Medical aid in dying

Medical aid in dying is an end-of-life medical practice in which a mentally capable, terminally ill adult with less than six months to live may request medication from her or his doctor for self-administration to bring about a peaceful death if her or his suffering becomes unbearable. According to data from the Oregon Health Authority which publishes annual reports on its first-in-the-nation aid-in-dying law, approximately one third of patients who qualify and receive a prescription never consume the medication.

The Oregon, Washington, Vermont, California and most recently Colorado laws expressly say that, “actions taken in accordance with [the Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.” This distinguishes the legal act of medical aid in dying from the act of assisting a suicide, which is explicitly prohibited by statute in 42 states and prohibited by common law in an additional six states and the District of Columbia. Assisted suicide is prohibited in every state where medical aid in dying is authorized.

Dr. Harold Glucksberg, along with four other physicians, three terminally ill patients, and Compassion and Dying, brought a case against the state of Washington for banning assisted suicide. The case was filed in District Court in 1994.

Following a series of appeals, the U.S. Supreme Court decided in 1997 in a unanimous decision to uphold Washington’s ban. They cited the Due Process Clause and argued that assisted suicide isn’t guaranteed as a fundamental liberty protected by due process. The case allowed individual states to decide independently on the medical aid-in-dying issue. It set the stage for legislative efforts on the state level.

In 1992, the group Californians against Human Suffering proposed Proposition 161 to allow patients with less than six months to live the right to receive assistance from physicians in dying. This proposition offered more safeguards against abuse by physicians than Washington’s Initiative 119, such as special protections for patients in nursing facilities. This measure failed to pass with 46 percent of the vote.

Subsequent efforts were tried to pass assisted death legalization through the California State Legislature in 1999, 2005 and 2006, all of which failed. The California legislature passed a bill legalizing the practice in September 2015, and the bill was signed into law by Governor Jerry Brown on October 5, 2015, making California the fifth state to authorize medical aid in dying and the second to do so through the legislature. The Act began implementation on June 9, 2016. The law went into effect in June 2016.

Aid in dying is legal in Montana through a state supreme court decision. In Baxter v. Montana the Montana Supreme Court ruled in a 5-2 decision that state law allows for terminally ill Montanans to request lethal medication from a physician under existing statutes. The Attorney General of the state of Montana sought an appeal from the Montana Supreme Court, but the court, by a decision of five to two, affirmed the lower court's ruling on the state law. The Court did, however, limit the scope of the decision by not determining if the state's constitution protected the right.

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