Sound Evidence over Sound Bites

Book cover of Dying with Dignity

This is a guest post by Dr. Giza Lopes (the subheadings and links are ours). Read our open call for guest posts →


Giza Lopes, PhD, is an assistant professor at the School of Criminal Justice at the State University of New York at Albany. She is the author of Dying with Dignity: A Legal Approach to Assisted Death (Global Crime and Justice), published by Praeger earlier this year.

This year advocacy efforts to legalize death with dignity in the United States have achieved unprecedented momentum. Over half of the state legislatures are entertaining bills largely patterned after the Oregon experience, many for the first time. Just last week, the Golden State’s Senate advanced a bill that, if approved by the Assembly, could give terminally ill Californians the right to end their life with the aid of a doctor.

A Long History of Legislative Action

This level of political activity and intense engagement is especially remarkable if one considers that the pursuit to legalize medically hastened death via legislative action has a long history. In fact, the first bills proposing a similar option to terminally ill individuals date back to 1906. Since then, while death with dignity has been enacted in Oregon and Washington through referenda, only infrequently has it been earnestly considered by legislative bodies, with the exception of Vermont’s “Patient Choice and Control at End of Life,” signed into law in 2013.

Opposition to Death with Dignity

While the current legislative impetus has clearly galvanized advocates and highlighted sympathetic public opinion on this matter, it has also stimulated opponents to voice their concerns and disapprovals loudly. Among the latter, three groups are particularly salient: organized medicine, organized religion, and certain disability organizations. Common to the first two is a reliance on dogma—”First do no harm” and the “inviolability of human life”—as the driving force behind their opposition. Disability rights activists, on the other hand, articulate their fears that legalization of medically hastened death would inevitably lead us down a slippery slope, risking the lives of vulnerable individuals.

Together, the first two of these sources of opposition reflect an ethos brewed over hundreds of years, seasoned with emotional rawness, and framed, for the most part, into an intransigent message. One could argue ad nauseam about how doctors do more harm by prolonging the inevitable, or that one’s right of self-determination trumps any religious notion of when life begins or should end. Realistically, though, while this discussion is philosophically stimulating, thought-provoking, and passion-fueling, rarely has it been productive.

Breakthroughs such as the California Medical Association’s recent position change from opposing death with dignity to a neutral stance on the matter are extraordinary and exceptional. To date, the only national-level medical organization to affirmatively recommend—and, in effect, seek—legalization of physician-hastened death is the Royal Dutch Medical Association. And while the Roman Catholic Church, thirty-five years ago, sanctioned for the first time the refusal of “forms of treatment that would only secure a precarious and burdensome prolongation of life,” even the most optimistic of pro-death with dignity advocates would not seriously expect any endorsements from the Pope in the near future. As a concerted duo, these two groups are hard to placate.

Data Refute Misinformation

The third source of opposition, however, is one to which advocates of physician assisted dying can cogently respond. Since the passage of Oregon’s Death with Dignity Act, a multitude of data—rich and broad in scope—have been collected by the Public Health Division of the Oregon Health Authority, and comprehensive, rigorously designed studies have been conducted and published in a series of peer-reviewed journals.

Thanks to these data, death with dignity advocates are armed with nearly two decades of sound information on the demographics and underlying illnesses of those who request and ultimately ingest the lawfully prescribed medication, the stated motives of those individuals, the physicians and institutions that accept such requests, and other issues. These data show that those utilizing the law are mostly white and well-educated, that most possess medical insurance, and that most are already enrolled in hospice at the time of the request. Furthermore, analyses of the cost of care at the end of life that attempt to project savings attributable to legal death with dignity do not support the claim that economic pressures would lead to or encourage hastened death. Taken as a whole, these data and studies dispel unequivocally the fears articulated by those who espouse the view that vulnerable individuals are at risk where death with dignity is legal.

It is precisely the collection of sound evidence that can get advocates past opponents’ sound bites. For that reason, those seeking legalization through the legislative process, should insist that proposed bills contain provisions to record the types of information mentioned above. Not all of the bills currently entertained throughout the country do. This lack of transparency adds no protection to patients’ privacy and threatens to deprive the movement of a powerful tool.

View full post on Death with Dignity National Center

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