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End-of-life care is, in broad terms, health care for patients with advanced or incurable conditions. This area of health care often opens up a number of sensitive treatment discussions and questions. There are questions regarding palliative care, a patient’s right to self-determination of treatment or life, and whether medical experimentation or intervention would be beneficial. Ultimately, the biggest discussion point surrounding treating terminal illness is that of patient autonomy, specifically regarding their right to choose how they want to die.
Death with Dignity Act
Generally speaking, medical decision-making rights vary by state. One example of disputed state legislation is known as the Death with Dignity Act, where a terminally-ill but mentally competent patient has the right to voluntarily accelerate their own death with self-administered prescription medication.
It is believed that these patients, who have untreatable diseases, have the right to choose to hasten their own death to prevent further pain and suffering if their process becomes unbearable.
Brittany Maynard, a 29 year old with a 6 month prognosis following an aggressive return of brain cancer, believed she had the right to have the option to die before her disease could kill her. Her case attracted media attention and put Death with Dignity in the political spotlight.
No treatment existed that would save her life, and recommended care would, in effect, destroy the quality of the life she had left. After much research, she came to the conclusion that Death with Dignity was her best option. She considered herself lucky enough to have the resources to relocate to Oregon, one of the three states with a Death with Dignity law.
In an op-ed for CNN, she asked, “Who has the right to tell me that I don't deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?”
“I do not want to die,” she said, “but I am dying. And I want to die on my own terms.”
To date, Oregon, Washington, and Vermont are the only three states that have enacted Death with Dignity laws. Oregon was first when voters approved of the act in 1994. Washington followed fifteen years later, and then in 2013 Vermont became the third state with a Death with Dignity law.
In order to obtain a prescription under the Oregon, Washington, or Vermont law, patients must:
- Have a terminal illness with a 6 month or less prognosis
- Be an Oregon, Washington, or Vermont state resident
- Be 18 years of age or older
- Be mentally stable and able to make decisions on their own behalf
In addition, at least two licensed physicians must agree that a patient is qualified, who will then help a patient take the next necessary steps.
But there are many patients who fall outside of these requirements, and who still want the same right to die with dignity. For someone like Sandy Bem, a 65 year old Cornell psychology professor who suddenly found herself a victim of Alzheimer’s, even moving to one of these states wouldn’t be enough. She made the decision that she wanted to die before she ceased being herself: “I want to live only for as long as I continue to be myself,” she said.
However, her prognosis wasn’t less than 6 months, and her deteriorating mind would make it difficult to meet the mental competency requirement of the Death with Dignity Act.
Ultimately, Sandy found a way around the government to hasten her death, and she died peacefully in her bed surrounded by her supportive loved ones, whom she was still able to remember.
The Future of Dying with Dignity
Those who oppose the movement argue that the risks of medically assisted death laws, or right-to-die legislation, far outweigh benefits. They call attention to issues like abuse, human error, and unfair pressure from others. However, there have been no reported cases of abuse, and statistics show that a number of patients who request the medication never end up administering it; more than anything, the option provides peace of mind.
After Maynard’s death in November 2014, many states have proposed similar bills. So far, none of them have passed. According to the Patients Rights Council, since 1994, roughly 140 proposals in 27 states have failed. Organizations like Compassion & Choices, a Death with Dignity advocacy group, continue to petition for the rights of patients like Maynard and Bem.