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Assisted Suicide/Right to Die (Medical Aid in Dying)

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There are three ways to help a person die: a negotiated death, assisted suicide (aid in dying) and euthanasia.

There are three ways to help a person die: a negotiated death, assisted suicide (aid in dying) and euthanasia.

A NEGOTIATED DEATH (sometimes referred to as "Letting go")

The American Hospital Association has estimated that 70% of the daily deaths in the U.S. are somewhat timed or negotiated. In these situations, all concerned parties (including the patient, the patient's immediate family and the doctor) privately agree about withdrawal of some death-delaying technology or not even starting it in the first place. A negotiated death can also involve an increase in dosage of morphine or similar drug knowing that it is likely to hasten death. Increasing the dosage to relieve pain is legal. Increasing the dose to hasten death is not. 

When Hannah was filled with cancer and in excruciating pain, likely to die within the next few days but also possibly having to endure the pain for weeks, she managed to say to her doctor: "Please increase the dosage of my morphine."  Her doctor responded: "But that is likely to cause you to die." She reponded: "I understand." They held each other's eyes for what seemed to be an interminable period of time. Finally he said, "Okay." Her death was attributed to the cancer.

Letting go can also occur with no outside assistance. For instance:

  • A patient can voluntarily refuse food and fluids. 
  • A peson who is your health care proxy can request withdrawal of food and fluid for a patient unable to speak for him or herself.

ASSISTED SUICIDE/ AID IN DYING

Assisted Suicide or Aid In Dying are the terms generally used when a doctor or other medical professional provides the means for a patient to end his or her own life. It is the patient, not the doctor, who actually ends life. For instance, a doctor gives a patient a prescription for an amount and type of drug that will cause death. Assisted suicide is only legal in a few states. Assisted suicide is also legal in a few countries in Europe. 

States in which assisted suicide is legal

  • California: The law requires:   
    • Two doctors must determine that a patient has six months or less to live. 
    • Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.
    • Patients must submit several written requests.
    • One of the meetings with doctors must be private, with only the patient and the physician present. That requirement is apparently aimed at ensuring the patient is acting independently. 
    • Patients must reaffirm in writing that they intend to take the medication within 48 hours.
  • Colorado
    • Law only applies to Colorado residents
    • The patient's doctor must certify that the patient has a terminal condition with six months or less to live, that the person has mental capacity and that the person voluntarily asked for a prescription for medical aid-in-dying medication
    • The person must orally ask for the assistance two times, separated by at least 15 days. There must also be a valid written request to the patient's attending physician.  There are specific rules about what the request must contain and how it is to be executed.
    • The right to aid-in-dying medication does not extend to aging or disability.
    • Patients are required to make informed decisions.
  • District of Columbia: Assisted suicide is legal
  • Montana:  In Montana, there is a law against assisted suicide. However, thanks to a court decision in the case of Baxter vs. Montana, physicians are protected against prosecution. Many commentators read this decision to mean that assisted suicide is legal in Montana.  Technically it is not. However, doctors who do agree to help can use the Baxter case as a defense against prosecution. In any event, as with all physician aid in dying, the patient – not the physician – commits the final death-causing act by self-administering a lethal dose of medicine.
  • New Mexico.  In 2014, the New Mexico Supreme Court authorized doctors to provide lethal prescriptions and declared a constitutional right for “a competent, terminally ill patient to choose aid in dying.” The case has since been reversed. Physician assiseted dying is not legal in New Mexico.
  • Oregon
    • Two doctors must certify that the person is at the end of life before a doctor is permitted to prescribe a lethal dose of medication. 
    • The person must be a resident of Oregon, but there is no minimum residency requirement.  It is up to the physician to determine whether the person is a resident or not. Some documents which have been used to prove residency include a drivers license or a lease.
    • Once the requirements are met, the drug must be self-administered.
    • A  copy of the law is located at: http://egov.oregon.gov/DHS/ph/pas/ors.shtml offsite link.
  • Vermont
    • Doctors are permitted to prescribe a lethal dose of medication which a patient can then take him or herself, provided the patient is certified to be within six months of the end of life.
    • Patients must make 3 requests for death inducing drugs.
  • Washington
    • Any patient asking for a lethal prescription must be a resident of the state, be at least 18 years old, declared mentally competent to make the request, and two doctors have to certify that he or she has six months or less to live. The two doctors are the patient's primary physician and a consulting doctor.
    • The patient must be mentally capable of making an informed decision.
    • The patient's make the request in writing (witnessed by two people). The request must be made twice, with a period of at least 15 days in between the two requests. This is referred to in Washington as the  "15 day waiting period".

NOTE:

  • State opt-out provisions allow any individual or institution to decline to provide prescriptions. Because of this, it may require effort to locate a doctor willing to prescribe drugs and a pharmacy that is willing to dispense them.
  • With respect to payment:
    • Some private insurers pay for the necessary doctors' visits and drugs.
    • Medicare and the department of Veterans Affairs do not cover these costs.
    • For people who receive Medicaid:  Some states such as California and Oregon have agreed to cover the costs for people who receive Medicaid Other states do not. 

Europe

  • Belgium, and the Netherlands: In Belgium and the Netherlands, two medical doctors must be involved. If there are any doubts about the patient's competence, a psychologist must also be involved.
  • Switzerland: There is no stipulation that doctors have to be involved. However, assisted suicide in Switzerland is usually carried out under the rules of right-to-die societies such as Dignitias, a right-to-die organization based in Zurich.  The right-to-die societies insist that at least one doctor be in attendance and certify the existence of a hopeless or terminal condition before handing out the lethal drugs. Dignitas accepts foreigners if appointments are made ahead of time. To learn more, contact Dignatas at dignatas@dignatas.ch, Tel.: 41.44.9804459 or see: www.dignitas.ch/ offsite link. The German text can be translated at Google Translate:: http://translate.google.com/translate_t# offsite link#

EUTHANASIA

Euthanasia is when one person takes action to end the life of a second person at the request of the second person. Euthanasia is illegal in all 50 states. Euthanasia is legal in a few countries in Europe such as the Netherlands, Belgium and Luxembourg.

For additional information about ending life, contact Compassion & Choices, offsite link or speak with a counselor at 800.247.7421 

NOTE:

  • Ending your life yourself, even with the help of a book or an organization, is known as suicide (as contrasted to assisted suicide.) For information about suicide, including why not to do it, how to get help through depression, as well as how to do it, click here. 
  • We are not aware of any prosecutions that have been brought in the U.S. against people who help a person make travel arrangements to go to a country where assisted suicide is legal. In theory, the person who helps make the arrangements is assisting in suicide. If such a case is brought, it may be difficult to find a jury to convict. However, there is the risk. If this is a concern, speak with an experienced lawyer.

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