Imagine you are in unbearable pain. Every single moment of your life. Only drugs that your doctor prescribed to you hold this pain manageable to the extent that you are not screaming, that you can fall asleep. Even when you sleep, you are not getting that peaceful rest. You fall into a deep hole of drugs, drugs that keep you almost painless, but not emotionless. A few months ago your doctor diagnosed you with an incurable disease. You tried several treatments; you kept trying for all these months, but nothing helped. You are dying. Dying slowly. Your disease eats your body from inside; it eats your brain, your mind, and your memories. Your memories… you lived your life fully, you worked, you raised your children, they are all grown up by now and you already have grandkids. These little angels… Your children, your grandchildren. Thoughts about your family keep you awake at night more than your pain from the disease does. You hate, you despise until your old fingers tremor that your beloved family is seeing you slowly dying, dying helplessly and in pain. You have already arranged all your estate, you wrote a will. You are waiting for God to take you away. But not. Your doctor told that you might live for another month. You are still competent. You still have feelings. Yet you know that inevitably comes the moment when you will not be able to care for yourself anymore, you will be fed by feeding tube, wear diapers, confined to a hospital bed. You will lose the last piece of dignity. And your family will see that. It breaks your heart. There ARE things worse than death. You ask for death… with dignity.
Does a competent terminally ill person have the constitutional right to die with dignity? The right that incorporates the assistance of a doctor in obtaining drugs that the person can take to end her own life? How can any country that declares personal freedom for people and that has outlawed torture deny its own citizens the right to peacefully die? Isn’t it humane that people should be allowed, when the time comes, to end their lives with dignity without punishing those who ease their passing? Isn’t it humane to allow people to peacefully die if and when they determine that they want to end their lives? If the disease cannot be cured, if all that medicine can do is to slow the spread of the disease or mitigate dreadful, unbearable pain with drugs, isn’t it humane to allow assistance of a doctor to end the life painlessly? Doctor-assisted suicide is a complex and deeply personal subject; it affects all of us and our families as we approach the end of our lives. Assisted suicide offers terminally ill people the “bodily integrity” to humanely end their lives without lengthy suffering. When terminally ill and suffering people have only months, weeks or days to live, we should respect and honor these people’s decisions to end their suffering and pain, to allow them “end-of-life option.”
Doctor-assisted suicide is a controversial subject and only a few countries currently allow it. Countries that allow some form of assisted suicide are Germany, Switzerland, Belgium, Netherlands, Japan, Colombia, Albania, and Canada. All countries except Switzerland forbid foreigners from obtaining aid in dying. All countries except Belgium currently forbid people with psychiatric conditions such as bi-polar disorder or schizophrenia to apply for doctor-assisted suicide. In the United States, assisted suicide is legal in six states: Oregon, Washington, Vermont, New Mexico, Montana, and California. And more states are coming. For example, the D.C. City Council already gave initial approval to allow physician-assisted suicide and a final vote on the bill will be on November 15, 2016. Council member Kenyan R. McDuffie called his vote on assisted suicide as a “toughest vote,” loosing his composure while describing “natural” death of his father and wishing it to no one to watch how the loved one suffers and slowly dies from terminal illness. The state of Colorado will vote on the assisted suicide today, November 8, 2016. In the rest of U.S. states, aid in dying is still a criminal offense, felony manslaughter.
Oregon was the first U.S. state to approve doctor-assisted suicide by enacting the Death With Dignity Act in 1997. The state has no minimum residency requirement and people who want to obtain medical aid in dying only have to prove their residency to a doctor showing the doctor their driver’s license or a rental agreement. A total of 859 people have died under assisted suicide law since Death With Dignity Act was enacted. The state has no report on how many of terminally ill people have moved to Oregon to die. Yet the Oregon health authority’s annual reports show that more and more terminally ill patients have gotten a prescription for medical aid in dying. In 1998, only twenty-four people received those prescriptions, and sixteen used them. In 2015, seventeen years after the passing the Death With Dignity Act, 218 people requested prescriptions, and 132 used them. In fact, during 2015, the number of prescriptions increased by 24.4% and the rate of doctor-assisted suicide deaths was 38.6 per 10,000 of total deaths in Oregon.
