Assisted death in the United States

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Assisted death, known as medical aid in dying to proponents and assisted suicide to opponents, is a practice in which a terminally ill adult with less than six months to live may request a lethal dose of drugs from her or his doctor for self-administration to bring about death if he or she feels that the dying process has become unbearable. Data from the Oregon Health Authority, which publishes annual reports on its first-in-the-nation assisted death law, approximately two thirds of patients who qualify and receive a prescription take it.[1]

The Oregon, Washington, Vermont, and most recently Colorado laws expressly say that, “actions taken in accordance with [the Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.” This language is intended to distinguish the legal act of what proponents call “medical aid in dying” from the act of helping someone commit suicide, which is prohibited by statute in 42 states and prohibited by common law in an additional six states and the District of Columbia. Helping someone commit suicide is technically prohibited in every state where assisted death is authorized, but opponents feel that this distinction is erroneous.[2]

History[edit]

Glucksberg v. Washington[edit]

Dr. Harold Glucksberg, along with four other physicians, three terminally ill patients, and Compassion and Dying, brought a case against the state of Washington for banning assisted suicide. The case was filed in District Court in 1994.

Following a series of appeals, the U.S. Supreme Court decided in 1997 in a unanimous decision to uphold Washington’s ban. They cited the Due Process Clause and argued that assisted suicide isn’t guaranteed as a fundamental liberty protected by due process. The case allowed individual states to decide independently on the assisted death issue. It set the stage for legislative efforts on the state level.

States where assisted death is authorized[edit]

California[edit]

In 1992, the group Californians against Human Suffering proposed Proposition 161 to allow patients with less than six months to live the right to receive a lethal prescription of barbiturates from a physician. This proposition offered more safeguards against abuse by physicians than Washington’s Initiative 119, such as special protections for patients in nursing facilities. This measure failed to pass with 46 percent of the vote.[3]

Subsequent efforts were tried to pass assisted death legalization through the California State Legislature in 1999, 2005 and 2006, all of which failed. The California legislature passed the California End of Life Option Act, a bill legalizing the practice in September 2015, and the bill was signed into law by Governor Jerry Brown on October 5, 2015, making California the fifth state to authorize medical aid in dying and the second to do so through the legislature. The Act began implementation on June 9, 2016. In May 2018, Judge Daniel A. Ottolia of the Superior Court of Riverside County ruled that the method of enacting the law was unconstitutional,[4][5] but the law was reinstated by a state appeals court the following month.[6]

Montana[edit]

Assisted death is legal in Montana through a state supreme court decision. In Baxter v. Montana the Montana Supreme Court ruled in a 5-2 decision that state law allows for terminally ill Montanans to request lethal drugs from a physician under existing statutes. The Attorney General of the state of Montana sought an appeal from the Montana Supreme Court, but the court, by a decision of five to two, affirmed the lower court's ruling on the state law. The Court did, however, limit the scope of the decision by not determining if the state's constitution protected the right.[7]

Oregon[edit]

Oregon voters first approved the Death with Dignity Act (DWDA) by general election in November 1994 by a margin of 51% to 49%. Ballot Measure 16, a citizen initiative sponsored by Oregon Right to Die Political Action Committee,[8] asked if terminally ill patients with less than 6 months to live should be able to receive a prescription for lethal drugs and included many provisions to protect against misuse, such as two oral requests and a written request from the patient. The patient must also be referred to counseling if a mental illness is suspected.

The law went into effect in October 1997 after an injunction delayed implementation. In November 1997, Measure 51 was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%.[9]

Challenges[edit]

Lee v. State of Oregon[edit]

In December 1994, doctors and patients argued that the DWDA violated the U.S. Constitution’s first and fourteenth amendments in Lee v. Oregon. U.S. District Court Judge Michael Hogan placed a temporary injunction, that he later made permanent, on the Act.

In February 1997, the Ninth Circuit Court of Appeals ruled to dismiss the challenge to the Death with Dignity Act.

Measure 51, Oregon Repeal of Death with Dignity[edit]

In 1997, Measure 51 was placed on the November ballot. It failed and 60% of Oregon voters, more than the original 1994 vote, expressed their support for the Death with Dignity Act.

Oregon v. Ashcroft[edit]

U.S. Attorney General John Ashcroft issued a directive in 2001 to prevent the Oregon Death With Dignity Act from being implemented. The state of Oregon successfully sued and proceeded with implementation.[10][11]

Vermont[edit]

In May 2013, the Vermont Legislature passed the Patient Choice and Control at End of Life Act. Governor Peter Shumlin signed it into law. The law is based on, but is less restrictive than, the Oregon model.[12]

Vermont was the first state to pass an assisted death law through the legislative process. In January 2013 the act was introduced to the Senate, and in May 2013 it was passed by both the house and senate.

Vermont residents 18 years old or older who are mentally capable adults with a terminal illness and a prognosis of 6 months or less to live can make an oral request and obtain a lethal dose of barbiturates from a physician. The bill requires a second opinion, written and oral requests, and other provisions.[13]

Washington[edit]

In 1991, a ballot question asked if terminally ill adults should be allowed to receive physician assisted death.The initiative failed, receiving 46 percent of the vote.[3]

Washington voters approved the Death with Dignity Act by general election in November 2008 by a margin of 58% to 42%.[14]

In practice[edit]

Health departments in Oregon[15] and Washington State[16] publicly report yearly on the use of assisted death; as required in their respective statutes.

