Just Another Prescription

Unless you live in the Pacific Northwest, you may not know that the voters in the state of Washington passed a “death with dignity” initiative on No­vem­­ber 4 by a 16-percentage-point margin. In 1997, a fero­cious battle preceded the narrow approval of an Oregon law allowing doctors to write lethal pre­scriptions for dying patients. In 2006, the law survived a Su­preme Court chal­lenge brought by two attorneys general. Now, in contrast to the earlier drama, the extension of the so-called right to die to a second state in Novem­ber was almost ­ho-­hum ­news.

Part of the reason is that in 10 years of experience with Oregon’s law, only 541 patients in a state of 3.7 million acquired pre­scriptions for lethal drugs. Of those, only 341 used them. None of the fears surrounding the new law have proved justified. No public outcry has arisen over pressuring dad to die so junior can sell the business. No flood of law­suits has been filed over the legislation.

A decade-old Washington state law allowing doctors to write lethal prescriptions for dying patients has led to improved care at the end of life.

What has happened, writes Courtney S. Campbell, a religion and philosophy professor at Oregon State University, is that doctors have almost certainly changed the way they practice medicine. One of the law’s major selling points was that it would lead to the alleviation of unbearable pain among the dying. The public response to the issue caused doctors, hospitals, and hospices to pay more attention to pain. Laws and licen­sure requirements were altered so that doctors no longer faced investi­gation if they boosted dosages of medication to potentially dangerous levels for terminally ill peo­ple. Today, the issue of pain has become secondary. More than 80 percent of the patients re­quest­ing lethal drugs cite a “loss of auto­nomy” as justifi­cation. Pain is sixth on the ­list.

The expressed purpose of the Oregon law, like that of the Washington initiative, is to allow residents to choose death with dignity. Drugs are not a precondition for such a death, Camp­bell says, nor does the “possession of a right [entail] its subsequent use.”

It may be, writes Campbell, who considers the law a “moral mistake,” that the mere possibility of legalizing physician-assist­ed death serves as sufficient impetus to find alternatives for improving care at the end of ­life.

THE SOURCE: “Ten Years of ‘Death with Dignity’” by Courtney S. Campbell, in The New Atlantis, Fall ­2008.

Photo courtesy of Flickr/Alex