Policy Brief

To:  Steny Hoyer
From:  Julia Wadolowska
Date:  January 18^th, 2020
Re:  Federal Mandate for Implementation of the Death with Dignity Act

Statement of Issue: Death with Dignity is a law that allows the terminally ill to end their life through a prescribed medication. It allows for mentally competent adults who have a terminal illness and a prognosis of less than 6 months to hasten their death. The idea of physician-assisted suicide has been debated and opposed for decades. While many still find it controversial and morally wrong, there are many people who believe in having a safe and supervised way to end one’s life when faced with terminal illness and excruciating pain. The Death with Dignity act has faced large opposition and only 8 states and Washington, D.C. have implemented laws based on the Death with Dignity Act. The act should be implemented in all states to allow people the choice to die with dignity if they wish to do so. Not having such as act leaves terminally ill patients in pain for months, waiting for their lives to end, and dreading their illness instead of peacefully dying on their own terms.

• Patient autonomy is a highly respected principle in medicine. Patients have the right to refuse treatment, choose providers, and decide what care is best for them. If patients have the right to decide how to live with their diseases and disorders, they should also have the right to choose how they die because of those diseases and disorders. Dying is a personal matter that should be decided by the patient, and how a patient dies should be left to an individual decision, not current legislature that limits this crucial decision.
• “Do no harm” is an oath sworn by medical providers as a promise to ensure patient wellbeing. While preserving life is a goal of medical providers, the pain and suffering endured by the patient while preserving their life should be considered. Upholding the Hippocratic Oath in a patient that is awaiting death while in excruciating pain directly contradicts the promise of “do no harm.”
• The agreement amongst the medical community is progressively changing toward support of Death with Dignity acts. The Medscape Ethics Report in 2014 showed attitudes toward physician-assisted suicide growing in favor of the act, with 54% of physicians supporting the idea, compared to 46% just four years earlier.
• Opposition to Death with Dignity includes the argument that the laws may be used unethically to pressure or coerce poor or elderly individuals to utilize the law instead of seeking expensive treatment and palliative care options. However, since the first law was enacted in Oregon in 1997, there have been zero documented cases of such coercion.
• Death is an extremely emotional process, for patients and for families. Having compassion for all involved means that patients can choose to stop suffering, and families can say goodbye and not watch their loved one suffer. Having the option to hasten death and not prolong suffering is the compassionate and fair choice to provide to patients.
• There are strict and thoroughly thought out requirements for eligibility in the Death with Dignity Act. The patient must be a resident of the state, be deemed mentally competent, be diagnosed with a terminal illness that will lead to death within 6 months and be able to self-administer and ingest the prescribed medication. All of these requirements must be approved by two physicians and the process takes a few weeks to finalize. There are no hasty decisions involved, rather the process is meant to make certain that the patient has chosen what is right for them and has been deemed a candidate for the prescription.

Policy Options

• Federal mandate of the Death with Dignity Act with obligatory state participation. The act would be made law in all 50 states and Washington D.C. This would require all states to provide patients with the option to end their life with accordance to current Death with Dignity eligibility requirements. All states must provide accessibility to physicians and facilities that are willing to participate and honor patients wishes. If a facility or physician would not want to participate, then patients would be allowed to switch providers and/or facilities in order to accommodate their decision to end their lives.
  • Advantages: Allows patients to exercise their autonomy and die with dignity on their own terms. Patients wouldn’t be limited by their state of residence abiding by the law if all states had the law in place.
  • Disadvantages: Physicians may choose not to participate as it is their decision, therefore some states may face trouble in providing patients access to facilities and providers that are willing to fulfill the patients choice.
• Federal mandate of the Death with Dignity Act with willing participation from physicians and facilities. The states would not be responsible for securing facilities and providers, but the act would become law and make physician-assisted suicide a legal option for patients.
  • Advantages: providers and facilities could choose to participate according to their willingness so no burden of having to participate would be mandated against anyone’s will
  • Disadvantages: There may be a shortage of providers and facilities willing to participate due to some states and/or areas of the country having strict religious beliefs against suicide, making physician-assisted suicide inaccessible to many patients that don’t hold the same beliefs.
• State implementation of the Death with Dignity committee: set up a committee to work with state legislators individually to promote passing of this law in their respective states.
  • Advantages: a committee that approaches each state individually could work to reason with and persuade legislators about the act based on specific opposition each state has against the act. Individual approach could target specific issues and work to combat the negative stigma many states have about the act.
  • Disadvantages: with legislation left to states to implement, states that have been strongly against this act and unlikely to implement it or work alongside a committee to understand their perspective.

 

Policy Recommendation: The American Medical Association states that physicians participating in ending a patient’s life would cause more harm than good, yet the AMA also stands for patient autonomy. Fulfilling the belief that all patients should have autonomy in their medical care while upholding the oath “do no harm” means that if a patient decides that they want to end their life and feel that death would bring them less harm than living with illness, then physicians should honor the patients request. The act should be implemented as law in all 50 states and Washington, D.C. to allow people the choice to die with dignity if they wish to do so. The federal mandate should include obligatory participation from states, in that states would be required to enlist providers and facilities that will participate in the act. Obligatory participation will ensure that every patient across the country will have access to physician-assisted suicide and will not be left helpless due to the beliefs of providers and facilities in their area.

Sources:

Simmons, Kevin M. “Suicide and Death with Dignity.” Journal of law and the biosciences vol. 5,2 436-439. 15 May. 2018, doi:10.1093/jlb/lsy008

Death with Dignity. Death with Dignity National Center and Death with Dignity Political Fund. Web. 17 Jan 2020. https://www.deathwithdignity.org/

Blanke, Charles et al. “Characterizing 18 Years of the Death With Dignity Act in Oregon.” JAMA oncology vol. 3,10 (2017): 1403-1406. doi:10.1001/jamaoncol.2017.0243

Kane, Leslie. “Medscape Ethics Report 2014, Part 1: Life, Death, and Pain.” Medscape. WebMD LLC. December 16, 2014. Web. https://www.medscape.com/features/slideshow/public/ethics2014-part1#2