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The last five years have seen an extension of rights in American society, notably for homosexual Americans that wish to get married and for transgendered individuals. However, there is another rights movement that has been very active and is now beginning to win legislative victories. The “right to die” movement, whose advocates say that patients who have terminal illness should be able to take their life with prescription medication at a time of their choosing, recently won a victory in California. California state legislators approved the End of Life Option Act last week, which would enable Californians to obtain life-ending prescription medication from a doctor. Currently, only four states allow for a form of physician-assisted suicide (also referred to as “physician-assisted dying”) – Oregon, Washington, Vermont, and Montana – but advocates of the “right to die” movement argue that a victory in California, which can be assured if Governor Jerry Brown signs the bill into law, could lead to other states passing similar legislation.
This topic brief will provide some basic information about the “right to die” movement, explain the reasons supporters give for why it should become a universal right, and then provide counterpoints from those who argue that “right to die” legislation constitutes a threat to basic human values.
Readers are also encouraged to use the links below and in the related R&D to bolster their files about this topic.
Background on the “Right to Die” Movement
Some of the origins of the modern right-to-die movement come from Europe. In 1942, Switzerland passed legislation allowing for euthanasia and other nations such as Belgium, the Netherlands, Luxembourg, Colombia, and Canada have followed suit. The New Yorker writes on June 22 that the “right to die” philosophy is an example of secular humanism, an ideology that bases its outlook on science and reason, especially on matters of ethics. Secular humanists support the “right-to-die” movement on the grounds that an individual has a right to possession and use of their body. According to this line of reasoning, those who choose to pursue physician-assisted suicide are merely exercising their right to control their destiny and future.
When it comes to the United States, Dr. Jack Kevorkian was the most notable supporter of euthanasia for much of his life. Arguing that “dying is not a crime,” Kevorkian played a role in helping more than one hundred terminally ill patients take their lives. Eventually, Kevorkian was convicted of second-degree murder for playing a part in the death of Thomas Youk, who was suffering from Lou Gehrig’s Disease, in 1998. Kevorkian was sentenced to ten to twenty-five years for giving Youk a lethal injection before being released from prison in 2007 for good behavior. While controversial, Kevorkian’s name became synonymous with the activism of right to die advocates.
In 1994, Oregon voters made their state the first to approve of physician-assisted suicide, with 51% of voters favoring it. The law survived a ballot measure that would have repealed it in 1997. The Philadelphia Inquirer writes on September 13 that the Oregon Death with Dignity Act allows a terminally ill patient to acquire life-ending drugs from a doctor, but there are some safeguards in place. Doctors have to attest that the patient is not suffering from a mental illness or mood disorder that is causing them to make a poor decision. Also, the person must get hospice counseling and palliative care (care that provides aid to patients with various pain and mental and physical ailments) and be told that they do not have to fill the prescription for life-ending drugs or to take them. Vox explains on September 11 that since 1997, 752 people have chosen to take life-ending drugs in accordance with the law. The Bush administration challenged the constitutionality of the Death with Dignity Act, arguing that the law violated the Controlled Substances Act. However, the Supreme Court ruled in 2006 by a 6-3 vote in the case of Gonzales v. Oregon that the U.S. Attorney General, and by proxy the federal government, could not use the Controlled Substances Act to prevent a doctor from giving life-ending drugs to a patient.
Since Oregon physician-assisted suicide law, other states have followed suit. In 2008, Washington legalized the practice and Vermont did the same in 2013. Vox notes that Montana’s legalization of physician-assisted suicide came from a court ruling and New Mexico is currently involved in litigation over this issue as the Second District Court of Appeals found that a forty-nine-year-old cancer patient had the right to seek fatal drugs from two doctors. Last year, the case of Brittany Maynard, a twenty-nine-year-old woman who suffered from terminal brain cancer, led to greater calls within California for a physician-assisted suicide bill. The Huffington Post writes on September 11 that Maynard desired to take her own life so that she would not endure a painful death and could die in a way of her own choosing. However, California law prohibited her from acquiring the necessary drugs to accomplish her task. As a result, Maynard relocated to Oregon, where she eventually died on November 1, 2014 after taking a lethal dose of barbiturates prescribed under the Death with Dignity Act. Maynard’s relatives and right-to-die advocates used her case to illustrate how a lack of right-to-die legislation in California forced Maynard to die away from her home and community, which they say was a cruel emotional act in her final moments.
