Death with Dignity Act

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While all adults have the right to refuse potentially life-prolonging treatments in the face of death, it is illegal in most states for them to intentionally end their lives. Death with Dignity act is based on a growing movement in the United States, which believes that a terminally ill person should have the right to decide when, where, and how his death occurs. The state of Oregon was the first to adopt a Death with Dignity Act, which legalizes physician-assisted death. To explore this concept, consider the following Death with Dignity Act definition.

Definition of Death with Dignity Act

Noun

  1. A statute that allows a mentally competent adult diagnosed with a terminal illness to remain in control during his final days, by asking for and receiving a prescription medication to hasten his death.

Origin

1997    Oregon state law

What is Death with Dignity

Individuals suffering from terminal illnesses have the right to make statements in anticipation of the time when they will no longer be able to express their wishes, for both their healthcare, and for their deaths. What they have not been able to do legally is choose to end their lives by their own acts. Physicians treating patients who are suffering at the ends of their lives must watch those patients agonize, not being legally allowed to assist them in ending their lives.

Death with Dignity Acts

The idea behind the push for Death with Dignity acts is that terminally ill individuals, or their agents, should make their end-of-life decisions. Such decisions are based on the amount of pain and suffering they are experiencing, or anticipate. Many people believe that terminally ill people should be able to receive help from their physicians in ending their lives on their own terms, by use of a prescription medication that offers a painless route.

For example:

Mara is suffering with bone and lung cancer, which originated two years ago when she had breast cancer. The treatments she has undergone have not been successful, and Mara’s doctor advises her she has only a few weeks to live. Mara wishes to choose the time and method of her death. She wishes to die before she is in even more agonizing pain, after having an opportunity to say goodbye to her family.

The state in which Mara lives has made it legal for Mara’s doctor to give her a medication that will end her life peacefully. This example of a death with dignity act gives Mara control over her death.

Death with Dignity Act States

For years, there has been a great deal of controversy over the issue of physician-assisted death. Compassionate doctors treating terminally ill patients often wished they could give them more control over the final days of their lives, enabling them to end their lives peacefully. The laws of every state did not allow for that, however, making the acts of helping someone commit suicide, or euthanasia of humans, homicide.

In 1990, the U.S. Supreme Court determined that people have the right to refuse life-saving medical treatment, and that they may designate a healthcare agent to make such decisions on their behalf. Patients may specify their end-of-life wishes in a living will, or on a “Do Not Resuscitate” form. The Court did not, however, address the issue of physician-assisted death.

The state of Oregon became the first to vote in a Death with Dignity Act, as 50 percent of the voters approved it in 1994. In this example, the Death with Dignity Act was challenged in 1997, but 60 percent of the voters ensured it remained in effect. In 2006, the U.S. Supreme Court upheld Oregon’s law, with certain built-in requirements. Since that time, only five other states have instituted Death with Dignity Acts of their own.

  1. California – End of Life Option Act signed by Gov. Jerry Brown in 2015. Requires 3 physician requests, one of which must be in writing.
  2. Montana – Rights of the Terminally Ill Act broadened by the state’s supreme court to shield doctors from prosecution for assisted suicide, as long as they have the patient’s request in writing.
  3. New Mexico – Assisted suicide ruled legal by the 2nd District Court in Albuquerque in 2014. NOTE: As of 2016, the New Mexico Court of Appeals had overturned the 2014 decision, making assisted suicide once again illegal. It is expected the case will be appealed to the state’s Supreme Court.
  4. Oregon – Death with Dignity Act requires two physician requests, at least 15 days apart, followed by a specified waiting period.
  5. Vermont – Patient Choice and Control at End of Life Act was passed by legislation in 2013. Requires three physician requests, followed by a specified waiting period.
  6. Washington – Washington Death with Dignity Act was voted in by 58 percent of the state’s voters in 2008. A series of separate requests is required, following a waiting period.

All death with dignity acts require the patient to have been diagnosed with a terminal illness, be within a certain period of time until his expected death (usually 6 months), and be of sound mind, and able to communicate clearly when the requests are made. The purpose in requiring multiple requests, made to separate doctors, is to ensure the patient has had ample opportunity to think about the decision, not making it in a rash moment of despair.

For example:

John has suffered through treatment for prostate cancer for many months, and has been told he now has only months to live. The treatments leave John terribly sick and weak, and he decides to discontinue them, and after talking with his wife, wants to end his life on his own terms. As a resident of California, John must ask his physician to assist him in ending his life. He must then discuss ending his life with two other physicians. At least one of these requests must be in writing. In this example of a Death with Dignity Act, once these requests have been documented, John’s doctor may provide him with a prescription medication that he can take when he is ready to end his life.

Support for Death with Dignity Act

The Death with Dignity National Center (“DDNC”) provides information on death with dignity for patients and their families, healthcare providers, and advocates. The DDNC promotes the belief that, “The greatest human freedom is to live and die according to our own desires and beliefs.” The group also provides links to each state’s information on death with dignity laws, as well as the required forms, for both medical providers and patients.

