Medically Assisted Death

There are limits to palliative care. Even under hospice, where one would assume excellent palliative care, there are those who spend their last months in uncontrolled pain. And, this unbearable suffering, despite our best efforts, leads to requests by patients to end their life prematurely. Physician-assisted suicide, or perhaps more accurately physician-assisted dying or medical aid in dying, allows the terminally ill to end their lives through the voluntary self-administration of a lethal dose of medication expressly prescribed by a physician for that purpose. U.S. public opinion has shifted towards greater acceptance of the process. By 2017, fully two-thirds of U.S. adults support legalizing the practice, though in that same year, dozens of states reviewed and rejected legalization. A similar percentage of terminally-ill patients support it, though only about one in nine seriously considered requesting it for themselves.

Geriatrics physicians are split, with 47 percent supporting and 52 percent opposing the practice. Of 150 professional medical societies, not a single one has come out in favor of medical aid in dying. Only 12 took any sort of position, mostly in opposition, like the American Medical Association, though some, including the American Academy of Hospice and Palliative Medicine, took an official neutral position. At the time I write this, physician-assisted suicide is only legal in nine states plus the District of Columbia: California, Colorado, Hawaii, Maine, Oregon, Vermont, and Washington, plus New Jersey in 2019 and New Mexico in 2021. After, or pending legalization, most of the affected state medical societies adopted a neutral position.

Second only to Switzerland, the first state to legalize was Oregon, with its Death With Dignity Act passed by ballot initiative in 1994 (though it didn’t go into effect until an injunction against it was overturned in 1997). It was upheld by the U.S. Supreme Court in 2006, after which other state bills began to be introduced. In the few decades since it’s been active, about 3,000 terminally-ill Oregonians have received such prescriptions, though only about 2,000 decided to go through with it. (Nine patients regained consciousness after ingestion.) More recently, that proportion has flipped, with only about one-third of those afforded the option ended up using it to end their lives, supporting the premise that much of the value to patients may just lie in having the choice.

In Oregon, the Death With Dignity Act now accounts for about 1 in 200 deaths in Oregon, similar to physician assisted suicide rates in some European countries that have legalized it. Medical aid in dying is now legal in Belgium, Luxembourg, the Netherlands, and Switzerland, along with Canada, Colombia, and one state in Australia (Victoria). In some countries, that aid is more direct than others. In Belgium and the Netherlands, euthanasia is legal, where the physician can actively administer the lethal medication to someone seeking to end their life due to unbearable, incurable suffering. Death by euthanasia now accounts for about 1 in 25 deaths in those countries.

Euthanasia is illegal everywhere in the United States. In 40 states, any physician aid in dying is illegal and punishable by law. In Montana, the state supreme court effectively decriminalized it, and a 2021 bill to remove it as a defense against charging prescribing doctors with homicide failed in the Montana Senate with a vote of 25 to 25. In contrast, V.S.E.D. is legal throughout the U.S.: voluntarily stopping eating and drinking, which I detail in a series of videos starting with How to Die a Good Death.