Death With Dignity: A Policy Analysis

Death with dignity is one of many titles attributed to the practice of providing a patient with terminal illness a means to die in light of extreme suffering as a result of a terminal illness. The purpose of the Oregon Death with Dignity Act is to provide individuals suffering from a terminal illness with the right to make a written request for life-ending medication to end their life in a “humane and dignified manner.” Deborah Stone’s policy goals of equity, efficiency, welfare, security, and liberty provides a framework to analyze whether a policy is doing what it says it wants to do. As such, the goal of this presentation is to apply the policy goals framework to determine if the Death with Dignity Act is accomplishing its stated goals. Applying a theory of the policy process, the Death with Dignity Act was analyzed using the most recently available data from the Oregon Health Authority. Results showed that since the Death with Dignity Act passed in 1997, 2,518 people have received prescriptions for life-ending medications, and of those, 1657 or 66% have used the medication to end their lives. Based on the data aggregated between 1997 and 2019, the Death with Dignity Act has mostly met its purpose of providing individuals with a terminal illness with the right to die on their own terms and with dignity. However, there are still several issues regarding equity, especially for low-income BIPOC populations. Implications for practice, policy and research are discussed.

The Right to Die and the Communal Body - An examination of the media influence, ethical principles and stakeholder attitudes towards assisted dying in New Zealand from a sociology in bioethics perspective

<p>This thesis is based on a sociology in bioethics approach which seeks to demonstrate that the current rhetoric being used by parties on both sides of the debate is no longer useful for the realities that people are expressing or living. In sociology, the assisted dying literature has tended to focus on the social, political, economic and cultural contexts within which it is sought, and to understand the range of definitions that are used to conceptualise a good death. Bioethics literature, on the other hand, has removed the socially situated individual from ethical discussions of assisted dying. By engaging with an idea of the communal body, interpreted as a moral community who experience intersubjective realties, this thesis provides a platform to combine these two perspectives. It seeks to examine the range of possibilities for understanding the socially situated and relationally autonomous individual requesting medically-assisted death. The debate in New Zealand surrounding the right-to-die was brought to the fore in 2015 when terminally ill Lecretia Seales took a case to the High Court. Her argument sought a clarification of the current law, which would have allowed her doctor to provide life-ending medication should her pain and suffering become unbearable. Seales’ case was unsuccessful but it, along with the following events, has succeeded in bringing attention about end-of-life choices to the New Zealand public and media. The current End of Life Choice Bill, which stands before Parliament and was proposed by Member of Parliament (MP) David Seymour of the ACT Party, will once again provide a chance for these issues to be voted on by New Zealand’s elected officials. A critical analysis of provincial New Zealand media articles, across the time periods between 2002-2005 and 2012-2015, has sought to highlight the ways the media influences public perceptions of the debate and emphasises the limited discourse available. These years represent significant periods during which events in time led the media to variably describe these deaths from murders to mercy killings. Further thematic analysis (TA) of 12 interviews undertaken with stakeholders in the field of medically-assisted dying show discrepancies between lay public knowledge and informed stakeholder views. Overall, this thesis situates the communal body within the right-to-die argument in New Zealand. The results lend themselves to support a view that the current lack of available discourse has for the most part irrevocably rendered a divide between those who campaign for change and those who do not. In this thesis, I argue that by positioning itself within a sociology in bioethics approach, the right-to-die debate in New Zealand will be afforded a clearer understanding.</p>

The Right to Die and the Communal Body - An examination of the media influence, ethical principles and stakeholder attitudes towards assisted dying in New Zealand from a sociology in bioethics perspective

<p>This thesis is based on a sociology in bioethics approach which seeks to demonstrate that the current rhetoric being used by parties on both sides of the debate is no longer useful for the realities that people are expressing or living. In sociology, the assisted dying literature has tended to focus on the social, political, economic and cultural contexts within which it is sought, and to understand the range of definitions that are used to conceptualise a good death. Bioethics literature, on the other hand, has removed the socially situated individual from ethical discussions of assisted dying. By engaging with an idea of the communal body, interpreted as a moral community who experience intersubjective realties, this thesis provides a platform to combine these two perspectives. It seeks to examine the range of possibilities for understanding the socially situated and relationally autonomous individual requesting medically-assisted death. The debate in New Zealand surrounding the right-to-die was brought to the fore in 2015 when terminally ill Lecretia Seales took a case to the High Court. Her argument sought a clarification of the current law, which would have allowed her doctor to provide life-ending medication should her pain and suffering become unbearable. Seales’ case was unsuccessful but it, along with the following events, has succeeded in bringing attention about end-of-life choices to the New Zealand public and media. The current End of Life Choice Bill, which stands before Parliament and was proposed by Member of Parliament (MP) David Seymour of the ACT Party, will once again provide a chance for these issues to be voted on by New Zealand’s elected officials. A critical analysis of provincial New Zealand media articles, across the time periods between 2002-2005 and 2012-2015, has sought to highlight the ways the media influences public perceptions of the debate and emphasises the limited discourse available. These years represent significant periods during which events in time led the media to variably describe these deaths from murders to mercy killings. Further thematic analysis (TA) of 12 interviews undertaken with stakeholders in the field of medically-assisted dying show discrepancies between lay public knowledge and informed stakeholder views. Overall, this thesis situates the communal body within the right-to-die argument in New Zealand. The results lend themselves to support a view that the current lack of available discourse has for the most part irrevocably rendered a divide between those who campaign for change and those who do not. In this thesis, I argue that by positioning itself within a sociology in bioethics approach, the right-to-die debate in New Zealand will be afforded a clearer understanding.</p>

