Ethics, Laws and Reasons
By Larson Palmgren
Brittany Maynard was 29 years old when her doctors diagnosed her with a stage four glioblastoma multiforme, a brain cancer, less than a year after marrying her husband Dan Diaz. She was determined to be terminally ill, and the doctors gave her an estimated six months to live. Brittany knew that she was going to die, however she did not want to suffer. She looked for a way to relieve this suffering and found Death with Dignity, a service that aids in physician assisted suicide by lethal dosage. However, Brittany lived in California, where at the time, it was not legal. Her and her husband had to pack up and move to Oregon, one of only eight states that has legalized this practice currently. She claimed: “I met the criteria for death with dignity in Oregon, but establishing residency in the state to make use of the law required a monumental number of changes. I had to find new physicians, establish residency in Portland, search for a new home, obtain a new driver’s license, change my voter registration and enlist people to take care of our animals, and my husband, Dan, had to take a leave of absence from his job.” From there, she could die in peace, around those who loved her, and most importantly, free from suffering.
After reading Brittany’s story, what do YOU think?
Should the Right to Die be legal Nationwide?
- Is it fair that Brittany had to move just to die peacefully?
- Do you think that a practice like Death with Dignity should be legal?
This is video displays the process patients go through during the last few hours when excersising their right to die. However, this video takes place in Switzerland, not the United States, where the process of the right to die is legal throughout the entire country.
UN Sustainability Goal
These are a group of seventeen goals created by the United Nations General Assembly in 2015. Each goal has guidelines and are aimed to be achieved by 2030. The right to die aligns with Goal 16, Peace, Justice and Strong Institutions. It is really emphasized with justice, as the right to die is a process that is not widely available throughout the United States and world.
What is the Right to Die?
The right to die is hard to define. It is a vast topic with many different variations. All in all however, the right to die refers to a patient, most often terminally ill, making the decision to take a physician supplied medication or injection that will allow them to die in peace and on their own terms to avert unnecessary suffering.
“I refuse to subject myself and my family to purposeless, prolonged pain and suffering at the hands of an incurable disease.”-Brittany Maynard
Why is it Controversial?
Out of fifty U.S. states, only eight, including Washington D.C., have legalized right to die and death with dignity. The topic is very controversial around medical practitioners especially as many people see it as a violation of bioethical and medical principles.
What are the bioethical principles relevant in right to die cases?
Autonomy can be defined as respecting the decisions that each individual has the ability to make by themselves. The decisions the patients make are made in regards to their health and future. In the case of the right to die, the decision to end one’s life is solely that of the patients. No outside influences should ever fully coerce the patient into doing what he or she does not want to do.
Non-maleficence is defined as practicing treatments, or making decisions that are not intended to harm the patient or those around them. This is one of the most controversial topics concerning assisted suicide and the right to die. Doctors claim that it goes against their medical principles to administer a fatal treatment to a patient, whether they want it or not.
“Assisting in the taking of a human life is against everything physicians stand for and defiles the reputation and meaning of being a physician.”-Argument from the case to introduce the bill Sb-128 to California, legalizing the right to die
VICE. “Right to Die (VICE on HBO: Season 4, Episode 3).” YouTube, YouTube, 30 June 2017, www.youtube.com/watch?v=xgj2VXltbuI.
Beneficence in bioethics is defined as exercising or practicing actions that are meant to benefit the patient or others in a society. In terms of the right to die, these treatments, while are fatal for the patient, are administered with beneficence in mind. The object of death with dignity is not to kill the patient, but to ultimately relieve their suffering and the suffering of their family caused by these untreatable diseases.
Like non-maleficence, justice is one of the great controversial principles in question when it comes to the right to die. As of this year, only 8 out of the 50 United States have legalized death with dignity and physician assisted suicide. Terminally ill patients seeking this type of treatment, like Brittany from earlier, are having to pack up and move to a whole new place, just to live out the last little bit of their life knowing they have the right to die and relieve their suffering when the time comes. This raises some questions:
What laws do some states have in place to legalize/illegalize the right to die?
Why is it illegal?
What can we do to change that and bring justice to those who seek this treatment?
The Right to Die in the U.S.A
The legality of the Right to Die in the United States is a highly controversial topic. Out of the fifty states, only eight have legalized assisted suicide and death with dignity.
Why so Controversial?
Like explained earlier, the main controversies of the right to die legality come from physicians. They believe that the process is totally unethical and goes against their medical principles. Where it might be the main opposition to the right to die movements, physicians and doctors have recently become more supportive as more states legalize and pass laws for it.
As well as that, many believe it goes against their religion. Almost all religions believe that this s killing a patient and goes against many of their beliefs.
