Autonomy is a pillar of Western medicine’s values and ethics. “It is
plausible that autonomous persons are often in the best position to
determine what would be good or bad for them and, consequently, it
is arguable that there is good reason to consider patients’ autonomy
to have instrumental value in medicine (Varelius, 2006).” Some
bioethicists hold this to be true, in cases where there is no risk of
harm to others, even when other parties would be better positioned
to make decisions that would serve the patients’ wellbeing (Varelius,
2006). Though a low-tech issue, death with dignity carries a
significant ethical burden from personal and regulatory perspectives.
Death with Dignity laws allow terminally ill adults, who meet certain
criteria, to request and receive a prescription medication that will
end their life at a time of their choosing. Currently, five states and
the District of Columbia have death with dignity laws. In Colorado,
Proposition 106, the Colorado End of Life Options Act, amended
Title 25 of the State Statues to permit adults diagnosed with a
terminal illness, with a life-expectancy of six months or less to
receive medical assistance to end their life (Colorado Secretary of
State, 2016). The person must make two separate oral requests,
separated by at least 15 days, and one written request to their
physician (Colorado Secretary of State, 2016). The written request
must be signed by two witnesses, one of which has no familial
relation to the requestor and is not a beneficiary of the requestor’s
estate, nor an owner, operator, or employee of a healthcare facility
where the requestor is receiving care (Colorado Secretary of State,
2016). Physicians and individuals with Qualified or Durable Power of
Attorney are disqualified from acting as witnesses. Witnesses attest
that the requestor is of sound mind, requesting voluntarily and is not
being coerced to make the request (Colorado Secretary of State,
2016). Prescribing physicians must determine if the person
requesting has mental capacity and is voluntarily making the request
and provide comprehensive disclosure of risks and responsibilities of
the person receiving the prescription related to taking the aid-in-
dying medications (Colorado Secretary of State, 2016).
The Colorado law is consistent with other states’ laws in that it
requires two oral and one written request (Death with Dignity, n.d.).
All laws require residency in the state, though they differ on how
residency may be established according to each state’s law (Death
with Dignity, n.d.). All state laws require requestors to be 18 years of
age, or older and mental competence must be established (Death
with Dignity, n.d.). Finally, all state laws stipulate as a requirement of
qualification, requestors must be diagnosed with a terminal illness
that will, within reasonable medical judgment, lead to death within
six months of diagnosis (Death with Dignity, n.d.).
If one is able, end-of-life decisions are left to the individual.
Difficulties arise when a person has not made end-of-life decisions
and is incapacitated by injury or illness. I am a strong proponent of
advanced directives, living wills, living trusts – any instrument that
allows a person to document their end-of-life decisions and or
designates a person to make those decisions if the person is not able.
I have personal experience getting a Durable Power of Attorney in
place to care for a family member who suffered a stroke. The person
did not have a living will or trust and, to our knowledge, no
documented end-of-life instructions. It is an on-going process, that
continues to significantly impact our family.
I am in favor of Death with Dignity laws. The ultimate expression of
autonomy is making the decision to end my life on one’s own terms.
One could argue that denial of that expression is causing the
additional patient harm. Allowing the patient to determine to not
undergo additional treatment, to determine that they do not want to
put their family through a long and difficult end, to honor one of their
last wishes on this earth is the epitome of benevolence. From a just
utilization of resources perspective, a significant amount of medical
dollars and resources focus on treating very ill patients, including
catastrophic illnesses, such as cancer. I am not advocating that every
cancer patient would qualify for aid-in-dying, because not every
cancer patient is terminally ill. However, for people who are
diagnosed and who have six months or less, death with dignity
should be a legal option. Death with Dignity is consistent with and
supported by all four ethical principles.
References:
Colorado Secretary of State, 2016. Final #145 – Title 25, Article 48 of
the Colorado Revised Statutes, April 8, 2016. Retrieved April 23, 2022
from
http://www.sos.state.co.us/pubs/elections/Initiatives/titleBoard/fili
ngs/2015-2016/145Final.pdf
Death with Dignity, n.d. How to Access and Use Death with Dignity
Laws. Retrieved April 23, 2022 from
https://www.deathwithdignity.org/learn/access/#Colorado
Varelius, J. (2006, December). The value of autonomy in medical
ethics. Medicine, Health Care and Philosophy, 9(3), 377-388.
doi:10.1007/s11019-006-9000-z
