Will Assisted Suicide Tourism Hub Be Vermont Or Oregon?

Will Assisted Suicide Tourism Hub Be Vermont Or Oregon?

Oregon was the first state to permit physician-assisted suicide in 1997, but this past month Vermont became the first state to have a law that does not require residency in the state to participate. Vermont previously permitted physician-assisted suicide, but it changed its law to waive state residency as a result of a lawsuit. Oregon no longer enforces its law that still requires state residency to participate under its Death with Dignity Act. Oregon stopped enforcing the residency requirement as a result of a settlement of a federal lawsuit last year.

It appears that the right to die movement is growing as now 12 states permit physician-assisted suicide although Oregon and Vermont are the only states that do not require state residency to participate. Due to the success of lawsuits against Oregon and Vermont, it seems to be only a matter of time that other states will follow and permit the waiver of state residency. However, there was a Supreme Court ruling more than 20 years ago that there is no fundamental right to assisted suicide. Those who oppose “death with dignity” argue that it erodes the purpose and role of physicians in our society. A part of the Hippocratic Oath is to neither prescribe a deadly drug nor give advice which may cause death.

The requirements of a patient for physician-assisted suicide are similar in the states that have passed these laws although California relaxed its informed consent safeguards last year. The qualifications of a patient to be eligible for medical assistance to die are generally as follows:

  1. Be at least 18 years of age or older.
  2. Have a diagnosis of a terminal illness that will lead to death within six months.
  3. Be capable of making and communicating heath care decisions for himself/herself; and
  4. Be able to self-administer the medication.

In order for a patient to get a prescription from a participating doctor, the following steps are generally needed:

  1. The patient must make two oral requests (in the physician’s presence or by telemedicine) to the attending physician (who is a doctor licensed in the state of the applicable law), separated by at least 15 days.
  2. The patient must provide a written request to the attending physician, signed in the presence of two witnesses (who can’t be the doctor, a relative of the patient by marriage, blood or adoption – although some states require only one not be related to the patient while some states require no person can be a witness if they are a beneficiary of the will or trust of the patient or by intestacy and some states require that the witness neither be an owner or employee of a facility where the patient is receiving medical treatment).
  3. The attending physician and a consulting physician must confirm the patient’s diagnosis and prognosis.
  4. The attending physician and consulting physician must determine whether the patient can make and communicate health care decisions for himself or herself.
  5. If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination.
  6. The attending physician must inform the patient of alternatives such as hospice care and pain control.
  7. The attending physician must request, but not require, the patient to notify their next-of-kin of the prescription request.

A physician does not need to be present when the medications are taken by the patient. The physician does not administer the lethal dosage of the medicine as that would be euthanasia, which is not permitted in any state. The physician will list “natural” as the cause of death (due to confidentiality and privacy laws). This will also reduce the risk of a life insurance policy company denying a claim for suicide.

It seems throughout history that people desire to die as gently as possible. For some, hospice and pain control may not be adequate resulting in more states permitting medical aid in dying. The majority of states, including Texas, have not gone that far. In fact, in many countries such assistance would be criminal. However, it would not be hard to imagine this law becoming more commonplace in the future.

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