Death With Dignity: Divergent Media Perspectives on Assisted Suicide

As biological creatures, the human species shares a fundamental instinct: survival. The steady continuation of life some 200,000 years after the development of modern humans  is a testament to our commitment to survival–a species with a death wish would quickly become extinct. Unique to the human species is our elaborate mental processing, sophisticated method of communication, and complex social structure. To investigate the human experience exclusively through either a biological or sociological lens would be to ignore the crucial implications of the other. Although at their core, our societies, institutions, and policies mirror our biological inclinations towards survival, the sociological aspect of human life presents circumstances in which survival might not be the best option. Debates regarding end-of-life options for terminally ill patients are no exception.

Every year, a number of terminally ill individuals seek the aid of the United States healthcare system in order to end their lives. This, however, is an opportunity only afforded to some individuals. Oregon’s Death with Dignity Act (DWDA) made Oregon the first U.S. state to legalize medical aid in dying (MAID) for those who qualify. Enacted in 1997, DWDA has been a point of contention since its inception. Regardless, 11 jurisdictions have followed Oregon’s example as of May 2023, adopting similar statutes. Under DWDA, MAID is highly regulated. Two physicians must openly concur that the patient has a terminal illness and a prognosis of six months or less to live. If the patient is deemed eligible under these conditions, the individual enters a waiting period prior to the prescription of a lethal dose of a medication that must be self administered to end one’s life. Throughout the process, medical professionals are required to report any indication of patient coercion or signs of impaired judgment, upon which immediate action is taken and the procedure is terminated.

In this article, I investigate divergent media perspectives of MAID under DWDA, which offer valuable insights regarding the ideological frameworks that motivate individuals’ position on the topic. I find such media perspectives to be useful in understanding the nature of institutional and individual perceptions of both death and human rights issues. Upon further examination, I ultimately side with proponents of DWDA. I argue that Oregon’s DWDA provides an exceptional model for the federal legalization of medical aid in dying because it is a safe medical practice, relieves suffering for those involved, and preserves patient autonomy–thereby upholding the utmost quality care for terminally ill individuals. Arguments which oppose the federal legalization of MAID under DWDA and similar statutes are rooted in overly simplistic interpretations of human rights standards and outdated conceptions of the role of the medical system. 

MAID as a Safe Medical Practice

Despite its legalization in various regions of the United States, the media continues to debate the safety of MAID as a medical practice. Most broadly, opponents remain unwavering in the deduction that DWDA “is a dangerous public policy,” and claim that it “threatens… the most vulnerable in society.” They insist that the legalization of MAID would undoubtedly be abused, and that no legal safeguards can be put in place to prevent such abuse. While these claims may be alarming, their rhetorical strength far surpasses their practical force, a trend which remains consistent at the individual level. Here, many media sources pay particular attention to the influence of institutions on patient decision-making. Proponents tend to take on a positive view of institutions, assuming their commitment to the best interest of individuals within the community. By contrast, critics take on a more negative view of the primary interests of institutions and emphasize their motivation for profit. Because life-saving medical procedures can be expensive, critics heed the possibility that insurance companies may simultaneously cover MAID while denying coverage of some more expensive life-saving procedures. In light of this concern, media sources which oppose DWDA commonly cite testimonials from individuals who have experienced such a disparity in care. 

The case of Barbara Wagner is a prime example. Wagner, an Oregon woman whose lung cancer had been in remission, had recently learned that the disease had returned and would likely kill her. Wagner’s insurance plan refused to cover the $4,000 treatment which had the potential to save her, but agreed to cover a lethal prescription under DWDA. Rhetoric used in an article published by ABC News illustrates the frustration experienced by Wagner and her loved ones. According to the article, the insurance company essentially offered to “stand there and watch [her] die,” but not to “give [her] the medication to live.” 

