What is the greatest impact of the Oregon and Washington laws?
The greatest impact of Death with Dignity laws may lie in the peace of mind it provides those who will never use it but who know it is an available option. Many more lethal prescriptions are requested under the law than are used.
What is the current state of physician-assisted dying in America?
Every day in every state, when a dying patient suffering intolerable pain asks for and receives a doctor’s help in hastening death through legal medication, this is physician-assisted dying. Only Oregon, Washington, and Vermont strictly regulate and monitor this common practice. In other states the practice is forced underground, exposing dying patients to possible abuse or coercion and doctors to possible prosecution and imprisonment.
Are Death with Dignity laws a “slippery slope” toward euthanasia?
This is a common and completely false claim. The simple fact is Oregon and Washington residents wouldn’t have voted for a loosely written, open-ended law. The law’s multiple safeguards specifically require and guarantee direct patient involvement. In direct contrast, euthanasia is an ambiguous concept that often implies a person’s involuntary death. Euthanasia is illegal throughout the United States and has no relation to the two carefully written and regulated Death with Dignity laws, and there have been no efforts to expand either law beyond their strict guidelines.
Why are some states trying to replicate Oregon’s and Washington’s laws?
The strength of the Oregon and Washington laws lies in their very strict and specific guidelines, which leave nothing to guesswork or interpretation. The three main reasons other states hope to replicate theses two laws are because:
The laws respect and uphold the integrity of the doctor-patient relationship.
The laws require the patient self-administers the prescribed medication to hasten death.
The laws ensure the patient — and no one else — is the driving force, the ultimate and conscious decision maker in the process.
Under the law is a doctor legally required to write a prescription that will allow the patient to hasten his/her death even if the doctor is opposed to doing so?
No. The law does not require any doctor to write such a prescription if he/she chooses not to.
Do Death with Dignity laws encourage patients to act too soon?
No. Only terminally-ill patients who are diagnosed with six months or less to live may request to use the law to hasten their deaths — and typically only as a last resort if each day becomes increasingly unbearable. The primary physician’s diagnosis must also be certified by a consulting physician, which ensures an accurate prognosis and helps prevent mis-diagnoses.
Can patients be coerced to request the law by unethical or over-burdened care givers or family members?
No. The State of Oregon reports of no evidence of coercion since the law’s implementation in 1998, and the state of Washington also hasn’t found any incidence of coercion since the law took effect in 2009. The Oregon and Washington laws specifically require the request process to stop immediately if there is any evidence of coercion. The laws further require the two physicians who work regularly and closely with terminally ill patients to be involved throughout the request process. These two qualified and independent diagnoses ensure against coercion.
With today’s medical advances, doesn’t proper pain management negate the need for Death with Dignity Acts?
No. In fact, even many of the law’s opponents admit the most aggressive pain management measures fail to alleviate the suffering of 5% of terminally-ill patients, and many Drug Enforcement Administration activities today prevent physicians from providing adequate pain management for suffering patients out of fear of investigation and possible prosecution. Moreover, pain is only one of many complex issues terminally ill patients face which also include loss of dignity and autonomy and immeasurable mental and emotional anxiety and fear.
Can’t people simply hasten death through overdoses or by refusing medication, nutrition or hydration?
Ironically, such measures can take several weeks before resulting in death and may include unanticipated and agonizing effects — effects that often can only be palliated through days or weeks of deep sedation. In contrast, the purpose of the Oregon and Washington laws is to provide dying patients with the control, predictability and peace of mind that comes with knowing the how and when of death.
Have Washington’s and Oregon’s laws resulted in decreased use of hospice?
Directly the opposite, actually. People who make requests under the Oregon and Washington laws are enrolled in hospice at a much higher rate than the national average. According to the states’ 2010 reports: 93% of patients who requested to use Oregon’s law and 84% under Washington’s law were enrolled in hospice. A recent poll by National Journal and The Regence Foundation found residents in Oregon and Washington were more knowledgeable and supportive of a variety of end-of-life options — including hospice and palliative care — than most Americans.
With the Oregon and Washington laws, how can patients trust their doctor will do everything possible to treat the terminal illness?
