Legislating The Right To Die

A look at Oregon’s controversial Death with Dignity Act, the world’s first official state-sponsored physician-assisted suicide law.

By Jessica Reaves

When Oregonians first endorsed the landmark Death with Dignity Act in 1994, they opened a Pandora’s box of legal and ethical dilemmas. The law, which allows terminally-ill adults to end their own lives, attracted national attention.

Three years later, after surviving political challenges from everyone from District Court judges to the U.S. Department of Justice, and in the face of sustained opposition, the world’s first official, state-sponsored physician-assisted suicide law was back in the hands of Oregon voters, who approved the measure. Since the law went into effect in the winter of 1997, roughly 50 Oregonians have used the Act to end their lives.

Under the law, both an attending and consulting physician must first determine that a patient, who is required to be mentally capable and a resident of Oregon, is suffering from a terminal disease. A prescription for a lethal dose of drugs is written only after both patient and doctor have followed a strict protocol. The patient makes two oral requests and one written request for medication over the course of 15 days; the prescription can be filled on the 15th day, which is also when the second oral request is presented. Doctors cannot administer the medication; a critical requirement of the Oregon law demands that patients be able to take the lethal dose themselves. If doctors suspect that a patient is depressed or otherwise mentally incapable of making an informed decision, they can refuse the prescription requests and refer the patient to a mental health professional.

Death with Dignity advocates have issued numerous reports to vindicate their support for what they term a dignified and autonomous way of dying. It’s critical, advocates say, for the terminally ill to have a chance to end their own suffering. And, they insist, the introduction of Oregon’s law has actually improved medical care; they cite examples of doctors providing more comprehensive and attentive pain relief for seriously ill patients. Even doctors who approve of the law, advocates say, are in no way eager to write the lethal prescriptions, and will do everything in their power to avoid that final step.

The Act’s many opponents are concerned that the legislation muddies the waters of acceptable medical practices. If a doctor is permitted to prescribe lethal doses to patients who are apparently terminally ill, for example, what is to keep a doctor from bending the rules for someone who is in pain and wants desperately to die, but is not technically terminal? Opponents also argue the Act invites physician error, abuses of the practice and may prolong the suffering of patients who attempt suicide under the law’s provisions and fail.

As of June 2000, Oregon stands alone in its support of the Death with Dignity Act. Watching Oregonians weather the emotional firestorm surrounding the legislation has dulled many states’ interest in pursuing the issue at length, and several attempts at duplicating Oregon’s law have failed. The California legislature considered a similar bill before tabling it last year; Washington state voters narrowly defeated a physician-assisted suicide ballot measure in 1991. But despite many politicians’ aversion to the subject, public interest in Death with Dignity remains strong: This November, Maine voters will vote on a bill that’s virtually identical to Oregon’s Act—a very public referendum that’s bound to be closely watched—and judged—by Death with Dignity supporters and opponents alike.

Jessica Reaves is a freelance healthcare writer and has worked for Ms., Time, Mamm (a women’s breast cancer magazine), and Women.com

Educational Broadcasting Corporation/Public Affairs Television, Inc. Reprinted with permission.

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