For Roman Catholics:
“Freedom to kill is not a true freedom but a tyranny that reduces the human being into slavery.”“Religion and Spirituality.” Death With Dignity, www.deathwithdignity.org/learn/religion-spirituality/.https://www.deathwithdignity.org/learn/religion-spirituality/
In the eyes of the Jewish:
“Judaism places the highest importance on palliation of pain, particularly in the case of terminal patients,” and that “Judaism teaches that suicide is an offense against the Deity who is the Author of life.”“Religion and Spirituality.” Death With Dignity, www.deathwithdignity.org/learn/religion-spirituality/.https://www.deathwithdignity.org/learn/religion-spirituality/
“So a person’s state of mind at the time of death is important: their thoughts should be selfless and enlightened, free of anger, hate or fear. This suggests that suicide is only appropriate for people who have achieved enlightenment and that the rest of us should avoid it.”“Religion and Spirituality.” Death With Dignity, www.deathwithdignity.org/learn/religion-spirituality/.https://www.deathwithdignity.org/learn/religion-spirituality/
A survey was done by SERMO, a medical talk website, with all sorts of doctors to get an idea on their opinions. The number of “yes” or no” as well as “undecided” varies differently between each kind of practitioner.
“In a Sermo Physician Poll conducted in May of this year, 48% of physicians thought assisted suicide should be legalized, while 38% were opposed and 14% were undecided.”-SERMO Survey
“Physician-Assisted Suicide.” SERMO, 18 Aug. 2017, blog.sermo.com/2013/12/17/physician-assisted-suicide/. http://blog.sermo.com/2013/12/17/physician-assisted-suicide/
However, even though the numbers seem pretty strong for physician assisted suicide, many doctors have claimed that even though it is legal in their state, they do not administer the necessary drugs often, as explained in a recent article by MedScape, a medical news website:
“Doctor Support for Assisted Death Rises, but Debate Continues.” Medscape, 7 July 2017, www.medscape.com/viewarticle/882334.https://www.medscape.com/viewarticle/882334
“Sixteen percent of almost 300 physicians who responded to a recent Medscape Medical News poll said they practice in states with a physician-assisted dying law. Only 17% of those physicians said they have used it with a patient. Thirteen percent said they’d received a request but had declined, and 70% said they’d never been asked to facilitate a patient’s death.”
Most physicians now have rising opinions and claim that physician assisted suicide and the right to die is a beneficial procedure that they’d support. From that 2013 survey, 62% of physicians responded saying that they’d been in a situation where they’d wished to have that treatment available. Dr. Roger Kligler, MD, who was diagnosed with an incurable prostate cancer explains that:
“Having cared for many patients who have died with my disease, I know that the end of my life will be difficult,” he said. Making assisted death available can improve the use of hospice and palliative care and end-of-life discussions, decrease suicide in the terminally ill, and give them peace of mind…”“Doctor Support for Assisted Death Rises, but Debate Continues.” Medscape, 7 July 2017, www.medscape.com/viewarticle/882334. https://www.medscape.com/viewarticle/882334https://www.medscape.com/viewarticle/882334
States and Laws
Does your state or country have laws concerning the right to die? Is it legal in your state or country? Why? This section will dive more into depth on the laws and regulations on the right to die in the United States.
Out of these states shown in the map, California, Washington D.C., and Hawaii have all legalized physician assisted suicide. New Jersey recently legalized it on April 15th, 2019!
Out of the 50 United States, physician assisted suicide is legal in:
- Washington State
- Washington D.C.
- New Jersey
California, Oregon, Washington State, Colorado Vermont, Washington D.C., Hawaii, and New Jersey have all legalized physician assisted suicide.
Montana is special, thus it is a different shade than all other states. Montana law states that physician assisted suicide is legal when opted for through a court case. Therefore, it is not fully legal like the other 8 states (including D.C.)
Now, we’ll dive deeper, and find out more about one of each state where:
- The right to die is legal
- It is legal by court decision
- It its being considered whether or not to legalize the right to die
- No legislative action has taken place to legalize it
California: The Right to Die is legal
In California, the right to die by physician assisted suicide is legal. The law legalizing it was put in place on June 9th, 2016 and is still in order almost three years later. The fight to earn the right to die was a long one, and lasted over 25 years. However, California was not the first state to legalize physician assisted suicide, and hopefully will not anywhere near one of the last.
The law to legalize the right to die in California is called:
The law, officially put into place on June 9th 2016, allows for terminally ill patients to seek a doctor’s assistance in helping them relieve their suffering by death. Like explained in the introduction, Brittany Maynard lived in California before the time this law was passed, and therefore had to move to Oregon, the first state to legalize it. California’s End of Life Option Act also follows pretty suit to that of Oregon’s. For more detailed information on the specifics of the law itself, click the link above.
In a 2015 poll done by Stanford University, 72% of Californians were for a law like this. Since its passing the law has shown massive support from people and institutions like The California Medical Society and has become a Death with Dignity Statute.