A documentary was produced in 2011 called How to Die in Oregon which follows a woman who uses assisted death and interviews her family and interviews opponents of the law.

Controversy[edit]

One of the most common terms used for what proponents call “medical aid in dying” is “physician-assisted suicide (PAS)”, which employs the technical terms for self (sui) killing (cide). Like all heated debates, terms for the latter practice are subject to political framing. Proponents are more likely to use terms like"physician-assisted dying", "physician-assisted death", "aid in dying", "death with dignity", "right to die", "compassionate death", "compassionate dying", "end-of-life choice", and "medical assistance at the end of life". Opponents do not view the latter practice as a legitimate medical procedure, hence they regard the aforementioned labels as euphemisms and use the term “assisted suicide.”

Controversy concerning the legalization of this practice typically arises from concerns regarding its intersection with manipulative circumstances or family members; inaccurate prognoses, the accuracy death certificates, unequal access to healthcare, financial problems, the Werther Effect, advocacy for the practice’s expansion to those with disabilities, evidence of the latter and ableism. Opponents view these factors as legitimate reasons to keep what they would term “assisted suicide” illegal.

Debate over Whether Assisted Death is Suicide[edit]

Suicide refers to someone taking their own lives. Opponents feel that this term is appropriate to describe assisted death, because of the social and personal dynamics that can pressure someone into choosing death. Opponents also cite the fact that oncologists and other non-psychiatric physicians responsible for referring patients for counseling are not trained to detect complex, potentially invisible disorders like clinical depression.

Proponents feel that “medical aid in dying” differs from suicide because a patient must be confirmed by two physicians to be terminally ill with a prognosis of 6 months or less to live and must also be confirmed by two physicians to be mentally capable to make medical decisions. That is why proponents support death certificates that list their underlying condition as the cause of death. According to the proponents, suicide is a solitary, unregulated act whereas aid in dying is medically authorized and is intended to allow for the presence of loved ones. Proponents define “suicide” as an irrational act committed in the throws of mental illness. They assert that the latter act is fundamentally distinct from the practice that they are advocating, as it is intended to be a measured act.

In contrast, opponents feel that this characterization of suicide is erroneous. They point out that people commit suicide for political reasons, for the same reasons that proponents cite as rational justifications for assisted death, and that mentally ill people who become terminally ill may experience assisted death as a potential “out” in regard to suicidal ideation that they had previously fought. Moreover, they argue that the highly publicized deaths of assisted death advocates are political acts.

Assisted Death vs. Euthanasia[edit]

In the United States, assisted death is a practice by which a terminally ill person who is believed to be of sound mind and has a prognosis of six months or less requests, obtains and — if they feel their suffering has become unbearable —self-administers barbiturates to end their life.

Euthanasia, which is practiced in Canada, Belgium, Columbia and the Netherlands, is a practice in which another person (generally a physician) acts to cause death. Euthanasia is illegal in the United States, whereas assisted death is currently authorized in five states.

Public opinion[edit]

Public support for assisted death ranges from around 45% to 75% depending on how in-depth the questions are and how they are phrased. For instance, in “The Murky Issue of Whether The Public Supports Assisted Dying,” reporter Katherine Sleeman noted:

“Not surprisingly, the acceptability of assisted dying varies according to the precise context...a ComRes/Care poll in 2014 found that 73% agreed with the legalization of a bill which enables, “Mentally competent, adults in the UK who are terminally ill and have declared a clear and settled intention to end their own life, to be provided with assistance to commit suicide by self-administering lethal drugs.” But 42% of these same people subsequently changed their minds when some of the empirical arguments against assisted dying were highlighted to them-such as the risk of pressure on people to end their lives so as not to be a burden on loved ones.”

Gallup[edit]

In a May 2016 Gallup poll, 69% of Americans said they agree that “when a person has a disease that cannot be cured...doctors should be allowed by law to end the patient’s life by some painless means if the patient and their family request it.”[17] The fact that the caveat in this poll is incurable illness rather than terminal illness represents one of the opponents’ primary objections to assisted death.

In a May 2015 Gallup survey, 68% of Americans agreed that “individuals who are terminally ill...have the right to choose to end their own life.” [18]

A 2014 gallup survey found that 69% of Americans think that doctors should be allowed by law to end the life of a patient who has a disease that cannot be cured “by some painless means if the patient and their family request it.”[19]

Other surveys[edit]

In 2014, a Harris Poll found that 74% of Americans agree that “individuals who are terminally ill...have the right to choose to end their own life.”[20]

17,000 U.S. doctors representing 28 medical specialities were surveyed by Medscape on end-of-life issues. The survey found that 54% of doctors believe assisted suicide, or medical aid in dying, should be available as an end-of-life option.[21]

Advocates[edit]

Religious leaders[edit]

Actors[edit]

Public personalities[edit]

Opponents[edit]

Public Personalities[edit]

Policians[edit]

Lawyers[edit]

Doctors[edit]

Activists[edit]

Actors[edit]

Academics[edit]

Supportive organizations[edit]

Neutral organizations[edit]

Opposing Organizations[edit]

References[edit]

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