Right to die
The right to die is an ethical or institutional entitlement of any individual to commit suicide or to undergo voluntary euthanasia. Possession of this right is often understood to mean that a person with a terminal illness should be allowed to commit suicide or assisted suicide or to decline life-prolonging treatment, where a disease would otherwise prolong their suffering to an identical result. The question of who, if anyone, should be empowered to make these decisions is often central to debate.
The patient typically gets to make the ultimate decision if he or she wants to practice their right to die. This is generally called the Death with Dignity act. Death with Dignity is an act that was created to give mentally competent patients that are terminally-ill the right to end their own life with a lethal amount of physician prescribed medication. Although this right has not been available to everyone. Oregon was the first state that accepted the Death with Dignity law in 1994. Other states such as Washington, Vermont, and New Mexico have given their people who are terminally-ill the decision to act upon their right to die. This law is slowly starting to motivate other states. However, not everyone is on board as religion and other beliefs are playing a major factor in this act becoming available to those who are terminally-ill all throughout America.
Proponents typically associate the right to die with the idea that one's body and one's life are one's own, to dispose of as one sees fit. However, a legitimate state interest in preventing irrational suicides is sometimes argued. Pilpel and Amsel write, "Contemporary proponents of ‘rational suicide’ or the ‘right to die’ usually demand by ‘rationality’ that the decision to kill oneself be both the autonomous choice of the agent (i.e., not due to the physician or the family pressuring them to ‘do the right thing’ and commit suicide) and a ‘best option under the circumstances’ choice desired by the stoics or utilitarians, as well as other natural conditions such as the choice being stable, not an impulsive decision, not due to mental illness, achieved after due deliberation, etc."
Hinduism accepts the right to die for those who are tormented by terminal diseases or those who have no desire, ambition or no responsibilities remaining; and allows death through the non-violent practice of fasting to the point of starvation (Prayopavesa). Jainism has a similar practice named Santhara. Other religious views on suicide vary in their tolerance, and include denial of the right as well as condemnation of the act. In the Catholic faith, suicide is considered a grave sin.
A debate exists within bioethics over whether the right to die is universal, only applies under certain circumstances—such as terminal illness, or if it exists at all. A court in the American state of Montana, for example, has found that the right to die applies to those with life-threatening medical conditions. Suicide advocate Ludwig Minelli, euthanasia expert Sean W. Asher and bioethics professor Jacob J. Appel, in contrast, argue that, all competent people have a right to end their own lives. Appel has suggested that the right to die is a test for the overall freedom of a given society.
The 1991 Patient Self-Determination Act passed by The Congress of the USA at the request of the financial arm of Medicare does permit elderly Medicare/Medicaid patients (and by implication, all "terminal" patients) to prepare an advance directive in which they elect or choose to refuse life-extending and/or life-saving treatments as a means of shortening their lives to shorten their suffering unto certain death. The treatment refused in an advance directive under US law, because of the 1991 PSDA, does not have to be proved to be "medically futile" under some existing due-process procedure developed under state laws, such as TADA in Texas.
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Most often, the idea of the right to die is related to a person's wish that caregivers allow death—for example, by not providing life support or vital medication—under certain conditions when recovery is highly unlikely or impossible. It may also refer to issues regarding physician-assisted suicide. It may be called passive euthanasia in cases where the patient is unable to make decisions about treatment. Living wills and Do Not Resuscitate orders are legal instruments that make a patient's treatment decisions known ahead of time; allowing a patient to die based on such decisions is not considered to be euthanasia. Usually these patients have also made explicit their wish to receive only palliative care to reduce pain and suffering.
Although specialized legal instruments differ from place to place, there are two more that are important in this context. The Five Wishes document allows a person to state in advance the priorities and values they wish to have honored at the end of life. And the Medical Durable Power of Attorney (or MDPOA) designates an agent to make decisions in case of incapacity, and can be used to give written guidance regarding end of life decision making. The MDPOA is generally considered to be the most powerful of all such instruments. All others may require interpretation on the part of health care providers or even court-appointed guardians; the MDPOA takes the job of interpretation out of the hands of strangers and gives it to a person selected and trusted by the individual; of course it is a personal decision.
