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The Need for Carefully Crafted Death with Dignity Laws

The Lancet journal
The Lancet journal

Physician-assisted death happens every day in every state. This reality is often avoided by patients and the medical community in discussions about end-of-life care, and it's time we started talking about it. A new study published last week in The Lancet looked at this situation in the Netherlands.

The researchers analyzed the prevalence of assisted death before and after the Dutch law went into effect in 2002. The results of this study showed two important trends regarding assisted death:

  • The practice was already happening before the law was in place: The same percentage of deaths were attributed to physician-assisted death before and after the law was in place.
  • Presence of a law doesn't result in increased use: The law didn't lead to a common myth spouted by opponents that legally regulating assisted death will lead to people clamoring to access the law. Or as it was known in Oregon, "People would flock to our beaches to die."

This study echoes the findings of a US study published in the New England Journal of Medicine which found it wasn't rare for physicians to be asked to help patients die nor unusual for physicians to honor their patients' requests. In other words, assisted death already happens throughout the US. But in most states, rather than having a law in place which creates a standard of practice, contains specific safeguards, and makes sure the law is adhered to through required reporting, the practice is done with a wink, a nudge, and a prescription for enough medication to 'keep the patient comfortable'.

There are many advantages to changing the dynamic from a secretive practice to bringing the practice out in the open. By carefully regulating assisted death through Death with Dignity Acts, everyone involved is safer and more informed:

  • No question the patient is making the decision and no one else: A mentally-competent, terminally-ill person must request the prescribed medication—three times, no less—and the written request must be witnessed by two people.
  • Patients become more informed about all feasible options: When doctors in Oregon or Washington are asked for the life-ending medication by their patients, the doctor is required to tell the patient about end-of-life care options including hospice and palliative care.
  • Doctors have a clear standard of practice to follow: Death with Dignity Acts outline physicians' responsibilities which include having two doctors confirm a terminally-ill person's mental competence and that their patients will die of their illness within six months.
  • Patients decide whether or when to take the medication: The entire process is patient-driven. The patient initiates the request and the terminally-ill person can change his or her mind and opt out at any point.
  • Annual reports of usage ensure law is working the way it's intended: In the two states with narrowly-defined Death with Dignity laws—Oregon and Washington—government agencies are required by law to report usage of this important and safe end-of-life option. (Read the stats for yourself with our links to Oregon's 14 years of reports and Washington's annual reports.)

You can read more about the safeguards written into Death with Dignity Acts on our page about accessing the acts. You will also find the laws themselves are written in plain language (minimal legalese). Check out the full language of the Oregon, Washington, and proposed Massachusetts Death with Dignity Acts.

As a nation, we need to face reality: terminally-ill people are asking for an option to shorten their suffering and physicians are honoring these requests. Death with Dignity Acts codify what is already happening, and the strict safeguards within these laws ensure this important end-of-life option is safe for all involved.

Posted on July 19, 2012 in Ask DDNC, Massachusetts, New England, Press Room, Vermont

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