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A Dignified Death: What Does That Mean for Those Who Are Not Terminally Ill?
I. Introduction
At age eleven, Kelly Niles was accidently hit in the head while fighting with one
of his friends over whose turn it was to bat.1 After being rushed to the emergency room
by his father, Kelly was diagnosed with a concussion and sent home.2 Unfortunately, the
doctors misdiagnosed Kelly’s head injury and failed to notice the expanding blood clot in
his brain.3 Although the doctors eventually detected the blood clot and successfully
removed it through surgery, Kelly was ultimately confined to a wheel chair for the
remainder of his life due to irreversible brain damage.4 Kelly remained mentally
competent but required assistance to eat, bathe, urinate, walk, or to do anything that
required physical movement because he could not control his body’s muscle movement.5
After twenty-two years of being confined to a wheelchair and requiring continual
assistance, Kelly felt his quality of life had deteriorated and that he was losing personal
dignity.6 Although Kelly’s condition was predicted to eventually cause his death, the
timing would be unpredictable.7 After time, Kelly articulated to his family that he wanted
to commit suicide.8 His family agreed to help Kelly so long that they could find a way to
do so legally.9 After Kelly’s family could not find a legal avenue to help him end his
1 Lonny Shavelson, A Chosen Death 113, 161 (1995).
2 Id. at 162.
3 Id.
4 Id. at 163.
5 Id.
6 Id.
7 Id.
8 Id. at 164.
9 Id.

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suffering, Kelly became impatient and decided to starve himself.10 Kelly’s attempt at
committing suicide failed when after forty-eight days of starvation he could no longer
bare the pain and quit.11 Although his first attempt was a failure, he continued to try and
his desire to die did not cease.12 Kelly finally succeeded in committing suicide with the
help of his mother.13 Kelly’s tragic and painful end-of-life situation could have been
circumvented by legally allowing Kelly and his family the opportunity to seek the
assistance and advice of a physician to assist Kelly in ending his life.
Kelly is not the only mentally competent, not terminally ill individual with a
strong desire to die with what dignity remains, before the suffering increases.14 Imagine
living with an irreversible or incurable disease such as AIDS,15 Lou Gehrig's,16
Parkinson's,17 or Huntington's disease.18 These individuals often times experience chronic
10 Id.
11 Id.
12 Id. at 165.
13 Id. at 166.
14 In Lonny Shavelson’s A Chosen Death, there are five otherstories similar to Kelly’s.
15 HIV/AIDS is an irreversible disease that affects certain cells in the body so that your body cannot fight
off infection or disease.This disease is painful and often times leads to illnesses such as anemia,
lipodystrophy,insulin resistance, and lactic acidosis.Aids.gov, https://www.aids.gov/hiv-aids-basics (last
visited Dec. 13, 2015).
16 Amyotrophic Lateral Sclerosis or Lou Gehrig’s disease is a disease of the motor tracts of the spinal cord,
causing progressive muscular atrophy, increased reflexes, fibrillary twitching and spastic initiability of
muscles. This disorder affects adults,is 90-95% sporadic in nature, and is usually fatal within 2 to 4 years
of onset.WebMD, www.webmd.com (last visited Dec. 13, 2015).
17 Parkinson's disease is a chronic and progressive movement disorder, meaning that symptoms continue
and worsen over time. There is currently no cure. Symptoms include shaking of the hands,arms, legs, jaw
and face, bradykinesia or slowness of movement, stiffness of the limbs and impaired balance and
coordination. Parkinson Disease Foundation, www.pdf.org (last visited Dec. 13, 2015).
18 Huntington's disease is an incurable inherited disease that causes certain nerve cells in the brain to
deteriorate. Symptoms may include uncontrolled movements, clumsiness, and balance problems; it can take
away the ability to walk, talk, and swallow. Some people stop recognizing family members. Others are
aware of their environment and are able to express emotions. MedlinePlus, www.nlm.nih.gov (last visited
Dec. 13, 2015).