Although disheartening, these testimonials do not carry significant weight in the federal government’s verdict in regards to MAID under DWDA as a safe medical practice. Rather, opponents’ time and energy may be better spent reforming the American institutions which routinely prioritize profit over the community’s best interests. Prior to the existence of comprehensive scientific data from DWDA in Oregon, such a concern for potential adverse impacts on individuals without access to inclusive health insurance may have been well-founded. Since the enactment of DWDA in 1997, however, comprehensive data collection and research has been conducted. An abundance of empirical data reveals patient election of MAID under DWDA to be equally divided among gender, income, education, race, and ethnicity within the state of Oregon. This reality undermines opponents’ concern that individuals with less access to quality health insurance may be routinely coaxed into accepting MAID as their only option. While Wagner’s story remains disconcerting, her experience is more likely an anomaly than a normality. 

In fact, it may be the case that the majority are more likely to endure challenges related to the procedure of MAID under DWDA. Contrary to many opposing media assertions, research indicates vulnerable groups to be underrepresented in the election of MAID nationally. Individuals who utilize MAID across all jurisdictions are typically older, white, and educated. There are a variety of plausible explanations for this disparity. First, members of one or multiple of these groups may be economically advantaged, and therefore more able to take on the expenses associated with traveling to jurisdictions where MAID is accessible. Additionally, it is plausible these statistics are partially due to differential treatment from the healthcare system at large. 

There are a number of key issues which contribute to health inequities for marginalized groups, including high costs and disparate levels of access to primary care physicians or preventative health services. Considering these disparities, the federal legalization of MAID may actually stand to support vulnerable populations in the long run. Equal protection of human rights means that all individuals are able to enjoy the highest standard of health without discrimination. Failure to address health inequities perpetuates inequality by denying vulnerable populations opportunities which are more accessible to socio-economically advantaged populations. Therefore, federal adoption of Oregon’s DWDA would bolster health equity and individual safety by making end-of-life services more accessible for people of all backgrounds. 

Patient Suffering

When qualifying individuals are unable to elect MAID, they may resort to an alternative methods to manage their suffering. Hospice is perhaps the most commonly recognized option for patients who experience extraordinary suffering. When patients are admitted into hospice care, health care professionals shift their attention towards pain management for the patient rather than the search for a potential cure for them. As a result, patients in hospice are often prescribed high doses of various pain medications. 

While hospice programs may be effective in the suppression of physical pain, terminally ill patients typically experience suffering in a range of other domains. A study of 3,368 prescriptions for lethal medications under DWDA asked participants to report their primary reasons for electing MAID. Of the participants, 87.4% reported loss of autonomy, 86.1% reported impaired quality of life, and 68.8% reported loss of dignity. Statistics from Oregon’s DWDA echo this gap in treatment. Death With Dignity, a news publication founded in Oregon, reports that 90% of patients who elected MAID in 2014 were already in hospice. This reality simultaneously undermines the argument for hospice as an alternative to MAID and illustrates the significance of emotional suffering. 

 Voluntarily Stopping Eating and Drinking (VSED) is a legally available alternative that has the potential to relieve the aforementioned emotional suffering. Just as it sounds, the procedure requires the patient to forgo nutrition and hydration in order to end their lives. The federal legality of VSED compared to MAID prompts a discussion about the similarities and differences of the two practices. Both methods are reliable in hastening death, and the patient and physician intent between the two practices is almost identical. Compared to MAID, however, VSED requires a high level of commitment from the patient and a low level of involvement from the physician. Death can be achieved in as little as ten minutes following the ingestion of a lethal medication under DWDA, but when an individual undertakes VSED, death occurs in about one to three weeks.

