut Hospice in Branford.

“That’s a vision that probably haunted her and … it was her dad, so maybe it stuck with her,” said Tracy Wodatch, interim executive director of the Connecticut Association for Healthcare at Home, which is based in Wallingford and advocates for home-based health and hospice care.

It’s possible, Wodatch said, that Lori Conners did not receive “the grief and bereavement support that she needed to heal, and that’s something that hospice does a wonderful job of.” While Connecticut Hospice, the first in this country, is well known for its facility overlooking Branford Harbor, most hospice care is given at home by that agency and about 30 other hospice organizations in the state, as well as at nursing homes and hospitals.

“Hospice is not a place to go to to die. Hospice is a philosophy,” Wodatch said.

Kevin Conners described himself and his wife as born-again Christians who were members of Cornerstone Community Church in Clinton. Conners’ pastor, Darren DePaul, did not return a call requesting comment.

Family members could not be reached and Kevin Conners’ lawyer, Raymond Rigat of Clinton, did not return a call seeking comment, so it remains unknown what services were offered to the family, but Wodatch said “it sounded as though they didn’t have the support that they needed to deal with her demise.”

Before hospice services are needed — they are generally covered by insurance when a patient has a prognosis of six months or less to live — palliative care brings “a team approach to treating that patient holistically while they’re still getting active treatment, focusing on quality of life while still managing the patient’s symptoms,” Wodatch said. That approach takes into account the patient’s emotional, psychosocial and spiritual needs, she said.

Palliative care “should be offered fairly early,” Wodatch said. “The oncologist, along with the [primary care physician], can make the recommendation. They usually have a connection to a palliative care department or team that they can make a referral to.” Yale New Haven Hospital “has a really strong palliative care team,” she said.

“In this day and age, pain and symptom-management treatments are extremely effective,” Wodatch said. However, she said, Oregon’s annual report on its Death with Dignity Act, passed in 1997, shows that pain is low on the list of reasons that terminally ill people decide to take their own life.

Of 1,459 patients who had taken a lethal dose of medication, such as secobarbital or pentobarbital, since 1998, close to 90 percent said “losing autonomy” and being “less able to engage in activities making life enjoyable” were their main concerns, followed by “loss of dignity” at 74 percent. “Inadequate pain control, or concern about it” was cited by less than 26 percent of patients.

Conners had been diagnosed with stage three or four ovarian cancer in March 2018 that spread to her colon, liver and abdomen and “had also been battling Lyme disease for the past 17 years,” the affidavit reported. Chemotherapy conflicted with her Lyme symptoms, making her ill. She had suffered from depression for the last two years, which became “more pronounced” after the cancer diagnosis.

Lori Conners had a history of health problems, including a 37-day hospital stay to have an abscess removed from her liver. State police reported she had written more than a dozen “(suicide) good bye letters” to her husband and children and that Kevin Conners told troopers his wife had tried to commit suicide on Aug. 8, 2018, by overdosing on the sleep medication Ambien and whiskey. He said she told her family “she no longer could endure being sick and wanted to be with God,” according to the warrant affidavit.

No ‘aid in dying’ in Connecticut

She had researched “death with dignity” on the internet but realized she couldn’t move to a state such as Vermont, where physician-assisted dying is legal, because she would need to be a resident of that state. Eight states, plus the District of Columbia, have enacted laws enabling mentally competent, terminally ill people to receive a doctor’s prescription for lethal medication. Maine became the most recent state to do so on June 12.

In Connecticut, however, five bills introduced since 2013 to legalize physician-aided dying have not made it out of the Public Health Committee. Opponents have included the Roman Catholic Church and networks of people with disabilities, including Second Thoughts Connecticut and Not Dead Yet.

Cathy Ludlum of Manchester, a member of Second Thoughts Connecticut, would not comment on the Conners case itself, which she called “such a tragic situation all the way around,” but said aid-in-dying bills threaten the members of society who may be abused or neglected. “Once you change the legal and medical definitions of what treatment means, so there is a treatment goal including death, it jeopardizes people who are already vulnerable and at risk,” she said.

Making it legal to prescribe pills that a patient can take to kill themselves would have an impact on the health care system, Ludlum said. “It’s not as simple as people would like to believe,” she said. “It affects how funding goes for treatment; it affects how funding goes for research. It’s not just people with disabilities who are at risk; it’s people with these terminal illnesses.”

Laws to allow physician-assisted dying generally require the patient to be mentally competent, terminally ill and to have two doctors sign off on the patient’s request. Advocates say the patient is in control of how they will die. Ludlum, however, said, “You can’t deny the power of the insurance companies and you can’t deny the influence and the respectability of the medical profession. I think people can be swayed by that.”

Elaine Kolb of West Haven, a member of both Second Thoughts and Not Dead Yet, said, “I understand and have great compassion for the husband and how difficult it was to watch someone suffering in such pain. … I have been that person. I have been the person who was suffering” and trying to decide “what course to take.”

