Death With Dignity National Center

Bonus Myth: People would flock to Oregon to die on our beaches

Melissa Barber — Sat, 25 Feb 2012 06:00:00 -0800

Reality: This is one of the more whimsical myths which was very popular in Oregon during the 1990s, and one which has died down in popularity due to the complete lack of evidence to support it. According to state-issued reports, year after year, the number of deaths related to Oregon's Death with Dignity Act account for roughly the same percentage of total deaths in Oregon.

After the initial early days of the law, there's been a slight increase over time as more Oregon residents have become more aware of this end-of-life option. Had people been flocking to our beaches to die, you'd see a disproportionate increase in deaths related to the state's Death with Dignity Act compared to the total number of deaths. This simply hasn't happened as demonstrated by 13 years of data.

It's good to see at least one myth fade away into obscurity since it was so obviously incorrect. More than that, it was just plain silly.

Myth 5: The Oregon and Washington laws are the same as the laws in the Netherlands

Melissa Barber — Fri, 24 Feb 2012 06:00:00 -0800

Reality: It's odd, but there seems to be an assumption that all laws allowing for physician-assisted dying are the same. They're not. The Oregon and Washington Death with Dignity Acts are far more restrictive than the Dutch laws.

The reason opponents try to convince people the different laws are the same is to play on the slippery slope myth and to scare people into thinking about PolitiFact's 2009 Lie of the Year: 'Death Panels'. Rick Santorum tried this recently and was rebuffed by media outlets and the Dutch government.

Among the many safeguards, in order to qualify to use the Oregon or Washington law people must be:

An adult, 18 years old or older
Residents of Oregon or Washington
Diagnosed with a terminal illness with six months or fewer to live
Able to self-administer the prescribed life-ending mediation
Free of any mental health condition, such as depression, which impairs their ability to make health care decisions

The law in the Netherlands has many of the same safeguards as the Oregon and Washington laws, but has four major differences. Unlike the Death with Dignity Acts in the US states, the Dutch law allows:

People who don't live in the Netherlands to request assistance in dying.
A person doesn't necessarily have to have a terminal illness (though the patient's suffering must be unbearable with no prospect of improvement).
A physician can administer the lethal dose (euthanasia) if the qualified patient is unable to self-administer medication.
The patient must be at least 12 years old.

Those four differences make the US laws very different from the Dutch laws. What's acceptable to people in the Netherlands is different from what American voters want in their laws.

The voters of Oregon and Washington stated very clearly they approve of their states' laws at the ballot box, and support continues to grow. According to a poll by the National Journal and The Regence Foundation 77% of Oregonians and 70% of Washingtonians have a favorable opinion of their Death with Dignity Acts. They like the laws as they stand, and there won't be an effort to change them to be more like Dutch laws.

Myth 4: It's suicide

Melissa Barber — Thu, 23 Feb 2012 06:00:00 -0800

Reality: People who oppose Death with Dignity Acts typically say these laws allow assisted suicide. This term is used by opponents to scare people, and assisting a suicide is a banned practice under the law. Assisted suicide is a broad, undefined term, which more accurately refers to criminals like this guy not physicians practicing lawfully under Oregon's and Washington's laws.

In order to make a request for prescribed medication to hasten death, a person must have a terminal diagnosis with six months or fewer to live. The person is in the process of dying and seeking the option to hasten an already inevitable and imminent death. For this reason, the request to hasten a death isn't equated with suicide.

None of the moral, existential, or religious connotations of suicide apply when the patient's primary objective is not to end an otherwise open-ended span of life, but to find dignity in an already impending exit from this world. Individuals who use the law are likely to be offended by accusations of assisted suicide, because they're participating in an act to shorten the agony of their final hours, not killing themselves. Cancer (or another underlying condition) is killing them.

For another perspective here's what a revered psychologist in Washington had to say about it. Dr. Ethan Remmel died of incurable colon cancer last year and had kept a blog about his experiences living with a terminal illness. In one of his posts, he mentioned he'd requested the prescribed medication from his doctor so he could decide his own fate in his remaining days. This generated some amount of feedback from his readers and colleagues about how what he was doing was suicide. His response:

I do not view it as "suicide" (although that is a convenient term), because I would not really be choosing between living and dying. I would be choosing between different ways of dying. If someone wishes to deny me that choice, it sounds to me like they are saying: I am willing to risk that your death will be slow and painful. Well, thanks a lot, that's brave of you.

