Death With Dignity
Yes. We are going there. We are going to talk about death. Last year my father died after living a good long life. He was ready to die and said so, but he and we had to wait, and he suffered emotionally. He had exceptional care and was on hospice, but would he have chosen a medically assisted death if he had the option? We will never know.
It's probably not a stretch to state that America is a death-denying culture. So much so we have devised ingenious technological ways to keep people alive. It is common for families to demand these life-saving medical techniques for a family member long after any hope for a meaningful recovery or quality of life. We know discussing death isn’t easy, but we all deal with it at one time or another. And we can’t predict how or when it will happen.
The term Death with Dignity is used most often to describe the legal end-of-life option that allows specific eligible individuals to request and obtain medications from their physician to end their life peacefully, humanely, and with dignity. State legislation determines Death with Dignity laws. At its core, Death with Dignity gives individuals the autonomy to decide that they no longer want to be kept alive.
As our healthcare system continues to find ways to keep people alive longer, in some cases, it is a miracle, but in others serves to prolong life at the expense of quality of life. Do Not Resuscitate orders become more common as individuals consider the complications of living with a significant disability. And even in those cases, DNR orders are not always followed or people change their minds at the last minute and request medical intervention.
You may have heard other terms such as medical aid in dying or physician-assisted suicide (an expression Death with Dignity advocates discourage). There are strong opinions on both sides of this issue, and states that have or are considering laws around Death with Dignity are always in flux.
States that Currently Allow for Death with Dignity
These are the states that currently have Death with Dignity laws. Legislation in other states is considering Death with Dignity laws, but many states have no pending Death with Dignity legislation.
Mandated by Law Death with Dignity States
Colorado
District of Columbia
Hawaii
Maine
New Jersey
New Mexico
Oregon
Vermont
Washington
Mandated by Court Ruling Death with Dignity States
Oregon was one of the first states to legislate Death with Dignity laws, and last year, they eliminated the residency requirement. But, before you think you can travel to Oregon to end the suffering associated with a terminal condition, you must meet these criteria:
An adult (18 years of age or older),
As of 2022, Oregon no longer requires that terminally ill people seeking to end their lives be residents of the state. As of this writing, all other states require residency.
Capable of being able to make and communicate health care decisions.
Diagnosed with a terminal illness that will lead to death within six months.
Patients meeting these requirements can request a prescription for lethal medication from a licensed Oregon physician. The following steps must be fulfilled to receive a prescription for lethal medication:
The patient must make two oral requests to his or her physician, separated by at least 15 days. A change to the law, effective January 1, 2020, allows patients whose life expectancy is less than 15 days to skip the waiting period.
The patient must provide a written request to his or her physician, signed in the presence of two witnesses.
The prescribing physician and a consulting physician must confirm the diagnosis and prognosis.
The prescribing physician and a consulting physician must determine whether the patient is capable.
If either physician believes a psychiatric or psychological disorder impairs the patient's judgment, the patient must be referred for a psychological examination.
The prescribing physician must inform the patient of feasible alternatives to Death With Dignity, including comfort care, hospice care, and pain control.
The prescribing physician must request, but may not require, the patient to notify their next of kin of the prescription request.
The pros of death with dignity include that it allows terminally ill individuals to die with autonomy and control over the circumstances of their death, can provide relief from suffering for those in the advanced stages of incurable illnesses, and gives a person the right to die.
The cons of death with dignity are that it can be difficult to determine whether a person is making a voluntary and informed decision to end their life. Is the person competent to make such a decision? Are they coerced into making the decision? What about religious and ethical objections to taking the life of another person?
Given that only a few states have Death with Dignity laws, what choices do people at the end of life who are not in one of those states that have these laws? Many stop eating, and others suffer until the end or opt for hospice care, offering comfort and pain relief at the end of life.
It is possible to have death with dignity at the end of life without opting for medical aid in dying. But it takes a clear understanding of what the individual wants, what they consider quality of life at the end of life, and the ability to make informed decisions whether you agree with those decisions or not. I think we would all choose a “good death,” which we will discuss in another article!