Meaning of Death with Dignity

Death with dignity, sometimes called physician assisted suicide PAS, is a loaded topic with a controversial history. There are both proponents and opponents of death with dignity, however there are a lot of gray areas associated with the topic, which makes it difficult for some people to take a solid stance. The decision to end a life is a multi-step process, where terminally ill or afflicted people may visit a physician, lawyer, pharmacist, or social worker.

Around the world, some forms of euthanasia or assisted suicide (EAS) are legal. In Canada and Switzerland, physician-assisted death is even allowed for those without terminal illnesses. However in the US, the legality of PAS depends on which state a patient is in. As of 2016, physician-assisted suicide is legal in OR, WA, VT, CO, HI, and DC. Legally, a person can be given a prescription for a life-ending drug if they are terminally ill (6 months to live). However, even if a person desires PAS and matches the criteria, they still may not be successful, since US patients who use PAS tend to be white, well-educated, and well-insured.

The idea that PAS allows patients to die on their own terms gets tricky when you take into consideration those who are not mentally competent but had made their wishes clear when they were competent, and people who are not terminally ill but have a poor quality of life. For example, a quadriplegic who wishes to end their life cannot legally do so, as they are not terminally ill, even if they have a poor quality of life. Another example is an elderly person with dementia, who, before becoming incompetent, may have written a document stating that if they become incompetent, they wish to end their life. Such wishes cannot be fulfilled because the law only applies to currently mentally competent people; prior expression does not apply.

Michigan has an interesting history concerning PAS. Dr. Jack Kevorkian, a former UM student, got interested in PAS in 1986, when he heard about euthanasia in the Netherlands. He became famous for his “Thanatron”, a machine that allowed someone to self-administer a lethal dose of potassium chloride. In 1990, a woman who was diagnosed with Alzheimer’s asked Dr. Kavorkian to help with her suicide in a public park. The state of Michigan charged Kevorkian with assisted suicide, but the case was dismissed because there was no clear definition of what that meant. However, the next few years helped elucidate the gray areas, and in 1992, a bill was passed outlawing assisted suicide in Michigan. In 1998, Michigan legislators made assisted suicide a punishable offense, and in 1999 Dr. Kevorkian was sentenced to 25 years in prison after he let 60 minutesair one of his assisted suicides.

Here are 2 links about Dr. Kevorkian, demonstrating the mixed beliefs about physician assisted dying: https://www.nytimes.com/2007/06/05/opinion/05tue3.html

https://www.nytimes.com/2011/06/04/us/04kevorkian.html

Typically, patients approved for PAS will receive a prescription for some combination of benzodiazepines, barbiturates, and non-opioid muscle relaxants to take on their own. Proponents of the cause often see PAS as a way of easing patients’ suffering and creating autonomy, while opponents see it as unethical, sacreligious, or not the best medical alternative.

As health professionals, it is important to be educated on the topic and be able to inform our patients about the medical and legal implications of what they are asking us. Interprofessional cooperation is crucial in cases like these, and not only is it an interesting topic that I hope you enjoyed reading about, but it is also very valuable to stay well-informed on hot topics like these.

Natasha Deb, University of Michigan School of Dentistry class of 2021 & Madeleine Davies University of Michigan College of Pharmacy class of 2021.

https://advocacyfornas.weebly.com/statistics-and-figures.html

https://euthanasia.procon.org/view.resource.php?resourceID=000132&print=true

https://www.dailysignal.com/2016/02/12/according-to-oregons-numbers-heres-what-would-happen-if-assisted-suicide-was-legalized-nationwide/