Death with Dignity

November 12, 2008 | | Comments Off on Death with Dignity

In a historical election that stirred political excitement in unprecedented ways, it was easy to overlook some of the potentially groundbreaking state measures that made it on the ballot. One such measure was Initiative 1000, Washington’s Death with Dignity Act (PDF), legalizing physician-assisted suicide for terminally ill, competent adults, medically predicted to die within six months.

Physician assisted suicide (PAS), or death with dignity, the term its proponents prefer, has been a relatively dormant issue on the legislative front for some time. Almost all states explicitly criminalize the act; in some, it is subsumed under manslaughter, in others, it is considered a separate offense (inducement to commit suicide). Prior to November 4th, the only state to legally recognize the right of a terminally ill patient to die was Oregon. The Oregon Death with Dignity Act was passed in 1994 and recently upheld by the Supreme Court in Gonzales v. Oregon (PDF).

As any issue of life and death, PAS is fraught with ethical dilemmas. How do we decide if and when a person has the right to die? How do we determine who that person is without discriminating and institutionalizing certain types of medical conditions over others? How do we distinguish, morally and legally, PAS from murder? How do we prevent potential abuse by patients, doctors and the health-care industry at large?

Initiative 1000 attempts to answer at least some of these questions. Under the proposed act, eligible patients gain the right to request and self-administer (at a time and place of their choosing) lethal medication prescribed by a physician. This distinguishes the practice from euthanasia, where the doctor rather than the patient performs the terminating procedure. Putting the patient in charge is meant to ameliorate concerns with physicians committing “murder”, breaking the Hippocratic Oath, or simply abusing their powers. In addition, the law is full of administrative hurdles designed as safeguards. Each eligible patient must make two oral requests, separated by a period of 15 days, as well as a signed written request, witnessed by at least two individuals, with multiple restrictions on who qualifies as a witness. Two separate physicians must confirm the patient’s diagnosis and ensure that the patient is competent of making an informed decision. The list of requirements goes on and on: physician responsibilities, informed decision, family notification, right to rescind the request, mandatory waiting periods, medical record documentation, residency requirement, disposal of unused medications, reporting requirements, effect on wills, contracts, statutes, insurance and annuity policies….

Undoubtedly, it is impossible to resolve all problems with PAS. Questions of morality and constitutionality will always linger in the air. Patients who are more than six months away from death will still be forced to endure pain and suffering against their will. And who is to say doctors won’t begin discriminating in the amount of care they give to a patient who they know has lethal medication at home? But on November 4th the voters in Washington decided to take the chance anyway.

Initiative 1000 passed with a convincing 58% approval. Moreover, it appears that Washingtonians are not alone. Gallup polls, conducted annually since 2001, indicate that when posed with the question, “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his family request it?”, the majority of Americans (65-75% depending on the year) consistently answered yes. Could this mean the tides are turning?

Photo courtesy of Flickr user ‘bert.


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