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Editorial: Final Choices; 'Right to Die' Is Difficult to Legislate

The United States justifiably prides itself on being a nation of laws, but ironically, many of the most vexing questions in American life prove highly resistant to solution by statute. A case in point is legislation now pending in the Vermont House that attempts to address what is variously called “physician-assisted suicide,” “death with dignity” and “end-of-life choices.”

The whole notion that patients have a right to die, instead of a mere obligation to do so, is an evolving one. Many people rebel at the idea that terminally ill patients ought to have the ability to determine the time and place of their death. The objections may be religious or simply based on the belief that natural processes must be left to run their course. Yet the idea that individual liberty encompasses the right to end life on one’s own terms is self-evident to many other people and powerfully appealing to those who fear a loss of control over their own destiny as life nears its end. Perhaps the debate really boils down to two views of how to die in a way that is consistent with the values that one lives by.

Into this arena of moral complexity, legislators need to tread with a full appreciation of their limitations. If they choose to intervene at all in such an intensely personal decision, they need to establish safeguards adequate to prevent outcomes that are at odds with their compassionate intent.

As staff writer Chris Fleisher reported in the Sunday Valley News, the Vermont Senate originally considered legislation this year modeled on Oregon’s landmark 1994 law. It would have allowed a patient suffering from an incurable and fatal illness to request from a willing physician a prescription for lethal drugs that the patient could use, or not use, as he or she deemed appropriate. We’re not entirely sure that patients suffering from terminal illness are always equipped to exercise sound independent judgment in these circumstances, but the bill did contain safeguards intended to prevent abuse, including that the patient had to initiate the process, make multiple requests for the lethal medication, be of sound mind and be informed of all end-of-life options. The diagnosis of a terminal illness had to be confirmed by more than one doctor.

Some senators were apparently uncomfortable with this process, believing that it amounted to a state sanction of suicide — as indeed it does. At that point, two senators offered an amendment that simply eliminated the original text and substituted for it legal immunity for physicians who prescribe medication that patients use to kill themselves, as well as for family members and friends who are present when the suicide occurs. Supporters argued that the amended bill simply recognizes the facts as they currently exist, when such life and death decisions are made tacitly within the confines and privacy of the doctor-patient relationship. They carried the day, and the Senate adopted the amended bill.

There are obvious problems with this approach. For one, granting legal immunity to a physician who plays a role in helping a patient to end his life is no less a state sanction of suicide than the bill it replaced, even if it preserves the fig leaf that the medication has been prescribed solely to treat the symptoms of the disease. There is no moral difference between the two.

Secondly, the removal of the safeguards outlined in the original bill creates ambiguity, and an accompanying potential for coercion of patients or other types of abuse. It thus seems to us that granting blanket immunity by statute before the fact in these situations is unwise. The state ought to preserve the right to prosecute in the event that abuse occurs.

Moreover, this bill could place an intolerable burden on doctors who experience a conflict between their compassionate instincts and what they believe are their professional obligations. In the case of such a conflict, having a specific procedure to follow seems likely to produce a degree of comfort that the right outcome has been reached.

We hope the House will reject the Senate’s approach and return to something closer to the original bill. Either that or simply recognize that legislation is too blunt an instrument to address such morally charged questions.