Physician-assisted suicide is one of the most controversial yet important ethical issues related to Elder Law. It has been the topic of numerous attempted legislative acts, controversial court decisions, and heated debates held by people from all walks of life.
According to the American Medical Association’s Code of Medical Ethics, physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform a life-ending act. As with any ethical or legal debate, there are always two sides to the argument.
On one side there are those who oppose physician-assisted suicide and believe that it is against a doctor’s role as a healer. Many also believe that it would be extremely difficult, if not impossible, to control and would pose serious societal risks. This is the “slippery slope” argument. This argument claims that legalized physician-assisted suicide will increase instances of undue influence and coercion among the elderly, poor, or those who live with a disability, and ultimately lead to euthanasia. The main arguments against physician-assisted suicide are that it comes with a risk of abuse, it jeopardizes physician integrity, and it is wrong to kill.
On the other side of the debate, there are those who support the death-with-dignity movement and prefer to call it “physician-assisted death.” These individuals believe that physician-assisted death provides a dignified option for the dying to control their own end-of-life care. The main arguments for legalization include promoting patient autonomy, mercy, and providing a legal means for physicians to fulfill their obligation to relieve suffering.
Most jurisdictions in the United States have prohibited physician-assisted death either with specific statutory provisions or judicial decisions. Several methods have been used when attempting to change the law. The constitutionality of the prohibitions have been challenged by two U.S. Supreme Court cases, Washington v. Glucksberg and Vacco v. Quill. On the state level, the Montana Supreme Court interpreted its constitution to allow physician-assisted death in the Baxter v. Montana case. There have also been state referenda aimed at legalizing physician-assisted death. This method has only been successful in Oregon and Washington thus far.
In Washington v. Glucksberg, 521 U.S. 702 (1997), the Supreme Court unanimously held that the Due Process Clause did not protect a right to assistance in committing suicide. In this case, the Court feared that if it declared physician-assisted suicide a constitutionally protected right, then the Court would start down the slippery slope to voluntary, and possibly involuntary euthanasia. In Vacco v. Quill, 521 U.S. 793 (1997), the Supreme Court ruled that a New York ban on physician-assisted suicide was constitutional, and preventing doctors from assisting their patients was a legitimate state interest that was within the state’s authority to regulate. This decision established that, as a matter of law, there was no constitutional guarantee of a right to die. Although these decisions were a major roadblock for the “death with dignity movement,” they did not place a federal ban on physician-assisted death. They merely allow states to prohibit it.
States still have the right to legalize physician-assisted death as evidenced by The Oregon Death With Dignity Act (Oregon DWDA), The Washington Death with Dignity Act (Washington DWDA), and the Montana Supreme Court’s interpretation of the Montana Constitution. In Baxter v. Montana, 354 Mont. 234 (2009), the Montana Supreme Court stated that, while the state’s Constitution did not guarantee a right to physician-assisted suicide, nothing in Montana Supreme Court precedent or statutes indicate that physician aid-in-dying is against public policy. This decision was a major success for the death with dignity movement because it allowed terminally ill patients to obtain lethal prescription medication from their physicians in Montana.
In 1997, Oregon voters affirmed physician-assisted dying as a legitimate medical practice under specific conditions and with very specific guidelines. These guidelines were designed to protect patients and doctors. The referendum resulted in the Oregon DWDA, which was upheld by the Supreme Court in Gonzales v. Oregon, 546 U.S. 243 (2006).
In Washington, the Washington DWDA was passed on November 4, 2008, and went into effect on March 5, 2009. This act gives terminally ill adults who are seeking to end their life the ability to request lethal doses of medication from their physicians. As with the Oregon statute, these terminally ill patients must be state residents who have less than six months to live.
There are a number of other states that have attempted to pass laws similar to those enacted in Oregon and Washington, but have ultimately failed. It seems many voters cannot get past the slippery slope argument and still fear that legalizing physician-assisted death may ultimately result in euthanasia. While these concerns may be valid, the way in which Oregon has successfully maintained its law for more than 14 years without sliding down the slippery slope is a great example for other states.
Part II of this article will discuss the death with dignity movement’s impact on our culture and alternatives to physician-assisted death.
Please feel free to email Eric Einhart at ericjeinhart@gmail.com or post any comments or concerns you may have.
