Individuals considering end-of-life decisions have many questions at this difficult time and may turn to their health care providers for guidance.
Death with Dignity Acts
At this time, four states have enacted Death with Dignity Acts: California, Oregon, Vermont, and Washington. Learn more about the Death with Dignity laws:
- Information about the laws and how to access them
- Death with Dignity Act: A Guidebook for Health Care Professionals [pdf] from The Center for Ethics in Health Care, Oregon Health & Science University
Oregon Death with Dignity Act
- Full text of the statute
- Information about the Oregon Death with Dignity Act from the Oregon Health Authority
- Oregon implementation forms
- “A Guide to Oregon Resources” from The Center for Ethics in Health Care, Oregon Health & Science University
- Oregon Hospice Association
Washington Death with Dignity Act
- Full text of the statute
- Information about the Washington Death with Dignity Act from the Department of Health
- Washington forms
- Washington State Hospice & Palliative Care Organization
Vermont Patient Choice and Control at the End of Life Act
- Full text of the statute
- Information about the Patient Choice and Control at the End of Life Act from the Vermont Department of Health
- Vermont forms
- Hospice and Palliative Care Council of Vermont
California End of Life Option Act
- Full text of the statute
- California Department of Public Health
- “How to Access the California End of Life Option Act” – a guide for patients
- “Death with Dignity in California” – a handout by the Death with Dignity National Center
- Patient forms for the implementation of the California End of Life Option Act
- Attending Physician Checklist and Compliance Form [pdf for printing and handwritten completion]
- Attending Physician Follow-up Form [pdf for printing and handwritten completion]
- Consulting Physician Compliance Form [pdf for printing and handwritten completion]
Health Care Providers and Medical Organizations
- “Implementing Aid in Dying in California – a brief by the UCLA Center for Health Policy Research
- “Understanding California’s End of Life Option Act” – a fact sheet by UCSF/UC Hastings Consortium on Law, Science, and Health Policy
- UCSF End of Life Option Act Task Force
- “Physician Assisted Death” – a case study by the Stanford School of Medicine
- “Stanford Physician Assisted Death Education & Training Module Application” – a free training for clinicians and health personnel about various aspects of physician-assisted death
- “Implementing Physician Aid-in-Dying: What Can California Learn from Other States?” – recording of a UCLA Center for Health Policy Research webinar
- “End of Life Option Act” – an information page of the Coalition for Compassionate Care of California
- “The End of Life Option Act Webinar” – a product of the California Hospital Association (the webinar guide is available here)
- “Document #3459: The California End of Life Option Act” – physician guidelines by the California Medical Association
- “The California End of Life Option Act: An Overview” – a webinar by the California Medical Association
- “Legislative Analysis of the End of Life Option Act” – a white paper by the Medical Board of California
- “A Family Physician’s Guide to the End-of-Life Option Act” – an information page with a video by the California Academy of Family Physicians
- “What Physicians Need to Know About the New California End of Life Option Act” – an article in the National Law Review, May 20, 2016
- “California’s End of Life Option Act: Key Requirements and Considerations” – an article in The National Law Review, June 1, 2016
Frequently Asked Questions
Please also refer to the FAQ pages of the Oregon Department of Human Services and Washington State Department of Health, The Oregon Death with Dignity Act: A Guidebook for Health Care Professionals, developed by the Task Force to Improve the Care of Terminally-Ill Oregonians, and The Final Months of Life: A Guide to Oregon Resources, developed by The Task Force to Improve the Care of Terminally Ill Oregonians.
WHAT IS PHYSICIAN-ASSISTED DEATH?
Physician-assisted dying generally refers to a practice in which the physician provides a patient with a lethal dose of medication, upon the patient’s request, which the patient intends to use to end his or her own life.
ISN’T PHYSICIAN-ASSISTED DEATH THE SAME AS EUTHANASIA?
No. Physician-assisted dying refers to the physician providing the means for death, most often with a prescription. The patient, not the physician, will ultimately administer the lethal medication. Euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient’s life. Some other practices that should be distinguished from Death with Dignity are:
Terminal sedation: This refers to the practice of sedating a terminally ill competent patient to the point of unconsciousness, then allowing the patient to die of her disease, starvation, or dehydration.
Withholding/withdrawing life-sustaining treatments: When a competent patient makes an informed decision to refuse life-sustaining treatment, there is virtual unanimity in state law and in the medical profession that this wish should be respected.
Pain medication that may hasten death: Often a terminally ill, suffering patient may require dosages of pain medication that impair respiration or have other effects that may hasten death. It is generally held by most professional societies, and supported in court decisions, that this is justifiable, as long as the primary intent is to relieve suffering.
IS PHYSICIAN-ASSISTED DEATH ETHICAL?
The ethics of assisted death continue to be debated. Some often argue that physician-assisted dying is ethical on the grounds that it may be a rational choice for a person who is choosing to die to escape unbearable suffering. Furthermore, the physician’s duty to alleviate suffering may, at times, justify the act of providing assistance with dying. These arguments rely a great deal on the notion of individual autonomy, recognizing the right of competent people to chose for themselves the course of their life, including how it will end.
