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    “Death with dignity” laws gain traction in several states

    Ned MilenkovichNed Milenkovich“Death with Dignity” laws are on the rise around the nation. Today, five states legally recognize assisted suicide in the face of terminal illness. They include Oregon, Washington, Montana, Vermont, and most recently, the most populous state, California.

    It is estimated that in 2016 one in 10 Americans will live in jurisdictions in which it is legal for a physician to prescribe a lethal drug to a terminally ill patient who, under a variety of safeguards, may commit suicide. While only five states currently allow individuals to choose this option, more than 25 other states have introduced bills that discuss the legalization of some form of “right-to-die” measures.

    See also: Valeant business practices embroiled in controversy

    The end-of-life option

    California’s “End of Life Option Act” serves as a good touchstone in understanding the death-with-dignity landscape, particularly in regard to how far it has come and in what direction it may expand in the future.

    The act, which became effective in January 2016, authorizes adults to request a drug for the purpose of ending their lives if they meet certain qualifications and their physicians determine that they suffer from a defined terminal disease. While the act creates an avenue for individuals to make right-to-die choices, its restrictions and qualifications create limits on who may avail themselves of this option.

    See also: EpiPen adoption in U.S. schools soars

    In California, the act requires that the individual suffer from a “terminal disease,” which is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months. The act goes on to require that the individual be a resident of California, be physically and mentally capable of self-administering the aid-in-dying drug, and that the application process for the medication include two verbal requests, a minimum of 15 days apart, and a written request, all addressed to the patient’s attending physician.

    Excluded

    California’s End of Life Option Act still excludes a large range of people who may want to be covered. This includes people with progressive debilitating diseases who don't have a clear six-months-to-live prognosis as well as people with dementia, one of the fastest-growing health threats in the United States. There are similar restrictions in the other four states that currently allow this practice.

    Moreover, there are medical conditions that are unpredictable, in terms of life expectancy as well as how, when, and in what order bodily functions are lost. Examples include progressive neurological diseases such as multiple sclerosis and ALS; patients with these conditions who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to self-administer the life-ending medication may become impossible.

    Utah’s death-with-dignity bill proposed that an individual could seek life-ending medication if they were suffering from an “intractable and unbearable disease,” meaning a bodily disorder that cannot be cured or successfully palliated, and that caused suffering severe enough to cause a patient to prefer death. This bill was put on hold for further review; however, State Representative Rebecca Chavez-Houck plans to reintroduce the bill again in the 2016 session.

    Ned Milenkovich, PharmD, JD
    This article is not intended as legal advice and should not be used as such. When legal questions arise, pharmacists should consult with ...

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    • MichaelRupp
      Shortly after I moved to Arizona in the late 1990s, I spotted an elderly supporter of assisted suicide wearing a button that read “Let me die like a dog.” Her point was that we should extend the same level of dignity and compassion to people who suffer incurable suffering as we do our pets. Oregon’s Death with Dignity Act (implemented in 1997 after being approved in two separate statewide referenda) is an excellent model for how assisted suicide can be implemented in a way that minimizes the potential for abuse. People who have an objection to the decision by a cognitively intact and fully informed person to end their life should devote their efforts to mitigating some of the reasons why people feel the need to make such a decision. In Oregon, this opposition found a productive outlet in the area of supporting improved palliative care rather than presuming to deny people the right to decide what happens to perhaps the only thing any of us really owns.
    • BradleyWilliams
      I have found (serving 60 fair booth days) that about half of the public thinks they are in favor of such a law, that is until they learn about the flaws in the laws that create new paths of elder abuse with immunity. Once they learn that a predatory heir may steer the signup process and then forcibly administer the lethal dose without oversight, they all said, "I am not for that!". Anyway all of these Oregon Model bills have the same flaws that eviscerate flaunted safe guards. Here is an example list of flaws posted recently about the New Jersey bill that failed. The New Jersey Alliance exposed the following flaws in S 382: • No requirement of mental health evaluation or pain relief consultation. • Permits an heir to witness a death request. • Requires no oversight on whether the patient was willing to take the lethal drugs. • No requirement that a medical person be present to supervise the ingestion of lethal drugs. • Allows a third party familiar with how the patient communicates to make the death request. * Permits lethal drugs to remain in a patient’s home without securing them. * Relies on the inaccurate premise that a doctor can predict death within six months. * No distinction as to whether the death prediction is with or without treatment of the patient. * No required notification of family members. Immunizes from prosecution anyone participating in administering lethal drugs, even if their participation was coercive and out of self-interest Falsely certifies the cause of death. The New Jersey Alliance Against Doctor-Prescribed Suicide is a broadly-based, diverse coalition of organizations strongly opposed to the legalization of assisted suicide. Before you expound on your beliefs, read the bill. Use this as a check off list on your bill when it is published. Well worth your time. At your service, Bradley Williams President MTaas dot org Hamilton, MT 59840
    • BradleyWilliams
      Your source has done you a disservice. The promoters of assisted suicide have worn out their thesaurus attempting to imply that it is legal in Montana. Assisted suicide is a homicide in Montana. Our MT Supreme Court ruled that if a doctor is charged with a homicide they might have a potential defense based on consent. The Court did not address civil liabilities and they vacated the lower court’s claim that it was a constitutional right. Unlike Oregon no one in Montana has immunity from civil or criminal prosecution. Does that sound legal to you?