Aging: Change and Adaptation

1. Aging: Change and Adaptation Death and Dying April 8, 2003

2. Euthanasia: “a good death” • Voluntary, active euthanasia: at the patient’s request, a physician or someone else causes the person’s death, for example, by administering a lethal injection.

3. Euthanasia Attitudes • “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his family request it?”

5. Physician-assisted suicide • The patient causes his/her own death, i.e., commits suicide using means--usually a lethal dose of medication--provided by a physician • Euthanasia: someone else causes the death • PAS: the patient causes his/her own death

6. Suicide Attitudes • “Do you think a person has the right to end his or her own life if this person has an incurable disease?”

8. Autonomy • A person is autonomous if he/she is self-governing, capable of making decisions, and fixing a course of action in the absence of controlling constraints • It involves self-determination, freedom, independence, liberty of choice and action

9. Autonomy • It refers to human agency free of outside intervention and interference.

10. Other Perspectives • Beneficence: The ethical obligation to minimize pain and suffering, to reduce and remove harms, and to bring about benefits to an individual. • Nonmaleficence: Do no harm • Justice: What principles should guide the allocation of scarce resources?

11. Chronology of Recent Developments • 1991: Washington’s Initiative 119 • Shall adult patients who are in a medically terminal condition be permitted to request and receive from a physician aid-in-dying?

12. Aid in dying • “a medical service, provided in person by a physician, that will end the life of a conscious and mentally competent qualified patient...

13. in a dignified, painless, and humane manner, • when requested voluntarily by the patient through a written directive.” • Defeated: 54-46%

14. 1992: California’s Proposition 161 • Shall adult patients who are in a medically terminal condition be permitted to request and receive from a physician aid-in dying?

15. Aid in dying • “a medical procedure that will terminate the life of the qualified patient • in a painless, humane, and dignified manner,...

16. whether administered by the physician at the patient’s choice or direction or • whether the physician provides means to the patient for self-administration.”

17. Defeated: 54-46% • 1994: Oregon’s Ballot Measure 16 - The Oregon Death with Dignity Act

18. Shall law allow terminally ill adult Oregon patients voluntary informed choice to obtain a physician’s prescription for drugs to end life?

19. The Oregon Death with Dignity Act • Requirements • The patient must be 18, terminally ill (having less than 6 months to live), and an Oregon resident. • The patient must voluntarily make an oral request...

20. to the attending physician for a prescription for medication to end his or her life. • A 15-day waiting period then begins.

21. The attending physician makes sure the patient understands the diagnosis and prognosis. • The patient is informed of all options, including pain control, hospice care, and comfort care.

22. The attending physician also must inform the patient of the risks and expected result of taking the medication. • The attending physician…

23. determines whether the patient is capable of making health care decisions and is acting voluntarily; • encourages the patient to notify his or her next of kin;

24. informs the patient that he or she can withdraw the request for medication at any time and in any manner;

25. refers the patient to a consulting physician who is asked to confirm the attending physician’s diagnosis and prognosis.

26. The consulting physician also decides whether the patient is capable of making the decision and is acting voluntarily. • If either or both physicians believe the patient is suffering...

27. from a psychiatric or psychological illness or depression that causes impaired judgment, the patient will be referred for counseling.

28. Once the preceding steps have been satisfied, the patient voluntarily signs a written request witnessed by two people. • At least one witness cannot be a relative or an heir of the patient.

29. The patient then makes a second oral request to the attending physician for medication to end his/her life.

30. The attending physician again informs the patient that he or she can withdraw the request for medication at any time and in any manner.

31. No sooner than 15 days after the first oral request and 48 hours after the written request, the patient may receive a prescription for medication to end his or her life.

32. The attending physician again verifies at this time that the patient is making an informed decision. • Safeguards

33. Immunity: Physicians who prescribe medication for a terminally ill patient to end his or her life would be protected from civil or criminal liability. Physicians are not obligated to participate.

34. Residency requirements: Onlyrequests made by Oregon residents may be granted.Physicians must be licensed in Oregon.

35. Reporting requirements: Each year, the Oregon Health Division must review a sample of records of deaths that occur under this law.

36. Effect on insurance or annuity policies: A qualified patient’s act of ingesting medication to end his or her life will not have an effect upon a life, health, or accident insurance or annuity policy.

37. A qualified person who takes medication to end his or her own life will not have his/her insurance policies affected -- even if those policies specify that death by suicide is not covered.

38. Liabilities: Coercion of a patient, altering or forging a request for medication or concealing a withdrawal of that request, with the effect of causing the patient’s death, are Class A felonies.

39. Passed 51-49% by a margin of 32,000 votes on Nov. 4, 1994. • On Dec. 8, 1994: District Court issues a temporary injunction preventing the law from going into effect.

40. On Dec. 28, 1994: injunction continued • “Surely, the first assisted suicide law in this country deserves a considered thoughtful constitutional analysis.”

41. Aug. 3, 1995: law ruled unconstitutional • “There is little assurance that only competent terminally ill persons will voluntarily die.

42. Some ‘good results’ cannot outweigh other lives lost due to unconstitutional errors and abuses.”

43. Ruling overturned in Feb., 1997 by the US Court of Appeals and the US Supreme Court on October 14, 1997.

44. Both courts held that the persons who brought the challenge were not in good standing, i.e., were not immediately affected or threatened by the law. • Oregon legislature asks voters to vote on the proposed law again.

45. In November, 1997: the original law passed again by a margin of 60% to 40%.

46. Oregon’s Physician-Assisted Suicide LawUpdate

47. Legal and LegislativeChallenges

48. Pain Relief Promotion Act • June 1999—Introduced in U.S. House by Hyde, Stupak, & Nickles • Would prohibit use of federally controlled drugs for PAS

49. Pain Act, cont. • Encourages aggressive pain management for dying • Would impede or stop PAS under Oregon’s law

50. PAS Act, cont. • October 27, 1999—U.S. House votes 271–156 to pass the Pain Relief Promotion Act • Pain Relief Promotion Act has since languished in the U.S. Senate and has not been reported out of the Committee on Health, Education, Labor, and Pensions