Do the Terminally Ill Have a Right to Die?

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Some people argue that doctor aided dying for the terminally ill will lead to a situation where people are involuntarily forced to end their lives. Or that physician-assisted dying will disproportionately affect the less educated, poor, women, those without health insurance, physically disabled people and the mentally incompetent. In addition, opponents of the practice claim that people might choose assisted suicide as a way to save their families money or ease the burden on them, or that they will be forced into it, either by greedy doctors or impatient family members.   Yet the evidence over the last ten years in the only state in which the practice is legal, shows otherwise.

Oregon is the only state in the US that has legalized physician-assisted ending of life. The Death with Dignity Act was twice approved by voters, once in 1994 and again when a ballot initiative challenged it in 1997. It requires that a patient be an adult, resident of Oregon, and that two doctors certify that the patient seeking to end their life is mentally capable (able to make and communicate health care decisions) and is suffering from a terminal illness and has less than half a year to live.   In addition, the act prohibits euthanasia, having someone other than the patient administer the life ending drugs.

No one is being forced to involuntarily end their life. In fact, a patient must make three separate requests…two orally to his or her physician, at least 15 days apart, and one written request that is signed in the presence of two witnesses. Finally, the prescribing physician must notify the patient of feasible alternatives, including hospice care, comfort care, and pain control.  

Ten years of experience also has shown that the poor, undereducated, underinsured or disabled are not being targeted, and that the practice of physician-aided dying is not being abused. Just the opposite. Since Oregon’s Death with Dignity Act was passed in 1997, only 341 patients have died with doctor assistance. Of those, over 97% have been white and 64% have attended college or have advanced degrees. Almost 86% were enrolled in hospice care and 99% had private insurance or Medicaid or Medicare.  

When asked about their end of life concerns, 89% included losing autonomy, 87% less ability to engage in life enjoying activities, and 82% loss of dignity. Only 39% included being a burden on family, friends, or caregivers, and less than 3% cited financial implications of treatment as a factor.   93.5% of the patients died at home (either their own, their family’s or a friend’s) 5% in assisted living or foster care, and less than half a percent in a hospital.   

Finally, of the 539 prescriptions that have been filled under the Death with Dignity Act, only 341 (or 63.3%) of the patients have taken the dose. For many, it appears that the prescription merely served as comfort to know that the option of ending their life existed. A comfort, at the very least, that they deserve.