Terminal illnesses are a heartbreaking reality of life–in many cases, doctors can only provide care to help patients feel less pain in their remaining days. But, some activists believe that it doesn’t have to be that way, and that patients with terminal illnesses should be able to have control over their deaths. Physician-assisted suicide is legal in six states in the United States, and multiple states have weighed whether or not to allow it in the last few years. Read on to learn what physician-assisted suicide is, where it’s legal, and the arguments for and against the controversial practice.

What is Physician-Assisted Suicide?

Physician-assisted suicide is the prescribing of some sort of life-ending drug to a patient by a doctor. The patient then takes the steps to end their own life. Physician-assisted suicide should not be confused with euthanasia–in euthanasia, the physician physically performs the death-causing act. There are other names for physician-assisted suicide, including “physician-assisted death,” “aid-in-dying,” “right to die,” and “death with dignity.”

Across states that have legalized the practice of physician-assisted suicide, the process varies. But there are some consistent elements–only licensed medical doctors (M.D.s) or doctors of osteopathy (D.O.s) can issue the prescription. Additionally, doctors must be willing to issue the prescriptions–by no means are they obligated to do so. Many of the states that have legalized physician-assisted suicide also require that there’s some sort of waiting period between when a patient requests the procedure and when it’s granted, and that multiple doctors are consulted in the decision.

Where is Physician-Assisted Suicide Legal?

Currently, there are six states where physician-assisted suicide is legal: Oregon, Washington, Vermont, California, Colorado, and Montana. It is also legal in Washington D.C.

Oregon legalized physician-assisted suicide in 1994, with 51 percent of Oregon voters voting for it. However it wasn’t enacted until 1997. That was just a few months after the Supreme Court decided in Washington v. Glucksberg that state laws banning physician-assisted suicide are not unconstitutional. This meant that the decision of whether or not to legalize physician-assisted suicide would be left up to each state to determine; other Supreme Court rulings have since continued to validate that it’s a matter for states to decide.

In 2008, Washington became the second state to legalize physician-assisted suicide, via a voter referendum. In Washington, terminally ill residents who have less than six months to live may request drugs that would end their lives.

In 2009, the Montana Supreme Court ruled on Baxter v. Montana, and became the first case to essentially legalize physician-assisted suicide through a court case. Although there was no regulatory framework for physician-assisted suicide set up in the state, it ensured that a doctor cannot be prosecuted for the act.

In 2013, Vermont became the first state to legalize physician-assisted suicide through its state legislature. Like many of the other laws, it includes caveats, including that terminally ill patients need to make multiple requests and wait 15 days after their initial request.

Then, in 2015, the California legislature passed the End of Life Option Act. Like the other states, California put certain restrictions on physician-assisted suicide. The patient must be at least 18, must have a diagnosis that will–within reasonable medical judgment–result in death within six months, and be deemed competent to make medical decisions, among other restrictions.

On November 8, 2016, Colorado voters voted in favor of Proposition 106, which legalized physician-assisted suicide in the state. Almost two-thirds of Coloradans voted in favor of the proposition, which like other states’ legalization measures, requires that the patient has less than six months to live, and is deemed competent to make a decision to end their life.

In late 2016, Washington DC’s council approved a Death with Dignity law, and Mayor Muriel Bowser signed it into law. However, based on the way that DC is set up, Congress has the ability to block laws enacted by the district. While Congress did not succeed in blocking this particular law, it has been known to prevent the city from setting up successful regulatory frameworks through budgetary measures, which could still happen.

Have Other States Tried to Legalize Physician Assisted Suicide?

Many states have introduced some sort of law or measure to legalize physician-assisted suicide recently, with most floundering. Michigan lawmakers proposed a physician-assisted suicide bill in late March 2017. Hawaii’s House of Representatives “deferred” a physician-assisted suicide bill, essentially killing it for now. New Mexico’s Senate just voted down a physician-assisted suicide bill. Other states have considered or may consider bills soon, including Maine, while others, like Kansas, are considering resolutions that would ban physician-assisted suicide. For many of the states considering legalizing physician-assisted suicide, it’s not the first time. In the mid-1990s, when the debate about physician-assisted suicide first began to heat up, measures failed in many states.

