How to Die in New York

Tonight (weather permitting), my colleagues and I from the Bioethics Program of Union Graduate College are hosting a special event: a screening and discussion of the award-winning but controversial film “How to Die in Oregon.”

That film, which won the Documentary Grand Jury Award at the 2011 Sundance Film Festival, follows several terminally ill Oregonians — including Cody Curtis, a 54-year-old mother of two — as they consider if and when to end their lives by lethal overdose.

In 1994, through popular referendum, Oregon became to first state to legalize physician aid-in-dying (sometimes called physician-assisted suicide). In 1997, following voter rejection of a second initiative that sought to repeal this law, Oregon’s Death with Dignity Act went into effect. Since then, only one other state — Washington — has passed a similar law. Montana’s Supreme Court has also ruled that physician-assisted suicide is not a crime, but the legality of physician aid-in-dying in that state still remains in legal limbo as state legislators continue to debate the practice.

Under the Death with Dignity Act, any terminally ill adult resident of Oregon who has less than six months to live can request a prescription for a lethal dose of medicine for the sole purpose of ending their life.

There are, of course, several important restrictions. For example, the request must be voluntary, made in writing, and made in the context of a meaningful physician-patient relationship. The request must be confirmed by two witnesses, including one witness who is not a family member, caring for the patient, or entitled to any portion of the patient’s estate. The patient must wait 15 days and make a second verbal request for the prescription. Finally, the patient’s terminal diagnosis must be confirmed through an independent medical consultation, and the patient must undergo a psychiatric evaluation to ensure that they are not depressed or suffering from any other mental illness. Any physician or pharmacist who has moral objections may also refuse to write or fill the prescription, and the patient alone must be the individual who administers the lethal dose of medication.

Fourteen years later, the legalization of physician aid-in-dying has had a remarkable impact on end-of-life care in Oregon. Requests for lethal prescriptions are quite rare, and fewer than 600 terminally ill Oregonians have ended their lives by overdose. Oregon also now leads all other states in hospice referrals, training of physicians in palliative care, and in the number of deaths occurring at home.

Despite this, the Death with Dignity Act remains contentious. During the Bush Administration, US Attorney General John Ashcroft tried to use the federal Controlled Substances Act to suspend the license of any doctor who prescribed life-ending drugs under the Oregon law. His efforts were blocked by the US District Court for the District of Oregon, a position that was upheld by the Ninth Circuit Court of Appeals and the US Supreme Court.

Organizations in many states are also actively campaigning against laws like Oregon’s Death with Dignity Act. Many right-to-life groups oppose physician aid-in-dying on religious grounds. I respect these objections, but I am opposed to forcing a particular faith-based perspective upon those of us who might not share the same religious convictions. Ensuring that any request for physician aid-in-dying is voluntary while also allowing for conscience-based objection by healthcare providers is, in my opinion, a better approach and one that respects the plurality of religious faith and moral conviction in the US.

Disability advocates fear that physician aid-in-dying laws will be expanded to include people who are not terminally ill but who have otherwise incurable conditions and who feel that their suffering is unbearable. People with disabilities still face considerable stigma and discrimination in our society, and many able-bodied individuals see disability as “a fate worse than death.” Thus, it is feared, expanding existing laws to allow those with non-terminal but unbearable illnesses to seek physician aid-in-dying could lead many with disabilities to feel pressured to end their lives. I believe that this is a very valid concern. In the absence of radical changes in how our society views and treats those with disabilities, we must be careful that laws like Oregon’s Death with Dignity Act do not add to the stigma and discrimination these individuals face.

Whatever your position on physician-assisted suicide, you should see the movie “How to Die in Oregon.” Despite the bias with which it presents the stories of terminally ill individuals like Cody Curtis, the movie raises important questions about end-of-life care, physician-assisted suicide, and the way in which we as a society deal with (or refuse to deal with) the inevitability of death and dying.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on March 1, 2012. It is also available on the WAMC website.]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
This entry was posted in End-of-Life, Physician Aid-in-Dying, Policy. Bookmark the permalink.

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