Respecting freedom and dignity at the end of life

In North Carolina, legislation is expected to be introduced that clarifies whether a person near death can request a lethal prescription. (Photo: Travis Long / The News & Observer)
In North Carolina, legislation is expected to be introduced that clarifies whether a person near death can request a lethal prescription. (Photo: Travis Long / The News & Observer) N&O file photo

No person can choose the time and place of one’s birth, but increasingly, people are seeking to have the final word on the time and place of their death when they’ve been diagnosed with an incurable, terminal and insufferable illness.

In eight U.S. jurisdictions there is a legal procedure called Medical Aid in Dying (MAID), which allows terminally ill, mentally competent patients acting on their own volition to ask a participating physician to write a lethal prescription. The movement began in Oregon in 1997. Washington, Vermont, Montana, California, Colorado, the District of Columbia, and Hawaii followed,

The individual is then free to take the medicine at the time and place of his or her choosing, usually at home in a familiar and comforting setting surrounded by friends, family, and spiritual advisers. The gathering becomes a last celebration of the person’s life. In many cases the individual doesn’t ever take the medicine, but instead keeps it by the bedside to serve as a last resort if needed, and to provide a final sense of autonomy and control.

Contrast this self-directed, peaceful scenario with the death endured by the overwhelming number of Americans suffering from a terminal disease: in a hospital hooked up to life-sustaining machinery, with invasive tubes making every motion an ordeal, drugged almost to unconsciousness by pain-killers, and weeks if not months of unrelenting suffering.

Very few people would wish such an end, but once the implacable bureaucracy inherent in every hospitalization takes hold, the individual begins to lose control of the process.

North Carolina has an opportunity to move forward with its demonstrated respect for end-of-life autonomy for its citizens. Currently, North Carolinians are afforded the right to assign a health care power of attorney, which allows them to execute any number of health directives through scope-of-treatment forms and decisions, and to spell out in detail the level of care they desire under various medical scenarios.

What remains unclear and untested in our state is whether an individual with six months or less to live can request a lethal prescription to abbreviate the inevitable suffering and wasting away, and whether a physician can legally comply. Bills have been introduced in the past to clarify the ambiguity so that doctors and patients can engage in a frank discussion about end-of-life wishes. We anticipate that, very soon, there will be a renewed legislative push by lawmakers committed to respecting end-of-life freedom and dignity. We believe this issue is worthy of bipartisan support.

Ultimately, it should be the right of the individual to freely determine how one dies when medical science indicates the future holds little, if any, hope, but much suffering. Far from being an abnegation of the Hippocratic Oath of ‘do no harm,’ it is consistent with the doctor’s ultimate duty to care for a patient in the hour of greatest need.

Edmund Tiryakian is Executive Director of Dying Right NC. Kory Swanson is President & CEO of the John Locke Foundation