The Death with Dignity Act often sparks controversy and brings to the forefront important questions about the role of doctors in end-of-life care. The American Medical Association defines “death with dignity” or “medical aid in dying” (MAID) as when a physician offers “the necessary means and/or information” to assist a patient in choosing to end their own life.” Throughout this blog the terms “death with dignity” and “medical aid in dying” will be used interchangeably.

What constitutes dying with dignity varies from person to person. It is a highly personal perspective. For instance, if someone believes that dying in a confused state, being incontinent, or heavily relying on others is undignified, then, for them, it is indeed undignified.

The Danish philosopher Soren Kierkegaard once said that “dying well is the highest wisdom of life.” However, many experts and doctors have noticed a concerning trend in American culture, what they call the “plague of bad dying.” This term describes the unfortunate situation where individuals spend their final days in an institutionalized setting, receiving care from strangers, being monitored by technology, and having limited control over their dying process.

One way to address this issue is by legalizing methods overseen by physicians to help terminally ill patients choose when their death will occur. This approach, often referred to as death with dignity or medical aid in dying (MAID), is becoming more common.

First, we will clarify some terms related to this topic:

Death with Dignity: Also known as “physician-assisted dying” or “medical aid in dying,” it is legal in all states with existing Death with Dignity laws. It allows mentally competent adult patients with terminal illnesses to request a prescription for life-ending medications from their physicians. The patient must self-administer and ingest the medication without any assistance. It is different from euthanasia.

Euthanasia: This term translates to “good death” and involves painlessly and deliberately causing the death of someone suffering from an incurable, painful disease or condition. It is often associated with lethal injections and is sometimes referred to as “mercy killing.” Euthanasia, in all its forms, is illegal in the United States.

What is Death with Dignity?

Death with dignity, as an end-of-life option, is governed by state legislation (hence, the Death with Dignity Act). It allows specific individuals with terminal illnesses to request and receive prescription medication from their physician to hasten their death in a peaceful, humane, and dignified manner voluntarily and legally.

Other Terms for Death with Dignity

The term “Death with Dignity” originates from the Oregon statute that governs the prescribing of life-ending medications to eligible individuals with terminal illnesses. Other related terms include:

  • Medical aid in dying
  • Physician-assisted death
  • Physician-assisted dying
  • Aid in dying
  • Physician aid in dying

Opponents of physician-assisted dying sometimes use incorrect and misleading terms like “assisted suicide,” “doctor-assisted suicide,” “physician-assisted suicide,” and “(active) euthanasia.”

It is important to note that a legal prescription for life-ending medications is only available in states with Death with Dignity laws, the qualifications may vary slightly from state to state. To qualify under these statutes, you must be:

  • An adult resident of a state where such a law is in effect.
  • Capable of making and communicating your healthcare decisions.
  • Diagnosed with a terminal illness that will lead to death within six months, as confirmed by qualified healthcare providers.
  • Capable of self-administering and ingesting medications without any assistance.

Death with Dignity Laws in the United States

The Oregon Death with Dignity Act, in operation since 1997, has proven to be safe, effective, and profoundly meaningful for those it serves. It consistently achieves its intended purpose. It empowers individuals with terminal illnesses to have the control they desire during their final days.

Currently, ten US jurisdictions allow physician-assisted death. This process enables physicians to prescribe medication that patients can choose to self-administer to end their lives. These jurisdictions include Oregon (since 1994), Washington (since 2008), Montana (since 2008), Vermont (since 2013), California (since 2015), Colorado (since 2016), the District of Columbia (since 2017), Hawaii (since 2018), New Jersey (since 2019), and Maine (since 2019). Physician-assisted death is now a legal option for terminally ill patients in states representing nearly 25 percent of the US population.

The Impact of Death with Dignity Laws

For over 25 years, the Oregon Death with Dignity Act has fostered collaboration among doctors of various specialties to enhance end-of-life care by utilizing educational resources for patients and providers. This law has not only improved the patient experience but also inspired better end-of-life care in Oregon. Hospice workers strongly support Oregonians’ right to choose from legal end-of-life options, contributing to open discussions about death and dying, both in Oregon and nationwide. Policymakers and healthcare systems have responded by creating policies to ensure patients’ care preferences are documented and respected, reflecting the importance of patient autonomy and compassionate care.

These laws can reshape societal attitudes toward end-of-life choices, emphasizing patient decision-making and compassionate care. The legalization of such options encourages healthcare providers to engage in open and empathetic conversations with patients about their end-of-life decisions, promoting more patient-focused and end-of-life care and hospice services.

