On Death With Dignity

The widely publicized physician-assisted death of Brittany Maynard has resulted in California reconsidering legislation that would permit physician-assisted death in this state.

Ms. Maynard was a 29 year old graduate student who had recently married before being diagnosed with inoperable brain cancer.  As her pain and seizures worsened, she moved from California to Oregon to be able to legally be prescribed medication to use for her death.  She took the medication after a last walk in the woods with her family and friends, and died painlessly and peacefully (and legally) half an hour later.

Oregon, Washington and Vermont legally allow physician-assisted death; New Mexico and Montana have court rulings that allow the practice.

Oregon legalized this practice first, 17 years ago.  This is not a quick or simple procedure.  In order to legally be prescribed a lethal dose of medication,

• You have to be at least 18 years old,
• you have to be diagnosed with a fatal illness,
• your must be felt to have less than 6 months to live,
• you must be able to take the medication yourself,
• you have to have the mental capacity to understand the diagnosis,
• you must make the choice freely and without coercion,
• the fatal illness must be agreed upon by two physicians,
• psychiatric evaluation must be obtained if mental competency is in question,
• two oral requests must be made at least 10 days apart,
• a written request must also be made, and signed by two witnesses,
• the request may be rescinded at any time, and 
• tampering with the request is a felony.
• Physicians and patients are legally protected.

Like I said, not fast and loose.  These safeguards are in place to balance the desires of terminally ill patients to be able to choose to die comfortably with assuring that lethal doses of medications are not used in a hasty or ill-considered fashion.

In the past 17 years in Oregon,

• There have been zero incidents of abuse.
•  Out of 25 people requesting medication, 1 person receives it.
• 1,200 prescriptions have been written in 17 years.
• 752 of these patients took the medication and died.
• 92% of patients who used medication died at home, most with hospice involvement.

At this point, about 66% of Californians support such a law for California, and also 54% of doctors.

For what it's worth, I am one of those doctors and one of those Californians.  I was a medical intern and resident in Washington where physician-assisted death is a legal practice.  (No, I was never asked for any medication for this purpose.)  I was aware of the procedures around it which were similar to Oregon's.  I also recall that no physician was required to participate, nor was any patient: it was up to the individual doctor and the individual patient.  Certainly, it would have been impossible to legally obtain medication for the purpose of "euthanizing" elderly or disabled people.

The California legislature has an End of Life Option Act before it.  It is similar to Oregon's Death With Dignity Act  insofar as it would require that a patient be a mentally competent adult with a fatal illness and a life expectancy of less than six months diagnosed by two doctors.  It would also require two oral and one written request at least 15 days apart co-witnessed by two other people.

Also, this Act would require doctors to discuss other treatments such as pain medication or hospice care.  Furthermore, the Act exempts Catholic hospitals and allows doctors, pharmacists and other providers to opt out.

In much the same respect that terminally ill patients have every right to pursue vigorous treatment even if odds are not in their favor, I think patients should also be able to have control over the time and means of their death if they wish  to do so.  In my experience, patients do not fear dying so much as they fear dying in pain or dying alone.