Should someone with terminal illness, chronic pain or an otherwise severely compromised quality of life have the right to choose the time of his or her own death? How should they decide? Who should help them? How should they do it? These difficult and very real questions arise from one of the most controversial issues in the end-of-life discussion: assisted dying. Though many organizations have their own particular terms for this procedure, the basic premise is the same. A physician prescribes for a patient with severe terminal illness a dose of medication that will “hasten” the dying process.
Although assisted dying sounds like assisted suicide or euthanasia, those who support assisted dying are quick to point out some crucial differences. Assisted suicide suggests that someone actively helps another in the act of suicide. Many advocates for assisted dying see assisted suicide as a crime akin to 2nd degree murder. Euthanasia refers to the merciful ending of a person’s life in order to save the person from excruciating pain and misery. The doctor or someone besides the patient administers the medication. In assisted dying, however, the doctor only supplies the prescription, and the patient administers the medication on his or her own. Indeed, one of the central requirements for assisted dying is that they must be able to take the medication themselves.
And this is only one of many more steps, requirements and restrictions involved in the assisted dying process. First, it’s purely a states’ rights issue, and right now only 3 states – Oregon, Washington and Vermont – have fully legalized assisted dying and all very recently. Oregon was the first in 1994. Montana passed legislation that protects doctors who are prosecuted for assisted dying. Just last January, New Mexico ruled that doctors can help with assisted dying, but this law is still fresh and open to appeal. Second, even if the patient lives in one of these states, he or she must fill some very specific criteria in order to qualify for assisted dying. To name a few, he or she must have a sound mind and terminal illness that will end his or her life within six months. Two doctors have to approve the prescription, and the patient must request the prescription twice with 15 days between each request. Rightfully so, assisted dying is by no means a casual process.
So how did such a difficult, complicated topic start to gain momentum? In the US, there are three primary organizations spearheading the movement, but the one that got it off the ground was Death with Dignity. It was their legislative model that led to the Oregon Death with Dignity Act, which was passed in 1994 and enacted in 1997, and they also influenced the laws passed in Washington and Vermont. Since 1994, there have been 1,050 DWDA prescriptions and 673 deaths. As seen in their results, their work focuses mostly on large-scale, governmental change. Aside from assisted dying, they also use the terms “physician-assisted dying” and “death with dignity” interchangeably. They do not consider it suicide because it involves hastening the end of a life that is already known to be ending soon; whereas suicide suggests ending a life before having any idea of when it will naturally end.
Another influential organization promoting assisted dying is Compassion and Choice. With 40,000 members and 25 chapters nationwide, they are the largest of the three primary organizations. Similar to Death with Dignity, Compassion and Choice works to effect large-scale political change, but their services go far beyond the courtroom. They offer free advance directive counseling, planning resources, referrals and other end-of-life related information to the general public. Although they advocate for assisted dying, it is only one among the many issues they approach.
And then there’s Final Exit Network. The most radical of these organizations, Final Exit is run completely by volunteers and works well outside of the government. In fact, on two separate occasions, a few members have been convicted of assisted suicide. (The charges all fell through and they were acquitted.) It’s not that they’re a bunch of outlaws — they simply focus on lending support to individual people who are dying rather than on politicians, and they don’t seem to pay as much attention to state laws or lines. They are the only organization that doesn’t require their patients to have a terminal illness, and by referring to assisted dying as “self-deliverance,” they wield the strongest, most controversial language. Their services, moreover, are particularly striking. If a patient passes Final Exit’s criteria, they are assigned an Exit Guide who helps them set up a timeline, tell them what method Final Exit recommends, what to get and how to conduct the “self-deliverance.”
Final Exit Network epitomizes the controversial aspect of the entire assisted dying movement. The questions they raise on our right to administer our own deaths or facilitate others’ may alarm some people while giving others hope. Nevertheless, they suggest that, no matter how our opinions on the subject fall, the conversation on death is opening up across the nation. Whether radical or not, we must face the issue as it enters our homes and courtrooms, our lives and those of our parents and grandparents. Perhaps assisted dying is only the beginning.
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