States with Doctor Assisted Suicide: Understanding Death with Dignity Laws

Physician-assisted suicide, often referred to as medical aid in dying or death with dignity, is a deeply personal and complex issue gaining increasing attention across the United States. This practice allows terminally ill, mentally competent adults to voluntarily end their lives through the self-administration of medication prescribed by a physician. While controversial, it is a legally authorized option in a growing number of States With Doctor Assisted Suicide, each with its own specific regulations and safeguards. Oregon was the first state to legalize this practice with the enactment of the Death With Dignity Act (DWDA) in 1997, setting a precedent for other states to follow. This article aims to provide a comprehensive overview of states that have legalized doctor assisted suicide, exploring the key aspects of these laws and the considerations surrounding them.

What is Doctor Assisted Suicide?

Doctor assisted suicide, under laws like Oregon’s Death with Dignity Act, is defined as the voluntary termination of one’s own life by taking lethal medication prescribed by a licensed physician for that explicit purpose. It’s crucial to distinguish this from euthanasia, where a physician directly administers the medication. In states with death with dignity laws, the patient must be the one to self-administer the medication. These laws are designed to empower individuals facing the end of life to have more control over the timing and manner of their death, offering a choice to those suffering from terminal illnesses.

Oregon’s DWDA, born from a citizens’ initiative, was twice affirmed by Oregon voters, first in 1994 and again in 1997 after a repeal attempt. This history underscores the public debate and evolving societal views surrounding end-of-life choices. It’s not a state “program,” but rather a permissive law that allows qualified patients and willing physicians to engage in this practice on an individual basis, emphasizing personal autonomy and informed consent. The Oregon Health Authority plays a vital role in collecting data and issuing annual reports on DWDA participation, ensuring transparency and providing valuable insights into the law’s implementation.

Which States Currently Allow Doctor Assisted Suicide?

The legal landscape of doctor assisted suicide in the U.S. is evolving. As of [current date – please update with the actual current date], the following states and the District of Columbia have enacted laws that permit physician-assisted suicide, often termed “medical aid in dying”:

• Oregon (1997): As the pioneering state, Oregon’s Death with Dignity Act serves as a model for many other states.
• Washington (2008): The Washington Death with Dignity Act closely mirrors Oregon’s law.
• Montana (2009): While not through explicit legislation, the Montana Supreme Court ruled in Baxter v. Montana that physician-assisted suicide is legal for terminally ill, competent adults based on the state’s constitutional right to privacy and dignity.
• Vermont (2013): Vermont’s Patient Choice and Control at End of Life Act legalized medical aid in dying.
• California (2015): The End of Life Option Act in California allows terminally ill patients to request aid-in-dying medication.
• Colorado (2016): Colorado’s End-of-Life Options Act provides a similar framework for physician-assisted suicide.
• District of Columbia (2017): The District of Columbia’s Death with Dignity Act legalized the practice within the capital.
• Hawaii (2018): Hawaii’s Our Care, Our Choice Act allows medical aid in dying for terminally ill residents.
• New Jersey (2019): The New Jersey Medical Aid in Dying for the Terminally Ill Act was signed into law, making it legal in the state.
• Maine (2019): Maine’s Death with Dignity Act was enacted through a citizen referendum.
• New Mexico (2021): New Mexico’s Elizabeth Whitefield End-of-Life Options Act legalized physician-assisted suicide after a court ruling and legislative action.

It’s important to note that the specifics of these laws can vary slightly from state to state, but they generally share core principles and requirements. For the most up-to-date information and details on each state’s laws, resources like the Death with Dignity National Center (https://www.deathwithdignity.org/) are invaluable. This organization tracks the status of these laws and advocates for their expansion, providing detailed information and resources for individuals and policymakers alike.

Who is Eligible for Doctor Assisted Suicide?

