A Free Society But Not Free to Die?
In the well known Hippocratic Oath, doctors are charged with the duty of saving lives. But when they run out of treatment options and must give their patients a terminal diagnosis, that duty gets replaced with difficult questions: Should doctors prolong the lives of their patients as much as technology allows? Should they only provide options for comfort in cases of inevitable death? Should they provide life-ending prescriptions, so that the patient can die on his or her own terms? Or, should they present all of the options listed above and allow the patient to determine the best course of action?
Twenty-nine year old Brittany Maynard captured national headlines last fall when she voluntarily chose to end her life in accordance with Oregon’s controversial “death with dignity” legislation. Maynard had moved from California to Oregon to exercise her right to end her life after she was diagnosed with terminal brain cancer that would kill her in under six months. Maynard chose to die with dignity, which has been legal under Oregon state law since 1997. An Oregonian can choose to end his or her life with prescribed medication when faced with a terminal illness that gives him or her less than six months to live. Unfortunately for Maynard, her desire to die on her own terms is not legal in her native California. She ended her life last fall, but her legacy lives on: the End of Life Option Act, which is based off of legislation in Oregon, Washington and Vermont—the three states where death with dignity is legal—recently passed through the California State Senate.
In addition to the three states where aid in dying is legal, there are two states, New Mexico and Montana, where medically assisted death can be approved by the courts. Thirteen states are currently reviewing bills supporting death with dignity rights, including the End of Life Option Act. Most all of these pieces of legislation use language based off of the Oregon bill, “Death with Dignity” because it was the pioneering state.
The death with dignity movement is often referred to as promoting the right to die; however, the legislation put forward on the issue is much more nuanced. “Right to die” is a broad term that could apply to suicide, assisted suicide and forms of euthanasia. The End of Life Option Act has very specific stipulations. To qualify, a person must be competent, request the medication directly from the physician and take it without assistance, among other requirements. Naturally growing older, for example, does not qualify someone to elect to die under this act, because of the strict parameters in place that one must be given less than six months to live. However, Maynard definitely qualifies. She was a mentally competent woman faced with the serious emotional and physical challenges of terminal illness who chose to act in the face of her illness rather than watch it overtake her. Competency is an important requirement stipulated by death with dignity legislation. A person must be deemed mentally competent in order to request the life-ending medication. Additionally, two requests must be voiced, not written, no less than fifteen days apart before documentation can be signed for verification.
Opponents of the right to die movement argue that it conflicts with doctors’ moral obligations and that suicide should not become a medical treatment. Such opponents believe that this is a “slippery slope” that might lead to abuse of the law and a higher suicide rate. However, this line of thinking disregards the nuance and spirit of the End of Life Option Act. The people who might exercise their right to aid in dying are not choosing to die. Rather, they are terminal patients faced with the knowledge that their life is nearing an end much more quickly than natural causing would have indicated because of a debilitating diagnosis and they must decide how best to address it. Additionally, data from eighteen years of Oregonian law shows that this act is rarely invoked. Even when a doctor prescribes the medication, a patient is in no way required to take it. During this time, only 752 out of over 1,300 prescription recipients actually ingested the drugs prescribed to them. This accounts for one in every five hundred total deaths in the state, the average age of which is seventy-one.
The End of Life Option Act is used so rarely because it is just one of many end-of-life care options. Whether a patient chooses hospice care, aggressive and experimental treatment, or death with dignity, the important component is that there is choice involved. Choice will empower the patient and hopefully help him or her to cope with the debilitating disease that he or she must face. This ability should be made available for all Californians facing terminal diagnoses, not just those who are fortunate enough to be able to pack up and move to another state, as Maynard did. This act ensures personal liberty for an individual to decide his or her own fate in the event of terminal illness.
The End of Life Option Act should become law in California because it opens the door to further discussion on how we as Americans treat the nature of dying. How much of individual freedom still applies when it comes to ending a life by choice? If America truly were a free society, it would embrace the opportunity to allow people to die with dignity in humane ways of their choosing. Just like freedom of religion can imply freedom from religion, right to life can also mean the choice not to live.
The image featured in this article shows Brittany Maynard months before her death. The original image can be found on Zennie Abraham's flickr page.