Like in any law, there are certain guidelines that must be followed in order for one to excersise their right to die in California. Each individual must:
–Be an adult (18 years old or older).
-Be a California resident.
-Have a diagnosis from his/her primary physician of an incurable and irreversible disease which will, within reasonable medical judgement, result in death within six months.
-Be able to make medical decisions for themselves as determined by health professionals.
-Voluntarily request a prescription for an aid-in-dying drug without influence from others.
-Be able to self-administer (eat, drink, and swallow) the aid-in-dying drug.Sourced directly from a description of the End of Life Option Act
“End of Life Option Act in California.” Coalition for Compassionate Care of California, coalitionccc.org/tools-resources/end-of-life-option-act/.
These guidelines are put in place for each of the right to die laws. They address some of the concerns of abuse of the medication that had many physicians in question of assisted suicide.
Montana: The Right to Die is legal by court decision
While the right to die is legal in the state of Montana, it can only be accessed through a Supreme Court ruling, and is called the Montana Terminally Ill Act
The act was introduced on December 31, 2009 under the name of the Montana Terminally Ill Act. Doctors can legally prescribe a stable, 18 year old patient, a lethal medication, used in ending their own lives. The guidelines of this law are very similar to those of California’s.
A bill by the name of SB202, or the Montana Death with Dignity Act was introduced on Janurary 21st 2015, finalizing the actions of the Terminally Ill Act.
The guidelines of Montana’s Terminally Ill Act, are very similar to those of states where the process is totally legal, like California. Like California, the guidelines are modeled closely to Oregon’s. However, a patient must receive the right to die through a supreme court case. Some of the main guidelines are as follows:
-Be at least 18 years old
-Be terminally ill
-Be mentally competent
-Self-administer the prescribed medication.Sourced from a supreme court hearing of a terminally ill Montana truck driver, seeking the right to die
“End of Life Option Act in California.” Coalition for Compassionate Care of California, coalitionccc.org/tools-resources/end-of-life-option-act/.
Case Example: Robert Baxter
Robert Baxter was a 76 year-old retired Montana truck driver, who in 2007, was diagnosed with terminal lymphocytic leukemia. At the time, physician assisted suicide was not legal in Montana, but Robert was suffering and needed help. He filed a complaint, asking the state to help relieve him of his suffering. This caught the attention of Compassion and Choices, a non profit organization working towards the goal of aiding people in their end of life choices.
“On December 5, 2008, Judge Dorothy McCarter entered her Decision and Order, stating that the court found that Montana had a constitutional right to allow “a competent terminally ill patient to die with dignity.”“Baxter v. Montana.” Compassion & Choices, compassionandchoices.org/legal-advocacy/past-cases/baxter-v-montana/.https://compassionandchoices.org/legal-advocacy/past-cases/baxter-v-montana/
After this case, Montana became the third state to authorize physician assisted suicide, however, it needs to be done under the approval of a court hearing.
No real changes have been made to the current bill, but multiple efforts to criminalize death with dignity and physician assisted suicide have been made.
- 2011: Death with Dignity SB 167- prohibiting physician assisted suicide Status: not passed
- 2013: SB 220- new guidelines for death with dignity, new guidelines for who would be eligible to be treated Status: not passed
- 2015: SB 202- more guidelines, new procedures for requesting physician assisted suicide, rights to resend requests Status: not passed
- 2017: HB 536-“physician aid in dying is against public policy, and a patient’s consent to physician aid in dying is not a defense to a charge of homicide against the aiding physician.” Criminalizes physicians administering the deadly prescriptions Status: not passed, 52 to 48 vote
- 2019: HB 284- same proposed bill as 536 Status: passed through State House of Representatives Judiciary Committee (9 to 10 vote), Full Montana House of Reps (47 to 53 vote), finally shut down by State Senate (27 to 22 vote)
Connecticut: Neutral on the Right to Die
Connecticut, my home state, is one that is neutral on the Right to Die. While a few bills have been proposed to legalize it, none have been put in place as of now.
As of February 2019, Connecticut turned from opposed to neutral on issues concerning the Right to Die. However, death with dignity, physician assisted suicide and other aid in dying processes are still not completely legal in the state.
The Connecticut State Medical Society announced that it would be changing its view on assisted suicide from opposed to engaged neutral in February of 2019, claiming that:
“The CSMS is committed to protecting its members’ freedom to decide what medical aid-in-dying options to provide to patients in accordance with each physician’s personally held values, beliefs and ethical standards, including the decision whether or not to write a prescription or a lethal dose of medication, if legalized in Connecticut.”