One’s willingness to accept VSED as an alternative to MAID offers meaningful insights into their perspectives on the role of medical professionals. VSED avoids many concerns associated with MAID because it can be executed without assistance from medical professionals. Opponents of MAID typically emphasize the role of physicians in the preservation and saving of life, and argue that the provision of lethal medications under DWDA is inappropriate. An article published by The Wall Street Journal highlights this perspective, noting that “the Declaration of Independence puts life among its catalog of unalienable rights,” and asserting that the “‘pursuit of happiness’ cannot logically include the intentional destruction of an innocent human life.” However, VSED does not alleviate the patient from immense suffering; an article published by the New York Times notes that “no patient should have to suffer the indignity” of intentional malnutrition and dehydration under the supervision of a medical professional. Indeed, additional suffering is a likely reality for individuals who elect VSED. The vast majority of patients who undertake VSED experience at least two of a range of symptoms, including extreme thirst, hunger, dysuria, delirium, and somnolence.  When considering the place for DWDA, one must weigh the ethical concerns raised by critics with the ethical concerns raised by proponents. To be sure, proponents of DWDA emphasize relief from suffering as the primary role of medical professionals.

Patient Autonomy

Attempts to objectively define ethical guidelines for the healthcare system have been a pressing issue for much of our history. Composed amidst a slew of widely condemned  biomedical experiments–perhaps most infamously, the Tuskegee Syphilis Study–philosophers Beauchamp and Childress identified four cornerstones of biomedical ethics. Unsurprisingly, personal autonomy was top on the list, followed by beneficence, non-maleficence, and justice. Since then, the identified principles have become dominant in the field of biomedical ethics, and proponents of DWDA highlight personal autonomy as a key argument for the federal legalization of the MAID. They argue that it is unethical to inhibit a patient from acting on the basis of their personal desires and values. Former president of the Association of Academic Health Centers, Steve Wartman, concurs, arguing that even the most irrational of choices made by a competent patient must be honored. Wartman’s argument, involving what many might consider a “worst case scenario,” is a testament to the primacy of personal autonomy in medical decision-making. 

Opponents counter this argument for personal autonomy by asserting that, in light of the various administrative burdens and dependence on physician diagnosis, the election of MAID under DWDA is not truly autonomous. Surely, the prevalence of a variety of procedural and administrative burdens in the U.S. healthcare system is problematic. Survey data from one study reveals considerable administrative burdens to be the reality for 73% of respondents. The survey took into account five common patient administrative tasks, along with reports of forgone care as a result of the burden. As grim as these findings may be, they denote the experience of patients who are highly involved in the healthcare system for a variety of conditions. Therefore, while the prevalence of administrative burdens associated with the regulation of MAID under DWDA may be unsatisfactory, such burdens are characteristic of the U.S. medical system at large and are thus not a worthwhile argument against DWDA statutes specifically. 

Additionally, critics of DWDA who conceded to the prevalence of administrative burdens in the healthcare system remain adamant that personal autonomy is only one of four identified cornerstones. They urge their audiences to consider the influence of contemporary social contexts, and thus to reevaluate the priority of personal autonomy compared to the other principles. According to commentary published by the Psychiatric Times, “it has been primarily in the past 60 to 70 years [..] that autonomy has been enshrined as the primary, if not the sole, medical value,” a condition that is rooted in “the overly individualistic and near absolutist concept of autonomy that reigns in Anglo-American law.” 

Due to the concern over the potential influence of contemporary social contexts, it is reasonable to analyze the basis on which laws are created and amended. In democratic societies, the law should be made to reflect the ever-evolving cultural values of the people. Under this perspective, the law should be expected to be responsive to societal changes, such as increased individualism. Ultimately, the law should endeavor to honor modern cultural values while simultaneously upholding fundamental human rights. Oregon’s DWDA does exactly that. 

In Closing

Regardless of its divergence from the biological human instinct for the continuation of life, contemporary society calls for the adoption of a carefully implemented policy which legalizes and regulates MAID. The challenge of ethically supporting terminally ill patients is undoubtedly complex and daunting, but DWDA is carefully constructed and statistically backed. As debates regarding medical aid in dying continue, the federal government can find solace in Oregon’s successful implementation of DWDA. It is the moral imperative of the federal government to enable higher quality healthcare for terminally ill individuals by offering a safe, compassionate, and righteous option for those facing unbearable suffering, and Oregon’s DWDA serves as an exceptional example of how to do so.