Instead, Dr. Remmel's death was a wholly different experience—a peaceful one surrounded by his loved ones. His wife updated his blog one last time after his death:

Ethan died Monday, June 13th, surrounded by his loved ones. Both his parents held a hand, Eric stood with us, and I was snuggled in his arms, holding him, and loving him as we all have, for as long as we have known him.

Dr. Remmel's wasn't in the mindset of a suicidal person. Given an option, he'd have happily decided to live many more years with his loving family, but his terminal illness didn't allow for that possibility.

Myth 3: Death with Dignity Acts are a slippery slope and will lead to euthanasia

Melissa Barber — Wed, 22 Feb 2012 06:00:00 -0800

Reality: A key aspect of the Death with Dignity laws in Oregon and Washington is patients must self-administer medication prescribed under the safeguards of the laws. Euthanasia, on the other hand, refers to the act of painlessly but deliberately causing the death of another who is suffering from an incurable, painful disease or condition—most commonly administered through a lethal injection.

Conflating these two very different concepts is a specialty of people opposed to Death with Dignity Acts; their aim is to confuse people about what's allowed and what isn't. The fact is, these laws give patients control of their own dying process, and the option to shorten their suffering in their final days. The terminally ill individual is the only person who decides when or whether to take the prescribed medication—and fully a third of the people who request the medication never end up ingesting it.

The Oregon and Washington laws even go another step further with specific language barring euthanasia:

Nothing in this chapter authorizes a physician or any other person to end a patient's life by lethal injection, mercy killing, or active euthanasia.

Oregon's law has been in effect for 15 years and Washington's for three years. In order to change the scope of either law, it would take an act of the state legislature or approval of a ballot initiative by the voters. At no point in the long history of Oregon or Washington has there been any effort to expand or extend the Death with Dignity legislation to allow for euthanasia. There's been no slippery slope. It's a mentally competent, terminally ill individual's personal end-of-life decision and no one else's.

Myth 2: It attacks the dignity and threatens the lives of people with disabilities

Melissa Barber — Tue, 21 Feb 2012 09:44:08 -0800

Reality: This lie is quite pervasive. In order to qualify to make a request for medication under the Oregon and Washington Death with Dignity Acts, a person must be an adult (over the age of 18), a resident of Oregon or Washington, judged mentally competent by his or her physicians, and have a terminal illness which will result in death in six months or fewer. Nowhere in these laws does having a disability qualify an individual to request life-ending medication.

In fact, in section 127.805 s.2.01 the Oregon law specifically states, "No person shall qualify under the provisions of ORS 127.800 to 127.897 solely because of age or disability." The Washington Death with Dignity Act has the same stipulation in section 70-245-020. The proposed laws introduced in Massachusetts (Section 2) and Vermont (page 5, lines 16-19) have the same safeguards.

Research shows these protections work. Independent studies have found no evidence of risk to individuals living with disabilities under Oregon's Death with Dignity law. Here's one such published and peer-reviewed study.

This myth is a scare tactic, plain and simple, and glosses over the fact that Death with Dignity laws offer protections for all people living with or without disabilities. The multiple safeguards ensure the decision to shorten one's suffering when enduring a terminal illness rests solely in the hands of the person who's dying, and no one else.

Myth 1: It's a recipe for elder abuse

Melissa Barber — Mon, 20 Feb 2012 06:00:00 -0800

Reality: About 15 years ago when Oregon's groundbreaking Death with Dignity Act was going into effect, this lie was commonly spouted as "Duty to Die" by opponents of the voter-approved law. Here's the problem with this assertion: the lengthy request process with multiple doctors and witnesses as well as the requirement that a terminally-ill person must self-administer the six ounces of medication makes this virtually impossible.

The process to request the prescription starts with an oral request to a person's attending physician. The terminal diagnosis of six months or fewer to live as well as the patient's mental capability must be confirmed by another physician. The first oral request is followed by a 15-day waiting period; after which, the person can make the second oral request and complete the written request (witnessed by two people). There's then a 48-hour waiting period before a person can pick up the prescribed medication. After the person picks up the prescribed medication at the pharmacy, it is solely the decision of the patient whether or when he or she takes it—and about a third of the people who request the medication never do.

If either of the two doctors, in any of their conversations with their terminally ill patient suspect the person is being coerced in any way, the request process is stopped immediately. During the process, two witnesses are required to sign the written request form declaring the patient "appears to be of sound mind and not under duress, fraud or undue influence."