The fact is many healthy Oregonians and Washingtonians today discuss end-of-life issues with their doctors and increasingly demand active participation and decision making in their own end-of-life care. Oregon and Washington doctors, as a result, today work harder to prolong patients’ lives and enhance quality of life, while respecting patients’ final wishes when their suffering becomes intolerable. Because of the law’s protections, most Oregonians know they won’t face abandonment by their doctors when the suffering becomes unbearable and use of the law is requested. This is the root of the patient-doctor relationship.
Do the Washington and Oregon laws contribute to a “culture of death”?
Quite the opposite. Most people understand death as a natural part of life. Providing dignity, control and peace of mind during a patient’s final days with family and loved ones places much greater focus on the Gift of Life than on the often painful and agonizing process of dying.
Are people with disabilities encouraged to use the law?
To equate a disability with death is insulting, and no one can be encouraged to use the law. The Oregon and Washington Death with Dignity Acts exist only for dying patients whose mental, physical and emotional suffering has become intolerable and who wish a peaceful and dignified passing. There are many in the disabled community who support the Oregon law — not because they are disabled, but because they are people.
Are racial minorities and the poor, undereducated, uninsured and other marginalized persons encouraged to use the law?
No one is encouraged to use the law. To date, persons who have chosen to use the law have been well educated, have had excellent health care, have had good insurance, have had access to hospice and have been well supported financially, emotionally and physically. Absolutely no HMO or insurance company participates in this process.
Do people move to Oregon or Washington in order to use the states’ laws?
Statistics about people moving to states with Death with Dignity laws in order to use those laws do not exist. The laws themselves only require persons who are terminally ill to be legal residents, regardless of where they lived before. The Oregon Department of Human Services and Washington State Department of Health have no reports of individuals moving to the states in order to avail themselves of the laws.
What about under-reporting regarding use of the Oregon or Washington law?
Physicians who don’t comply with reporting requirements under the Death with Dignity Acts forfeit protection under the laws’ safe harbor provision and are subject to prosecution. Ongoing studies by the Oregon Department of Human Services and the Oregon Health Sciences University indicate that far more lethal medications are prescribed under the Oregon law than are ultimately used — further proving that the law is much scrutinized and seldom used.
Is the Oregon or Washington Death with Dignity Act the equivalent of “playing God?”
Those whose spiritual beliefs include opposition to physician-assisted dying are free to not use the Oregon or Washington law. However, many others with strong religious and spiritual beliefs also support a dying patient’s right to make one’s own end-of-life decisions. Limiting one’s end-of-life options to suffering terrible physical and emotional agony and the loss of personal dignity is neither humane nor divine. Those who are trapped in prolonged suffering prior to an inevitable death, and who choose to hasten that death, make that choice not as God, but as a conscious, self-determined individual. This is no more “playing God” than to suggest one more procedure, one more pill, or one more feeding tube may preserve a life that is all but ended.
Can the federal government overturn Oregon’s law?
The Bush Administration attempted to use the federal Controlled Substances Act (CSA) to overturn the Oregon law. Congress passed the CSA specifically to (1) ban the use and trafficking of illegal drugs and (2) regulate the use of legal narcotics for approved medical purposes. The CSA does not apply to the Death with Dignity Act because the Oregon law specifies only the use of legal narcotics for physician-assisted dying. In the United States, it is the states, not the federal government, that licenses physicians and determines what is and is not legitimate medical practice. The Supreme Court case Gonzales v. Oregon represents a unprecedented federal intrusion into state authority to regulate medical practice.
What is the legal history of Oregon’s law?
Oregon voters twice affirmed physician-assisted dying as a legitimate medical practice under very specific conditions and with very strict guidelines — designed to protect both patient and doctor. The resulting law was upheld in the U.S. District Court and Court of Appeals and the US Supreme Court, which previously found no constitutional right to physician-assisted dying and determined that the states can more appropriately decide the issue. Oregon decided the issue, and the Oregon Death with Dignity Law went into effect on October 27, 1997. Check out the legal and political timeline of Oregon’s law for more details. After the prevailing through so many legal challenges, Washington’s Death with Dignity Act, which closely emulates Oregon’s law, went into effect without any credible legal challenges.