Oregon Death With Dignity Law (Approved in 1994, upheld by the Supreme Court of the United States in 2006)
Under the law, a capable adult Oregon resident who has been diagnosed, by a physician, with a terminal illness that will kill the patient within six months may request in writing, from his physician, a prescription for a lethal dose of medication for the purpose of ending the patient’s life. Exercise of the option under this law is voluntary and the patient must initiate the request. Any physician, pharmacist or healthcare provider who has moral objections may refuse to participate.
The request must be confirmed by two witnesses, at least one of whom is not related to the patient, is not entitled to any portion of the patient’s estate, is not the patient’s physician, and is not employed by a health care facility caring for the patient. After the request is made, another physician must examine the patient’s medical records and confirm the diagnosis. The patient must be determined to be free of a mental condition impairing judgment. If the request is authorized, the patient must wait at least fifteen days and make a second oral request before the prescription may be written. The patient has a right to rescind the request at any time. Should either physician have concerns about the patient’s ability to make an informed decision, or feel the patient’s request may be motivated by depression or coercion, the patient must be referred for a psychological evaluation.
The law protects doctors from liability for providing a lethal prescription for a terminally ill, competent adult in compliance with the statute’s restrictions. Participation by physicians, pharmacists, and health care providers is voluntary. The law also specifies a patient’s decision to end his or her life shall not “have an effect upon a life, health, or accident insurance or annuity policy.”
NOTE: From 2006 to 2011, 935 people received a prescription, 596 used it– about 22 per 10,000 deaths. Average patient age was 70, most were Caucasian, well-educated and had cancer. (Oregon.gov)
Provisions of Washington Initiative
The official ballot summary for the measure, slightly amended following a February 2008 court challenge, is, “This measure would permit terminally ill, competent, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity.”
Provisions in the law include:
– The patient must be an adult (18 or over) resident of the state of Washington.
– The patient must be mentally competent, verified by two physicians (or referred to a mental health evaluation).
– The patient must be terminally ill with less than 6 months to live, verified by two physicians.
– The patient must make voluntary requests, without coercion, verified by two physicians.
– The patient must be informed of all other options including palliative and hospice care.
– There is a 15-day waiting period between the first oral request and a written request.
– There is a 48-hour waiting period between the written request and the writing of the prescription.
– Two independent witnesses must sign the written request, at least one of who is not related to the patient or employed by the health care facility.
– The patient is encouraged to discuss with family (not required because of confidentiality laws).
– The patient may change their mind at any time and rescind the request.
– The attending physician may sign the patient’s death certificate, which must list the underlying terminal disease as the cause of death.
NOTE: From 2009 to 2010, 152 people received a prescription and 87 used it.
Montana Law on the “Rights of the Terminally Ill”
The opinion of the Montana Supreme Court (2009) reads, in part:
… we find no indication in Montana law that physician aid in dying provided to terminally ill, mentally competent adult patients is against public policy.
… a physician who aids a terminally ill patient in dying is not directly involved in the final decision or the final act. He or she only provides a means by which a terminally ill patient himself can give effect to his life-ending decision, or not, as the case may be. Each stage of the physician-patient interaction is private, civil, and compassionate. The physician and terminally ill patient work together to create a means by which the patient can be in control of his own mortality. The patient’s subsequent private decision whether to take the medicine does not breach public peace or endanger others.
The Rights of the Terminally Ill Act very clearly provides that terminally ill patients are entitled to autonomous, end-of-life decisions, even if enforcement of those decisions involves direct acts by a physician. Furthermore, there is no indication in the Rights of the Terminally Ill Act that an additional means of giving effect to a patient’s decision — in which the patient, without any direct assistance, chooses the time of his own death — is against public policy.
In conclusion, we find nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy.
NOTE: While this doesn’t specifically allow physician aid in dying as the Oregon and Washington acts do, it saves physicians from prosecution for writing a lethal prescription. State legislators on both sides of the issue have proposed legislation to regulate the practice. Outside interests are gearing up for a battle.
OTHER ACTIVITY IN THE U.S. (Some states do no have laws that either allow or criminalize physician assisted dying, in others it is a criminal offense.)
Georgia – The state House committee passed a bill on February 22, 2012, aimed at ending assisted suicides. Rep. Ed Setzler, sponsor of the bill said it would not affect people who have living wills and who wish to decline extraordinary care at the end of an illness. They just didn’t want those Final Exit people coming into their state to help people commit suicide as they had done for a cancer patient who asked them to help him die. Key objections came from the Disability Rights Education and Defense Fund.
