Give Me Liberty and Death: Assisted Suicide in Oregon
Campbell, Courtney S., The Christian Century
A 43-year-old Oregon man is progressively paralyzed by the advance of amyotrophic lateral sclerosis (ALS). Cared for by a hospice and his family in his travel trailer, the man requests a lethal dose of medication so that he can end his life. A physician, acting under the state's Death with Dignity law, prescribes a sufficient supply of barbiturates. The man uses a straw to mix the barbiturates with a chocolate nutrition drink. When his paralysis makes it difficult for him to swallow the mixture, a brother-in-law helps the man to die, though the brother-in-law refuses to talk about how he did it (the Oregonian, March 11, 1999).
A new professional and moral era in medicine began in Oregon in 1998--the state entered a brave new world in which physicians assume the responsibility for hastening the death of their terminally ill patients, and patients determine the timing, circumstances and means of their deaths. Patients now can give their physicians a revolutionary command: "Give me liberty and give me death." How and why did this come about?
Oregon is a state that takes immense pride in its pioneer history. As people pushed westward in the 19th century, they left behind older social patterns and moral and religious traditions. That frontier spirit is still alive. Oregon's approach to assisted suicide displays the ethos and sentiments of libertarianism: personal autonomy, choice and self-determination are regarded as sovereign, and institutions with authoritarian pretensions, whether the government, the church or professional associations, are viewed with suspicion.
The Oregon Death with Dignity Act exemplifies both this ethos and the frontier imperative to continually expand and revise boundaries. Those who formulated the act had three purposes in mind: 1) To provide terminally ill patients with the right to "a humane and dignified death" through ingestion of a lethal medication; 2) to provide physicians with immunity from legal and professional sanction for participating (whether by offering a diagnosis, providing information or writing a prescription) in hastening patients' deaths; 3) to assure the public that such a practice could be subject to regulation and public accountability (in contrast to the unregulated methods of Dr. Jack Kevorkian and the absence of accountability of physicians in the Netherlands).
The Death with Dignity Act was initially approved by voters in 1994, though legal appeals postponed its implementation until fall 1997. It made Oregon the first jurisdiction in the world to give physicians the legal permission to assist in the suicide of terminally ill patients. The law was widely heralded as illustrating the "pioneering" role of Oregon in patient-directed medical practice and in ensuring "dignity" at death.
While the language of dignity and compassion gave the act its conceptual foundation, the legislation's practical focus was on enabling physicians to write prescription for lethal medication. What follows such authorization is largely unregulated and ambiguous, as the opening story illustrates; the state's deputy attorney acknowledges that the act is silent on many questions about implementation.
What the act does make clear are certain rights and responsibilities of both patients and physicians prior to the writing of the prescription. For example, adults with a diagnosed terminal illness (meaning that according to reasonable medical judgment, the patient's life expectancy is less than six months) have the right to request medication that will end life in a "humane and dignified" manner. (The act does not refer to the patient's request or the physician's action by the term "physician-assisted suicide.") Patients may ask for information about their diagnosis and prognosis; about the potential risks and probable results of ingesting lethal medication; and about alternatives, including palliative care and hospice. They may rescind their request. …