Friday, March 6, 2009

Washington State's "Death With Dignity Act" Now in Effect

The State of Washington now permits certain medical patients to seek physician-assisted suicide. Under the law, terminally ill patients whom doctors have diagnosed as having six or fewer months to live can end their lives with a lethal dose of medication prescribed by a doctor.

The Washington law is very similar to an Oregon law, which has existed for ten years. Oregon, Washington and Montana are the only states that permit physician-assisted suicide.

No U.S. Constitutional Right to Physician-Assisted Suicide, But to Refuse Life-Sustaining Medical Treatment
While Oregon and Washington moved to permit physician-assisted suicide through legislation, in Montana, a court recently held that the right exists under the state constitution. By contrast, in the 1997 case Washington v Glucksberg, the Supreme Court held that the U.S. Constitution does not confer upon terminally ill individuals a fundamental right to physician-assisted suicide. The Court recognized that states have always criminalized suicide and assisting a suicide.

The Court also attempted to distinguish physician-assisted suicide from the rejection of life-sustaining medical treatment, which Court precedent recognizes as implicating fundamental liberty interests. Even though both of these acts can ultimately cause the patient's death, the Court held that the "active" and "passive" distinction was still relevant.

The Court argued that throughout U.S. history, the delivery of unwanted medical treatment was seen as a "battery" -- while assisting suicide was a crime. Therefore, the active/passive distinction matters in terms of deciding whether a fundamental right to physician-assisted suicide exists. The Court's fundamental rights analysis often considers whether an asserted right has received protection historically.

For more information, see: State's Hospitals Formulate Assisted-Suicide Plan


FLRN said...

End of life issues are always difficult to navigate, they are emotionally charged and choices are influenced by the layers of pain and suffering – both experienced and witnessed. The Supreme Court compromise for care with drawl and palliative care delivery is a very humane alternative.
In a world environment that espouses making choices and solutions at the speed on light, physician assisted suicide may seem like the panacea for an effective end to suffering and agony but those that support these decisions are fooling themselves and their patients. In reality the same end is achieved simply by giving up and letting go – stop hydration and nutrition and choose by closing your mouth and stop supportive medications or treatments – when these actions are taken together as palliative bundle in the face of terminal illness death soon follows and suffering ends by passive withdrawal. Done right with support and communication to the family and the patient and there is little if any need for anyone’s help to die. Why does a person need help to die?
The real issue is that the survivors - the family, the loved ones, the doctors hurt simply witnessing the death so in truth everyone has an interest in seeing the end – this then makes physician assisted suicide a group effort and moves away from the argument of self determination. The need for oral intake during end of life events has been researched extensively. Anorexia is a natural consequence of terminal illness and is seldom (if ever missed). Thus palliative care remains the strongest option. Handled correctly with advocacy care and support, palliative care is the most dignified action and has the distinction of being a shining example of a true patient driven choice to end suffering. Bringing a physician to administer an end of life injection into the mix is only an opportunity to share responsibility when there is no need. Choosing to stop literal treatment and choosing pain medication management may seem an agonizing process – but I have seen it up close and personal- in reality the time goes by all too fast it is just hard to watch and takes a special strength to support and witness. Best of all this choice – palliation - is the literal definition of self-determination.

Darren Lenard Hutchinson said...

This is a fascinating post. I have learned a lot about the palliative care option. I pretty much support assisted-suicide -- so long as it is knowingly and intentionally done with informed consent by a competent patient. But I am glad to learn about how palliative care can diminish suffering.

I still wonder though about individuals who are not in pain, etc. It's harder to justify giving them lethal doses of pain medication. A person who is paralyzed, for example -- would doctors allow him or her to refuse treatment without a lawsuit?

FLRN said...

Good question - This is where the family and friend support system comes in to play Darren!

Health care is not just about one person and his or her relationship with their doctor, health care is also about the family, the loved ones and the care givers. In your question you ask about the paralyzed patient. This is what I mean about layers of agony and suffering and the psychology of dealing with a life altering disease or injury. Paralysis is a terminal disease/ injury. Without help and support these individuals would die as they cannot toilet,turn, dress, bathe,medicate or feed themselves independently. Inducing death via a lethal dose of anything is still ending their life for them and involves a group decision - not self determination.

Even administering a "pink shot" to my cat with a terminal illness is still my-self and my vet bringing about the death of the animal. The animal had no say in the process because of communication issues - the only benefit is a swift end that serves to stop witnessed suffering, but this is administering death not care. Palliation would be to take the cat home and provide comfort and pain medication until death arrives.

The moral and ethical dilemma then becomes what can a person do or not do to control his own body? When choosing palliation over suicide, a prudent doctor or nurse would ask for a psychological evaluation to determine if the patient were depressed or has an underlying treatable mental condition. This is where the patient needs an advocate not a manager telling them what to do, rather someone acting in their interest to lay out all the options.

Sometimes the courts would have to get involved to ask questions that have not been asked and review the options that remain in dispute, and then answers again become palliation vs. the full court press. If the patient chooses, they should be allowed to stop the feeding and receive comfort.

Paralyzed patients have other issues besides pain - like elimination, feeding and self care deficits, depression, dystopia, muscle atrophy, skin break down and organ failure. Their care is wholly dependent on others - self determination dictates that they too should be able to make their own care choices. Who are we to tell them how to live or how to die? Or more importantly who are we to "assist' their death - they can do it on their own.

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