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excruciating pain but do not have an estimated life expectancy and therefore do not have
access to die with dignity.19
While Kelly lived at a time when no law provided an option for people to request
physician-assisted suicide in his state20, even states that began adopting Death with
Dignity laws21 would not have provided him with the help he needed. Although current
Death with Dignity laws allow mentally competent, terminally ill individuals the right to
die with dignity by physician aid, they do not allow individuals who are physically
incapable of administering the physician-prescribed medication themselves, such as
Kelly, or those who are not terminally ill that same right.22
By allowing only mentally competent, terminally ill patients access to physician-
aid-in-dying, Death with Dignity laws fail to satisfy their legislative purpose.23 More
states should not only adopt a Death with Dignity Act, but also extend the law’s
protections to all mentally competent, physically suffering persons. The statutes should
be amended to ensure that physician-aid-in-dying is available to all patients who need it.
Although the current statutory mandates are a step in the right direction, there is still
work to be done to honor the interests of those, like Kelly, who wish to have a peaceful
exit from their long-term suffering. Those who are physically disabled or not terminally
ill are often times the people who suffer tremendous physical pain and may have the
19 SB – 128 End of Life, Health and Safety, 128th Leg, 15 (Ca. 2015)(effective 2016); Mont.Code. Ann. §
50-9-101 (WL 2015); Or. Rev. Stat § 127.805 (WL 2015); Vt. Stat. Ann.tit. 18, § 5283(a) (WL 2015);
Wash.Rev. Code Ann.§ 70.245.020(1) (WL 2015). Current Death with Dignity laws are only available to
those who have been diagnosed as terminally ill, with a life expectancy of six months or less to live.
20 Shavelson, supra note 1, at 161. Kelly lived in the state of Washington before they enacted a Death with
Dignity law.
21 While states call these types of laws a variety of terms, for the purposes ofthis paper, I will refer to aid-
in-dying laws as Death with Dignity laws.
22 SB – 128 End of Life, Health and Safety, 128th Leg, 15 (effective 2016); Mont. Code. Ann. § 50-9-101;
Or. Rev. Stat § 127.805; Vt. Stat. Ann.tit. 18, § 5283(a); Wash.Rev. Code Ann. § 70.245.020(1).
23 Death with Dignity laws focus on ending a patient’s suffering and respecting his or her autonomous
choice to end his or her own life in a “humane and dignified manner.” Or. Rev. Stat. Ann § 127.805(1).

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strongest desire to end their lives and current Death with Dignity laws ban these people
from dying with dignity, forcing them to face a life without dignity in the time when they
seek control of their uncertain future.24
In part II of this paper I discuss the need for and the statewide movement towards
Death with Dignity laws. In section III, I discuss how current Death with Dignity laws
fail to fulfill their legislative purposes by excluding mentally competent adults who have
incurable and irreversible physical diseases that cause chronic pain and suffering. Then, I
will explain how the diagnosis “terminally ill” is questionable in its accuracy as a
prognosis. Furthermore, I will compare passively hastening death, the taking patients off
of life- sustaining treatments, and actively hastening death, the prescribing of lethal
medication to a patient (also called physician-aid-in-dying), and discuss how those two
methods are not significantly different. Next, I will propose amendments to the statutory
language in current Death with Dignity laws to expand the availability of this relief for
mentally competent adults suffering from irreversible and incurable physical diseases.
Only then can legislatures begin to truly effectuate the interests underlying a dignified
death. Lastly, I will provide legislative solutions to common concerns over expanding
death with dignity laws to the not-terminally ill.
II. Growing Recognition for Need
A. Terminology
“End of life care,” “aid-in-dying,” “dignified death,” “physician-assisted
suicide,” and “assisted suicide” are all phrases that refer to the act of a physician, upon
patient request, actively prescribing a mentally competent, terminally ill individual with a
24 SB – 128 End of Life, Health and Safety, 128th Leg, 15 (effective 2016); Mont. Code. Ann. § 50-9-101;
Or. Rev. Stat § 127.805; Vt. Stat. Ann.tit. 18, § 5283(a); Wash.Rev. Code Ann. § 70.245.020(1).