Euthanasia under French law

Under criminal law, euthanasia can have two distinct qualifications: that of homicide in the event that the act of directly killing another person is characterized, or that of assisting a third party in the suicide. These two qualifications are applicable on the condition that the agent — the author of the act of causing death — is not the one who went through it. In fact, selfeuthanasia is nothing more than suicide.In addition to euthanasia imposed to a third party (such as in the case of Malevre, nurse from Mantes-la-Jolie, tried in 2003), the euthanasia requested and subscribed constitutes a complex legal question. Answering this question first involves specifying the position of contemporary criminal law in the face of suicide.In the event that suicide is only decriminalized, in fact, the author of the act — regardless of the outcome of his actions, who is himself the victim, cannot be prosecuted. Nor ultimately receive any condemnation.However, this lack of prosecution and conviction is by no means an endorsement of the act — suicide — by the law.Moreover, in the event that suicide is a right, it would then be necessary to agree that any candidate for this act can request assistance in the accomplishment of his death. Given these two opposing approaches, imposed on us the question of whether there is a right to die.Although the euthanasia imposed is unequivocally under ordinary criminal law, the euthanasia requested and granted is not based on any rights. To date, there is no right to approve a death request, but on the other hand, it does allow it to be respected and to some extent promotes its approach with dignity. This work will focus on two central points which are the possibility that euthanasia is a homicide under common law (I) and the attitude of French law concerning the right to death (II).

Deconstruction of Discernment in Child Euthanasia

Belgian law on child euthanasia uses the concept of discernment to bestow the right to die to minors. Jacques Derrida’s deconstruction of oppositional logic grasps the ambiguity of this use of discernment and generally challenges the alleged force of a textual sign meaningfully to differentiate itself from its different and meaningless else. This alleged ability to discern the presence of discernment impinges the truth-value of the distinction between worthy/unworthy lives. The resulting undecidability morally suggests the respect for otherness and promotes the moral value of the suspension of arbitrary judgment (epokhē) and, in so doing, de facto converges towards the praxis of the doctrine of the sanctity of life that embraces the ‘life is always quality’ argument.

IS THE RIGHT TO DIE WITH DIGNITY CONSTITUTIONALLY GUARANTEED? BAXTER V MONTANA* AND OTHER DEVELOPMENTS IN PATIENT AUTONOMY AND PHYSICIAN ASSISTED SUICIDE

This article examines the question of whether the right to life encompasses the right to die with dignity. It looks at the concepts of autonomy and paternalism as they exist as major themes on either side of the debate. Physician Assisted Suicide (Voluntary Euthanasia) has come under the spotlight in several jurisdictions, not just our own. Most recently in Montana, USA, the issue came before the Supreme Court for deliberation. The states of Washington and Oregon have legislations specific to PAS, legitimizing assisted suicide and removing wrongfulness from the actions of a physician who assists in the prescribed manner. Montana does not have specific legislation, but instead relied on the clauses of its Constitution, and it was held that the right to die with dignity is constitutionally guaranteed in that state. Here, argument is made suggesting that the right to die with dignity, in other words, to seek and easy passing through PAS, is also guaranteed in our Constitution.

Right to Try and Physician Assisted Suicide: Similar or Different?

"In the last few years, the debate whether terminally ill patients should have access to experimental treatments without governmental supervision has intensified. The so-called “Right-to-Try” (RTT) doctrine has become popular especially in the United States, where the federal parliament passed a bill allowing such practices. As many other policies concerning patients’ autonomy in end-of-life circumstances, the appropriateness of RTT has often been challenged. In this context, some authors recently put forward the argument that states where it is allowed to request physician assisted suicide (PAS) should also necessarily recognize a RTT. In the authors’ own words: “if states can give a terminally ill patient the right to die using medications with 100% probability of being unsafe and ineffective against his/her disease [i.e. the substances used for PAS], they should also be able to grant terminally ill patients a right to try medications with less than 100% probability of being unsafe and ineffective [i.e. ET]”. In this contribution, I will question this argument by underlying three flaws in the authors’ comparison of RTT and PAS. First, there is a fundamental distinction in the nature of the choices between the two situations concerning the (un)certainty of their outcomes. Second, the number of actors (and their potential conflicting interests) involved in these two situations is different. Third, the authors’ understanding of the object of patients’ rights in PAS is partially incorrect. I will conclude by arguing that, although reasons might exist to support RTT, such comparison with PAS is not one of them. "