By:
Sue Dessayer Porter
Oregon was
the first state to legalize aid-in-dying. Since 1998 it has
implemented “Death With Dignity (DWD),” which allows eligible terminally
ill people to end their lives peacefully with a legal prescription.
Contrary to
fears asserted by the opposition, there have been neither slippery slopes, nor
granny panels, nor hordes of people clamoring to Oregon to die. With over
sixteen years of experience, DWD has demonstrated successfully that cautious
adherence to the law provides safe choice and dignity with aid-in-dying.
In spite of
this flawless record, there is ever-increasing obstruction against choosing
this autonomous and personal end-of-life option. The problem? As religious
hospitals merge with financially imperiled medical centers or acquire
independent medical practices, they are enforcing policies which prohibit
doctors from participation with DWD. This restriction applies to all doctors;
therefore, a Muslim physician treating a Jewish patient is dictated by another
religious doctrine. Doctors are not even allowed to have a conversation with
their patients about DWD, so the “duty to refer” is not a consideration.
An
unintended consequence? Oregon’s DWD Act, Section
127.885 s.401 (5) (a), allows a health care provider to prohibit another
health care provider from participating in DWD. [1]
This was intended as a well-meaning compromise to appease the opposition and
move the law forward. In retrospect, lawmakers in the early 1990’s could not
have predicted the merger activity by religious hospitals twenty years into the
future. However, the state of medical economics has changed so dramatically in
the last two decades that private practitioners cannot sustain independently.
Therefore, doctors who previously supported patients through DWD can no longer
do so, because they are now employed by religious medical organizations.
Washington
state voted DWD into law in 2008 and is facing the same obstacles.
These health
care leaders state that they are in savior mode, in that if it were not for
them, many communities would be bereft of medical care. They say that they are
“driven by a mission to serve the underserved,” with a
commitment to help every human being. [2]
However, patients requesting end-of-life choices are being denied lawful alternatives.
This pervasive barrier to aid-in-dying affects increasing numbers of qualified
terminally ill patients who try to avail themselves to DWD. Because their
states voted DWD into law, residents of Oregon and Washington reasonably assume
that health policy, combined with their doctor-patient relationship, entitles
them access to aid-in-dying. Although this is a credible expectation, it is
proving to be false too frequently.
Doctors are
individually protected by conscience clauses to deny services that are in
conflict with their personal beliefs. Alternatively, as long as freedom
of choice is protected for doctors who do not want to
participate in specific procedures, the same principle of choice should be
guaranteed for doctors who do choose to offer what they
consider responsible, ethical, legal and dutiful medical care. And
logically, patients should be assured their rights to legitimate choice and
self-determination.
Sue has been a client case manager for Compassion & Choices since 2001, stewarding patients through Oregon’s Death with Dignity Act. She has a Masters of Science in Bioethics from Union Graduate / Mt. Sinai Med. Center (NY), a Masters in Business Admin. from St. Mary's College (CA) and a diploma from Yale's Interdisciplinary Center for Bioethics (2013). Sue is also a national board member for Compassion and Choices, the leading advocacy organization for end-of-life issues.
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