Physician-Assisted Death vs. Euthanasia

Many people are familiar with the concept of euthanasia, as it is commonly used to put beloved pets out of their misery, caused by disease or serious injury. Euthanasia refers to the doctor’s act of directly administering a life-ending dose of medication to cause the pet’s or person’s death. Physician-assisted death refers to situations in which a physician provides the means of death, usually in the form of a prescription medication, to the terminally ill patient. It is the patient who will self-administer the medication, not the physician.

Other important terms related to end-of-life treatments include:

  • Withholding or Withdrawing of Life-Sustaining Treatments – an individual may choose to deny life-sustaining treatments when he or she is terminally ill, and reaching the end of life. This often includes refusal of certain medications, the insertion of a feeding tube, the insertion of a breathing tube (called “intubation”), and CPR.
  • Terminal Sedation – the act of sedating a terminally ill patient to the point of unconsciousness, then allowing the patient to die as a matter of course.
  • Hastening Death through Pain Medication – many terminally patients suffer great pain at the end of their lives. Death may be hastened, and made less painful, through the administration of pain medication in a high dose, which impairs or stops the patient’s breathing. This is considered different from assisted death, justifiable because the primary intent is to relieve the patient’s suffering.

Death with Dignity Act Example in the Supreme Court

The first “right to die” case was brought to the U.S. Supreme Court in 1989, when the parents of a woman in a permanent coma were denied the right to have their daughter’s life-preserving feeding tube removed. In January 1983, Nancy Cruzan was involved in a car crash in which she was thrown out of the car, landing face-down in a ditch filled with water. She was not breathing, and had no heartbeat, when the paramedics arrived, but they resuscitated her.

Nancy remained in a coma, however, and three weeks later, doctors said she was in a persistent vegetative state, meaning she would not likely wake up. While she did not require a breathing machine, she would starve to death if not fed, so the surgeon inserted a feeding tube.  Five years later, Nancy’s parents asked the doctors to remove the feeding tube, so that their daughter could be allowed to die. The hospital refused, however, unless the parents could provide a court order.

The parents filed a motion with the state court, asking for an order to remove the feeding tube, and it was granted. This case, Cruzan v. Director of the Missouri Department of Health, which was appealed three times, became crucial in the death with dignity movement. At the trial, a close friend of Nancy’s testified, earlier in that year, that Nancy had told her that “she would not wish to continue her life unless she could live at least halfway normally.”

The trial court made its decision to grant the order, stating that the Constitution’s guarantee of every person’s “right to liberty,” which allows an individual “to refuse or direct the withholding or withdrawal of artificial death-prolonging procedures when the person has no more cognitive brain function … and there is no hope of further recovery.”

The trial judge went on to say that laws prohibiting the withholding or withdrawal of nutrition and hydration … is in violation of [the person’s] constitutional rights by depriving her of liberty without due process of law,” and “To decide otherwise that medical treatment once undertaken must be continued irrespective of its lack of success or benefit to the patient in effect gives one’s body to medical science without their consent.”

The state of Missouri appealed the decision to the state’s supreme court, which reversed the trial court’s decision, ruling that no one may refuse treatment for another person if there is not a living will, or other clear evidence of the patient’s wishes. The Cruzans appealed that decision to the U.S. Supreme Court, which heard the case in 1989.

The Death with Dignity Issue

The issue to be decided by the U.S. Supreme Court was whether the state had the right to require the Cruzans to provide “clear and convincing evidence” of their daughter’s wishes in order to remove her from life-prolonging treatment. More specifically, the Court needed to consider whether the state was violating the Due Process Clause of the Fourteenth Amendment.

The right-to-die issue deeply divided the Supreme Court, resulting in a 5-4 split decision in favor of the Missouri Department of Health’s right to require clear and convincing evidence. The Justices were so divided, that even the five of them voting in favor of the state’s right wrote separate opinions. Chief Justice Rehnquist wrote, in the majority opinion, that, while competent individuals have a right to refuse medical treatment, the matter is complex with incompetent individuals.

In a case like that of Nancy Cruzan, family members may not always make the decisions the incompetent person would have made or agreed with while still competent, and that such decisions would be irreversible. Because of this, it is reasonable for the hospital to require a higher level of evidence of the patient’s desires.

Following the Supreme Court’s ruling, the Cruzans took what evidence they could gather to the probate court, which issued an order to remove the feeding tube. Having won their right to require proof, the state department of health did not object. On December 14, 1990, nearly 8 years after her accident, Nancy Cruzan’s feeding tube was removed, and she was allowed to die naturally. This example of a death with dignity act conflict set a number of precedents in the death with dignity issue, and was the impetus for urging people to create living wills specifying their wishes in certain events, and naming an agent who could make such decisions in the event they become incompetent.

Related Legal Terms and Issues

  • Competence – Having the mental capacity to be responsible for one’s own decisions or acts.
  • Legislation – A law, or body of laws, enacted by a government.
  • Living Will – A document in which a person gives explicit instructions about medical treatment to be administered or withheld if he or she becomes terminally ill or permanently incompetent.
  • Resuscitate – To revive someone from apparent death.
  • Sound Mind – Having the capacity to think, understand, and reason for oneself.
  • Statute – A law enacted by a legislative body.