Death with Dignity as an End-of-Life Option
WHAT IS DEATH WITH DIGNITY AS AN END-OF-LIFE OPTION?
Death with dignity is an end-of-life option that allows certain terminally ill people to voluntarily and legally request and receive a prescription medication from their physician to hasten their death in a peaceful, humane, and dignified manner.
Death with dignity is governed by state legislation.
WHAT ARE SOME OTHER TERMS USED TO REFER TO DEATH WITH DIGNITY?
Death with dignity is a term originating in the title of the Oregon statute governing the prescribing of life-ending medications to eligible terminally ill people; because our founders authored the Oregon law, our family of organizations bears its name and it’s our preferred term for the practice.
Other terms include
- physician-assisted death
- physician-assisted dying
- physician-hastened death/dying
- aid in dying
- physician aid in dying
- medical aid in dying
Incorrect and inaccurate terms that opponents of physician-assisted dying use in order to mislead the public include:
- assisted suicide
- doctor-assisted suicide
- physician-assisted suicide
- (active) euthanasia
HOW CAN I USE A DEATH WITH DIGNITY LAW?
A legal prescription for life-ending medications in only available in states with death with dignity laws.
Physician-assisted dying is also legal in Montana by way of a 2009 State Supreme Court ruling.
To qualify under death with dignity statutes, you must be
- an adult resident of a state where such a law is in effect (CA, CO, HI, ME, NJ, OR, VT, WA + DC);
- mentally competent, i.e. capable of making and communicating your healthcare decisions;
- diagnosed with a terminal illness that will lead to death within six months, as confirmed by two physicians; and
- capable of self-administering and ingesting medications without assistance.
The process entails two oral requests, one written request, waiting periods, and other requirements.
SHOULD I TELL MY FAMILY I WANT TO USE THE OPTION?
Every family is different, and many families have had strained relations. However, even if there has been little communication for years, the months or weeks before death is a time when many people attempt to open up to each other. It is amazing how many families reestablish communication and offer support.
It is truly in the best interest of those who will be left behind that you tell your family what you are planning, and give them the option to accept or reject it, or to work out personal past differences. This helps those family members cope better after you die, as they have some good, positive memories.
Even if your family cannot support you in what you are choosing to do, by starting the dialogue you have at least given them the chance to understand and grow. And most families rise to the occasion by providing help, support, and understanding.
However, if after thought and consideration, you still feel strongly that telling your family would not be helpful, we encourage you to discuss this with a neutral third party like a friend, a religious counselor, or a social worker.
HOW CAN I FIND A DOCTOR IN CALIFORNIA, COLORADO, DISTRICT OF COLUMBIA, HAWAII, MAINE, MONTANA, NEW JERSEY, OREGON, VERMONT, OR WASHINGTON WHO WILL PRESCRIBE LIFE-ENDING MEDICATIONS?
There are no lists of physicians who participate in physician-assisted dying laws, for both confidentiality and safety reasons. Doctor participation in the law is strictly voluntary.
You are more likely to find a participating physician in a non-faith-based hospital and in larger cities. End of Life Washington has compiled information about which activities each hospital in the state permits or restricts when a patient asks for assistance using their Act.
To find out if your doctor is willing to participate in the law, make an appointment with him or her to discuss your end-of-life goals and concerns, including the option available under the state’s death with dignity law. Ask any kind of doctor: your hospice doctor, or your oncologist, or pulmonologist, or neurologist, or even your dermatologist or psychiatrist. Any physician licensed to practice in a “death with dignity state” is allowed to participate if s/he agrees; the law also says every physician has the choice not to participate.
If the first physician says yes, ask them for a referral to another doctor who will participate or ask another of your (probably many) doctors if they will participate. Both physicians need to certify that you meet the criteria under the law. The first physician will be your attending physician for the law. He or she will guide you through all the requirements of the law and, if you qualify, will write the life-ending medication prescription for you. The second certifying doctor will be the consulting physician under the law who has to certify all the criteria under the law have been met.
Nurse practitioners and physician assistants, while they can treat your basic disease, are not allowed to act as licensed physicians for the law.
WHERE CAN I TAKE THE MEDICATION?
Place of Your Choosing
You can take (self-administer and ingest) the medications at a place of your choosing. Most people (92 percent in Oregon) choose to take the medications at home; those who reside in assisted-living or nursing home facilities tend to take them there.
The aid-in-dying laws required your physician to advise you not to take the medication in a public place.
The laws also stipulate consequences for taking the medication in a public place by allowing governmental entities that incur resulting costs to recoup them from your estate. For example, California’s End of Life Option Act states that:
443.21. Any governmental entity that incurs costs resulting from a qualified individual terminating his or her life pursuant to the provisions of this part in a public place shall have a claim against the estate of the qualified individual to recover those costs and reasonable attorney fees related to enforcing the claim.
An additional issue is the need for a funeral home to be able to reach the area so as to remove your remains; most funeral homes refuse to do so in a public place.
If you take a dose prescribed under a death with dignity law outside the state where you obtained it, you may lose the legal protections afforded by the law in question. For example, your death may be ruled a suicide under another state’s law, with resulting effects on your insurance policies.