While eligibility criteria may have minor variations across different states with doctor assisted suicide laws, the fundamental requirements are largely consistent. To be eligible, a patient generally must meet the following conditions:

1. Age: Be 18 years of age or older.
2. Mental Capacity: Be mentally competent and capable of making and communicating healthcare decisions. This means the individual must understand the nature of their condition, the consequences of their choices, and be free from coercion or undue influence.
3. Terminal Illness: Be diagnosed with a terminal illness that is expected to lead to death within six months. This prognosis must be confirmed by both the attending physician and a consulting physician.
4. Residency (Varies): Historically, many states with these laws had residency requirements, meaning patients had to be residents of the state to be eligible. However, some states, like Oregon as of March 2022, have stopped enforcing residency requirements due to legal challenges related to the Equal Protection Clause of the U.S. Constitution. It’s crucial to check the specific residency requirements of each state at the time of inquiry.

The determination of whether a patient meets these criteria rests with the attending physician. They are responsible for evaluating the patient’s diagnosis, prognosis, and mental capacity. In cases where a physician has concerns about a patient’s psychological state, particularly if depression or another psychiatric disorder might be impairing judgment, a referral for a psychological examination is typically required. This step is a critical safeguard to ensure the patient’s decision is truly voluntary and informed.

The process for accessing doctor assisted suicide generally involves multiple steps designed to ensure patient autonomy and informed consent. In most states, these steps include:

1. Oral Requests: The patient must make at least two oral requests to their attending physician for aid-in-dying medication, separated by a waiting period (often 15 days).
2. Written Request: The patient must submit a written request to their physician, signed in the presence of two witnesses. Typically, at least one witness must not be related to the patient.
3. Physician Confirmation: Both the attending physician and a consulting physician must independently confirm the patient’s terminal diagnosis and prognosis, as well as the patient’s mental capacity.
4. Informed Consent: The attending physician is obligated to inform the patient about all feasible alternatives to doctor assisted suicide, including palliative care, hospice care, pain management, and other comfort care options.
5. Waiting Periods: As mentioned, waiting periods are mandated between requests to ensure the patient’s decision is considered and not made impulsively. However, some states provide exemptions to these waiting periods if the patient’s remaining life expectancy is shorter than the waiting period itself. For instance, in Oregon, patients with less than 15 days to live may be exempt from the 15-day waiting period between oral requests, and those with less than 48 hours to live may be exempt from the 48-hour waiting period after the written request.

Patients retain the right to rescind their request at any point in the process, in any manner they choose. Physicians are also required to offer patients the opportunity to rescind their request at the end of the waiting period, reinforcing the voluntary nature of this decision.

The Role of Physicians and Healthcare Systems

In states with doctor assisted suicide, the role of physicians is central yet voluntary. Only licensed Doctors of Medicine (M.D.) or Doctors of Osteopathic Medicine (D.O.) are authorized to write prescriptions for aid-in-dying medication. Importantly, no physician is obligated to participate in doctor assisted suicide. Participation is a matter of personal conscience and professional judgment. This voluntary aspect is a key component of these laws, respecting the diverse ethical and moral views within the medical community.

If a patient’s primary physician is unwilling to participate, they are responsible for informing the patient of their right to seek care from another physician. However, neither state health authorities nor medical boards typically provide lists of participating physicians due to patient and physician confidentiality concerns. Finding a willing physician can, therefore, be a challenge for some patients, particularly in areas with limited healthcare access or where healthcare systems have policies against participation.

Certain healthcare systems, particularly those with religious affiliations, such as Catholic hospitals, or government-run systems like Veterans Administration hospitals, may have policies that prohibit their physicians from participating in doctor assisted suicide within their facilities. Patients should inquire about their healthcare system’s policies if they are considering this option.

Physicians who choose to participate have specific responsibilities outlined by law. These include:

• Determining Eligibility: Assessing whether the patient meets all eligibility criteria.
• Providing Information: Informing patients about their diagnosis, prognosis, treatment alternatives, and the risks and benefits of aid-in-dying medication.
• Referring for Psychological Evaluation (if needed): Arranging for a psychological evaluation if there are concerns about the patient’s mental capacity or the presence of a psychiatric disorder affecting their decision-making.
• Prescribing Medication: If all criteria are met and the patient proceeds, prescribing the lethal medication. The specific medication and dosage are determined by the physician.
• Reporting Requirements: Physicians are required to report all prescriptions for lethal medications to the designated state health authority. In Oregon, this is the Oregon Health Authority’s Center for Health Statistics.

