The right to die: the social necessity for Death with Dignity Acts
By Madison Wood
An individual’s reaction to stress is commonly understood through fight, flight, freeze, or fawn. This physiological response, driven by the body’s central nervous system varies depending on an individual's experience. Despite being in an age of medical breakthroughs, society has not progressed past the implications of such physiological responses when it comes to the stress of a terminal diagnosis. However, laws throughout the United States still embed this fight-or-flight response when approaching an individual's end-of-life options. Despite debates of morality and ethicality, a growing number of people—struggling with a prolonged period of emotional and physical suffering—call for an expansion of Medical Aid in Dying legislation, ensuring that individuals navigate their final days with dignity, autonomy, and peace.
Following a terminal diagnosis, Michigan law requires physicians to provide their patients with their end-of-life options. The Dignified Death Act limits the choice to begin treatment, refuse treatment, or choose to be given enough medicine to control the pain until the time of death. Such options force a patient to choose between fighting their diagnosis or accepting their fate. No matter their decision, patients with a terminal illness are given an end date and asked to decide how they will approach physical and mental decay. A growing dissatisfaction over these options has led to Medical Aid in Dying initiatives. Formerly known as Physician Assisted Suicide, MAID has emerged as a controversial yet crucial alternative, offering terminally ill patients the option to maintain dignity and control in their final days. However, while proponents highlight its potential to honor personal autonomy and alleviate suffering, critics raise concerns about its potential abuse and impact on social ethics.
In 1997, Oregon became the first state to legalize assisted suicide when voters approved the enactment of the Oregon Death With Dignity Act. The ODWDA allows adult residents of Oregon with terminal diagnoses to request capacity assessments by their primary care physicians. These assessments determine the patient's capability to understand what medical aid in dying entails as well as their alternative options. Following eligibility, a comfortable physician will prescribe a cocktail known as DDMAPh (digoxin, diazepam, morphine, amitriptyline, and phenobarbital) which will lead to a sleep-like death within 24 hours of ingestion. Following the Supreme Court’s ruling on Washington v. Glucksberg (1997), federal law was ruled to neither legalize nor prohibit a state’s provision of medical aid in dying, leading to California, Colorado, the District of Columbia, Hawaii, Main, Montana, New Jersey, New Mexico, Vermont, and Washington passing similar legislation.
Proponents of MAID insist on understanding the law’s nuances. Medical aid in dying is an optional choice for both patients and doctors, no patient is required to use it nor is a doctor to advise on the matter if they are not comfortable doing so. A patient must be an adult with six months or less to live and be able to make an informed health care decision and take the medication themself—defining MAID against the outlawed practice of euthanasia. Medical aid in dying gives patients autonomy over their remaining time. Over the 40+ years of combined evidence and cumulative data from the laws passed across the globe, medical aid in dying is proven to help far more people than those who choose to pursue the prescription.
Through the legalization of MAID, the American conception of death is able to grow through conversation around end-of-life options. Medical advancements have infiltrated the concept of death, creating what used to be a family, communal, and religious event into a struggle for care. The distressing physiological process of death has created a distance between the healthy and the sick. This divide has led to the overpopulation of nursing homes and disproportionate access to hospice care. MAID initiatives serve to break down this stigma through conversation, leading to an improvement in end-of-life care for diverse groups of patients and their families.
On the other hand, opponents worry about the future implications of legalizing medical aid in dying. They argue that the practice goes against the duty of physicians to preserve human life, cautioning of the ethical violations in describing a ‘death cocktail’. However, a deep dive into the American Medical Association’s Code of Ethics pulls at the strings of this argument. Opinion 5.7 on Physician-Assisted Suicide reiterates that at the core of the public and professional debate lies “the aspiration that every patient comes to the end of life as free as possible from suffering”. Once again, the passage of Death with Dignity Acts that allow for the option of medical aid in dying does not require those morally opposed to the practice to participate. The stringent safeguards on practice ward against the slippery slope of precedent ensuring a comprehensive understanding of their choice. With the legality of MAID lacking constitutional protection, it is under the “laboratory of the states” to determine the extent and application of end-of-life options.
The Supreme Court recognized the right to refuse life-sustaining medical treatment under the 14th Amendment’s Due Process Clause in Cruzan v. Director, Missouri Department of Health (1990). However, the subsequent case of Washington v. Glucksberg (1997), detailed that this right does not extend to more active forms of medical intervention in hastening death. Complicated by the government’s motives to criminalize both suicide and assistance in suicide, the Court has not revisited the question of the right to die under the 14th Amendment despite the overwhelming prosecution of assisted death cases.
Familiar to the University of Michigan, Jack Kevorkian—known to most as Dr. Death—was a strong supporter of euthanasia following his graduation from the U-M Medical School. The retired pathologist became a household name for his research and physician-assisted suicide in upwards of 100 terminally ill patients. Kevorkian’s pursuit to destigmatize dignified death ultimately led to a conviction of Second-Degree Murder in 1999, following three previous acquittals. In recent news, 76-year-old Ellen Gilland is awaiting trial on charges of assisted self-murder/manslaughter following an unfulfilled murder-suicide pact with her terminally ill husband, who she fatally shot in 2023. A lack of legal precedent on this issue leaves Gilland unable to use his prior consent as a defense. The indictment of Gilland and Kevorkian highlights the need for the guidance of legal precedent on assisted-death legislation.
Unfortunately, justice for end-of-life care still has a long way to go with reform lacking extensive research. The safeguards in place for the provision of medical aid in dying discriminate against different socioeconomic classes who are unable to afford the medication, perpetuating the inability of marginalized individuals to receive medicare benefits. Furthermore, medical aid in dying is not available to people already experiencing deteriorating mental capacity, barring Alzheimer’s patients from a dignified death. Despite these limits, the legalization of MAID continues to be the first step in change. This year, Michigan lawmakers will re-consider SB681, collectively known as the Death with Dignity Act. This act will add the option of medical aid in dying to end-of-life options in the state of Michigan. The passage of SB681 is necessary to jump-start reform in end-of-life care by enabling conversation around the cognitive dissonance surrounding death while promoting legal guidance around individuals' right to die.
