DEATH WITH

DIGNITY LAWS
Renee Disher CJ 1010
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In recent years, Death with Dignity laws, also called physician-assisted dying, aid in

dying, right to die or end of life option laws, have sprung up all over the country creating debate

wherever they go. Death with dignity laws refer to laws which allow physicians to prescribe

medication to patients who are terminally ill to allow the patient to humanely end their own life.

The topic is understandably divisive as it brings up ethical questions not only for voters, but for

the families, physicians and patients who will be affected.

Death with Dignity laws in the United States often mirror Oregons Death with Dignity

Act which was the first such law passed in the country in 1994. In 1997 a ballot measure from

an anti-death with dignity group in Oregon was defeated 60/40 and the law went into effect in

1998 allowing terminally ill Oregonians to choose to humanely end their life. The law has been

in effect for over eighteen years now with little challenge. The purpose of the law is to empower

terminally ill patients to have control over the final moments of their life and how they die.

Because Oregons Death with Dignity Act has been around the longest, is the basis for other

states, and has the most data, this paper will mostly focus on Oregon.

Currently only ten percent of the states in the United States have Death with Dignity

laws. The states which have passed laws are California, Colorado, Oregon, Vermont and

Washington. Washington, District of Columbia has also passed legislation for physician assisted

suicide. Montana is often included in this list because in 2009 Montanas Supreme Court ruled

that there was nothing in state law that prohibits physician assisted suicide. However, Montana

also has not passed any laws to help safeguard and regulate the practice either. So, while

physician assisted suicide is technically legal in Montana, there has yet to be a law passed to put

in place any formal requirements that other states have.

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To protect the patient, doctors, and families who will be effected by the use of the Death

with Dignity laws there are usually several hurdles and requirements that both the patient and

prescribing physician have to go through. For instance, Oregon requires the patient to be an

adult of 18 years of age or older who is also a resident of the state. The patient must be

terminally ill, meaning that they have an incurable disease that will result in death within six

months or less, such as cancer. The patient cannot qualify based solely off of age or disability.

The diagnosis of a terminal illness must also be confirmed, in writing, by a second physician for

the patient to be considered eligible for a prescription to end their life. Anti-physician assisted

suicide advocates bring up the concern that a patients physician may lie to them about their

diagnosis and the requirement for a second confirmation of terminal illness is in place to try to

combat the possibility of this happening. In addition, the patient must be deemed capable of

making decisions on their own, meaning that they are mentally competent, and be able to

communicate their health care needs with their physician. The goal of these requirements is to

make sure that the patient understands their diagnosis and understand the consequences of taking

the medication.

The patients physician also has several responsibilities. The prescribing physician must

inform the patient of their diagnosis, risks involved with taking the medication and the probable

outcome of taking the prescribed medication. The physician is also required to ensure that the

patient knows that they have other end of life care options such as hospice, comfort care and pain

control. It is also required that the physician inform the patient that once they make the request

for a prescription that they can rescind the request at any time and that they are not required to

fill their prescription or to take the medication once they have it.
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The physician is also to advise the patient that they should inform their family of their

wishes, although it is not required that they do so. There are also other suggestions for the

physicians in the statutes including advising the patient not to take the medication in a public

place, although it is not illegal for the patient to do so. According to the Death with Dignity

Organization, ninety-five percent of the people who go through with taking the medication do so

at their own home with people living in assisted living centers or retirement homes taking the

medication at those places.

To begin the process of getting a prescription a patient must make two oral requests and a

written request to their physician as well as going through mandatory waiting periods. The

patient needs to fill out a form in the presence of two witnesses. It is required that a least one of

the witnesses is not related to the patient, isnt entitled to an inheritance, isnt the attending

physician and doesnt work at the health care facility where the patient is receiving treatment.

These witness requirements are all in place to ensure that the patient isnt being coerced into a

physician assisted suicide by somebody who will benefit from the patients death.

Once the patient has gone through the hurdles of getting the prescription it is up to them

to decide if and when they will take the medicine. By law, in all states that have passed physician

assisted suicide laws, the patient is required to be able to self-administer the medication without

help. To help somebody administer the drug would be illegal and arguably would be considered

homicide or manslaughter.

