Physician Assisted Suicide and Euthanasia: What to Know?

Physician-assisted suicide (PAS) is a controversial subject and is still debated in the medical field and by state regulations. PAS refers to a way to end a person's suffering so they may die with dignity.

Currently, 10 states and the District of Columbia participate in PAS. Euthanasia is different from physician-assisted suicide in many ways, which this article will go over in detail.

What should you know about PAS?

PAS goes by many names, including physician-assisted death, euthanasia, dying with dignity, and medical aid in dying. Dying with dignity has become an increasingly popular option for terminally ill patients and is becoming legal in multiple states.

Currently, there is no federal law against PAS, and it is overseen by individual state laws. Each state has different laws on how PAS will work. Still, it typically involves a lethal prescription from a qualified licensed physician.

As of today, this is where PAS is legal, and the year the state law passed:

• Oregon (1994)
• Washington (2008)
• Montana (2009)
• Vermont (2013)
• California (2015)
• Colorado (2016)
• District of Columbia (2016)
• Hawaii (2018)
• Maine (2019)
• New Jersey (2019)
• New Mexico (2021)

How are PAS and euthanasia different?

PAS is considered medical aid in dying rather than euthanasia. Euthanasia is defined as an act of assisting with someone's death to end suffering.

This means that euthanasia is the act of giving a lethal medication. With PAS, the patient has to be able to self-administer the medication, and physicians can only prescribe it.

Euthanasia, by definition, is illegal in every state in the U.S, although, the term is commonly used when referring to PAS. This can make understanding the process difficult and create confusion about what it is.

Countries where euthanasia is legal:

• Canada
• The Netherlands
• Belgium
• Colombia
• Luxembourg

How does the PAS process work?

When you and your doctor have chosen the death-with-dignity route, a series of protocols and legal steps must be followed. The patient requesting PAS must be capable of communicating their healthcare choices, and the family cannot decide for them. To qualify for PAS, you have to meet the following criteria:

• Be at least 18 years of age or older.
  
• Have 6 months or less of life expectancy.
• Capable of making and communicating your own healthcare decisions.
• Be a resident of the state you are requesting it from (except for Oregon, as of March 2022).
• Capable of self-administering the lethal medication.
• Submit the required number and type of requests to a qualified physician.

Each state has different guidelines regarding the number of requests to a physician, the mode of the requests, and the time between them. The exception is for Montana, as they do not currently have any legal protocol in place. Here is a breakdown of each state's request requirements.

Oregon

Two oral requests 15 days apart (except when the patient has less than 15 days to live).

One written request.

48-hour waiting period before being able to pick up medication.

Washington

Two oral requests 15 days apart.

One written request.

48-hour waiting period before being able to pick up medication.

Montana

No legal protocol in place.

Vermont

Two oral requests 15 days apart.

One written request.

48-hour waiting period before being able to pick up medication.

California

Physically and mentally able to self-administer the medication.

Two oral requests 48 hours apart.

One written request.

Colorado

Two oral requests 15 days apart.

One written request.

District of Columbia

Two oral requests 15 days apart.

One written request 48 hours before medication is to be dispensed.

Hawaii

Two oral requests 20 days apart.

One written request is witnessed by two people who are not related, cannot gain estate from the person, and are not healthcare professionals.

Maine

Physically and mentally able to self-administer the medication.

Two oral requests 15 days apart.

One written request 15 days from the first oral request.

The 48-hour waiting period after the written request.

New Jersey

Two oral requests 15 days apart.

One written request.

48-hour waiting period before picking up medication.

New Mexico

One written request signed and witnessed by two qualified adults.

What happens after you receive the medication?

Once you have met the requirements to qualify for PAS and the doctor prescribes you medication, you will need to pick it up from the pharmacy. No specific law in any state dictates what the drug, dosing, or route needs to be.

This being said, the medication can be a lethal dose of sleeping medication, opioid-based medication, or barbiturates. These can be crushed up and given in juice, as a cocktail, or taken by themselves orally.

Most people choose to take their medication in the comfort of their own homes. However, no law dictates where you decide to take it. Physicians are required to advise not to take it in a public place or outside for the safety of others.

How does one make the choice?

It may be hard to think about the choices you have when given the diagnosis of a terminal illness or only 6 months to live. If you meet your state qualifications for death with dignity and are curious for more information on the process, the best place to start is by talking to your primary care physician.

Once you have made your decision, speak with your primary care physician to see if they or someone they can refer you to is qualified for PAS. Unfortunately, no database lists participating physicians due to the controversy of the subject.

There are other means available to help with end-of-life suffering, such as hospice care or palliative care. Ultimately the choice is yours and yours alone to make. Even if you have the medication in hand, you are not required to take it.

How to tell your family you want PAS?

Talking to loved ones about death and dying is never an easy subject. Many people find the subject challenging and uncomfortable to talk about. It is up to you who you decide to tell about your decision. You can tell everyone or just those closest to you.

It is important to remember that everybody's grieving process is different. It is their right to decide how they feel about your decision. Supporting their feelings while asking for support with your feelings and your decision can aid in the healing process.

What if the doctor disagrees?

Each state has its guidelines and protocols for physicians to use when handling a request for PAS. Some states dictate that the physician has to offer specific therapies first before agreeing to PAS.

You need two doctors that are enrolled in the state program to agree to PAS. It can be any two doctors that see you; your primary care physician, hospice care doctor, or even your dermatologist.

Some specific laws and requirements must be met on both your and the physician's end for PAS to be legal. If your physician is a participant in the program and says no, it may be for your benefit.

Several laws and protocols are in place to ensure you are not being taken advantage of or neglected. There are also laws in place to protect the physician involved legally as well.