It’s important to emphasize that the physician’s role is to prescribe the medication; they are not to administer it. The patient must self-administer the medication to remain within the legal definition of doctor assisted suicide and to avoid crossing into the territory of euthanasia, which remains illegal in all states, including those with death with dignity laws. While the law does not require a physician to be present when the patient takes the medication, a physician may be present if the patient wishes, as long as they do not administer it.

To further ensure patient safety and wishes are respected, patients considering doctor assisted suicide are often encouraged to complete a Physician Orders for Life-Sustaining Treatment (POLST) form and register it with their state’s POLST registry. A POLST form documents the patient’s wishes regarding medical treatment, particularly in emergency situations. This can be crucial if the patient requires emergency services after taking the medication, ensuring their end-of-life wishes, such as Do Not Resuscitate (DNR) orders, are honored.

Ethical, Legal, and Practical Considerations

Doctor assisted suicide raises numerous ethical, legal, and practical considerations for patients, families, healthcare providers, and society as a whole.

Confidentiality: States with death with dignity laws prioritize patient and physician confidentiality. While some data collection is required for oversight and reporting purposes, the identities of participating patients are protected. In Oregon, while patient names are collected for cross-checking with death certificates, this information is not released to the public or media, and source documentation is destroyed after a period to further safeguard privacy.

Cost and Insurance Coverage: The financial aspects of doctor assisted suicide are not explicitly addressed in most laws. Direct costs may include physician consultation fees, psychological evaluations (if required), and the cost of the prescribed medication. Insurance coverage for these costs varies depending on individual insurance policies, as insurers determine whether this procedure is covered, similar to any other medical procedure. Oregon state law clarifies that participation in DWDA is not considered suicide, which is intended to prevent insurance benefits from being negatively impacted by this choice.

Cause of Death on Death Certificates: For death certificates of individuals who die under death with dignity laws, the recommended practice is to list the underlying terminal disease as the cause of death and mark the manner of death as “natural.” This approach balances patient and family confidentiality with the need for accurate public health statistics. State health authorities often reconcile prescription records with death certificates to ensure accurate data collection while maintaining patient privacy.

Oversight and Regulation: Oversight of doctor assisted suicide primarily falls under the purview of state medical boards. While health authorities like the Oregon Health Authority are responsible for data collection and reporting, they do not typically investigate individual cases for compliance unless potential deviations are identified in the reported data. If a physician is found to be non-compliant with the prescribing or reporting requirements of the law, the state medical board may initiate an investigation and potentially impose disciplinary actions.

Ethical Debates: Doctor assisted suicide remains a deeply debated topic. Proponents emphasize patient autonomy, the right to self-determination, and the relief of suffering for terminally ill individuals. Opponents raise concerns about the sanctity of life, potential for abuse, the role of physicians as healers, and the adequacy of palliative care as an alternative. These ethical considerations continue to shape the legal and societal discussions surrounding end-of-life choices.

Resources and Further Information: For those seeking more detailed information about specific state laws, regulations, and forms related to doctor assisted suicide, state health authority websites are primary resources. For example, the Oregon Health Authority provides statutes, administrative rules, forms, and annual reports related to the Death with Dignity Act on its website. Organizations like the Death with Dignity National Center also offer extensive resources, advocacy information, and updates on the legal status of doctor assisted suicide across the country.

Conclusion

States with doctor assisted suicide represent a significant shift in the legal and ethical landscape of end-of-life care in the United States. These laws aim to provide a compassionate option for terminally ill, mentally competent adults seeking to exercise autonomy over their final moments. While the practice remains a subject of ongoing debate, the growing number of states adopting these laws reflects a broader societal conversation about patient rights, dignity in death, and the limits of medical intervention. Understanding the nuances of these laws, including eligibility criteria, procedural safeguards, and the roles of physicians and healthcare systems, is crucial for patients, families, healthcare professionals, and anyone interested in this complex and evolving area of healthcare. Access to accurate information and resources is essential for informed decision-making and ensuring that end-of-life choices are made with dignity and respect for individual values and beliefs.