To some, including doctors, physician assisted suicide is inherently wrong. There will

never be anything that could convince them otherwise, whether its based on religious grounds or

just straight up moral fortitude. Doctors are not required to endorse a patients request for a

prescription to end their life and in some cases a patients primary physician may refuse. The
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physician may refuse in general or based on religious grounds. They do not need any reason to

deny the patients request. If this occurs, a patient would have to seek out a new physician who

may approve their request.

It is possible that hospitals backed by religious organizations may also mandate that their

physicians cannot prescribe euthanasia drugs to patients based on religious grounds. The first

amendment protects the religious rights of these physicians and hospitals stating, Congress shall

make no law respecting an establishment of religious, or prohibiting the free exercise thereof.

To force these people and organizations to prescribe medication for patients to end their life

would be unconstitutional.

So, what are the options of terminally ill patients who want to end their life but live in a

state that has not passed legislation for physician assisted suicide? They may turn to palliative

care, hospice, pain killers, sedation or other end of life options. However, they may also turn to

other options to end their life. Some people are also choosing to move to states that have passed

end of life statutes so that they may take advantage of the law. All they must do is prove to the

prescribing physician that they are a current resident of the state. In 2014, Brittany Maynard

made the news when she spoke out publically about physician assisted suicide. Maynard was

terminally ill with brain cancer and moved to Oregon from California to get a prescription to end

her life. The following year California passed the End of Life Option Act which would have

allowed her to get a prescription for the medication in her own state.

If a patient temporarily moves to a state that has passed death with dignity laws and then

returns to the state that they came from to take the medication, they risk having their death ruled

a suicide by a coroner. Part of the legislation of these right to die laws is that patients who take

the medication will not have their death ruled a suicide. This means that their death will not have
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an effect on their life, health or accident insurance policies. To take the medication in another

state is to risk nullifying these policies.

In the same way that Death with Dignity laws do not force physicians or hospitals to

prescribe life ending medication, health insurance is also not required to cover end of life

prescriptions. This means that patients may have to pay for it out of pocket or they may be

priced out of the option completely since the most commonly prescribed end of life drug costs

around $3,000-$5,000 out of pocket. Medicaid and Medicare do not cover end of life

prescriptions.

Advocates against Death with Dignity legislation argue that insurance companies may

offer or suggest physician assisted suicide to terminally ill patients instead of covering the cost of

paying for treatments or other end of life care options. The documentary How to Die in

Oregon depicts such a scene in which a patient receives a letter from his health insurance

company denying him additional chemotherapy treatments and mentioning physician assisted

suicide to him as an option. Stories like this rightly give fodder to anti-physician assisted suicide

groups.

With such a divisive topic, how do we as a society agree whether something is moral or

not? The book Criminal Justice in Action brings up the idea of the consensus model. The

consensus model revolves around the idea that, as people gather together to form a society, its

members will naturally come to a basic agreement with regard to shared norms and values,

(Gaines & Miller, 5). Basically, society as a whole determines what is or isnt moral and what is

considered acceptable may even change over time. The same thought can be applied to the

growing Death with Dignity movement. At first, when we hear the idea of it we may reject it

completely as being abhorrent. But when we are exposed to it in the media more frequently and
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society allows discussion on the topic it becomes possible for something that was once viewed as

unacceptable to become the new norm.

Each year, by law, the Oregon Public Health Division releases a report that contains data

on the number of patients who requested end of life medication and the number who actually

ingested the medication. It then breaks down the collected patient data into other characteristics

which it reports to the public yearly. According to this data, the number of patients who have

requested end of life prescriptions and who have gone through with taking the prescriptions has

been on a steady rise since the law first went into effect. In the first year, 1998, twenty-four

patients received prescriptions and sixteen patients ingested the prescription they received

resulting in death.

In 2015, 218 patients received prescriptions and 132 patients ingested the medication

resulting in death. In the eighteen years since the Oregon law was passed a total of 1,545 people

received prescriptions to end their life and 991 patients have died from taking those medications.

The average annual growth rate is 12.1 percent and the average rate of death by physician

assisted suicide is by the Oregon Health Authority as 38.6 out of 10,000 deaths. Of the 218

people who received a prescription in 2015, fifty did not take the medication and died from other

causes such as their underlying illness and forty-three have an unknown ingestion or death status.

