The Legislation That Supports a Patient's Right to Die

States Laws Protecting Their Citizens' Rights to Die

There is extreme passion on both sides of the debate, but the legal right to choose death has gained some traction in the United States through laws that have been passed both at the federal and state levels.

Legislative History of Right-to-Die Measures

The first law passed at the federal level that regards a patient’s right to choose continued life, or death, was called the Patient Self-Determination Act, passed in 1991. This law gave American citizens the right to develop legally binding advance directives that outline whether and which life-sustaining treatments they will accept in dire and difficult circumstances. This can be achieved through documents like livings wills, do not resuscitate orders (DNR), physician or medical orders to end life-sustaining treatment (POLST, MOLST), and others.

Passive Death vs. Proactive Death

But choosing what will happen to you when you find yourself in grave circumstances (or when you aren’t conscious enough to understand those circumstances) is not the same as making the conscious and alert decision to actively take your own life rather than suffer through illness or the dying process.

While the right to refuse treatment has been granted in the United States for many years, requesting that someone else speed up the dying process is a different matter, both ethically and legally.

In some cases, patients who refuse treatment have taken active steps to die by deciding to no longer eat or hydrate. They may be able to accelerate their own death by starving themselves or dying of thirst. This sort of choice may take a period of weeks.

In both scenarios, patients choose death by actively not doing something. That is a different approach from actively taking steps, by ingesting lethal drugs or by suffocating yourself and inhaling certain agents, that can cause death in a matter of minutes. Such proactive steps to euthanize yourself usually require assistance from another person.

Right to Die Legislation Across the United States

There are a number of options, considerations, and resources to end life whether a patient lives in a state where the laws support them. However, if those options require the assistance of another person, patients must reside in a state with supportive laws.

As of late 2017, five states and the District of Columbia have enacted death-with-dignity laws.

Oregon

The first of America’s states to codify physician assisted suicide, the right to die, Oregon passed its Death with Dignity Act in 1997. It allows residents of Oregon who are terminally ill to self-administer lethal medications that have been prescribed by a physician to help them die.

Those who wish to lean on this law to help them die must be legal residents of Oregon, at least 18 years of age, capable of making rational decisions about their demise, and they must be diagnosed (and certified) to have a terminal illness that will end within six months.

The law is very specific as to how those criteria must be met, and all patients who make this choice are tracked by the state.

Washington

In 2009, the state of Washington implemented its Death with Dignity Act, which allows patients to request their doctors help them die.

Similar to Oregon, patients must be terminally ill with prognoses of less than six months and residents of the State of Washington. If they meet that criteria, they may request aid from a physician to help them acquire the lethal drugs needed to end their lives.

There are many forms that need to be completed by both the patient and the doctors, and timeframes which must be followed to keep the request and dispensing legal. Further, there must be a witness to the death, and there are very specific rules about who the witnesses may and may not be. For instance, the witness may not be a relative, an employee of healthcare facility, nor the physician who prescribes or dispenses the drugs.

Vermont

With the passage in 2013 of Act 39 (Patient Choice and Control at the End of Life Act), Vermont became the fourth state to pass death with dignity laws, and the first state in the eastern part of the United States.

The requirements for patients who want to find a physician to help them die are similar to the other states that have passed such laws, but the process seems to be spelled out more clearly on their website than in other states.

California

In 2015, the state of California passed their End of Life Option Act and went into effect in June 2016. California's new legislation closely follows Oregon's Death with Dignity Act with some modifications.

Colorado

Colorado passed Proposition 105, the End of Life Options Act, in 2016. It went into effect at the end of 2016. It applies to terminally ill individuals with a prognosis of six months or less to live. Physicians may prescribe medical aid-in-dying medication that is then self-administered.

District of Columbia

The District of Columbia D.C. Death with Dignity Act went into effect February 18, 2017, and implementation began on June 6, 2017. However, it can be stymied if federal budget legislation doesn't fund its reporting requirements.

Pending Legislation and Clarification in Montana and Other States

Montana's Supreme Court ruled in 2009 that no state law prohibits a physician from honoring the request of a terminally ill, mentally competent patient by prescribing medication to accelerate the patient's death. Legislative attempts to make this illegal or regulate it failed in 2013 and 2017.

Many additional states are considering right-to-die legislation. ProCon.org maintains a state-by-state listing of states and their stance on the right to die. 

Continue Reading