Others have often argued that assisted death is unethical because it runs directly counter to the traditional duty of the physician to preserve life. Furthermore, many argue if hastened death were legal, abuses would take place. For example, many opponents falsely claim the poor or elderly might be covertly pressured to chose assisted dying over more complex and expensive palliative care options. Oregon’s law went into effect in 1997 and Washington’s in 2009, and throughout the laws’ history, there’s never been a case of coercion or undue influence related to the Death with Dignity Act. Not one.
WHAT ARE THE ARGUMENTS IN FAVOR?
Those who argue Death with Dignity Acts are ethically justifiable offer the following arguments:
Respect for autonomy: Decisions about time and circumstances death are very personal. Every competent person should have right to choose death.
Justice: Justice requires that we “treat like cases alike.” Competent, terminally ill patients are allowed to hasten death by treatment refusal. For some patients, treatment refusal will lead to more suffering. Justice requires that we should allow assisted death for these patients.
Compassion: Suffering means more than pain; there are other physical and psychological burdens. It is not always possible to relieve suffering. Allowing terminally ill people to determine the timing and manner of their deaths is a compassionate response to unbearable suffering.
Individual liberty vs. state interest: Though society has strong interest in preserving life, that interest lessens when person is terminally ill and has strong desire to end life. A complete prohibition on assisted death excessively limits personal liberty.
Openness of discussion: Assisted death already occurs, albeit in secret. For example, morphine drips ostensibly used for pain relief may be a covert form of assisted death or euthanasia. In states without Death with Dignity laws, open discussions between patients and physicians are avoided and prohibited. Legalization would promote open discussion.
WHAT DOES THE MEDICAL PROFESSION THINK OF ASSISTED DEATH?
A 2014 Medscape survey found that 54% of medical doctors favor physician-assisted dying, up from 46% in 2010. We also know that many physicians who support the end-of-life option are reluctant to declare so publicly for fear of repercussions in their workplace or medical community.
The American Medical Association opposes aid-in-dying laws. However, not only does the AMA represent a declining number of physicians (only about 1 in 3 doctors are AMA members), a 2011 survey of physicians conducted by Jackson & Coker found that 77% of physicians believe the AMA no longer reflects their views. In 2015, the California chapter of the AMA changed its position on physician-assisted dying from opposed to neutral, stating that they “believe it is up to the individual physician and their patient to decide voluntarily whether the End of Life Option Act is something in which they want to engage.”
A number of medical associations have endorsed physician-assisted dying, including the American Public Health Association, the American College of Legal Medicine, the American Medical Women’s Association, the American Medical Student Association, and the Denver Medical Society.
For my patients who have used this law, I was honored that I could be with them every step of the way, ensuring that they were cared for, and that they had control of the final days of their lives. That’s what death with dignity really means.
WHAT DO PATIENTS AND THE GENERAL PUBLIC THINK OF PHYSICIAN-ASSISTED DEATH?
Surveys of patients and members of the general public find that the vast majority think that PAS is ethically justifiable in certain cases, most often those cases involving unrelenting suffering.
IF I AM A DOCTOR, WHAT SHOULD I DO IF A PATIENT ASKS ME FOR ASSISTANCE IN DYING?
One of the most important aspects of responding to a request for assisted dying is to be respectful and caring. Virtually every request represents a profound event for the patient, who may have agonized over his situation and the possible ways out. The patient’s request should be explored, to better understand its origin, and to determine if there are other interventions that may help ameliorate the motive for the request. In particular, one should address:
- motive and degree of suffering: are there physical or emotional symptoms that can be treated?
- psychosocial support: does the patient have a system of psychosocial support, and has she discussed the plan with them? accuracy of prognosis: every consideration should be given to acquiring a second opinion to verify the diagnosis and prognosis.
- degree of patient understanding: the patient must understand the disease state and expected course of the disease. This is critical since patient may misunderstand clinical information. For instance, it is common for patients to confuse “incurable” cancer with “terminal” cancer.
WHAT IF THE PATIENT PERSISTS?
If a patient’s request for assistance in dying persists, each individual clinician must decide his or her own position and choose a course of action that is ethically justifiable. Careful reflection ahead of time can prepare one to openly discuss your position with the patient, acknowledging and respecting difference of opinion when it occurs. Organizations exist which can provide counseling and guidance for terminally ill patients. No physician, however, should feel forced to supply assistance if he or she is morally opposed to assisted death.
Source for the above information: University of Washington School of Medicine (1998) – Clarence H. Braddock III, MD, MPH, Project Director, Bioethics Education Project; Faculty, Departments of Medicine and Medical History and Ethics, with Mark R. Tonelli, MD, MA, Assistant Professor, Pulmonary and Critical Care Medicine.
- American Academy of Hospice and Palliative Medicine
- Center to Advance Palliative Care
- American Pain Society
- Association for Death Education and Counseling
- Hastings Center Bioethics
* Note: Listing of the resources in this section does not constitute our endorsement thereof. We make no warranties and cannot vouch for content developed by individuals or organizations not affiliated with California Death with Dignity, Death with Dignity National Center, or Death with Dignity Political Fund.