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lethal dose of medication that, when administered by the patient himself, causes the
patient’s death.25 Although many phrases are used to describe this process, health policy
organizations such as the American Public Health Association as well as individuals who
are proponents of Death with Dignity laws have recognized that referring to the process
as “assisted suicide” or “suicide” is inappropriate, offensive, and conducive to negative
connotations and therefore, should not be used when discussing peaceful and dignified
deaths under Death with Dignity laws.26 Hence, for the purpose of this paper, I will use
the term physician aid-in-dying or dignified death to refer to this process.
B. Why the Need?
The debate about the legalization of physician aid-in-dying and has resonated for
years.27 Proponents of Death with Dignity laws argue that the debate is not about letting
people commit suicide, but rather helping individuals in the dying process.28 Peg
Sandeen, Executive Director of the Death with Dignity National Center,29 testified that
“‘modern medicine, palliative care, pain release, hospice care can provide relief for most
people, but not all people.’”30 She explains that, “’ modern medicine... can keep people
alive for a very long time past what any natural death would be, and people die badly.”’31
Death with Dignity laws are needed to provide individuals with a right to escape a bad, in
25 Lindsay Reynolds, Losing the Quality of Life: The Move Towards Society’s Understanding and
Acceptance of Physician-Aid-in-Dying and the Death with Dignity Act, 48 New Eng. L. Rev. 343, 346
(2014).
26 Kathryn L. Tucker, When Dying Takes Too Long: Activism for Social Change to Protect and Expand
Choice at the End of Life, 33 Whittier. L. Rev. 109, 154 (2011).
27 Derrick Augustus Carter, Knight in the Duel with Death: Physician Assisted Suicide and the Medical
Necessity Defense, 41 Vill. L. Rev. 663, 680 (1996).
28 Reed Karaim, Assisted Suicide,23 CQ Researcher 449, 453 (May 17, 2013),
http://library.cqpress.com.
29 Death with Dignity National Center, https://www.deathwithdignity.org (last visited December 2, 2015).
The Death with Dignity Center is a non-profit dedicated to promoting Death with Dignity laws across the
U.S. and providing information, education,and support about Death with Dignity as an end-of-life option.
30 Karaim, supra note 28, at 453.
31 Id.

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other words “painful or lingering, debilitating, death”.32 Proponents argue that those who
are mentally competent and are making a rational decision to choose not life or death
because that decision has already been made, but when and how they will meet death, is
an act that is far from suicide.33 It is a peaceful and gentle option in the dying process.34
The argument for Death with Dignity laws is not proposing that other end-of-life options
are terminated, but rather that aid-in-dying is one of those options when discussing end-
of-life care.35
Death with Dignity laws also help prevent individuals from taking matters into
their own hands.36 There have been many ill individuals who, when enduring constant
pain and suffering, have looked to taking their own lives as an answer to alleviating
agony.37 Consequently, physically suffering individuals have attempted to commit
suicide on their own or with the help of family members because they felt they had no
other option besides facing the terrifying prospect of long-term painful treatment and a
deteriorating quality of life.38 Many times, these attempts have failed and have caused
even greater harm both physically and emotionally to the individual and their loved ones.
By passing Death with Dignity laws, those who are diagnosed with a disease that will
eventually cause death or a deterioration of dignity would have an option to discuss a
peaceful exit rather than attempting to end their misery themselves.39
32 Id.
33 Id.
34 Id.
35 Id.
36 Cyndi Bollman, A Dignified Death? Don’t Forget About the Physically Disabled and Those not
Terminally Ill: An AnalysisOf Physician-Assisted Suicide Laws, 34 S. Ill. U.L.J. 395, 409 (2010).
37 Id.
38 Id. at 346.
39 Id. at 409.

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Furthermore, Death with Dignity laws are needed for health care providers to
fulfill their obligation to relieve pain and suffering and promote the dignity and autonomy
of their patients.40 Without debate, one of the most basic values that supports and guides
all health care decision-making is respecting a patient's self-determination and
autonomy.41 Proponents of physician aid-in-dying assert that the physician is trained and
knowledgeable in the field of medicine, which includes aiding patients with a
comfortable and dignified death just as much as it does with the rendering of help to the
living.42 Opponents claim that there is no role for a physician in aiding death due to the
Hippocratic Oath which states, “I will neither give a deadly drug to anybody if asked for
it, nor will I make a suggestion to this effect.”43 Opponents of Death with Dignity laws
say this oath means that the all-encompassing duty of a physician is to give life, not
death.44
Although most health care providers do take the oath when they graduate from
medical school, they do not swear to it.45 Almost every medical school requires some sort
of oath of its graduates, but not all are the same, 46 and most are seen simply as
“ceremonial and nonobligatory” providing general moral and ethical guidance.47 Because
some current physicians find that the original oath is lacking, many of the contemporary
oaths written omit some problematic parts about euthanasia, abortion and sexual relations
40 Id. at 346.
41 Charles H. Baron, A Model State Act to Authorize and Regulate Physician-Assisted Suicide,33 Harv. J.
on Legis. 1, 5 (1996).
42 Paul Moore, Physician-Assisted Suicide:Does “The End” Justify the Means?, 40 Ariz. L. Rev. 1471,
1472 (1998).
43 Id.
44 Id.
45 Melissa, Doctors Aren’t Bound by the Hippocratic Oath, Today I Found Out: Feed Your Brain, Nov. 15,
2013, http://www.todayifoundout.com. (Melissa chose not to have her last name disclosed within the
organization’s website.)
46 Id.
47 Id.