Arguments For and Against Death with Dignity

For thousands of years, medical practice strictly followed the Hippocratic model, which prioritized preserving life above all else. The conversation about physician-assisted death continues to evolve as opinions and perspectives develop. It is a complex issue that reflects the changing landscape of patient care and medical ethics.

Advocates for Death with Dignity Perspectives

The growing acceptance of legalized physician-assisted death is rooted in the moral principle of the “right to die.” This principle upholds that patients hold fundamental interests in:

  • Preserving their bodily integrity.
  • Avoiding invasive medical procedures that offer little hope of improving their quality of life or extending their lifespan.
  • Making autonomous decisions about ending their life in harmony with their values.

The Key Arguments for Legalizing Physician-Assisted Death

The most common arguments in favor of legalizing medical aid in dying (MAID) revolve around respecting patient autonomy and alleviating suffering. A third related argument emphasizes that MAID should be carried out as a safe medical practice under the guidance of healthcare professionals.

The prevalent reasons for supporting a Death with Dignity Act (DWDA) are grounded in the principles of autonomy and dignity. Patients themselves have expressed these justifications, with “losing autonomy” being the foremost reason for DWDA patients to choose this option.

Autonomy signifies having control over one’s own actions, which extends to healthcare settings where patients decide which medical interventions to pursue or forego. Patient autonomy serves as the basis for informed consent, allowing patients to make informed decisions about their treatments or participation in medical research. Advocates argue that this principle naturally extends to MAID, permitting individuals accustomed to making their own healthcare decisions to have control over the circumstances of their death.

As Brittany Maynard, whose case sparked California’s Death with Dignity Act, articulated in her CNN Op-Ed, it is about the right to choose in one’s final moments. She questioned who had the right to deny her the choice of dying with dignity when faced with weeks or months of severe physical and emotional pain. She emphasized the importance of individual choice in these deeply personal matters.

Advocates for medical aid in dying emphasize its safety as a medical practice. Doctors can ensure a peaceful death. Medical aid in dying becomes one of the options available for end-of-life care. While state laws vary, most incorporate safeguards to prevent abuses and provide structure to an act some people might pursue in an unregulated or unsafe manner. It aims to offer a safer and more compassionate choice for those facing the end of life.

Opponents for Death with Dignity Perspectives

Individuals who oppose Death with Dignity laws raise ethical and moral objections. They worry that involving doctors in assisting patients’ deaths leads to a dangerous slippery slope. Others argue that this slippery slope becomes evident in the growing list of reasons people cite for choosing MAID. It is not just about ending unmanageable physical pain anymore. According to cumulative data, most MAID patients in Oregon choose this option because they fear “losing autonomy” (90.6%) or being “less able to engage in enjoyable activities” (89.1%). Other concerns include the “loss of dignity” (74.4%), being a “burden on family, friends, or caregivers” (44.8%), or “losing control of bodily functions” (44.3%). In contrast, inadequate pain control is the primary reason in only 25.7% of cases.

Historical Ethical and Legal Views on Suicide

In the United States, the opposition to suicide, deeply rooted in Christian theology, has both ethical and legal dimensions. Traditionally, the belief held that God, as the creator of life and controller of all things, made suicide a final and irredeemable rejection of God.

More recently, people have argued that everyone possesses the autonomy to make decisions about their own life, including the choice to end it. This shift in ethical outlook is partially due to the increasing awareness of mental health issues. As society’s beliefs about end-of-life choices continue to change, the historical ethical and legal views on suicide remain integral to the broader conversation about individual autonomy, mental health, and the role of society in supporting those facing life’s challenges.

Addressing Concerns About Potential Misuse

Regarding restrictions on death with dignity, each state has valid interests in regulating the medical profession and preventing the misuse of medical aid in dying for illegal purposes. It is reasonable to establish safeguards to protect both interests, such as witness requirements, requiring that a person be mentally capable of making an informed healthcare decision and be able to self-administer the medication.

The Rising Issue of Euthanasia

Some opponents also highlight the increasing calls in the United States for euthanasia. In 2017, Senate Bill 893 was introduced in the Oregon State Legislature. This bill would have allowed patients to specify in a legal directive the person they wanted to administer their lethal medications, effectively legalizing euthanasia. It raises important questions about the direction of end-of-life choices in the country.

The Future of Death with Dignity

In several states, ongoing efforts are being made to pass laws related to Death with Dignity. The results of these efforts vary.