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The Netherlands legalized voluntary euthanasia in 2001 and is one of the few countries in the world to have done so. Under current Dutch law, euthanasia by doctors is only legal in cases of "hopeless and unbearable" suffering. In practice this means that it is limited to those suffering from serious medical conditions (including mental illness) and in considerable suffering like pain, hypoxia or exhaustion. Helping somebody to commit suicide without meeting the qualifications of the current Dutch euthanasia law is illegal. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life.
In February 2010 a citizens' initiative called Uit Vrije Wil (Out of Free Will) further demanded that all Dutch people over 70 who feel tired of life should have the right to professional help in ending it. The organization, initiated by Milly van Stiphout and Yvonne van Baarle, started collecting signatures in support of this proposed change in Dutch legislation. A number of prominent Dutch citizens supported the initiative, including former ministers and artists, legal scholars and physicians. Among them were former politicians Frits Bolkestein, Hedy d'Ancona and Jan Terlouw, as well as television personality Mies Bouwman. This initiative has never been legalised.
As of August 2011 a B.C. Supreme Court judge had been requested to speed up a right-to die lawsuit so that Gloria Taylor could have a doctor assist her in committing suicide. She suffered from Lou Gehrig's disease. She died of an infection in 2012.
A B.C. Civil Liberties lawsuit is representing six plaintiffs and challenges the laws that make it a criminal offence to assist seriously and incurably ill individuals to die with dignity.
On June 5, 2014 Quebec became the first Canadian province to pass right-to-die legislation. The federal government is expected to challenge this measure.
On February 6, 2015 the supreme court of Canada officially declared that denying the right to assisted suicide is unconstitutional. The court’s ruling limits physician-assisted suicides to “a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition, including an illness, disease or disability, that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” The legislature has been given exactly 12 months to draft a new and constitutional law to replace the existing one.
The term 'right to die' has been interpreted in a number of ways, including issues of suicide, passive euthanasia, active euthanasia, assisted suicide, and physician assisted suicide. As health of citizens is considered a police power left for individual states to regulate, it was not until 1997 that the US Supreme Court made a ruling on the issue of assisted suicide and one's right to die. In 1997 the Supreme Court heard two appeals arguing that New York and Washington statutes that made physician assisted suicide a felony violated the equal protection clause of the Fourteenth Amendment. In a unanimous vote, the Court held that there was no constitutional right to physician assisted suicide and upheld state bans on assisted suicide. While in New York this has maintained statutes banning physician assisted suicide, the Court's decision also left it open for other states to decide whether they would allow physician assisted suicide or not.
Since 1997, four states in the US have recognized the right to die with dignity. Oregon, Washington, and Vermont, in 1997, 2009, and 2013 respectively, have laws that provide a protocol for the practice of physician assisted suicide. The law in these three states allows terminally ill adult patients to seek lethal medication from their physicians. Montana's law, passed in 2009, does not provide a protocol for the practice, but rather provides legal protection for physicians in the case that they write a prescription for lethal medication upon patient request.
In early 2014, a New Mexico Second District Judge Nan Nash ruled that terminally ill patients have the right to aid in dying under the state constitution, ie. making it legal for a doctor to prescribe a lethal dose of medication to a terminally ill patient. The ultimate decision will be made with the outcome of New Mexico's Attorney General's appeal to the ruling.
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- See Washington Initiative 1000, which passed on 4 November 2008.
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- Frans Bosman en Corrie Verkerk (2007-02-10). "70-plus eist zachte dood" (in Dutch). Het Parool.
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- (Dutch) "Uit Vrije Wil — Burgerinitiatief voltooid leven"