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but continue to keep most of the original themes such as respecting patient self-
determination or autonomy.48
C. Growing Recognition for Need
Without question, there has been a strong move towards the legalization of Death
with Dignity laws.49 Starting in 1994, Oregon was the first state to pass a Death with
Dignity law for mentally competent patients who were terminally ill.50 Almost fifteen
years later, the State of Washington joined Oregon in enacting its own Death with
Dignity law.51 At the end of 2009, the Montana Supreme Court indicated that aid-in-
dying is not against the state's public policy and prohibited the state from prosecuting
doctors who helped the terminally ill die with dignity.52 A few years later, in 2013,
Vermont established a Death with Dignity law modeled after Oregon and
Washington’s.53 Most recently, California legalized physician aid-in-dying, again, for the
mentally competent and terminally ill; it will go in effect next year.54 Additionally, Utah,
Wyoming, Colorado, Wisconsin, New York, and New Hampshire are currently
considering Death with Dignity bills similar to Oregon, Washington, and Vermont’s.55
Furthermore, the number of persons in this country who support Death with
Dignity laws has continued to grow.56 According to a national poll done by The Gallup
48 Id.
49Browne C. Lewis, A Graceful Exit: Redefining Terminal to Expand the Availability ofPhysician-
Facilitated Suicide,91 Or. L. Rev. 457, 458 (2012).
50 Alan Meisel, Physician-Assisted Suicide:A Common Law Roadmap for State Courts, 24 Fordham Urb.
L.J. 817, 819 (1997).
51 Katie Franklin, Physician-Assisted Death, Dementia, and Euthanasia:Using an Advanced Directive to
Facilitate the Desires of Those with Impending Memory Loss, 51 Idaho L. Rev. 547, 552 (2015).
52 Baxter v. State,224 P.3d 1211, at 250 (Mont. 2009).
53 Franklin, supra note 51, at 552.
54 Patrick Mcgreevy, How Assisted Suicide Will Work in California,Los Angeles Times, Oct. 5, 2015,
http://www.latimes.com.
55 Death with Dignity Around the U.S., Death With Dignity Nat'l Ctr. (last updated Nov. 18, 2015), http://
www.deathwithdignity.org/advocates/national.
56 Lewis, supra note 49, at 458.

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Poll in 2014, a majority of Americans believe that death with dignity is morally
acceptable.57 When the question was asked, “When a person has a disease that cannot be
cured, do you think doctors should be allowed by law to end the patient’s life by some
painless means if the patient and his or her family request it?” almost seven out of ten
Americans said yes.58
III. Current Assisted Suicide Laws Should be Amended to Meet Legislative Purposes
A. Current Failures within Death with Dignity Laws
Death with Dignity laws provide an option for a dignified death to those who are
competent and terminally ill, but fail to meet their full statutory legislative purpose by
excluding a large group of individuals who are also mentally competent and diagnosed
with irreversible and incurable physically debilitating and painful diseases.59 Current
Death with Dignity laws require that the individual requesting a dignified death must be
terminally ill, which the statutes define as “an incurable and irreversible disease that has
been medically confirmed and will, within reasonable medical judgment, produce death
within six months.”60 The laws also require that the patient be able to physically
administer the lethal physician prescribed mediation themselves, usually orally.61 Those
who do not satisfy these two conditions are forced to live their life in a way that no one
should be forced to live.
57 Compassion and Choices, https://www.compassionandchoices.org/tag/gallup-poll/ (last visited Dec. 18,
2015).
58 Justin McCarthy, Seven in 10 Americans Back Euthinasia,Gallup, June 18, 2014, www.gallup.com.
Results for this Gallup poll are based on telephone interviews conducted May 8-11, 2014, with a random
sample of 1,028 adults,aged 18 and older, living in all 50 U.S. states and the District of Columbia. When
the question was re-worded to, “When a person has a disease that cannot be cured and is living in severe
pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if
the patient requests it?,” the percentage of supporters dropped to 58%. Although this percentage still shows
that a majority of Americans still support aid-in-dying, it also shows that when the word “suicide” is added
to the mix, people are more hesitant to support it.
59 Bollman, supra note 36, at 395.
60 Or. Rev. Stat § 127.800(12); Vt. Stat. Ann. tit. 18, § 5283; Wash.Rev. Code Ann. § 70.245.010(13).
61 Or. Rev. Stat § 127.800(12); Vt. Stat. Ann. tit. 18, § 5283; Wash.Rev. Code Ann. § 70.245.010(13).

