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.

People Facing the Question of Euthanasia: Patients, Family and Friends, Healthcare Workers

Since the Oregon Death with Dignity Act was adopted in 1997, an increasing number of people have requested euthanasia, showing that life has become unbearable for them. However, a person who expresses the wish to die by euthanasia is not saying that he/she prefers death to life, but rather that death seems preferable to life under the actual circumstances. In order to respond to a person’s suffering, we need to understand the nature of that suffering, as they experience it. Suffering may be physical, psychological, relational, spiritual, or existential; frequently these different aspects overlap or intermingle, particularly in a serious illness. Euthanasia does not improve life—it ends it by giving death. But when the response involves listening and accepting the person in his/her present situation, it becomes possible to work together with the person to see what can be done to help reduce suffering. We can look for means of relief for the person’s individual, unique suffering, in partnership with the patient and his/her family and friends, using the resources of both medical knowledge and our shared humanity. The willingness to walk on this shared path with the sick person is in itself an affirmation of his/her human dignity.

D.C. news media coverage of the district’s Death With Dignity Act

In 2016, the District of Columbia City Council passed the Death With Dignity Act. Afterward, Congress attempted to block its implementation by first invoking Congress’s power to overturn the law and then, when unsuccessful in that effort, withhold money from the District. Previous studies examining local news media coverage of aid-in-dying legislation have identified several recurrent frames. D.C. news publications invoked those frames as well as others more specific to the District. Understanding how aid in dying and related legislation is portrayed in newspaper coverage is important as more jurisdictions consider legalization of the practice.

Author(iz)ing Death: Medical Aid-in-Dying and the Morality of Suicide

In 2017, Oregon marked the twentieth anniversary of enacting the Death with Dignity Act, allowing terminally ill, mentally competent adult patients to end their life by ingesting a lethal medication prescribed by their physician. In U.S. public discourse, medical aid-in-dying is frequently equated with the terminology and morality of suicide, much to the frustration of those who use and administer the law. This article reflects on the stakes of maintaining a distinction between a medically assisted death and the most common cultural category for self-inflicted death—suicide. It uncovers the complicated dialectic between authorship and authorization that characterizes medical assistance in dying and attendant moralities of purposive death, speaking to broader disciplinary concerns in the cultural study of death and medicine. By stressing the primacy of debilitating, life-limiting illness in an aided death and by submitting such a death to the rationale and management of institutionalized medicine, advocates carve out a form of intentional death that occupies a category of its own. The diffusion of agency onto a patient’s fatal illness, medicine, and the state—both discursively and in practice—enhances the moral and social acceptability of an assisted death, which becomes an authorized form of dying that looks very different from the socially deviant act of suicide.

Amyotrophic Lateral Sclerosis and a “Death With Dignity”

The Oregon “Death With Dignity” Act (DWD Act) allows a terminally ill patient with 6 months to live to ask a physician for medication to end their life. To receive the medication, the DWD Act requires the patient to verbally request the prescription twice 2 weeks apart as well as in writing. Patients with amyotrophic lateral sclerosis have three main barriers to using DWD: (a) the ability to communicate their informed consent as the disease progresses further, (b) the possibility of dementia which may affect their decisional capacity, and (c) given the nature and speed of amyotrophic lateral sclerosis, limited time is available for patients to self-administer the prescription and may rush the time line for the death. This article reviews the current knowledge and addresses the need for adjustments to existing law and recommendations for states considering a DWD law.