Oregon’s Death with Dignity Act has been a model for many other states across the country, yet the actual legal complexities are little known. Some people think so-called “assisted suicide” laws encourage people to take their own lives or cause doctors to hasten death amongst the poor or disadvantaged, but nothing could be further from the truth.
To take advantage of this law, people must:
Be 18 years of age or older.
Reside in Oregon.
Be diagnosed with a terminal illness with a prognosis of death within 6 months.
Be mentally competent at the time of the request.
Two physicians must then agree that the eligibility requirements are met.
The patient needs to make two verbal requests separated by at least 15 days, and one written request witnessed by two people, at least one of whom will not benefit financially from the patient’s death. The patient must be mentally competent at the time of medication administration, and meds must be self-administered, either taken orally or through a feeding tube.
All of the people who qualify are dying soon, and they just want a say in how and when. As Brittany Maynard told People magazine in 2014, “There is not a cell in my body that is suicidal or wants to die. I want to live…I’m dying, but I’m choosing to suffer less, to put myself through less physical and emotional pain, and my family as well.”
How long does it take to get the medication?
The average time between the initial request by the patient and receipt of the medications is 45 days.
What medication is used and what does it cost?
The medication prescribed is Seconal, which is a barbiturate. The prescription costs $3500, which is another hurdle patients face. Some insurance companies cover it, but Medicare policies do not, because Medicare is a federal program and Death with Dignity is a state law. Oregon Health Plan (state-administered Medicaid funds) does cover the cost. Pharmacies and individual pharmacists can elect to opt out and refuse to dispense the medication, if it violates their policies or religious beliefs.
Who typically takes advantage of this option?
The majority of those who choose this option have cancer, and the vast majority are enrolled in hospice. The narrow parameters of having to be able to self-administer the medications and having 6 months or less to live put this option out of reach for many people with degenerative neuromuscular disorders, when their life expectancy might be 1 year and yet 6 months from now their bodies might deteriorate to the point that they are unable to administer the medications themselves.
Despite dire predictions of a “death tourism” scenario, less than 0.03% of deaths in Oregon in 2013 were as a result of medical aid in dying (MAID). In 1998, 24 people got the prescription, and 16 actually administered it. In 2014, 155 people received a prescription and 105 took it, so the proportion has stayed relatively steady at 66%. The majority of them were Caucasian, over 65, and college-educated. They typically are people who dread the loss of dignity and autonomy they fear the natural progression of their disease will bring.
How can I make sure I am in control of the decisions?
If this is something you might ever be interested in, you need to be up front with your physician. Ask your provider proactively if he/she would write you a prescription should you be diagnosed with a terminal illness. Providers have the right to decline, based on their own personal beliefs or the policies of the group or institution their are affiliated with.
How is this different from suicide?
This is a fair question, and the distinctions are clear.
With MAID, the patient is terminal, whereas in suicide they are not.
With MAID, the patient is mentally competent, which may not be the case in suicide.
With MAID, the patient wants to live but is dying, whereas many suicidal people are living and want to die.
With MAID, death is gentle. Suicide is often a violent death.
With MAID, those left behind have time to come to terms with the impending illness and death, whereas with suicide the loss is quite sudden and unexpected and leaves lots of unanswered questions and hurt feelings.
What will be listed on the death certificate?
The disease process, i.e. lung cancer, will be listed as the cause of death, not suicide. This is an important distinction when life insurance is involved.
How can I learn more?
The State of Oregon has specific forms for all of these steps. You can learn more from www.healthoregon.org/dwd
Kathy Presnell is the creator of mybobrocks.com, which makes glass cremation keepsakes.