On October 27, 1997, Oregon became the first state to legalize physician-assisted suicide. Oregon’s Death with Dignity Act permits “terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.”
Despite opposition from religious groups, disability rights advocates, and its state medical association, Washington enacted a similar law in March 2009.
While proponents of legalized suicide applaud such measures – they cite the need for options that allow terminal patients to avoid needless suffering at the end of their lives – even well-intentioned and meticulously-crafted legislation cannot address all of the potential pitfalls of this medically complex and emotionally sensitive issue.
The Process of Getting a Prescription for Suicide is Convoluted
In order to receive a prescription for life-ending medications, a patient must first prove residency in a state that allows physician-assisted suicide. Since this could entail obtaining a state driver’s license, registering to vote, owning or leasing property in the state, and filing a tax return for the most recent year, many individuals won’t qualify for residency before their illnesses claim their lives.
Once a terminal diagnosis has been ascertained (at least two physicians must certify that the patient’s life expectancy is less than six months), patients must submit at least two oral requests and a written request for a prescription, and they must observe defined waiting periods between their requests and the receipt of a prescription. During this time, they may be referred for psychological evaluation to ensure that they are not depressed or suffering from some other mental disorder that might prompt suicidal behavior.
Many Physicians Do Not Want to Participate in Suicide
For many doctors, writing a prescription for medications that are expressly intended to end a patient’s life violates their ethical standards. For some, legal liability raises additional concerns: Medical professionals are mistrustful of potentially litigious situations even when protective legislation ostensibly absolves them of guilt.
A 2001 review in The Journal of the American Medical Association revealed that only one in three Oregon physicians were willing to write prescriptions for patients who wanted to end their lives. Therefore, patients who wish to avail themselves of physician-assisted suicide might have to consult with a doctor who is unfamiliar with them and their medical history.
Physician-Assisted Suicide Does Not Always Go Smoothly
The administration of a lethal dose of medications is fraught with problems. The effects of these drugs can be influenced by a variety of factors, including interactions with other medications, impaired absorption, or the patient’s underlying medical condition.
A number of patients who take their life-ending prescriptions do not die. They often awaken within hours or days, and regurgitation of stomach contents frequently occurs during their period of unconsciousness. Occasionally, these patients regain consciousness in hospitals, having been resuscitated when family members panicked in response to unexpected complications.
In 2010, fewer than one in ten suicide patients in Oregon were attended by their physicians when they took their medications; any complications that arose were thus addressed by family members or hospice personnel.
State laws surrounding physician-assisted suicide explicitly prohibit anyone other than the patient from administering a lethal overdose. For people with ALS (Lou Gehrig’s disease), multiple sclerosis, or other disabling conditions, this can present an almost impossible dilemma. If a family member or medical professional “helps” such a patient to end his or her life, prosecution is a very real possibility.
Statutes permitting physician-assisted suicide are far from perfect. While they attempt to address the issue of autonomy that is so important to people nearing the end of life, they do not adequately address the technical, ethical and emotional milieu that surrounds one of the most profound stages of a human life.
Regardless of a person’s stance on euthanasia or physician-assisted suicide, it seems that Death with Dignity legislation has achieved at least one desirable end: Since these laws were enacted, physicians in both Oregon and Washington report that they are making greater efforts to improve care for patients at the end of their lives.
Sources:
- State of Oregon: Death with Dignity Act
- Ganzini L, et al. Oregon physicians’ attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. JAMA 2001;285:2363-9
- Steinbrook R. Physician-assisted death – from Oregon to Washington State. N Engl J Med 2008; 359:2513-2515
Stephen Allen Christensen - Dr. Steve Christensen's writing has appeared in magazines, professional journals, poetry anthologies, and children's books since 1976.
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