The Christian Science Monitor writes on September 12 that California lawmakers were lobbied after Maynard’s death to pass legislation similar to Oregon’s law. Trying to do so during the regular legislative session was difficult because of opposition to the measure from the Catholic Church, disability rights groups, and the California Medical Association. Supporters did not give up, though. The Los Angeles Times explains on August 21 that California legislators recently held a special session on dealing with rising healthcare costs in the state, tackling measures such as raising the smoking age to twenty-one and treating e-cigarettes as cigarettes (both measures failed to pass). Special sessions have different committee compositions, which right-to-die advocates used to their advantage to get a bill out of a logjam that plagued it during the regular meetings of the legislature. Last week, both houses of the California state legislature approved the End of Life Option Act. This legislation is modeled after Oregon’s law, with terminally ill Californians having the right to seek life-ending drugs from a physician so long as they have less than six months to live. U.S. News & World Report writes on September 11 that patients must take the life-ending medication (doctors are not allowed to administer lethal injections under the law), two doctors must approve of the patient’s request, and the patient has to submit several written requests and there have to be two witnesses for these actions. As an additional safeguard of the Oregon model, patients must sign a statement within forty-eight hours of deciding to die that they are of sound mind and are capable to taking the prescribed medication on their own.
However, it is thus far unclear whether California Governor Jerry Brown, who is a Democrat, will approve the legislation. The Wall Street Journal on September 11 writes that Brown has stated his unhappiness at how the bill was moved through the legislature, explaining that he wished that legislators had approved of it as part of the normal legislative process. There are also religious questions as Brown is Catholic and Pope Francis has criticized the right-to-die movement as giving a “false sense of compassion.” Still, as Time notes on September 11, 76% of Californians approve of some form of physician-assisted suicide, so Brown may feel pressure to approve the legislation. If Brown vetoes the bill, advocates of the legislation say that they will seek a ballot initiative next year. He has thirty days to make a decision, but Brown could choose to do nothing, in which case the bill would become law and go into effect next year.
The California battle is significant because other states are looking at physician-assisted suicide bills. BBC writes on September 9 that at least twenty-four states saw “aid-in-dying” laws presented in their legislative sessions this year, but none of those bills became law. Advocates of “right to die”-type bills hope that if California passes the legislation that other states may follow, as has been the case for the state’s other initiatives in stem cell research and education reform.
Arguments in Favor of the “Right to Die”
Those who favor a “right to die” take the secular humanism argument that individuals, not the state, control their bodies and they have the right to do with themselves as they please as long as it does not harm others. The Tennessean writes on September 13 that people with terminal illnesses experience substantial pain in their final months and some lose the ability to dress and bathe themselves and lose the use of their other faculties. Advocates insist than an individual should be able to choose their final moments, surrounded by loved ones and in a familiar setting, rather than being hooked up to machines at a hospital.
Aside from an argument of personal autonomy, supporters of “right to die” legislation note that existing practices show that abuses do not occur. The Washington Post notes on August 28 that 1,327 persons have received lethal drugs from physicians under Oregon’s Death with Dignity Act since 1997, but one-third of these people never took their medications, thereby showing that they may have been used to reassure a terminally ill patient or act as a hedge against an agonizing death. Furthermore, advocates note that only seventy-four people a year opt to take their lives under Oregon’s law, so the state’s experiment with physician-assisted suicide shows that it does not lead to the deaths of large numbers of individuals. The Washington Post adds that although only four states have legalized physician-assisted suicide, doctors in the other states can still legally kill a terminally ill patient with “terminal sedation” where an excessive dose of morphine is administered, and Vox explains that a poll of 3,000 oncologists in California in 2000 found that more than 10% of them had assisted in a patient’s suicide over their years of practicing medicine. Therefore, doctors in the status quo are practicing some form of physician-assisted suicide so there is nothing unusual legalizing the practice.
