Viewpoint: Examining the issues surrounding "Death with Dignity"

March 20, 2009

In 48 out of 50 U.S. states, the law has decided for you how to handle requests for assisted suicide: It is illegal.

Fifty dollars gets you a lifetime membership in the Final Exit Network, assuming your lifetime lasts no more than a year.

That's the price of doing business with one of America's most prominent support groups for people seeking assisted suicide. Final Exit claims to be the only organization of its type that does not consider your imminent death a prerequisite for membership, though most presumably would sign up in their hour (or year) of need.

The nonprofit, Georgia-based group formed in 2004 and now counts some 3,000 members nationwide. Roughly 130 others have already gone to their death with the help of Final Exit-most by inhaling helium-according to published reports.

And as one state ushers in its era of assisted suicide, another is cracking down on the practice. One week prior to the Washington law's enactment, Georgia authorities charged four members of the Final Exit Network with taking part in a series of assisted suicides, according to the Associated Press. The probe involves raids in nine states, including Montana, where a district court judge approved physician-assisted suicide in December. (The state has appealed the ruling.)

Not surprisingly, the arrests prompted an outcry from Final Exit and other groups dedicated to assisting those who suffer from devastating diseases. "We're just a group of compassionate people who feel that the Exit clients that we serve deserve a connection with our compassion as they take their own lives," says Final Exit President Jerry Dincin, 78. "We don't turn any valves. We don't hold anybody down. We don't solicit people to die. We don't do any of those things. People come to us who are determined because of their condition."

Washington's Death with Dignity Act mirrors a law that passed 12 years ago in Oregon, where, through 2008, some 350 residents have used it to end their lives with the help of a physician.

But in 48 out of 50 U.S. states, the law has decided for you how to handle such requests for assistance: It is illegal. Washington physicians, like those in Oregon, now can make that decision for themselves.

Beginning "Lives in the balance" of this issue, we examine the thorny factors surrounding the passage of Death with Dignity in Washington, as well as the possible impact it will have on physicians and citizens there. Malpractice Consult "Do you have an assisted-suicide plan?" discusses your options, regardless of the state in which you practice, in the event one of your patients requests assistance with his own suicide.

"The debate over assisted suicide seems, in many ways, to parallel the debate over abortion: issues of an individual's control over his or her own body vs. society's right to legislate against the taking of life," says Steven I. Kern, JD, a Medical Economics legal consultant. "Just as some physicians will agree to perform abortions while others will refuse, some physicians will agree to assist in suicide while others will refrain. Given the relatively few seeking assistance, there will, most likely, be more than enough physicians willing to provide that assistance."

If the law proves successful in the Pacific Northwest, it may be only a matter of time before states across the nation follow suit. With or without the law on your side, do you know what you'll do when a dying patient pleads for your help?