TORONTO – The death of 29-year-old Brittany Maynard, who moved to Oregon after a terminal brain cancer diagnosis to access the Death with Dignity Act, rekindled arguments surrounding doctor-assisted suicide and raised questions about how the state’s laws work.
Is it a slippery slope that could lead vulnerable people at risk of being coerced to kill themselves? One McGill professor thinks so, but a retired Canadian doctor who suffers from AIDS and associated complications says no.
“I think we’re at a point where we have sufficient evidence from other jurisdictions, both European and U.S., that say the safeguards are appropriate; we’re not going to have a slippery slope that people are going to be killed in the name of some other reason, and we know that people can make these choices if they actually want these choices available to them,” Dr. Gregory Robinson told Global News.
The U.S. jurisdictions he refers to include Montana, Vermont, Washington, New Mexico and Oregon–where Maynard moved to end her life.
So how does the state’s Death with Dignity Act work?
Oregon Public Health Officer and State Epidemiologist Dr. Katrina Hedberg said the main question is: Does the person have a terminal illness with six months or less to live? Patients also have to be at least 18 years old and residents of Oregon. Some examples of documentation include a rental agreement, a voter registration card or a driver’s licence.
“They also have to be able to make and communicate a healthcare decision. So they have to be of sound mind … And it’s up to the physicians to verify that,” said Hedberg.
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Two physicians are involved in the decision–primary and consulting–which Hedberg says are often made up of a pain specialist, oncologist or end-of-life care specialist–it depends who is willing to write the prescription for lethal medication.
Click here to see Oregon’s Death with Dignity compliance forms
Hedberg stressed the act is permissive–it’s up to the patient to find two doctors willing to participate, and it’s also the patient who administers the drug. With respect to concerns around vulnerable patients, she says Oregon data shows participants in the Act are largely white and educated–not lower-educated or minority groups that might typically be thought of as “vulnerable” in the U.S.
“So it has not played out that people feel there is any coercion or any of that,” she said. “The vast majority of these are people who are educated, white, and have cancer. And are also being treated in hospice so they do have good access to pain control.”
Over the past 16 years since the Act–which started as a citizen initiative in Oregon–was passed, Hedberg says there have been over 1,170 prescriptions written but just over 800 people who ended up using the lethal medication to die.
One concern in Canada is that physicians will become “reluctant gatekeepers” should physician-assisted suicide legislation pass. Hedberg says she doesn’t get that feeling from doctors in her state.
Robinson said if this option had existed in Canada when he was practicing, he would have been comfortable writing a prescription.
“I think there’s a point where someone can actually define that their pain medication isn’t working any longer, that the symptoms they have are uncontrollable,” he said.
“I would have honoured people’s requests. …I saw enough pain at the end of life that I would very clearly want to see someone released from their body.”
Oregon was the first U.S. state to make it legal for a doctor to prescribe a life-ending drug to a terminally ill patient of sound mind who makes the request. The patient must swallow the drug without help; it’s illegal for a doctor to administer it. The median age of those who’ve accessed the Act up to Dec. 31, 2013 is 71; only six were younger than 35.
Oregon voters approved the law in 1994, and reaffirmed it with 60 per cent of the vote in 1997.
Hedberg says regardless your position, it’s important to have a discussion with loved ones on what they want for the end of their lives.
“That’s kind of the silver lining: It’s brought death out from behind closed doors, regardless of whether or not you agree with this option.”
With files from Global News reporter Sean Mallen and The Associated Press
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