Refuting the argument that the poor and disabled would be more subject to “right to die” efforts, Vox writes that in Oregon most of those taking advantage of the legislation are better educated and affluent. It notes that more than fifty percent of those who have chosen to die under the terms of the Death with Dignity Act had a bachelor’s degree and nearly 97% of them had insurance. Supporters are sensitive to criticism that the idea of “death with dignity” is reminiscent of Nazi attempts to eliminate “undesirables” during their control of Germany from 1933-1945. Such fears and criticisms are one reason Oregon publishes yearly data about its program.
Arguments Against the “Right to Die”
Opposition to the “right to die” comes primarily from two fronts: social conservatives and disability rights groups. For social conservatives, this movement shows the dangers of secularism, with The National Review writing on August 24 that it leads to less respect for the quality of life. Conservatives railed against “secular humanism” in the late 1970s and 1980s, using it as a springboard to attack efforts for gay rights and abortion rights. National Public Radio explains on September 12 that social conservatives are worried that older Americans could one day be pressured to pursue end-of-life care through physician-assisted suicide options. The Washington Post notes that 30% of Medicare expenditures are for patients that are in their last six months of life, and The Christian Science Monitor explains that there is a case in Oregon where an insurance company refused to pay for cancer treatment for a patient, but was willing to pay for “suicide pills.” This perceived lack of concern for human life is one reason that social conservatives criticize “right to die” advocates.
Disability rights groups have concerns that peoples that suffer from physical and mental ailments may be susceptible to pressure to accept end-of-life options. The Philadelphia Inquirer notes that disability groups campaigning against California’s law warn that the existence of physician-assisted suicide laws may cause insurance companies to coerce vulnerable people into accepting a cheaper option of dying rather than continuing to pay for medical care. They also warn that people that suffer from depression may be vulnerable under the laws, pointing out that “doctor shopping” takes place in Oregon where an individual can call Compassion & Choices, a non-profit organization that advocates for end of life care, to get the necessary medical paperwork to obtain lethal drugs. Some of these concerns may have more validity when one looks at European practices. The New Yorker explains that Belgium and the Netherlands allow for euthanasia of non-terminal illnesses and over the past five years the number of euthanasia cases in both countries have increased 150%. Some of the people seeking euthanasia include those suffering from autism, anorexia, borderline personality disorder, partial paralysis, blindness, and manic depression. Disability rights groups say that this progression could one day happen from physician-assisted suicide bills, which could be an entering wedge for more expanded euthanasia options.
A final argument that has been made against physician-assisted suicide laws is that they threaten religious liberty, distort the doctor-patient relationship, and undermine families. The conservative National Review finds that physician-assisted suicide laws could force doctors, who may object to any form of one taking their own lives on religious grounds, to one day direct patients to those who would potentially give them lethal drugs. It warns that this would lead to a nation forcing doctors to kill people. The conservative Heritage Foundation on March 24 argues that physician-assisted suicide would distort the doctor-patient relationship that is currently grounded in betterment and care. Instead of doctor’s committing themselves to the health of their patients they may look to other non-personal factors such as monetary issues when making medical decisions and this could reduce trust in doctors. It also finds that as the population ages, the presence of physician-assisted suicide bills may cause elderly family members to view themselves as burdens, thereby harming family cohesion. The New Yorker finds that there have been some complaints in Belgium that doctors are euthanizing patients without consulting other family members and The Minneapolis Star Tribune writes on August 24 that “right to die” groups have sometimes gone too far, as Final Exit Network was recently fined $33,000 and convicted of a felony for interfering in the death scene of Doreen Dunn, who took her life in 2007.
The debate over the “right to die” could be a hot button social issue in the next few years. If Governor Brown approves California’s law, advocates in other states, especially those with liberal beliefs, are likely to follow. The issue involves complicated moral, religious, and ethical questions, making it potentially explosive in the future.