Right-to-Die Debate

A judge’s ruling Monday makes New Mexico the fifth state in the U.S. to allow terminally ill, mentally competent patients the right to request life-ending drugs from their doctors. 

Barbara Coombs Lee, president of Compassion & Choices—a plaintiff in the case, along with the American Civil Liberties Union—said the court's decision affirms that the choice to end one's own life is the purview of patients and doctors, not the state.

“It’s not only autonomy, but the [ruling offers] protection under the New Mexico state constitution,” Coombs Lee told Healthline.

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A Win for the Right-to-Die Movement

While the New Mexico ruling doesn’t allow physicians to directly assist in a patient’s suicide, it doesn’t prevent doctors from prescribing lethal drugs if a lucid, dying patient requests them.

“It’s welcomed news. It’s a step forward, but it’s a baby-step in the right-to-die movement,” said Derek Humphry, president of the Euthanasia Research and Guidance Organization. “It’s the ultimate personal and civil liberty, to die at the time and manner of your choosing.”

With the U.S. facing the largest aging population in its history, the issue of ending one’s own life will continue to be a part of the national healthcare debate. The U.S. Supreme Court has ruled that the right-to-die issue is best left to the states.

A recent poll in the New England Journal of Medicine found that 67 percent of U.S. citizens are against physician-assisted suicide. Globally, the same poll found that 65 percent of people objected to the practice. 

Currently, New Mexico, Oregon, Washington, Montana, and Vermont have protections in place for doctors who prescribe lethal medications in such cases. 

The most notable practitioner of physician-assisted suicide in U.S. history was Dr. Jack Kevorkian, who claimed to have performed 130 physician-assisted suicides by delivering a lethal dose of chemicals to dying patients at their request. Without state protection in Michigan, where Kevorkian practiced, he was convicted of second-degree murder.

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Who Creates the Guidelines for Doctors?

Oregon, Washington, and Vermont passed their “death with dignity" laws through referendum or legislation, each spelling out guidelines for doctors regarding when, where, and how these practices can be used. In Oregon and Washington, such cases must be reported to the state health department.

In Montana and New Mexico, where decisions were made through legal challenges in the courts, the legal parameters of the practice aren’t as clear, Humphry said.

“I see very few doctors in New Mexico who will act on this, unfortunately,” he said. “We need the medical participation in this, but doctors need laws to guide them.”

One advantage New Mexico doctors will have is ample information from Oregon, where right-to-die laws have been on the books since 1997. As far as who decides what’s best for the patient, Coombs Lee said that should be a doctor’s decision, not a lawyer’s.

“A standard of care doesn’t come from legislators or the courts,” she said. “Physicians themselves develop a standard of care.”

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Misdiagnosis and the Definition of 'Suffering'

Rita Marker, an attorney and executive director of the Patient’s Rights Council, is wary of the consequences of the New Mexico decision.

She said that end-of-life choices can change family dynamics, can make a patient choose death because he or she feels like a burden on the family, and could possibly lead doctors to choose death over continued treatment for financial reasons. What’s worse, she added, is the issue of misdiagnosed diseases.

“There’s no question that a lot of well-meaning people would see this [ruling] as good,” she said. “We need to be realistic about this.”

Marker pointed to Belgium, which recently extended their euthanasia laws to include children suffering from incurable diseases. She said the U.S. needs firm guidelines for what constitutes suffering, as it could even be applied to people with treatable mental disorders, such as depression.

“If a person got the pills from someone on the street, it’s considered assisted suicide, but if a doctor prescribes them, it’s medical treatment,” she said. “Once you remove the barriers, then you change everything.”

An Ethical, Medical, and Religious Decision

Besides being a medical issue, ethics, morality, and religion have played a key role in the decision-making process for the states.

The largest and most outspoken groups opposing right-to-die measures have historically been devoutly religious.

When Humphry and others fought for the “Act Relative to Death with Dignity” during a 2012 referendum in Massachusetts, it was defeated 51.9 percent to 48.1 percent. Those in favor spent $2 million, while the Roman Catholic Church spent $4 million to defeat the measure, Humphry said.

Many Roman Catholics believe that ending one’s life, even with the help of a doctor in the final stages of life, constitutes a mortal sin.

“The United States of America is based on the separation between church and state,” Coombs Lee said. “It’s never been okay to legislate religious beliefs into law.”

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