“CSMS asserts that the medical aid-in-dying option that involve prescribing lethal doses of medication in compliance with a patient’s request, should be practiced by a duly licensed physician in conformance with the highest standards of good medical practice, if this becomes legal in Connecticut. “Sourced from CSMS February 2019 statement https://gallery.mailchimp.com/9342ca2167afd1d7acac84254/files/5cc2f8e9-f396-4f47-ad49-a61fe555cf2a/Aid_in_Dying_Policy_Final.pdf
Bills Proposed in the Past
While physician assisted suicide is not yet legal in this state, there have been multiple efforts to try and do so. Unfortunately, none of the bills shown here made it out of committee or came up for vote.
- 1995: HB 6928- A Bill for Physician Assisted Suicide
- 1995: SB 334- A Bill for Physician Assisted Suicide
- 1997: HB 6083- A Bill for Physician- Assisted Suicide
- 2013: HB 6217– An Act Concerning Death with Dignity
- 2014: HB 5326– An Act Concerning Compassionate Aid in Dying for Terminally Ill Patients
- 2015: HB 7015– An Act Concerning Aid in Dying for Terminally Ill Patients
- 2017: HB 6024– An Act Concerning Aid in Dying for Terminally Ill Patients
- 2018: HB 5417– An Act Concerning End of Life Care
- 2019: HB 5898– An Act Concerning Aid in Dying for the Terminally Ill
“HB 5898, An Act Concerning Aid in Dying for the Terminally Ill did not come up for a committee vote in the 2019 session. Connecticut residents with a terminally illness have been denied the peaceful end-of-life option the death with dignity law would have allowed. Write your Connecticut State Legislators to urge their support for death with dignity legislation!”-Death with Dignity Connecticut
“Connecticut.” Death With Dignity, www.deathwithdignity.org/states/connecticut/.
Florida: No Major Legislative Action Concerning the Right to Die
As of right now, Florida has made no major legislative action in order to legalize the right to die in the state. This has to due mostly with the medical, ethical, and religious reasons stated earlier. While it isn’t legal, most people around the country and state think it should be legalized across the map.
“Still today, Florida allows no assisted-suicide option. Although public opinion shows nearly 70 percent of Americans say terminally-ill adults should have right the right to hasten their deaths, the issue is on no political agenda here.”
Sun Sentinel Editorial Board. “Florida Should Pursue ‘Death with Dignity’.” Sun, 13 Oct. 2015, www.sun-sentinel.com/opinion/editorials/fl-editorial-death-dignity-gs1012-20151012-story.html. https://www.sun-sentinel.com/opinion/editorials/fl-editorial-death-dignity-gs1012-20151012-story.html
With one of the largest elderly populations in the United States, the issue of whether or not to legalize the right to die in this state begs to be put into question.
“As the population ages further, the problems of terminal disease will continue to rise as will the burdens of health care costs explode.”
Frank, Marshall. “Time to Allow Death with Dignity in Sunshine State.” Florida Today, Florida Today, 9 June 2017, www.floridatoday.com/story/opinion/2017/06/09/time-allow-death-dignity-sunshine-state/102560874/. https://www.floridatoday.com/story/opinion/2017/06/09/time-allow-death-dignity-sunshine-state/102560874/
While the right to die and physician assisted suicide might not be legal in this state yet, the movements for it are starting to get attention
A 30 year old case, about an elderly man named Roswell Gilbert who was forced to end his wife’s life sparked interest in the ideas. His wife Emily, had Alzheimer’s, and begged him to put her out of her misery, and with no laws or alternatives, Gilbert was forced to shoot her. He served a sentence in jail for the “crime”.
This case, along with Sun Sentinel and Florida Today articles drew attention on the issue. Many hope that Florida will consider the legalization of the right to die. If so, it will most likely follow a model or Oregon’s law, as most states legalizing this treatment have.
Conclusions: Time for a Change
The Right to Die has always been one of the greatest bioethical dilemmas of the century. Its movements and cases however, have gone almost unknown by the general public, let alone those fighting for its legalization. Nonetheless, the right to die has become a more apparent part of our society, as it is being recognized in the legislatures of the fifty United States with each day that goes by.
Like mentioned earlier, only eight of the fifty U.S. states have legalized assisted suicide. In the mind of many, even physicians, who are seemingly the main opposition of this movement, it is time for a change.
But what can we do?
Change always comes from the people. By spreading information for this movement, as well as its history and current status, we can increase awareness and hopefully gain supporters for the right to die. Along with that:
- Browse the Death with Dignity website to learn more about how you can help
- Research on the right to die laws in your state (if they weren’t already covered here)
- Reach out to your local state authorities! Get the movement recognized to help spread awareness
- Tell your friends everything you learned here
- Research further into any of the topics here that interested you
Thank you so much for reading my work, I hope you enjoyed!
Sources and Works Cited: https://docs.google.com/document/d/1flo9Q-pTO2LnkLxpvkVUAoR6mHH2u-d0s4ZtzezRWaE/edit?usp=sharing