Editor’s note: This op-ed is by Fred Crowley, M.D., who was president of the Vermont Medical Society from 1993-94.
As a physician and former president of the Vermont Medical Society I am concerned, as are my colleagues, about issues that may affect our patients.
For years I have closely followed the evolving debate over what options might be allowed to a patient facing the end of life. Some of these paths have been readily recognized and answered by hospice and better pain management. But one is only more slowly being addressed, and is clouded by concerns and fears … it is called “physician assisted suicide” by opponents,” and “aid-in-dying” by proponents. My fellow physicians do not speak with one voice, and have taken positions on both sides; I would now like to add my voice (with a quick review of legal history).
The seminal legal ruling came in a 1990 Supreme Court decision (the Cruzan case, the first ruling on a constitutionally protected interest on the issue of dying), which recognized that competent adults have a right to refuse medical treatment; in this, the court also allowed states to impose procedural safeguards to protect its interests.
In 1994 and again in 1997 Oregon voters took up the court’s permission and approved the first in the nation death with dignity law permitting terminally ill patients, under proper safeguards, to obtain a prescription to end life in a humane and dignified manner.
Vermonters have had such a bill before its legislators since 2002. During this current legislative session we once again have the opportunity to approve such a bill. Vermont’s bill, S.103, follows Oregon’s law because its law has been shown to work well and to improve end-of-life care. Our proposed law has an additional important protection which ensures that those exercising this right do so voluntarily, with informed consent about alternatives and available support.
We are not reinventing the wheel. Fourteen years of data … real facts published every year from the Oregon Department of Health (go to http://public.health.oregon.gov/Pages/Home.aspx; and under “Most Popular” click “Death with Dignity Act”) are a powerful answer to these recurring charges and fears brought up by opponents during each attempt at passage in Vermont. Fears of patient coercion, elder abuse and decreased hospice usage simply haven’t happened. Patients and physicians have been protected by the law’s carefully written procedures and safeguards.
The greatest impact a death with dignity law has is in the peace of mind it provides those who may never use it but who know it is an available option.
Based on the Oregon experience, many more lethal prescriptions are requested than are used. In the past 14 years, 935 people received the prescription but only 596 actually consumed medication to end their life. However thousands more who never started the process found comfort in knowing it was available to them in the event their condition worsened.
In Vermont this would extrapolate to about 20 patients per year initiating the death with dignity process, and about 10 completing it. However, as noted, this would provide comfort to hundreds, if not thousands, of Vermonters knowing they have a humane and dignified process available to them.
It is time Vermont passes a law that permits terminally ill patients to choose how their final days will end. People should be able to choose from a full range of options such as palliative care, hospice care, voluntarily stopping eating and drinking, total sedation and aid-in-dying. Under this proposed law no physician, pharmacist nor dying patient is required to participate, but for those of us who believe it is humane to do so, the option should be made legal and available. I strongly encourage our legislators to provide legal sanction for Vermonters to have the freedom to choose these various end of life options, a freedom as Episcopalian minister Rev. Alexander Zabriskie noted at the Judiciary Committee hearing this week, that God has already granted.