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Is it right that someone who is physically suffering and medically predicted to live
six months or less can choose a dignified death, but someone who is suffering equally
and has a prognosis of more than a year to live is prevented from doing so? This
inconsistency demonstrates the need for an expansion of these laws. The purpose of
Death with Dignity laws is to respect patient autonomy.62 Under current Death with
Dignity laws this legislative purpose is not being met. The statutes fall short of protecting
those who need it most by failing to provide particular groups of competent individuals
the opportunity to die with dignity. There is little justification for preventing patients
diagnosed with irreversible and incurable diseases from dying with dignity, particularly
when they are expected to suffer significantly for an undetermined amount of time. This
argument demonstrates that these laws fail to accommodate competent individuals who
have chronic diseases or are physical disabled and are in desperate search of a way to end
their pain.
B. An Inaccurate Prognosis: Terminally Ill
The terminally ill diagnosis requirement not only fails to meet legislative purpose
by denying a large group of suffering individuals a dignified death but also is
questionable in its accuracy. The less than six-months to live requirement in the
“terminally-ill” definition 63 is an imprecise and inaccurate standard. One study found
that almost 15% of patients in hospice care, which requires a similar diagnosis, live
longer than six months, and more than 8% live longer than a year.64 Dr. Rex Greene, a
retired oncologist, affirmed, “‘Terminal illness is a meaningless term, the law in Oregon
says a six-month prognosis. There's no physician on Earth [who] can make a six-month
62 Reynolds, supra note 25, at 363.
63 Or. Rev. Stat § 127.800(12); Vt. Stat. Ann. tit. 18, § 5283; Wash.Rev. Code Ann. § 70.245.010(13).
64 Moore, supra note 42, at 1484.

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prognosis. The best we can do is in the last weeks of life we can be pretty close.”’65 The
World Federation of Right to Die Societies Newsletter also admits that the diagnosis of
“terminally ill” is an “unreliable prediction.”66
For the purpose of Death with Dignity laws, the definition of terminally ill needs
to be interpreted more broadly due to the inaccuracy of this diagnosis. Opponents argue
that interpreting terminally ill more broadly will cause individuals to end their life
prematurely due to the constant improvements of medical technology and treatments.67
Although this argument has merit, it is weakened by the evidence that the terminally ill
prognosis is inaccurate and some individuals who have been diagnosed as terminally ill
have lived even longer than predicted. Furthermore, by interpreting the terminally ill
definition more broadly or not, a competent patient facing such a difficult and profound
decision would have considered these options prior to choosing to terminate her life
under Death with Dignity laws. To extend physician aid-in-dying to more deserving
cases, legislatures need to remove the specific durational requirement and more broadly
interpret the meaning of terminal. It should be sufficient enough to trigger the application
of Death with Dignity laws once a doctor diagnoses a person with an incurable disease
that is expected to result in death.
C. The Passive and Active Argument
One of the most common arguments against Death with Dignity laws is that
physician aid-in-dying accounts for actively hastening the death of a person.68 Although
this argument is frequently used by those who oppose physician aid-in-dying, current
65 Karaim, supra note 28, at 455.
66 World Right-to-Die Newsletter, May 2001, p. 3. (The World Right-to-Die Newsletter is a publication of
the World Federation of Right to Die Societies).
67 Reynolds, supra note 25, at 350.
68 Meisel, supra note 50, at 821.