The Oregon and Washington Death with Dignity Acts very clearly outline penalties to protect against coercion:

It shall be a Class A felony for a person without authorization of the principal to willfully alter, forge, conceal or destroy an instrument, the reinstatement or revocation of an instrument or any other evidence or document reflecting the principal's desires and interests, with the intent and effect of causing a withholding or withdrawal of life-sustaining procedures or of artificially administered nutrition and hydration which hastens the death of the principal.

In other words, coercion or exerting undue influence over a patient is a Class A felony under the law, punishable by life in prison and a $50,000 fine.

George Eighmey who recently retired from being the Executive Director or C&C of Oregon explained his personal experiences with Oregon's law:

In my 12 years facilitating dying Oregonians with the law, not one claimed they were being urged to use the law by their family. In fact, in most cases it was the dying person who had to persuade their loved ones to support them in their decision to use the law.

Looking beyond the anecdotal evidence, the most telling sign of this lie is the lack of anything supporting the opposition's claim. In all fifteen years of the law's existence in Oregon, there's never been a case of coercion or undue influence related to the Death with Dignity Act. Not one.

Vermont Governor Reiterates His Strong Support

Melissa Barber — Mon, 13 Feb 2012 13:14:18 -0800

Last Friday, Vermont governor Peter Shumlin fielded questions and comments from a live studio audience during Vermont Public Television's Town Hall with the Governor. Questions covered many different pressing issues Vermont lawmakers are facing including the economy and affordable higher education. Thirty two minutes into the meeting, host Kristin Carlson read an email from a viewer, Rabbi Robert A. Alper, asking about the proposed Death with Dignity law:

I was dismayed to learn that Senator Sears and Senator Campbell are stalling the bill. Vermonters have a shining record of reasoned debate. How might we bring this issue to the forefront for resolution?

Carlson followed up reading the email with her own question for Governor Shumlin about the proposed Death with Dignity law which has been introduced in both chambers of the Statehouse. She asked, "This is a bill you want. Is it going to happen?"

His response was very direct: "It sure is going to happen while I'm governor. I very much want to sign this bill into law."

Governor Shumlin then went on to describe an interaction from when he was campaigning in Ludlow. A woman asked Shumlin's view on Death with Dignity. After he said he supports it, he asked her why she asked. She's been fighting ovarian cancer for 6 years and explained:

I want to be on this earth for as long as I know how; you won't find someone who's fought harder to be here than me. But ovarian cancer is an extraordinarily painful way to die. There isn't really a worse way to die. And when it finally gets me, I want to be able to make the judgement whether I stay on this earth in extraordinary pain for two or three weeks toward the end, and I don't want you deciding for me.

Shumlin then told her, "as governor, I will do everything in my power to give you that right—to give you that choice—before you die. It's not my role to stand in your way."

With more than a third of lawmakers in both chambers signed on as sponsors, 64% of Vermont voters in favor of their lawmakers passing the legislation, and such strong support from the governor, Vermont's prospect of becoming the third state with a Death with Dignity law looks promising. Stay tuned through our blog, and to get involved, contact Patient Choices Vermont.

"How to Die in Oregon" Coming to DVD

Melissa Barber — Thu, 09 Feb 2012 14:11:48 -0800

At long last! Peter Richardson's acclaimed documentary, How to Die in Oregon, will be released on DVD next Tuesday, February 14th. For about a year, we've received inquiries from people all over the world about how they can get a chance to see the film. With the DVD release, the film will be more widely available for sale; to rent through your local video store or Netflix; or possibly borrow from your nearby library.

If you're thinking about purchasing the DVD, the Death with Dignity National Center is now an affiliate of both Amazon and New Video. Use these links to order your copy, and a percentage of your purchase helps to support our work!

For all you advocates out there, you might consider holding a small viewing party with your friends and loved ones and talk about why you support carefully-crafted and safe Death with Dignity laws. As one blogger put it, "After watching the movie, my wife and I can't understand how anyone could argue that death with dignity shouldn't be an option for everybody." To help facilitate a lively conversation we've created a discussion guide.

Another way to talk about the film with people from all over is through Twitter, and we're dedicating our #DWDchat on Twitter next week to talking about the film. The last time we held a TweetChat on How to Die in Oregon, it was a lively event. To give you a little primer, here are the discussion topics for the TweetChat:

Ray Carnay, who recorded his own eulogy in the film, was once an outspoken opponent of the law. Why may have his feelings changed?
In the film, Dr. Morris, Cody Curtis' oncologist, talked about how "do no harm" is different for every patient. Thoughts?
Director Peter Richardson in an interview: "You could almost call the film 'How to Live in Oregon.'" Thoughts?