The data collected lists malignant cancer as being the number one terminal illness of patients

who requested end of life prescriptions.

As a person who is healthy, it may be difficult to understand the reasons why terminally

ill patients may be interested in ending their life early rather than seeing their illness out until the

end. A few of the reasons patients may want to pursue physician assisted suicide are that they

are no longer able to engage in activities that once made life enjoyable to them, being a burden
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on their families, amount of pain and losing control of bodily functions. The top two reasons

patients in Oregon listed as pursuing physician assisted suicide were being less able to engage in

activities that make life enjoyable and losing autonomy.

In Utah, physician assisted suicide is not currently legal. In the years 2015 and 2016

Representative Chavez-Houck presented HB 391, Utah Death with Dignity Act to be considered

in Utah legislature. Both times they were referred for further study by the Utah House Health

and Human Services Committee. In 2017 the committee voted against the bill with a 9 to 3 vote.

When the bill was first being considered in 2015 a poll found that 58% of Utahns supported

legislation for physician assisted dying with people who identify as democrats supporting it the

most.

Utah HB 76, End of Life Options Act follows the trend in modeling itself after the

Oregon legislation. The same requirements for patients are in place such as being an adult over

the age of 18 who is a resident of Utah and suffering from a terminal illness which will result in

death within six months. Patients cannot qualify solely based off of age or disability. The Utah

legislation also stipulated the need for oral and written requests as well as mandatory waiting

periods that are also seen in the Oregon legislation. HB 76 also protected the patients existing

insurance policies, A qualified patients act of ingesting medication to end the patients life in a

humane and dignified manner does not affect a life, health, or accident insurance or annuity

policy. Like the Oregon legislation the same protections are in place for prescribing physicians

and patients. Patients may rescind the request at any time, they do not have to take the

prescription if they fill it and they must be mentally sound. HB 76 also states that physicians do

not have to prescribe the prescription and can deny it for whatever reason.
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Physician assisted suicide affects me because I am a student who is interested in going to

medical school and becoming a doctor. While I am on the fence about whether or not I would

personally prescribe medication to somebody to end their own life I think that it is something

that terminally ill patients should have the right to access if that is what they wish. Oregons data

shows that 95% of the patients who took the medication were on hospice care meaning they were

at the end of their life already. Cancer patients who are in the last days of their life are

uncomfortable and often loaded up on pain medication. In a time when they feel they have little

or no control over their lives I think that even just having the option to access this medication if

they want to may give them some sort of comfort knowing that it is an option.
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Bibliography

"Physicians' Experiences with the Oregon Death with Dignity Act." New England Journal
of Medicine 342.20 (2000): 1538. Web.

How to Die in Oregon. Dir. Peter Richardson. N.p., n.d. Web.

"The Constitution of the United States," Amendment 1

"Utah." Death With Dignity. N.p., n.d. Web. 20 Apr. 2017.

Oregon's Death with Dignity Act: the ... year's experience. Portland, OR: Dept. of Human
Resources, Oregon Health Division, Center for Disease Prevention and Epidemiology, n.d.
Print.

United States. Oregon Public Health Division. Oregon Death With Dignity Act: 2015 Data
Summary. N.p.: n.p., n.d. Print.

Gaines, Larry K., and Roger LeRoy. Miller. Criminal justice in action. Belmont, CA:
Wadsworth Pub. Co., 2011. Print.

Allmark, Peter. "Death With Dignity." Journal of Medical Ethics (2002): n. pag. Web. 9
Apr. 2017.

Ganzini, Linda, MD, Heidi Nelson, MD, Terri Schmidt, MD, Dale Kraemer, MD, Molly
Delorit, BA, and Melinda Lee, MD. "Physicians' Experiences with the Oregon Death with
Dignity Act." New England Journal of Medicine (2000): n. pag. Web. 9 Apr. 2017.

Utah End of Life Options Act, HB 76 (2015).

Schott, Bryan. "Poll: Majority of Utahns Support 'Right-to-Die'

Legislation." Utahpolicy.com. N.p., 10 Dec. 2015. Web. 15 Apr. 2017.