Hawaii – Several attempts to pass legislation have failed but bills continue to be written. Five physicians have now banned together under the Physician Advisory Council for Aid in Dying to write prescriptions for lethal doses to patients following the rules of the Oregon law to test whether doctor-assisted dying is allowed under state law. Hawaii’s Attorney General says manslaughter charges could be brought against these physicians. Co-founder Dr. Robert Nathanson says he’s retired, “the worst thing that would happen is that they’d take my license away. I don’t think I’m going to put in any jail time… My livelihood doesn’t depend on it so I can be very brave.”
Massachusetts – Initiative Petition for Law entitled “An Act Relative to Death with Dignity” was submitted December 7, 2011. Possible actions by the state legislature are:
- The General Court can pass the initiative as it’s written (this rarely happens).
- The Judiciary Committee can make a formal recommendation of Support, Do Not Support, or Neutral.
- The Legislature can put its own version of the initiative on the ballot (this is also rare).
Signatures are currently being gathered for the second round of signature gathering from May to July 3rd, 2012.
- 79,626 signatures gathered for first round
- 11,500 new signatures needed for second round
Primary opposition and funding comes from the very political Catholic Church. This indirect initiative process is a long, winding road to the ballot. If you want to get involved contact Dignity 2012.
“Collecting the signatures takes a lot more than a couple hundred people standing on street corners. We have to mail out thousands of petition sheets, provide return postage, get the petitions to the 351 Clerks, pick up the petitions, and file them with the Secretary of State, all in just 39 days. Because volunteers only have so much time to give over a 6 week period, we also have to hire workers to help collect signatures. All together, we estimate this process will cost somewhere between $85,000 and $100,000.”
New Mexico – Two physicians filed a challenge on March 16,2012 against a decades-old law which states that “whosoever commits assisting suicide is guilty of a fourth degree felony.” The statute does not reference a physician providing aid in dying to a terminally-ill and mentally-competent person. Compassion & Choices legal director Kathryn Tucker said lawyers intend to argue that the state law does not legally prohibit doctors from ending the lives of terminally ill patients. Morris v New Mexico complaint.
New York – Death with Dignity Act was introduced into the New York State Assembly on February 22, 2012
Vermont – After the House bill, titled “An Act Relating to Patient Choice and Control at the End of Life” failed to make it out of committee by the legislative deadline, proponents amended it to another unrelated measure in the Senate, which was defeated by a vote of 11-18 (April 2012). Governor Peter Shumlin had raised expectations for passage by campaigning on a promise of legalization but changed his mind. It seems this politician is also about to dis 90% of his constituents who support a mandatory labeling bill for genetically engineered foods. Monsanto threatened to sue.
In 1995, medical guidelines regarding euthanasia were introduced that allowed physicians to assist patients who are terminally ill or suffering from a degenerative disease to do so without risk of legal action. These medical guidelines became the foundation for a Dutch law permitting both euthanasia and assisted suicide. The law came into effect in April of 2002. The law states that a physician can terminate a life or assist in a suicide with due care if the patient requests it, that the procedure be carried out in a medically appropriate fashion, and that the patient’s suffering need only be defined as lasting and unbearable. This means there is no requirement that the suffering be physical or that the patient be terminally ill. The legislation also says that all other possible solutions have to be exhausted and the doctor must consult with, at least, one other medical practitioner before assisting in a suicide.
The legislation in the Netherlands also deals with the assisted suicide of children. Teenagers 16 to 18 years old may request and receive euthanasia or assisted suicide. A parent or guardian must have been involved in the decision process, but their consent is not required. And children 12 to 16 years old may request and receive euthanasia or assisted suicide. In these cases, a parent or guardian must agree with the termination of life or the assisted suicide.
Switzerland is interesting for its differences. Like Canada, Switzerland does not consider suicide a crime. But unlike Canada, assisted suicide is only an offence in Switzerland if it is done for corrupt or selfish reasons. In Switzerland, assisted suicide can be performed by physicians and non-physicians. Switzerland is the only country that permits non-residents to apply for assisted suicide.Under the Swiss protocol, any potential applicant must be at least 18 years of age and mentally competent. They must be seriously ill or in unbearable suffering with a poor prognosis and wishing to die. Diagnosis and prognosis must be confirmed by a doctor. When there is doubt, a team composed of a lawyer, doctor and psychiatrist makes a joint decision.
Facing Death – taking a loved one off life support – Frontline