Assisted Suicide Gains Momentum

Neuroethics Viewpoint
Philip M. Boffey
January 17, 2019
holding hands

Oregon took the lead in allowing physician-assisted suicide in 1997 and for 14 years it stood alone. Then Washington State followed suit with a nearly identical law in 2008 and soon other states followed their lead. Today, eight jurisdictions in the United States have authorized physician-assisted death through legislation, ballot initiatives, or state Supreme Court decisions. In addition to the two pathfinders, the list includes Montana, Vermont, California, Colorado, Washington D.C., and Hawaii.

New Jersey, which has twice failed to enact a law first introduced in 2012, seems poised to join the crowd. Meanwhile, California is moving in the opposite direction. A lawsuit has temporarily blocked implementation of its law and could conceivably overturn it on procedural grounds. It’s one more sign that the assisted suicide option, once gained, must be zealously guarded.

The Oregon law, the template for many other states, takes a restrained and responsible approach. Two physicians must agree that a patient is terminally ill and mentally competent to decide on suicide. If so, a doctor can prescribe a lethal medication that must be administered by the patient without assistance from the doctor. If a patient seems too depressed to make a sound decision, evaluation by a mental health professional is mandatory.

This careful approach is a far cry from the reckless days when Dr. Jack Kevorkian administered lethal drugs willy-nilly to applicants he had barely met. If anything, the laws may be too restrictive. Most, for example, define terminally ill as six months to live whereas some neurological diseases take longer to kill their victims.

Although some opponents consider the trend a slippery slope to unethical practices—such as pressuring patients to end their lives to ease the burden on their families—assisted suicide enjoys such overwhelming support from the public in polls and referendums that it seems here to stay. In tacit recognition of its durability, The National Academies of Sciences, Engineering, and Medicine held a workshop last February entitled “Physician-Assisted Death: Scanning the Landscape.” The goal was to identify research needed to evaluate at a deeper level the impact the laws are having on patients, doctors, and public attitudes toward suicide and end-of-life care.

Even doctors, who were long resistant to assisting in suicides, are changing their tune. A 2016 survey showed that a large majority of physicians in the US are pursuing the expansion of patient options at the end of life. Compassion & Choices, a non-profit organization that works to increase patient options at the end of life, reports that 10 state medical societies have dropped their opposition to assisted suicide laws. The New York State Academy of Family Physicians has even suggested that doctors who are not ethically opposed have an affirmative duty to help patients exercise the option because failing to help would amount to “patient abandonment.”

Despite the heated rhetoric the issue inspires, remarkably few people in the US actually apply for a physician’s help in committing suicide or, even if they successfully qualify, go through with the procedure. No one is quite sure why they hold back. Did they change their mind? Did their pain diminish? Did their prognosis improve? Did they die before they had a chance to obtain and take a lethal drug? My best guess is that they simply want to have the option ready should they want it but feel no need to rush things.

Where do we go from here? It would seem reasonable to extend or eliminate the six-months-until-death criterion as some foreign countries have done. And maybe death should not be the only criterion. Even more than they fear cancer, many patients dread the onset of Alzheimer’s disease. They would welcome the chance to take their own lives peacefully before their minds are permanently destroyed.

Phil Boffey is former deputy editor of the New York Times Editorial Board and editorial page writer, primarily focusing on the impacts of science and health on society. He was also editor of Science Times and a member of two teams that won Pulitzer Prizes.