Tuesday, November 22, 2016

Death With Dignity

This is a student paper about laws to allow terminally ill persons to kill themselves. 

What is Death with Dignity?

            If you live in Oregon, California, Washington, Vermont, or Montana, you have choices available to you if you are diagnosed with a terminal illness. According to the organization, Death with Dignity, these states have legislation in place which allows people with certain terminal illness diagnoses options for ending their lives while they still retain human dignity. But just receiving a diagnosis is not all that is needed. The states have outlined certain criteria that must be met in order to qualify for assisted suicide.
            All states have some of the same general requirements. First, a person must be a resident of the state in which they are seeking to end their lives. Also, each state requires the person be over the age of 18 and mentally competent, which might require a psychological evaluation at the order of the person’s physician. Lastly, the terminal diagnosis must be expected to lead to the individual’s death within six months.
            In Oregon, the first state to pass legalized assisted suicide legislation, there are very specific requirements to make before a patient is allowed to complete their desired departure from their physical life. The above conditions must be met, but then they must also do the following:  make three requests, two verbal and one written and signed by witnesses, to their physician at least 15 days apart; their diagnosis must be confirmed by the physician prescribing the lethal medication and a consulting physician; the prescribing physician must confirm that the patient is capable of self-administering the medication; and the physician is legally obligated to inform their patient of alternatives available for end-of-life care (Oregon Health Authority, n.d). All of these requirements must be met before the prescribing doctor can issue the prescription(s) to the patient, and then the physician must submit all the required forms and proof to the Oregon Health Authority.
            California, the most recent state to pass the End of Life Option Act [until a referrendum in Colorado passed in November of 2016], has many of the same guidelines as Oregon. As detailed by the Coalition for Compassionate Care of California (2016), multiple requests must be made to the physician, written and oral, and one of the requests must be made privately to the physician with no one else in the room (unless an interpreter is necessary). The patient must also have a second physician confirm the terminal diagnosis and estimated life expectancy, and they must also be capable of self-administering the medication(s) prescribed. California also requires the physician discuss several topics with their patient, like alternative care methods, whether the patient will notify family of their decision, if they will have someone with them at the time of taking the medication(s), the prohibition of taking the drug in public, and that they can cancel their request at any time. Patients in California must also sign a form called the Final Attestation for Aid-in-Dying before self-administering the medications dispensed to them, verifying they are voluntarily ending their lives.
            In addition to Oregon and Colorado, Washington and Vermont also have aid-in-dying legislation governing the requirements for physician assisted suicide. Their laws are similar to those of other states. According to the Washington State Department of Health’s website (n.d.), state residents must make 3 official requests, one oral, one written, and then at least fifteen days later, another oral request. The written request must have two witnesses, of whom they cannot be related to, have the intention to bequeath the individual any property or possessions in their will, or be a physician or health care facility employee. Vermont’s policy is called the Patient Choice and Control at End of Life Act. Like Washington, the Vermont Ethics Network (2011) says the patient must be a resident of Vermont, have two oral requests, and one written request with 2 witnesses following the same criteria. Both states also require a second physician evaluation as well.
            Montana, however, is different from the other states with assisted suicide legislation. In 2009, the Supreme Court ruled to expand the Rights of the Terminally Ill Act to include physician-assisted suicide, but did not make clear guidelines on how the ruling functioned (Patient Rights Council, n.d). It is often viewed as simply protecting physicians from prosecution if they choose to assist a patient in compassionate suicide (Patient Rights Council, n.d.).  
            With this information, it is possible to see responsible legislation being developed by states, most modeling after Oregon’s pioneering and effective implementation of the Death with Dignity Act. More states will soon see voters requesting similar legislation be passed. It is important to be armed with the knowledge of what these laws do and what they do-not do before you head to the ballot box.

Another source to learn about these policies is the Oregon Health Authority's annual reports.  In 2014 (the most recent year for which I can find information, in the 2015 report), it seems 155 persons went through the process of getting the lethal dose of medicine, and 105 actually ended their lives. 

Colorado passed the initiative 106, which means they will follow the lead of Oregon and other states.  The voters passed this option with nearly 65% voting in favor

Coalition for Compassionate Care of California. (2016) End of Life Option Act in California. Retrieved on October 1, 2016 from http://coalitionccc.org/tools-resources/end-of-life-option-act/.
Death with Dignity. (n.d.) How to Access and Use Death with Dignity Laws. Retrieved on October 1, 2016 from https://www.deathwithdignity.org/learn/access/.
Oregon Health Authority. (n.d.). Death with Dignity Act Requirements. Retrieved on October 1, 2016 from https://public.health.oregon.gov/ProviderPartnerResources/Evaluation Research/DeathwithDignityAct/Documents/requirements.pdf.
Patients Rights Council. (n.d.) Montana. Retrieved on October 1, 2016 from http://www.patientsrightscouncil.org/site/montana/.
Vermont Ethics Network. (2011). Physician Assisted Death. Retrieved on October 1, 2016 from http://www.vtethicsnetwork.org/pad.html.

Washington State Department of Health. (n.d.) Death with Dignity Act – Frequently Asked Questions. Retrieved on October 1, 2016 from http://www.doh.wa.gov/YouandYourFamily/ IllnessandDisease/DeathwithDignityAct/FrequentlyAskedQuestions

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