There is a lot of disagreement about the ethics of physician-assisted death. Some people believe that someone with a terminal illness should have the choice to end their suffering with dignity. Other people maintain that doctors can't help people end their lives because it's at odds with their role as healers.
What Is Physician-Assisted Dying?
Physician-assisted dying is when a doctor gives a patient a prescription for a lethal dose of medication that they can use to end their life when they're ready. Other terms used by medical, legal, and advocacy groups include aid in dying, medical aid in dying, and physician aid in dying.
You may see it referred to as physician-assisted suicide or euthanasia, but they are not the same.
Euthanasia
Euthanasia and physician-assisted dying are both designed to peacefully end someone's suffering by ending their life. However, with euthanasia, someone else administers the medication. With physician-assisted death, the individual ingests the medicine when they decide to, maintaining control over the process. Euthanasia is illegal in every state in the U.S.
Physician-assisted suicide
The American Association of Suicidology (AAS), which aims to prevent suicide through education, research, public awareness, and training, states that physician-assisted dying is not the same as suicide. All of the primary medical professional associations oppose the use of the term “physician-assisted suicide.”
Is Physician-Assisted Death Legal in the U.S.?
Physician-assisted dying is legal in the following states under different laws:
- California
- Colorado
- Hawaii
- Maine
- Montana
- New Jersey
- New Mexico
- Oregon
- Vermont
- Washington, DC
- Washington
Physician-assisted dying eligibility criteria
To be eligible for medical aid in dying, a person has to meet all of the following requirements:
- Age 18 or older
- Have a terminal illness with a prognosis of fewer than 6 months to live
- Be mentally able to make their own medical decisions
- Be able to ingest the medicine themselves
In 2023, both Oregon and Vermont changed their laws so that someone doesn't have to be a resident of those states to get medical aid in dying there.
How Do Aid-in-Dying Laws Protect Patients?
Additional safeguards are in place to help ensure that medical aid in dying honors the patient's preferences, values, and needs. These include:
Informing patients about their other options. The doctor prescribing the end-of-life medication must explain to the patient about their other options, including comfort care, hospice care, palliative care, and pain control.
Right to change their mind. Doctors must tell patients they have the right to change their minds about ingesting the medicine at any time, even after they filled the prescription.
Take back their request. Doctors have to offer their patients the opportunity to take back their request for medical aid in dying.
While the state laws aren't identical, most have similar provisions that are for the protection of patients and doctors.
- Patients have to talk with more than one doctor.
- Patients have to ask for medical aid in dying at least twice, with a waiting period in between that varies by state.
- Patients have to sign a document in front of witnesses stating their intentions.
- Doctors don't have to offer aid in dying if they don't want to.
The current laws require you to ask for aid in dying yourself, at a time when you're both terminally ill and still able to make health care decisions for yourself. Therefore, the request can't be written into a living will or other kind of advance medical directive.
Physician-Assisted Death Ethics
Doctors disagree about the ethics of providing medical aid in dying. Some support the option, while others think it shouldn't be a choice.
Arguments against medical aid in dying
Physicians opposed to providing aid in dying feel that doing so causes more harm than good. While they understand why some people may have valid reasons for preferring death, doctors shouldn't help them end their lives. They argue that physician-assisted dying is:
- Not compatible with a physician's role as a healer
- Difficult or impossible to control
- A risk to society
Instead of assisting with dying, doctors who oppose medical aid in dying believe that physicians should:
- Continue providing care, even after determining there's no cure
- Respect their patient's autonomy
- Communicate effectively and provide emotional support
- Provide comfort care
- Provide pain control
Arguments for medical aid in dying
Some people believe medical aid in dying should be legal because it doesn't cause any harm and benefits people who are suffering. The arguments in favor of medical aid in dying include the following:
It's proven to be safe. Medical aid for dying has been legal in Oregon for more than 25 years. Advocates say there are no credible claims that the process has been abused in Oregon or any other state where it's legal.
It's a choice the patient makes. Even in states where it's legal, it is rare for terminally ill patients to choose medical aid in dying. Only about 1 in 300 deaths occur with medical aid in dying in states where it's legal. Among patients who receive the medication, about one-third don't choose to take it. However, proponents say it comforts people to have the option.
It's the best option for some chronically ill people. Most people with terminal illnesses can receive adequate care from palliative care or hospice. However, not all suffering can improve with these options. People in severe pain and suffering should have options for a merciful, peaceful death.
Evaluating Requests for Medical Aid in Dying
Even in states where physician-assisted death is possible for patients who meet the legal requirements, doctors have to carefully consider those requests to determine if they can grant them in good conscience. The American Academy of Hospice and Palliative Medicine has guidelines to help physicians examine requests for medical aid in dying.
When doctors get such a request, they should consider:
- The nature of the request: Is the patient serious or just frustrated with their present circumstances?
- The cause of the suffering: Is there severe pain, emotional distress, or concerns over being a burden?
- The patient's decision-making capacity.
- Emotional factors: Is the request driven by depression or feelings of guilt, worthlessness, or fear?
- Situational factors such as whether there may be coercion, abuse, or exploitation involved.
These considerations begin the evaluation process. Doctors will carefully weigh all of the circumstances, including other options for comfort care, before agreeing to a patient's request.
How Does Using a Death With Dignity Law Impact Insurance?
State laws don't force health insurance companies to cover the cost of medical aid in dying. As with other procedures, companies set their own policies. Medicare, Medicaid, and any other health program paid for with federal money won't cover aid-in-dying services or medications.
As it relates to life insurance, the state laws that allow medical aid in dying make it clear that the process is not suicide. That means the restrictions that are often placed on life insurance benefits in the case of suicide generally don't apply. But you should check with your insurance company for its specific policies.