Since the Death with Dignity Act passed in Oregon in 1997, 1,545 people have been given lethal prescriptions under the act, and 991 of those patients died from them.[1] While many casual proponents of the act see Death with Dignity (DWD) as a painless, immediate end to a terminal situation, from a moral, medical, and legal perspective, the reality can sometimes be dangerously ambiguous. The time between a DWD patient’s state of unconsciousness and death can span from just one minute to over four days, leaving an uncomfortable amount of limbo time during which family members can have second thoughts and medical professionals can be held responsible for complications.[2] When an administered drug doesn’t take the intended action, what should doctors and nurses be prepared to do? Is it their duty to carry out the will of the patient or that of their family? Below are two key concerns that could reopen logistical and legal talks on this difficult topic.
Are the right drugs being used?
In Oregon, the second most commonly prescribed drug for physician-assisted suicide is pentobarbital.[3] Interestingly enough, this drug has also been used on many occasions to carry out the death penalty, and in those cases, it received much criticism.[4] Opponents of pentobarbital point to its usage on Michael Lee Wilson, who said, just before he died, that he could feel his whole body burning as the drug coursed through his veins.[5] Though such critics argue the drug is inhumane, and causes gruesome, unimaginable suffering in its victims, there has been little controversy over its use for Death with Dignity.[6] If the drug is so highly contested in the situation of death sentences, should it not be questioned as a prescription to suicide as well? Those undergoing DWD deserve to die as painlessly and easily as possible, and family members can be quick to act when they detect any sign of pain or discomfort, leading to potential anger and resentment directed in the form of prosecution.
What happens when things don’t go as planned?
For 80% of the 132 DWD deaths in Oregon last year, there is scant information on how immediate and successful the medication was; in 2015, there was only information on 27 deaths, and in four of those deaths, there were complications such as regurgitation or seizures.[7] Over the past 18 years, at least six people in Oregon have regained consciousness after ingesting medications intended to kill them.[8] These numbers may seem small, but the sample size is equally small; while complications are far from the norm, they do happen, and as DWD grows in acceptance nationwide, those complication numbers will rise. Determining the responsibility of the physicians involved if things don’t go as planned can be extremely difficult, and determining whose desires should be followed is a nightmare. Part of the problem is that such drugs are difficult to test for effectiveness – scientists can’t do clinical trials on drugs that end lives, so how people metabolize them isn’t fully understood – but an equal part of the problem is that there is no script for how to respond in such a situation. Until such a conversation happens and medications are perfected, concerns will exist.[9]
Whether you are a proponent of DWD or a skeptic, there is certainly room for growth when it comes to clarifying, legally and morally, what the responsibilities of each party are. With open discussions and further research, peace of mind is achievable for patients, families, and their physicians.
[1] Cook, Michael, “Oregon releases its 2015 ‘death with dignity’ stats,” BioEdge, Feb. 20, 2016, http://www.bioedge.org/bioethics/oregon-releases-its-2015-death-with-dignity-stats/11761
[2] Leonard, Kimberly, “Drug Used in ‘Death with Dignity’ is the Same Used in Executions,” U.S. News, Oct. 16, 2015, http://www.usnews.com/news/articles/2015/10/16/drug-shortage-creates-hurdle-for-death-with-dignity-movement
[3] Fass, Jennifer and Andrea Fass, “Physician-assisted Suicide; Ongoing Challenges for Pharmacists,” Medscape, 2011, http://www.medscape.com/viewarticle/742070_3
[4] Leonard, “Drug used in ‘Death with Dignity’”
[5] Ibid
[6] Ibid
[7] Cook, “Oregon releases”
[8] Cook, “Oregon releases”
[9] Leonard, “Drug Used in ‘Death with Dignity’”