Death with dignity

Bob Hatcher

June 1, 2015, June 26, 2015

          Physicians have been helping people to die with dignity by acts of omission or commission for centuries.

          This week’s New England Journal of Medicine describes a new law in Canada legalizing physician-assisted dying in Canada. This is the first law among countries with common-law systems in which law is often developed by judges through case decisions and precedent.  Strikingly the decision was unanimous with all 9 judges of the Supreme Court of Canada agreeing without dissent.

          After this decision became public fully 78% of Canadians polled agreed with the decision.  60% strongly so. And only 9% strongly opposed. Just before the decision the Canadian Medical Association dropped its opposition to physicians aiding in death. 

          What are the ways in which a physician may assist a fully competent person who wants help dying?   Generally interventions are categorized as acts of omission (such as adhering to a patient’s do not resuscitate order) or acts of commission (administration of excess barbiturates or other drugs to hasten death).

          The lynchpin of this issue as to whether both commission and omission will be allowed going forward is another legal concept called the harm reduction argument. And Canada’s Supreme Court has ruled in favor of harm reduction on a number of occasions. Since 2011, for example, unanimous judgments have involved the right to life, liberty and security of the person in legalizing supervised injection centers for drug addicts and brothels for prostitutes “because evidence showed that injecting drugs and selling sex are safer with oversight than without.”

          Canadian justices have concluded that as long as a patient in “grievous and irremediable straits can give informed consent, it doesn’t matter whether a physician assists actively or passively, because the patient’s dignity and autonomy demand control of the situation.

Legal milestones with regard to death with dignity issues include laws in the following states and countries:

November 1994: Oregon voters pass Death with Dignity Act (enacted in 1997)

April 2002: The Netherlands Law legalizing euthanasia and physician-assisted suicide goes into effect

September 2002: Belgian Law legalizing euthanasia goes into effect

November 2008: Washington State voters pass the Washington Death with Dignity Act (went into effect in March 2009)

December 2009: Montana State Supreme Court decides physician-assisted suicide is not prohibited by law 

May 2013: Vermont governor signs bill legalizing physician-assisted suicide

January 2014: New Mexico judge rules that terminally ill patients have a right to obtain “aid in dying” (decision under appeal).

February 2014: Belgium extends euthanasia law to apply to children with terminal illness. 

          These changes are definitely troubling to people who instinctively find the thought of physicians assisting their patient’s efforts to die, that is, legalized physician-assisted suicide, completely repellent. “But increasingly, society is acknowledging that denying people the right to die with dignity and safety is even more repellent.”

What are your thoughts on death with dignity?  Please share your thoughts with us.

Robert A. Hatcher M.D., M.P.H.

Emeritus Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, Georgia