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Death with Dignity laws have considered it to hold no merit and thus, should continue to
do so while amending the statutes to those who are not terminally ill or are physically
disabled.69 Passively hastening death, which has been legally practiced for years in the
medical profession, occurs when physicians take patients off a life-sustaining machine or
medication so they can succumb to their own disease. For example, when a patient
requests it, a physician can discontinue the use of a feeding tube or intravenous
hydration.70 Actively hastening death occurs when a physician affirmatively prescribes a
lethal medication to the patient upon request so that the patient can administer it, if and
when they choose, to cause their own death.71
The leading authority establishing a right to withdraw life support treatment is
Cruzan v. Director, Missouri Department of Health,72 which held that competent adults
have a constitutionally protected right to die.73 The court recognized mentally competent
terminally ill individuals’ right to refuse treatment at any stage in their illness.74 The
court found that this constituted an act of “constitutional responsibility” by showing
compassion and respect towards the patient’s autonomy and self-determination.75 Many
physicians who oppose expanding Death with Dignity laws to those who are not
terminally ill or physically handicap propose the already “adequate” alternative to
69 Id. at 822.
70 Carter, supra note 27, at 691.
71 Meisel, supra note 50, at 818.
72 Cruzan v. Director, Mo. Dep't of Health, 497 U.S. 261 (1990). Cruzan involved a patient, Nancy Cruzan,
who was in a persistent vegetative state after sustaining severe injuries in an automobile accident. She
exhibited motor reflexes, but there was absolutely no indication of cognitive function. Nancy survived
solely on artificial nutrition and hydration.
73 Id. at 278. Cruzan holds that an individual has a “Constitutionally protected liberty interest in avoiding
unwanted medical treatment, including life-sustaining medical treatment such as artificial nutrition and
hydration.”
74 Id.
75 Id.

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physician aid-in-dying is allowing death through the refusal of hydration and nutrition.76
Although the option to refuse treatment is a choice available to all individuals in end-of-
life situations, some patients who are suffering do not receive any life-sustaining
treatment or, if they do, forgoing such treatment will result in a prolonged, unbearable,
and inhumane dying process.77 For these patients, a more effective avenue of actively
hastening death is necessary, one which respects the patients' self-determination.78
Opponents of expanding Death with Dignity laws stand by the argument that
physicians who participate in actively hastening a patient’s death have a different motive
than physicians who participate in passively hastening death; that physicians under Death
with Dignity laws have to intent to cause death and the passively hastening physicians do
not.79 Advocates for expanding Death with Dignity laws argue that the active-passive
distinction is unacceptable because the intent of the actor is the same in both cases: to
prevent unnecessary pain and to respect the autonomy, dignity, and self-determination of
a suffering patient.80 Hastening the death of an individual is no different than the
physician's role in stopping life-support treatment or when a physician prescribes
palliative treatment that will also probably have the effect of causing the death of the
patient.81 In Cruzon v. Missouri, Justice Scalia comments on the absurdity of this active
passive distinction by writing, “It would not make much sense to say that one may not
kill oneself by walking into the sea, but may sit on the beach until submerged by the
incoming tide; or that one may not intentionally lock oneself into a cold storage locker,
76 Carter, supra note 27, at 718.
77 Bollman, supra note 36, at 409.
78 Id.
79 Id.
80 Meisel, supra note 50, at 838.
81 Moore, supra note 42, at 1472.

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but may refrain from coming indoors when the temperature drops below freezing.”82
Since the physician’s motive in both passively and actively hastening a patient’s death is
the same and it is permissible, compassionate, and constitutional to help a dying person
avoid a final few days or weeks of suffering, it would seem then that it is much more
compassionate to accommodate a similar request from a patient whose anticipated
suffering is measured in years, such as those without a definitive prognosis of six months
or less, whether physically disabled or not.83
D. Proposed Amendments
To address the current inconsistencies in the current Death with Dignity laws,
legislatures should amend the statutory language relating to terminal disease or illness to
include those that have been medically confirmed as irreversible and that, within
reasonable medical judgment, will eventually produce death. Further, the law should
specify that death does not have to be within six months, but rather, once a physician
diagnoses a person with an incurable or terminal disease that is expected to result in
death, the patient may request a dignified death. That way, those who are mentally
competent, not-terminally ill, or physically disabled will be provided the same right as
those who are already protected under current Death with Dignity laws. These laws are
designed to allow people to humanely and safely end their own lives when faced with an
untreatable or physically debilitating disease. With these changes in place, courts and
legislatures may begin to truly effectuate the interests underlying Death with Dignity
laws. In a broad sense, and looking at the issue of physician aid-in-dying through the lens
of personal autonomy and respect for patient self-determination, the concept is simple:
82 Cruzan, 497 U.S. at 296.
83 Bollman, supra note 36, at 404.