Over time, public opinion on Death with Dignity laws has changed. Most Americans now support the idea of allowing terminally ill patients to make their own decisions about their end-of-life options. This shift in public opinion can strongly influence legislative decisions.

The success of Death with Dignity laws often depends on public support. Advocacy groups play a key role in building and mobilizing this support. They do this by educating the public, sharing personal stories, and conducting polls to gauge public opinion. When a significant portion of the population backs these laws, it creates momentum for legislative action.

Death with Dignity in New Jersey

In New Jersey, medical aid in dying is permitted under the law. The New Jersey Medical Aid in Dying for the Terminally Ill Act, which allows medical aid in dying in the state, was signed into law by Governor Phil Murphy on April 12, 2019, and it went into effect on August 1, 2019.

This New Jersey law allows mentally capable adults with six months or less to live to request a doctor’s prescription for medication. They can choose to use this medication in their final days or weeks to end their suffering and pass away peacefully. It is a way to provide compassionate end-of-life options.

Eligibility for Medical Aid in Dying in New Jersey

To be eligible for medical aid in dying under New Jersey’s law, you must meet the following criteria:

  • Be an adult aged 18 or older.
  • Have a terminal illness with a prognosis of six months or less to live.
  • Be mentally capable of making your own healthcare decisions.

Additionally, you must:

  • Be a resident of New Jersey.
  • Act voluntarily.
  • Be able to self-administer the medication.

To qualify for a prescription for aid-in-dying medication, you must also adhere to certain regulatory requirements. This includes having at least two doctor visits for a medical evaluation and discussions about your request. As a result, the process can take as little as 15 days or three months for someone seeking a prescription. It is crucial for those interested in using this law to speak with their doctor early to ensure they are willing to write the prescription and if they will not, allow time to find a doctor in NJ that will. This early communication is important for a smooth process.

Proposed Death with Dignity Law in Pennsylvania

Pennsylvania’s Medical Aid-in-Dying Bill (HB 543) was introduced on March 20, 2023, to the PA health committee.

Key Legislation Details

This bill offers terminally ill, mentally capable adults with a prognosis of six months or less to live the choice to request, obtain, and take medication to peacefully end their life should their suffering become unbearable. The bill is modeled after laws in authorized areas, and it draws inspiration from the Oregon Death with Dignity Act, which has been in practice for 25 years without any reported instances of abuse or coercion.

Eligibility for Medical Aid in Dying in Pennsylvania

To be eligible for medical aid in dying, a person must meet the following criteria, like the Oregon Death with Dignity Act:

  • Be an adult aged 18 or older.
  • Have a terminal illness with a prognosis of 6 months or less to live.
  • Be mentally capable and capable of making an informed healthcare decision.

Age or disability alone cannot disqualify someone from accessing medical aid in dying.

Key provisions of the bill include the following:

  • Two providers must confirm that the individual is terminally ill with a prognosis of six months or less to live, mentally capable, and not subject to coercion.
  • A terminally ill person can change their mind or withdraw their request for medication at any point.
  • The attending provider must discuss all end-of-life care options with the requesting individual, including comfort care, hospice, and pain control.
  • A mental health evaluation is mandatory if either provider has concerns about the patient’s capacity to make informed healthcare decisions. The prescription cannot be written until a mental health provider confirms the patient’s capacity.
  • Anyone attempting to coerce or exert undue influence on a patient to request medication or destroy a request for medication will not be immune from criminal liability.
  • The families of those who use this law cannot be denied life insurance payments.
  • No healthcare provider is required to participate in this process.

There are additional regulatory requirements, including:

  • The individual must make two separate requests for the medication, with a 15-day waiting period between the first and second requests. The waiting period may be waived if the patient’s providers believe, within reasonable medical certainty, that the patient will not survive until the end of the waiting period.
  • A written request is required, and two witnesses must observe the written request, with one witness meeting specific eligibility criteria, such as not being a relative or someone who stands to benefit from the person’s estate.
  • Prescribing providers must adhere to medical-record documentation requirements and make records available to the state Department of Health.
  • The state Department of Health is obligated to issue a publicly available annual report. Individual patient’s and doctors’ identifying information is kept confidential to protect privacy.

The evolving discussion about death with dignity reflects the changes in patient care and medical ethics. Advocates emphasize the principles of autonomy, dignity, and compassion, while opponents raise ethical objections and fears of a slippery slope. Safeguards against misuse and ongoing legislative efforts focus on the importance of responsible implementation. As public opinion continues to shift, the future of death with dignity laws relies on fostering open conversations, informed decision-making, and a compassionate approach to end-of-life care.