New to Twitter and TweetChats? Here are some easy steps to join in the fun:

When: Thursday, February 16, from 6pm to 7pm Eastern (3pm to 4pm Pacific)
Where: TweetChat in the #DWDchat room. Once you're on the webpage for the #DWDchat, this hashtag will automatically be added to your tweet.
How:
1. Sign up on Twitter today
2. Follow us (we always follow-back)
3. Click here to go to the TweetChat site
4. Authorize TweetChat to use your Twitter account by clicking "Sign In"
5. You're ready to join the discussion!
Questions? Email me.

This TweetChat is part of our weekly conversations about different aspects of end-of-life care, including Death with Dignity laws. Through TweetChats, Twitter allows an open and candid discussion about a particular subject indicated by a hashtag. (Learn more about hashtags here.) Since we'll chat about Death with Dignity, we'll use #DWDchat as our hashtag. By participating in our TweetChats and tweeting publicly about Death with Dignity you:

Raise awareness about Death with Dignity
Find and meet others who support Death with Dignity
Let your friends and family know why everyone should have the opportunity to determine the manner and timing of their own deaths when faced with a terminal illness.

Georgia Supreme Court Strikes Down State Law

Melissa Barber — Mon, 06 Feb 2012 14:30:41 -0800

After years of limbo, the complicated assisted death case in Georgia was resolved today. The Georgia Supreme Court, in an unanimous ruling, found prohibiting the Final Exit Network volunteers from publicly discussing assisted death violated the defendants' First Amendment rights.

The ruling struck down a 1994 state law which made it a felony for anyone "who publicly advertises, offers or holds himself or herself out as offering that he or she will intentionally and actively assist another person in the commission of suicide and commits any overt act to further that purpose." From the ruling:

The State has failed to provide any explanation or evidence as to why a public advertisement or offer to assist in an otherwise legal activity is sufficiently problematic to justify an intrusion on protected speech rights.

This ruling means the four Final Exit members won't have to stand trial, and likely brings closure to a case which stretched on for three long years. After four members of the Final Exit Network were arrested in 2009, they were indicted by Forsyth County grand jury in March, 2010, and charged with tampering with evidence, violating anti-racketeering laws and helping a man kill himself.

The defense requested the trial court dismiss the charges on the grounds the Georgia statute on assisted death violated their First Amendment right of freedom of speech, and the state Supreme Court agreed to hear this appeal to determine if the grand jury trial would move forward.

The Cultural Shift Has Begun

Melissa Barber — Thu, 02 Feb 2012 14:01:37 -0800

"We need a cultural shift. Oregon is just a start."

I heard this from a person I chat with periodically on Twitter. It's true, Oregon is just the start.

Oregon's law's been tested at every level:

The majority of Oregon voters supported their Death with Dignity Act in 1994.
For three years, opponents unsuccessfully challenged the new law in courts and even convinced the Oregon State Legislature to send the law back to the people for a second vote in 1997.
This move motivated a larger margin of voters to send a clear message to state legislators: Oregonians definitely supported their law and didn't appreciate their elected officials second-guessing their 1994 decision.
After the Death with Dignity Act went into effect in 1997, the US Congress tried to step in by pressuring the DEA to challenge the law, and by crafting ill-formed bills, "Lethal Drug Abuse Prevention Act" and "Pain Relief Promotion Act", neither of which passed.
And then came the legal challenges by US Attorneys General John Ashcroft and Alberto Gonzales.
In every appeal, Oregon's law prevailed with the ultimate victory in 2006 when the US Supreme Court upheld Oregon's law and ruled the Attorney General had overstepped his authority.

With Oregon's law thoroughly tested and ten years of data proving its safety, the Death with Dignity National Center led the coalition in Washington state, and advocates there worked tirelessly to help their fellow citizens learn the facts about Oregon's law. In 2008, Washington voters overwhelmingly approved their own Death with Dignity Act emulating Oregon's law.

Now, with Massachusetts, Vermont and other states working on their own Death with Dignity laws, it appears the cultural shift is well underway. More and more people want to have a full range of options if faced with a terminal illness and be able to decide for themselves when or whether to shorten their suffering in their final days. It's time for lawmakers to acknowledge we live in a country with separation of church and state, stop pandering to groups wishing to insert their religious views into laws, and listen to the will of the people.