November 9, 2012 by astancilwomack
This is a rhetorical question, as I do not have an answer. I read an article during the recent election that Massachusetts was voting on legalization of physician assisted suicide. Massachusetts citizens ultimately decided against this ballot question, though the loss was marginal at 51%-49%. Several other states have attempted this type of legislation. So far three have been successful. Physician assisted suicide is legal in Oregon, Washington, and Montana.
This poses a major ethical and potentially legal matter for physicians. Each state’s legislation has different criteria (see below), but all have been able to maintain ethical standards and in most cases avoid legal actions. I am not sure the majority of Americans know assisted suicide is legal in some states, so I wanted to give an overview of each states law.
Oregon: This was the first state to pass an act that allowed for physician assisted suicide. The Death with Dignity Act was passed on November 8, 1994. This act allows physicians to administer a prescription of a lethal dose with intention to end the patient’s life. The patient must be an adult of sound mind, an Oregon resident, terminally ill (with less than six months to live) and make the request voluntarily. The request must be in the presence of two witnesses. The witness cannot include the treating physician, or anyone working for the healthcare facility in which the patient is residing. The witnesses cannot have any entitlement to the requesting patient’s assets. At least one witness has to be unrelated to the patient. Once the request is made another physician must evaluate the patient and confirm the diagnosis and prognosis. If the second opinion is consistent, and the request is granted the patient must wait 15 days and make a second request. After the second request the prescription may be written. If steps are followed appropriately, then this law protects the physician and facility from liability concerning the patient’s death. The patient can of course take back the request at any time.
Washington: The Washington Death with Dignity Act was passed on November 4, 2008. This act was modeled after the Oregon statute, and includes all of the same requirements, but added a few additions. The patient must submit the last request in writing (still 15 days after the first request). Once the written request is received there must be a 48 hour time frame before prescription is administered. The written request must be signed by the witnesses (same witness criteria must be met). The patient must be given all alternative options and should be encouraged, but not forced to discuss the options with family. The death certificate must list the underlying illness as the cause of death, not the suicide.
Montana: This is the last state to allow physician assisted suicide on December 6, 2009. This was actually enacted by case-law with Baxter vs. Montana. This was a Supreme Court Case that questioned whether or not the state constitution disallowed assisted suicide. This case was brought forth by four physicians on behalf of one of their dying patients, Robert Baxter. They plaintiffs wanted establish a constitutional right to “receive and provide aid in dying”. The state denied this case stating that it was not a right in their constitution. They appealed the decision with the Supreme Court. On December 31, 2009 the Supreme court ultimately decided that the state constitution did not grant the right to receive and prevent aid in dying, but they decided that it did not forbid it either. Because of this case it is now legal for physicians to assist in suicide for their terminally ill patients.
I am lucky enough not to have experienced a loved one who was terminally ill, but I imagine it is quite trying. My thought was if I were a physician I could not personally assist someone in their death. I discussed it with a friend of mine who is a physician, and he explained that the patients utilizing this option are begging for a way to die comfortably. Is it ethical to let them suffer until they die, or ethical it assist in their death? I don’t know the answer to this, but I’d love to hear your thoughts on this sensitive subject. Feel free to comment below.