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allow people the freedom and respect of determining when their quality of life is not
worth bearing.
Death with Dignity laws also should be amended to provide an opportunity for
physically disabled individuals who are diagnosed with an incurable or irreversible
disease that will eventually cause their death to request help from a family member in
administering the lethal medication. These patients may then have the same right as those
who are physically able to ingest the medication under the current Death with Dignity
laws. “At some point, all legally competent persons with disabilities have had adequate
opportunity to assess the long-term prospects for their quality of life, and we must respect
those determinations and the choices they make.”84 There are many people in the United
States who are endlessly suffering as a result of one disease or another.85 Individuals who
have the intense desire to end their suffering by terminating their lives should not be
prohibited from doing so. Whether the patient's prognosis is three months or three years,
if one decides to rid himself of unbearable and untreatable pain, he should be permitted to
have the option of a dignified death.
E. Addressing Concerns Over Expanding Death with Dignity Laws
The most common concerns opponents have against expanding Death with
Dignity laws to all physically suffering individuals include the negative impact it may
have on vulnerable groups, the possibility of abuse, and the encouragement of already
suicidal persons to utilize physician aid-in-dying as an easy escape. Fortunately, all of
these concerns can be addressed and answered by current Death with Dignity law
safeguards.
84 Id. at 408.
85 Reynolds, supra note 25, at 366.

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The concern that expanding Death with Dignity laws to those who are not
terminally ill poses a threat to some of the most vulnerable Americans, including the
physically disabled, the poor, or racial minorities, while warranted, has failed to
materialize.86 A study led by Margaret Battin, a distinguished professor of philosophy
and an adjunct professor of internal medicine in the Division of Medical Ethics, at the
University of Utah in Provo, found no evidence that supported that physician aid-in-
dying has had a disproportionate impact on patients in vulnerable groups.87 The typical
patient requesting physician aid-in-dying was white, married, college-educated, and over
sixty-five; the typical patient also has some kind of cancer, has private health insurance,
is enrolled in hospice care, is concerned primarily about the loss of autonomy, and dies at
home.88 Given the demographics of the persons who have requested the lethal
medication, current Death with Dignity laws have not unduly burdened vulnerable
groups.89
Current Death with Dignity laws provide several safeguards to avoid abuse. To
begin with, physicians who encourage or pressure patients into requesting a dignified
death risk losing their license due to culpability.90 Furthermore, two doctors, the patient's
primary physician and a second doctor, must agree the patient has a terminal illness and
is able to request the lethal medication.91 Further, the patient's decision to request the
lethal medication must be informed.92 The patient cannot make an informed decision
86 Karaim, supra note 28, at 453.
87 Margaret P. Battin, et al., “Legal physician-assisted dying in Oregon and the Netherlands: evidence
concerning the impact on patients in ‘vulnerable’ groups,” Journal of Medical Ethics, October 2007,
www.ncbi.nlm.nih.gov/pubmed/17906058.
88 Id.
89 Reynolds, supra note 25, at 345.
90 Or. Rev. Stat § 127.890.
91 Id. §127.815(1)(a).
92 Id. §127.815(1)(c).

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unless the physician makes sure that the patient understands the medical diagnosis and
prognosis; the potential risks and probable results of taking the medication; and the other
available options including comfort care, hospice care and pain control.93 The purpose is
to ensure that the patient has all of the relevant facts before making the decision to
request the lethal medication.94 The rights of the patient are further protected by the
presence of a waiting period; the law requires two requests for the drugs by the patient,
with fifteen days separating the first and second requests.95 The patient must also sign
and date the written request for the medication.96 In the patient's presence, at least two
persons must attest that “to the best of their knowledge and belief the patient is capable,
acting voluntarily, and is not being coerced to sign the request.”97 The law restricts the
pool of persons who can serve as witnesses to protect the interests of the patient; one
must be disinterested and the physician caring for the patient cannot act as a witness.98
Moreover, the statutory requirements ensure that a patient's choice to obtain the lethal
medication is voluntary and that the patient can change his or her mind at any time.99
In addition to these statutory safeguards, Death with Dignity laws also require
state agencies to monitor the trend of patients taking the lethal medication.100 Here, there
has been no evidence of abuse.101 For instance, in Oregon, annual reports show that
between 1998 and 2014, a total of 1,327 people have had lethal prescriptions written and
93 Id.
94 Reynolds, supra note 25, at 350.
95 Or. Rev. Stat § 127.840.
96 Id. §127.815(1)(B).
97 Id. §127.810(1).
98 Id.
99Id. §127.840.
100 Or. Pub. Health Div., Oregon's Death with Dignity Act 2014,
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Docu
ments/year17. (last visited Dec. 13 2015).
101 Id.

