Doctors without Borders: Washington State's New Physician-Assisted Suicide Law

By Callahan, Daniel | Commonweal, January 30, 2009 | Go to article overview

Doctors without Borders: Washington State's New Physician-Assisted Suicide Law


Callahan, Daniel, Commonweal


By a vote of 59 percent to 41 percent on November 4, 2008, Washington State voters endorsed a ballot initiative to legalize physician-assisted suicide (PAS). If the final outcome was never much in doubt, the margin of victory was surprising. In 1991, an initiative in favor of euthanasia had been defeated in Washington. But this time Washington's proponents shifted to PAS. The assumption, a shrewd one, was that the public would be more willing to accept a patient's self-administered death than one directly carried out by a doctor.

What, if anything, are the national implications of the Washington vote? The answer to that question is unclear. When Oregon's PAS law, passed as a ballot initiative in 1994, went into effect in 1997, there was a widespread expectation that other states would soon follow. With the exception of Washington, that has not happened. There seem to be no states anywhere now near a change in their laws, either through legislative or ballot initiatives. A number of such efforts in a variety of states failed in the 1990s, and recent years have not seen similar bursts of activity. The Washington vote might reignite such efforts, but that is by no means certain.

The history of the Oregon initiative and law offers some hints about what may happen in Washington. In Oregon, the most unexpected outcome has been the small number of people who have taken advantage of the law, only 341 in eleven years. One plausible explanation is that the law stimulated efforts to develop better palliative care and hospice programs. Another is that many of those who support the legalization of PAS do so out of tolerance for the convictions of others, but have no interest in making personal use of PAS. Still another is that for some people availability of PAS is attractive if worse comes to worse, but as a desperate and rare remedy only--much as some people feel comforted in having a gun in the house but hope never to use it. Finally, some expected that out-of-staters would flock to Oregon to take advantage of the law, but they didn't.

A major concern of opponents of PAS, almost always voiced in campaigns against both PAS and euthanasia, is the specter of possible abuse. Most notably, the argument goes, it will eventually be the poor, the old, and the socially marginalized who will be victimized--cajoled, coerced, or seduced into ending their lives. While I am sure there are many opponents who believe that will eventually happen--and some who think it a good tactic for conservatives to use as a way of appealing to liberals--I have never shared that belief. From what I can see, both in the Netherlands, the first country to legalize euthanasia (in 2000) and PAS, and in Oregon, that has not happened, and there is no compelling reason to think it will.

On the contrary, it seems that at the heart of the legalization drives has been an obsession with good old-fashioned bourgeois self-control: It is my body and my life, and if I want to die, I should be allowed to do so. It is no accident that the Netherlands led the way. It is by far the most libertarian nation in the world, famous for its legal prostitution and lenient drug laws. Self-determination is a very high value for the Dutch, as for many people in Oregon and Washington. An early study of PAS-users in Oregon and similar studies in Holland have shown that the main reason for embracing it is fear of losing self-control, not fear of pain. A study in Oregon of cancer patients in the first year following legalization found that those who wanted PAS were less likely to be in pain than patients who did not want it.

Appeals to the sanctity of life have little sway with those bent on maintaining a sense of self-control. They believe they respect that sanctity as much as anyone, and that one way to do so is to give people the freedom to manage their own lives, especially at the end. I don't share that view, but it is important to understand its appeal in secular democratic societies that see freedom of choice as a valued way of respecting human dignity (a concept that has both good and bad uses). …

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