Death with Dignity

 

By Brittany Henning

 

We’ve all known a family member, a friend or even just an acquaintance that has been diagnosed with a terminal illness.  If there was a way to eliminate their misery so they wouldn’t have to suffer the indignities that come as the end nears, would you support their decision? 
Enter: the Death with Dignity Act.  This statute has been met with much criticism and controversy for the last two decades.  So, which side of the fence are you on?

 

California, Colorado, OregonVermont, and Washington’s Death with Dignity laws allow mentally competent, terminally-ill adult state residents to voluntarily request and receive a prescription medication so they can die in a peaceful, humane manner in a place and time of their choosing. As of February of 2017, these five states plus the District of Columbia, have Death with Dignity statutes. In Montana, physician-assisted dying is legal by State Supreme Court ruling.

 

To qualify for a prescription under physician-assisted dying laws, there are several requirements you must meet.  You must be a resident of California, Colorado, Oregon, Vermont, or Washington; and 18 years of age or older; and mentally competent (capable of making and communicating your health care decisions); and diagnosed with a terminal illness that will, within reasonable medical judgment, lead to death within six months. You must also must be able to self-administer and ingest the prescribed medication. All of these requirements must be met without exception. Two physicians must determine whether all these criteria have been met.

 

Consulting physicians will examine the patient and their medical records and confirm the attending physician’s diagnosis of terminal illness. The physician then verifies the patient is competent, is acting voluntarily and has made an informed decision in order to qualify under this law. If the consulting physician believes the patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgement, the physician will refer the patient for counseling.  The patient will not receive a prescription for medication to end their life in a humane and dignified manner until they have made an informed decision. The attending physician defines these as: patient’s medical diagnosis and prognosis; potential risks and probable results associated with taking the medication to be prescribed; and feasible alternatives such as comfort care, hospice care and pain control. In Oregon, to receive a prescription for medication to end his or her life, the patient must be a capable adult, a resident of Oregon, terminally ill and voluntarily expressed their wish to die verbally and in writing.

 

Typically, individuals are given no less than 15 days to make a second verbal request to the attending physician. For a few of the states, a prescription cannot be written less than 15 days after the patient’s initial verbal request.  According to Oregon Revised State, no less than 48 hours shall elapse between the patient's written request and the writing of a prescription. A valid request for medication will be signed and dated by the patient and witnessed by at least two others in the presence of the patient.  The witness cannot be a relative of the patient, would not be entitled to any portion of the estate of the patient, or have any affiliation with the health care facility where the patient is receiving medical care.  When the patient makes his or her second oral request, the attending physician will then offer the patient an opportunity to withdraw the request.  A patient may revoke his or her request at any time and in any manner without regard to his or her mental state.  

 

As you can see, they do not make it easy for those choosing the Death with Dignity Act.  This is not a spur of the moment decision to make.  They have put these statutes in place so the patient has time to really think their decision through.  And even if a person goes through all of these steps to attain a prescription, they can still choose to not use it. About one third of qualified terminally ill people decide that they do not want to hasten their death by using the prescription. The prescription provides them with peace of mind and they know that if their symptoms get too bad, they have the medication to take. Nothing in Death with Dignity statutes tells a patient that he/she must take the medication after going through all the steps to qualify.

 

Of course, there are other options as well.  For instance, not starting new treatment or stopping current treatment, palliative sedation, and voluntary stopping eating and drinking. Aggressive medical treatment may not be beneficial and may prolong the dying process without improving quality of life in some terminally ill patients. Under certain circumstances, treatments can increase suffering, ruin the remaining quality of life, or even shorten life. For those dying, the pain can be so unmanageable that they cannot get relief from medications unless the dose is high enough to make them unconscious. Palliative sedation provides enough medication to keep them continuously unconscious and thereby free of pain and symptoms. All nutrition and hydration is stopped, and they usually die within a few days.

 

I currently have an aunt who has been diagnosed with liver cancer.  She has not chosen the Death with Dignity Act option, but she has refused any course of treatment and has made the decision to live her life out as it comes.  As a family member, I can’t say that I’m happy with her decision to refuse treatment but I have to accept and support her decision.  Most of us want the best for our families.  We want to keep our family members around for as long as possible and in a way, that could be considered selfish thinking.  The one thing I’ve learned from my research on death with dignity and my aunts decision on her treatment is this; we all have our own opinions on what is dignified and what is not.  If a terminally ill person feels taking a prescription to end their life peacefully, or they choose no treatment at all, we may not agree with their choice, but it is their choice and only their choice to make and as a family member, a friend or even just an acquaintance, we have to support and respect their decision. 

 

Death with Dignity Website Staff. (2017). How to Access and Use Death with Dignity Laws. Retrieved from Death with Dignity: https://www.deathwithdignity.org/learn/access/
Oregon Revised Statute. (2015). Retrieved from Oregon Health Authority: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx