The Legalities Here and Abroad
The Oregon law allows terminally ill residents to end their lives through the voluntary self-administration of lethal medications prescribed by a physician. Under this law, only an adult Oregonian who’s been diagnosed with a terminal illness that will undoubtedly cause death within six months may request—in writing—a prescription for a lethal medication. Any physician, pharmacist, or healthcare provider who isn’t comfortable being part of this process may legally refuse to participate.
The Oregon law requires that the request to “hasten one’s death” (the phrasing of choice for most advocacy organizations) must be confirmed by two witnesses, at least one of whom isn’t the patient’s physician or relative. Afterward, a physician must validate the medical diagnosis and examine the patient for any possible mental health issues. If there’s any question about the patient’s mental condition, he or she must undergo a psychological exam to ensure that there’s not impairment of judgment. After the request is approved, the patient must wait at least 15 days before making a second, oral request, and the right to withdraw the request at any time is available. The entire process is set up to ensure that unwilling people aren’t being pressured to end their lives for any reason.
One of the arguments against legalizing physician-assisted suicide in America is the “slippery slope.” Many opponents fear that if hastening one’s death becomes legal in more areas and less stigmatized among the general population, people will go too far, persuading some to take the step who might not really want to, or helping others die who aren’t terminally ill. But Dincin counters the slippery-slope argument by insisting that there’s an innate drive in every human to stay alive. He agrees, however, that it’s important to be meticulous about evaluating the physical and mental health of prospective assisted-suicide patients.
Since Oregon’s law was passed, death-with-dignity legislation has been introduced regularly in other states, including Washington and Montana, which enacted such laws in 2009. Vermont may be next, as legislation is being brought up for consideration in the state House of Representatives this fall.
Internationally, similar legislation has been considered in many countries and has succeeded in such places as Switzerland, Colombia, Albania, The Netherlands, Belgium, and Luxembourg. Each nation has its own rules and procedures, but all except Switzerland forbid visiting foreigners from receiving help in hastening their deaths. The World Federation of Right to Die Societies website lists 45 members drawn from 26 countries, underscoring the broad-based support for this idea all over the world.
Only physicians are allowed to help people die in Belgium and The Netherlands. In Switzerland, which has the most liberal legislation, nonphysicians, including right-to-die societies such as EXIT, the largest such group in the country, can provide assistance. The only requirements for hastening death in Switzerland are a poor medical prognosis, unbearable pain or unsustainable impairment, and the patient’s full discretion (mental competency).
In America, the Final Exit Network—comprised of volunteers from all over the country—is one of dozens of organizations that advocate for right-to-die laws, but it’s unique because it doesn’t take on the political or legislative side of the battle. It exists simply to support people and help individuals through the process of deciding whether hastening their death is right for them. Patients seek out the Final Exit Network (the organization never seeks out patients) and explain why they’re interested in taking their own life. They’re required to send medical records that verify that they have the terminal illness they claim to have. The organization has a panel of physicians who review the records, and ultimately turn down many people. For patients to receive assistance, they must be extremely ill with an irreversible and fatal disease.
Once a patient is accepted, the organization sends a trained volunteer to the house to ensure the patient’s competency. If there’s any question at all about the patient’s mental state, the organization sends one of its affiliated psychologists for further evaluation. Once competency is proven, the volunteers discuss with the patient the specific method the organization recommends for a quick, painless, and certain end—the method they consider most dignified. The organization never directly intercedes on a patient’s behalf. “We don’t assist in ‘assisted suicide.’ We don’t even use the word. We call it ‘hastening your end,’” Dincin explains. A volunteer will be present, however, if the patient wishes that someone from the organization be there at the moment of death—a request that’s often made.
The approach in Oregon, Washington, and Montana differs by allowing assisted suicide. In these states, two doctors independently certify that a patient has an illness that’ll certainly lead to death within six months, and then provide a prescription for a lethal drug that the patient self-administers; neither doctor is present when the patient takes the drug. Dincin takes issue with the six-month requirement because there are some illnesses in which it’s impossible to determine with certainty whether the patient will die in a few months’ time; some neurological, extremely painful illnesses—ALS, Huntington’s disease, Alzheimer’s—persist over a long period.
Of course, individuals with Alzheimer’s pose a complicated problem because those in the later stages lose mental competency. Dincin believes that, in the future, people should be able to have advanced directives regarding terminal illnesses, which would indicate that if they reach a certain stage in their mental competency, and if they don’t want to live anymore, hastening their deaths would be legally undertaken. But for now, the Final Exit Network considers helping only individuals in the early stages of Alzheimer’s.
“We see hastening death as a trend that’ll gradually—very, very gradually—move through the U.S. state by state, but it’ll take decades, if ever, before it becomes the usual practice,” Dincin says. That’s why the Final Exit Network concentrates on helping terminally ill individuals, rather than working toward changing the law.