Colorado “End of Life Options Act,” known as Proposition 106, is on todays’ ballot. Among several criteria for eligibility, the proposed law requires people to demonstrate that they are suffering from terminal illness and that two independent doctors verified that person has irremediable medical condition from which the person will naturally die within six months. Precluding the prospect of suicide tourism from other countries, the proposed law requires people to prove that they are residents of Colorado State. Safeguarding capacity and full consent, the proposed law ensures that people have given two oral requests and one written request, witnessed by at least two other persons, and gone through a waiting period of fifteen-days. The proposed law does not include such provisions as allowing capable of making medical decisions minors to choose assisted suicide, nor does the proposed legislation allow people in any stages of mental illnesses, like dementia, to request a doctor-assisted death. If the Colorado voters decide that the state should enact legislation allowing assisted suicide, Colorado will become a seventh state that allows the right to die with dignity.
The key aspects of assisted suicide’s medical practice now are the patient’s mental capacity, autonomy, and self-administration. All of the countries that currently allow assisted suicide ensure that dying from incurable disease and unbearable pain people have their actual choice of a peaceful death. Yet there are several strong arguments in opposition of assisted suicide. One of these arguments is a valid concern about vulnerable people. In fact, terminally ill people are particularly susceptible to overt and subtle pressures because of pain, effect of medication, and, often, depression. The elderly may find themselves under their inheritor’s undue influence and pressure to “hurry up” and die, making assisted suicide threatening the vulnerable, viewing them as expendable, “hiding killing with euphemisms,” transforming medical profession from “a healing into a killing profession.” Yet while vulnerability is a valid reason for making extra safeguards available, it is not a reason to deprive suffering people of their rights to die with dignity.
Many people struggle to balance their religious beliefs with support for the assisted suicide. Yet, as D.C. Council Member Anita Bonds rationalizes, personal feelings and beliefs do not justify an authority of “thinking for others on matters of life or death.” Indeed, in the states that already allow assisted suicide, the only people who make the decision is the patient and the doctor, but only the patient decides when to take the final medication. Assisted suicide in these states is nothing more than a medical program, nothing more than an option. As Barbara Coombs Lee, president of the national Compassion & Choices organization and a board member for the Colorado end-of-life options campaign explains, people who can use assisted suicide all suffer from terminal illness and the “choice” that they make is comparable “to the one made by people who jumped out of buildings on Sept. 11, 2001, to avoid burning to death.” To choose slow, agonizing, and painful death or to die with dignity is the most personal decision any competent terminally ill human being can make.
Some also rightfully argue that allowing medical aid in dying may lead insurance companies to find a loophole and deny coverage for lifelong medical care while “more cost-effective” option of assisted suicide is available. The line between death with dignity and premeditated murder of vulnerable is still unclear. And the law on where do we draw the line on assisted suicide requires careful consideration and more safeguards to assure that the option is solely based on the terminally ill people’ request.
All of us need to urge the government to “hold the line,” to set clear boundary when it comes to eligibility for doctor-assisted suicide, focusing on circumstances, and ensuring the safeguards are in place. The rights and protections of people with serious medical conditions should be carefully weighted. Yes, a terminally ill people should be allowed to make their final determination, should have the right to die with dignity. Yet we need to ensure that the thin line between dying with dignity and premeditated murder of the vulnerable is never crossed.
Today is November 8, 2016. Today is the day to vote for or against assisted suicide in Colorado. Today is the day to vote for or against the right to die with dignity. What is your choice, Coloradans?
Ilona Starchak is a 3L law student at the University of Denver Sturm College of Law, the Staff Editor on the Denver Journal of International Law & Policy and the Denver Criminal Law Review.