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Brittany Maynard’s suicide on Nov. 1 makes her the new face for the “death with dignity” movement. Her decision is so compelling, in part, because she was 29.
Based on case law precedent in the United States, momentum behind this movement often ends up languishing in legislation.
Oregon is one of only a few states that have “death with dignity” laws which make it legal for physicians to administer lethal doses of medications to patients who choose suicide.
Legislation legalizing physician assisted suicide might gain new steam but it will be short lived if history repeats itself. I suggest that our energies can be better directed elsewhere, like “quality of life” in lieu of a focus on death.
In 1997, the U.S. Supreme Court heard the case of Washington v. Glucksberg. This case dealt with physician assisted suicide and our Constitutional right to Due Process. Physicians and patients joined by the non-profit organization, Compassion in Dying, brought suit arguing that a Washington statute criminalizing assisted suicide was not fair.
They argued that there exists ‘a liberty interest protected by the Fourteenth Amendment which extends to a personal choice by a mentally competent, terminally ill adult to commit physician assisted suicide.’
The U.S. Supreme Court disagreed. While several fundamental rights have been recognized as protected by the Due Process Clause, legalization of assisted suicide for competent, terminally ill adults is not one of them. In fact, the Court stated that this kind of advocacy could start the state down a slippery slope leading to the practice of euthanasia.
Proponents of physician assisted suicide tried again in New York in the case of Vacco v. Quill. Now the argument was that the prohibition against physician assisted suicide violated the Equal Protection Clause of the Fourteenth Amendment. Once again, the Court disagreed.
The Massachusetts Medical Society, the liberal state in which I practice, has taken a firm stance against physician assisted suicide. They opposed a 2012 state ballot initiative - which failed to pass - that would have enabled terminally ill patients to ask their doctors to prescribe lethal drugs.
The American Medical Association takes the position that prescribing lethal drugs is 'fundamentally incompatible with the physician’s role as healer.'
There is inherent risk in passing laws that allow physician assisted suicide. There is a potential for escalating rates of elder abuse. Not to mention the fact that doctors are only human and sometimes make mistakes. Not everyone given a terminal diagnosis passes away within the estimated time they are given.
There is also a risk that someone opting for suicide might be too depressed to make a competent decision. Legislation, like the one proposed in Massachusetts, did not provide adequate safeguards to protect against these kinds of mistakes.
The answer might not be in passing laws to promote death, I would argue, but rather the answer could be in promoting healthy living. Legislation can do this by investing more in mental health services to help patients and families deal with end of life issues. Enhancing pain management options for those who are suffering (pain is a huge risk factor for suicide) will also be crucially important. Future proposed legislation should at minimum include some safeguards, such as a psychiatric assessment to determine if a patient is suffering from a treatable mental illness that is interfering with their decision-making capacity.
This very important issue is back in the spotlight. Let’s use the momentum to work together and initiate some positive changes!
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