Death With Dignity: The Legal and Moral Battle

Currently there are five states that allow a person to seek a physician’s help with hastening their death. When Jack Kevorkian brought national attention to the right to die movement in the early 1990s—culminating in seven years in jail for second-degree murder—the right to die movement was usually referred to as “assisted suicide.” That term carried a religious and legal bias against taking one’s own life. Today the movement uses terminology that shows how our thinking has shifted on this subject. Now we speak about “death with dignity” or “physician aid-in-dying.”

With passage of the Death with Dignity Act in 1997, Oregon became the first state to enact a law allowing doctors to prescribe lethal medication. Similar laws were enacted in Washington, Vermont, and most recently (June 2016), in California. Montana also allows a person to ask for lethal prescriptions because of a court ruling not a state law.  

New energy in the battle for death with dignity laws surfaced last year after the publicity around Brittany Maynard’s choice to end her life on her own terms. Brittany, who was only 29 at the time she received a diagnosis of brain cancer, moved from California to Oregon so she could avail herself of that state’s death with dignity law. She received her lethal prescription in May of 2014, but then held on to it until November, when she decided that her suffering was too great to put her death off any longer.

Many people who acquire a legal dose of life-ending medication don’t in the end take it. In Oregon, between 1997 and the end of 2014, 1,327 people received a lethal prescription; only 859 of them, or 65%, used that prescription to end their life. For those who didn’t use the prescription, knowing they had the choice eased their suffering.

Following Maynard’s death, laws to allow assisted dying popped up in nearly 25 states and the District of Columbia. Since then about half of those laws have failed in state legislatures or have been set aside even before consideration. But the legal battle for a person’s right to die has certainly been engaged across the country and will likely move ahead in many states.

A number of organizations are leading the fight for death with dignity. One of the most prominent is Compassion and Choice, which is the new name for the Hemlock Society that began in 1980 to raise this issue. Another is the Death with Dignity National Center. These organizations are a great source of information about the legal and moral considerations in the right to die movement.

The great difficulty states have in passing laws in favor of assisted dying reflects the strong religious and moral aversion some people have to allowing individual choice around death. Probably the strongest argument against assisted aid-in-dying comes from religious bans against taking one’s own life or another’s life. The reasoning behind this prohibition—with variations depending on the religion—goes like this: our life comes from God and only God has the right to determine when our life should end.

Other arguments against assisted death revolve around the inherent value of human life, the fact that for physicians it violates the Hippocratic oath, that it is a slippery slope leading to abuse, and that it takes away the possibility of miracles or medical breakthroughs that might lead to recovery. Finally, there is the notion that most pain and suffering can be relieved with palliative care—or in the extreme, by palliative sedation.

The arguments in favor of assisted death center a great deal on ending suffering and pain that doesn’t have a purpose and robs a person of their dignity. Our bodies and our lives belong to us—so the argument goes—and we should each of us individually have the right to determine when and how our life ends in the face of great suffering. Even with palliative sedation we are not certain that all suffering has ended for the dying person. Many people feel they should have the right to end their life before an illness takes away all their physical and mental capacity that defines who they are. Lastly, it eliminates a tremendous financial burden that a family might bear simply to extend suffering.

Of course, every individual must decide the question of assisted death for himself or herself in the states where the choice exists. It is the right to make this choice that the laws are intended to protect. Next month we will look at how an end-of-life doula can serve a person who decides to pursue assisted death in those states that allow it.