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only 859 of those patients have actually taken the prescription. This exemplifies a lack of
evidence of abuse because not even every patient who requests and receives the
prescription ends up taking it.102 In 2014 alone, 155 patients requested and received
prescriptions but only 94 actually ended up ingesting it.103 This data further suggests that
persons requesting the medication did not do so solely for the purpose of ending their
lives, but because they were simply comforted by having the ability to do so if their
suffering became unbearable.104
The fear that mentally incompetent or suicidal persons may unhealthily take
advantage of Death with Dignity laws is dealt with within current Death with Dignity law
safeguards.105 The statutes require physicians who believe that a patient is incompetent or
suicidal to refer the patient to a psychologist called in to assess the situation.106
Furthermore, the physician may refer the person to counseling before providing the lethal
medication.107 The statutes also mandate a waiting period between the request for the
medication and the writing of the prescription, which allows the physician to make sure
that the patient is capable of making an informed decision.108 With all the current
statutory safeguards in place, and the lack of evidence of abuse, the arguments against
expanding Death with Dignity laws seem unconvincing.
102 Id.
103 Id.
104 Id.
105 Lewis, supra note 49, at 473.
106 Or. Rev. Stat § 127.805.
107 Id.
108 Id.

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IV. Conclusion
Death with Dignity laws are needed to provide persons suffering from irreversible
and incurable physically debilitating and painful diseases a peaceful and gentle option in
the dying process, 109 an avenue to a dignified death by preventing individuals from
taking matters into their own hands, 110 and to fulfill physicians’ obligations to relieve
suffering and promote the dignity and autonomy of their patients.111 There is an obvious
growing recognition for the need of Death with Dignity laws throughout the United
States and currently six other states are working on passing bills similar to Oregon.112
Although current Death with Dignity laws are a step in the right direction as far as
providing mentally competent, terminally ill individuals a dignified death, those same
laws fail to meet their full statutory legislative purpose by excluding a large group of
individuals who are also mentally competent and diagnosed with irreversible and
incurable physically debilitating and painful diseases.113 The exclusive nature of current
Death with Dignity laws not only preclude those who are not expected to die within six
months but also individuals who are physically incapable of ingesting the medication.114
Legislatures should amend the statutory language relating to terminal illness to
include diseases or conditions which have been medically confirmed as irreversible and
which, within reasonable medical judgment, will eventually produce death. The law
should specify that death does not have to be within six months. Further, Death with
Dignity laws should be amended to provide an opportunity for physically disabled
109 Karaim, supra note 28, at 453.
110 Bollman, supra note 36, at 409.
111 Reynolds, supra note 25, at 346.
112 Death with Dignity Around the U.S., Death With Dignity Nat'l Ctr. (last updated Nov. 18, 2015), http://
www.deathwithdignity.org/advocates/national.
113 Bollman, supra note 36, at 395.
114 Or. Rev. Stat § 127.805; Vt. Stat. Ann.tit. 18, § 5283(a); Wash.Rev. Code Ann. § 70.245.020(1).

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individuals who are diagnosed with an incurable or irreversible disease that will
eventually cause their death to request help from a family member in administering the
lethal medication. That way, those who are mentally competent, not-terminally ill or
physically handicap will be provided the same right as those who are already protected
under current Death with Dignity laws.
Fortunately, current laws address several key concerns raised by the opponents of
legalized physician aid-in-dying. The statutory safeguards in place have been proven to
successfully circumvent common concerns such as targeting vulnerable groups, abuse of
physician aid-in dying, and encouragement of already suicidal persons. By amending the
statutory language of current Death with Dignity laws to include all those diagnosed with
an incurable or irreversible physical disease that will eventually cause death, legislatures
may then begin to truly effectuate the interests and full legislative purpose underlying
Death with Dignity laws.
“Death is not the greatest of evils; it is worse to want to die, and not be able to.”115
115 Sophocles Quotes, http://thinkexist.com/quotation/death_is_not_the_greatest_of_evils-
it_is_worse_to/161831.html, (last visited Dec. 13, 2015).