Arguments in Favor of Physician-Assisted Suicide

Most arguments in favor of physician-assisted suicide cite humanitarian arguments. Advocates of physician-assisted suicide argue that if an individual knows he’s going to die within the next six months, it’s cruel to force him to suffer through it. Instead, physician-assisted suicide allows him to end his life on his own terms, humanely and peacefully. Currently, mentally-competent people have the ability to refuse potentially life-saving treatments. Those in favor of legalizing physician-assisted suicide argue that it’s a similar concept.

Real Life Example: Brittany Maynard

In 2014, the story of Brittany Maynard captivated the nation. Maynard, a 29-year-old California woman, was diagnosed with an aggressive form of brain cancer. After trying treatments, none of which were successful in the long term, Maynard decided to end her own life. She became an advocate for physician-assisted suicide, and in many ways, a modern face of the movement. Maynard and her family moved to Oregon from California, as this was before California had legalized the practice. Maynard wrote an op-ed about her decision, explaining why she believed that physician-assisted suicide was the right choice for her, and explaining that her decision wasn’t about being “suicidal,” but about having an option at the end of her life:

I’ve had the medication for weeks. I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms.

I would not tell anyone else that he or she should choose death with dignity. My question is: Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?

Now that I’ve had the prescription filled and it’s in my possession, I have experienced a tremendous sense of relief. And if I decide to change my mind about taking the medication, I will not take it.

Maynard did take her own life, in November of 2014, and remains a face of the movement to extend physician-assisted suicide.

Arguments Against Physician-Assisted Suicide

Those who disagree with the legalization of physician-assisted suicide argue that suicide, regardless of the reasons, is immoral and should not be condoned by the government in any way, shape, or form. Many religious institutions argue against physician-assisted suicide; in some ways, it’s become linked to the pro-life movement. Others argue that physician-assisted suicide inherently creates issues for doctors, as the Hippocratic Oath essentially prescribes that doctors are not supposed to harm their patients. There are also concerns about a slippery slope–if we make any sort of physician-assisted suicide legal, we may open up the door to euthanasia or other harmful practices. Some who advocate against physician-assisted suicide argue that there’s no way to definitively guarantee that it’s completely a patient’s choice to request medicine that would end his life–they worry that a doctor or family member could pressure a patient.

Real Life Example: Dr. Jack Kevorkian

Dr. Jack Kevorkian was known as an advocate for physician-assisted suicide, but was found guilty of second-degree murder for actually administering drugs to one patient himself, and served eight years in prison. Dr. Kevorkian, nicknamed Dr. Death, was believed to have assisted in over 130 suicides throughout his career. He used multiple methods, including setting up ways for patients to inject drugs into themselves, carbon monoxide poisoning, and his infamous “suicide machine,” which was built into the back of a van.

There were claims that Dr. Kevorkian crossed serious ethical lines with his practices. An analysis conducted by a team at the University of South Florida at Tampa of 69 assisted suicides supervised by Dr. Kevorkian claimed that 75 percent of his patients were not terminally ill.

While some defend Dr. Kevorkian as a pioneer, his methods remain controversial, and are often cited as an argument against physician-assisted suicide.

Conclusion

In addition to ethical and moral arguments, there are many other concerns that come to mind when considering physician-assisted suicide. For one, the drugs that are used for physician-assisted suicide are very expensive, and not necessarily easy to get. A patient looking to move forward with physician-assisted suicide must find a doctor willing to help, which can pose challenges, even in states that have legalized the practice. And while the publicity surrounding Brittany Maynard certainly garnered attention for the physician-assisted suicide movement, she died in 2014, and momentum for state laws may be waning. But one thing is certain: the debate over physician-assisted suicide is very far from over.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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