Kolb also questioned whether Lori and Kevin Conners received appropriate medical advice and care. “Good palliative care says that you can specifically say that you want to have good pain management even if it hastens your death,” she said.

She said many people who are not disabled cannot imagine being limited and say they would rather be dead than depend on a wheelchair or a tracheotomy tube. “People have … what I call non-disablephobia: fear of being disabled. Some nondisabled who acquire a disability are suicidal,” she said.

But the real problem, she said, is that “it is a whole lot more common that people who have disabilities and want to live are being abused and neglected and that is huge, and one of the worst places is a nursing home.”

Rather than being able to end her life, Lori Conners “should have gotten better services, in my opinion. She needed more personal support on many levels, and so did he,” Kolb said.

However, Tim Appleton, Eastern field director for Compassion and Choices, which advocates for physician-assisted dying laws, said that without such laws, “family members could wind up caught up in the criminal justice system as they respond to the desperate pleas of loved ones.”

Appleton wouldn’t comment on whether such a law would have helped Lori and Kevin Conners avoid violent means to end her life. “We don’t have enough information to know if Lori Conners would have qualified for aid in dying,” he said.

However, he said, one in five Americans now have the legal ability to decide to end their lives and “ZIP codes are defining end-of-life journeys for people.” He said he knows of cases in which family members have been arrested for handing their terminally ill loved one a bottle of pills or a gun, even if they were not present when the relatives killed themselves. “This isn’t a philosophical argument. This happens more than it should,” Appleton said.

“In the 20 years this has been on the books in Oregon … there’s not a single case of abuse, misuse or coercion,” Appleton said.

He said palliative care also is important. “Other end-of-life options are considered. That’s part of the law and as a practical matter it already occurs,” he said. “In states where this exists, physicians are ready for this option.”

“Should it be the patient in consultation with their physician, their loved one, their faith leaders if they have them, about what their end-of-life journey should be, or should it be the government?” Appleton asked.

‘Aid in dying,’ not ‘suicide’

Appleton also objected to use of the term “assisted suicide” as a scare tactic by opponents. “‘Suicide’ connotes a mentally ill … physically capable person,” whereas “aid in dying” refers to a “mentally capable, physically incapable person who has less than six months to live.” He said the American Academy of Suicidology makes the distinction between suicide and “physician aid in dying.”

Connecticut House Majority Leader Matthew Ritter, D-Hartford, said he is in favor of an aid-in-dying law “because obviously it puts individuals who are in pain or suffering in a very difficult position. It is a very emotional decision. It has a lot of emotion on both sides.”

Ritter said, “I don’t see it passing with the current makeup of the General Assembly,” but added, “opinions can change and attitudes can change.” In its written testimony on the bill this year, the Connecticut Medical Society said it had changed its position from opposition to “engaged neutrality” because many doctors have changed the way they view their roles in helping a patient die a dignified death, free of suffering.

“This is a decision that I think should be made between a medical professional and their patient,” Ritter said.

An exception for aid in dying

Professor Brian Stiltner, who teaches religion and ethics at Sacred Heart University in Fairfield, said cases like that of Lori and Kevin Conners “are always tragic” but that he can understand why police might step in because there might be a question concerning whether the person in suffering has “legitimately” consented to ending her life.

“Because Connecticut doesn’t have the law, they have to hold back from the doctor that they’re thinking about suicide,” he said. “Such laws give options for such extreme and desperate cases like this but also give options for doctors to explore the full range of alternatives to suicide.”

Stiltner said that while suicide and helping another person to end her or his life generally are considered morally and ethically wrong, “we’ve carved out this space” where many will view it as acceptable. “Could this be an exception to our general rule against taking a life because of medical facts and intentions?” Stiltner asked. “The irony is that if we were in a state like Oregon, or Connecticut had this law, this is a woman who could have … done this in a legally prescribed way. … I think the sad thing here is that they both felt they had to resort to this.”

Dr. Matthew Kenney, a bioethicist and ethics adviser for the Archdiocese of Hartford, said the Roman Catholic Church’s stance against suicide or aiding in another’s death begins “with the fundamental principle of human dignity. … Human beings have inviolable worth because we’re created in the image of God. That has implications for the sanctity of life too in the sense we’re not the authors of life. Our destiny is with God, so we’re the stewards of our life.”

Neither vitalism nor subjectivism

Kenney said the Catholic Church does not promote the theory of vitalism, which says that “biological life is an absolute good no matter what” and that people should “insist on any and all medical interventions whether they were doing any good or not.”

The church also does not subscribe to the other extreme, subjectivism, which states, “My life is only of value to me and I can do whatever I want with it,” he said.

“Catholic teaching has long recognized the right of medical patients to forgo disproportionate medical treatment,” he said. In its “Ethical and Religious Directives for Catholic Health Care Services,” the church states, “Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.

It is permissible to have an advance directive to withhold treatment if a person is in a persistent vegetative state, for example, Kenney said. “A lot of people aren’t aware that Catholic teaching does allow that in some circumstances,” he said.

edward.stannard@hearstmediact.com; 203-680-9382