Policy Analysis on the Oregon Death With Dignity Act Term Paper

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Policy Analysis of Oregon's Death With Dignity Act

David Gil's writings have helped the public understand the true scope of the new Oregon Assisted Suicide law, and as a result, the percentage of Americans who say that doctors should be allowed to help with suicide when the patient and the patient's family request it has doubled to 70%.

The fact that Oregon's law was a citizen's initiative that passed and other facts concerning physician-assisted suicides that have surfaced recently signal a renaissance of activism on the part of citizens who wish to change existing law on that topic. Even with the new Oregon law, it is not easy to participate, as there are requirements that make it difficult to obtain permission.

David Gil's Policy Analysis Framework has three main sections: (1) the issues of the nature, scope and theory behind the new policy focus; (2) the objectives, values and ideological orientation of the policy, such as theories, people it will affect and manner in which the law is used, including financial costs and benefits, quality of life, background, size, resources and values of group supporting it, and (3) alternatives to the policy. Following are the points he makes:

The analysis attempts to settle the dispute as to what the incapacitated person really wants: to live in their current state of pain and/or terminal illness, or die with the air of anesthetizing medications. This has been confused in the past by guardians of the patient with conflicting interests, and other parties with authority.

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The values and ideological orientation of the law appear to be based on non-discrimination, civil rights and self-determination. Studies of groups wishing to utilize the law show that physician-assisted suicide may be a function of psychological stress and social factors. The underlying theory of the law is so terminally ill patients may be given an opportunity to die with dignity. This assumes that some people wish to die before becoming a burden or to die legally, rather than illegally.

Term Paper on Policy Analysis on the Oregon Death With Dignity Act Assignment

The law allows individuals to the legal right to die, but this is not an individual thing to do. Another must be there to facilitate. So far, there have been no limitations on time and no definitions of "terminal illness" for those patients who participate, although in Oregon, the legal interpretation of "terminal disease" is "an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months." [1995 c.3s.1.01; 1999 c.423 s.1] (Definitions, 12)

The Oregon law not only affects those who are terminally ill, but has an effect on others, as well. Oregon has the fourth largest rate of elder suicide and this law may be a solution to a long-term problem in that state. Physicians can judge if a suicide is rational and justified. This may also have an effect on those considering suicide while they are terminally ill. In certain cases their right to die will be supported.

The law protects physicians in Oregon who may otherwise have been charged with manslaughter or prosecuted under drug laws for assisting suicide. Although this gives large leeway to doctors in their decision-making, the Oregon Death with Dignity Act has safeguards built in for this possibility.

The law does not allow people to end their lives for fear of being a burden to others, although this accounted for 63% of deaths from assisted suicide reported this being one of the reasons.

Doctors who daily see death from illness support this law, as well as citizens desiring to lower health care costs.

David Gil's Social Policy Framework includes an analysis of alternatives to the Oregon Death with Dignity statute. He claims the major alternative is to return to an environment where people suffering from terminal illness foresee a bleak future of suffering and long-term medical care unless they terminate their own lives illegally. But that they will not be taken advantage of by those simply wishing to do away with ill patients for any reason.

Review of Thesis by Debra Leeb

Debra Leeb says that "the law regarding the right of an individual to end his/her life has been affected both by advances in medical science and by shifting attitudes about individual rights and the rights and responsibilities of society." (Leeb, 1) She presents the viewpoint that, while the Oregon Act allows terminally ill patients with the ability to end their suffering legally, it devalues life and offends those with strong ethical beliefs.

The Oregon Death with Dignity Act allows one who is terminally ill who wishes to end their life to consult a physician and to make a written request for medication to end their life in a humane and dignified manner. They may choose their own manner of death now, but in the late '80s, initiatives to legalize such practices attempted to qualify in both Oregon and California, but failed (Purdy, 2006). Washington State attempted this in 1991 and California again in 1992, but these both were defeated. Oregon's law was passed in November of 1994 by a margin of 51%. An injunction delayed its implementation, but in 1997 the injunction was lifted by the United State Supreme Court, the Ninth Circuit Court of Appeals, and it became a legal option for terminally ill patients to obtain physician-assisted suicide. When a measure to repeal the law was placed on the ballot in 1997, Oregon voters upheld the law 60% - 40%. Other states have attempted to consider such legislation, but Oregon has been the only state to enact such a bill. Michigan and other states have enacted new laws making it clear that physician-assisted suicide is illegal. (Coueman, 2000)

The Living Will was conceived in 1967 by Luis Kutner. It authorized only the refusal of extraordinary measures in cases of advanced terminal illness. In 1990, Congress passed the Patient Self-Determination Act that allowed patients to specify if they wished to accept or refuse specific medical care. They could identify a legal representative for urgent healthcare decisions. The right-to-die movement advocates an automatic proxy statute that would give a designated person power to make decisions for an incompetent patient who never appointed a proxy or signed a living will.

Leeb discusses the circumstances that surround an end of life situation. This is usually something patients and their families have not talked about or prepared for. Medical practices make choices complicated, as "life" can be sustained medically through medical procedures. Whether this is helpful is not clear to those involved.

Leeb's study examines the Oregon Death With Dignity Act's origins and tries to identify shortcomings, the social and philosophical aspects of end-of-life decisions and make recommendations for amendments to the Act.

Leeb discusses the difficulty the Act had in becoming law, and additional attacks on its legality in the years that have followed its enactment. During the past 30 years, courts have consistently rejected attempts at legalizing physician-assisted suicide in California. The Karen Quinlan case beginning in 1975 in New Jersey, allowed a young woman in a coma to finally die in 1985. In this case the Supreme Court decided a patient's ability to have their life sustained by a respirator was up to them and their family, under the right to privacy (Annas). Subsequent judgments have cited individual freedom and privacy to justify decisions for incompetent patients who had never indicated their wishes in such matters. Life support can be terminated by close members of a family, employing the concept of substituted judgment. Substituted decision-making concerning respirators has since been enacted by New Jersey, Massachusetts and California. California also included the withdrawal of food and fluids.

A complicated case arose in California, when a terminally ill woman with cerebral palsy requested the right to starve herself to death in a hospital and the hospital refused, treating her for suicidal intent instead, force-feeding her. ACLU lawyers came to her defense, but a court upheld a denial of the patient's injunction against the hospital. She was subsequently released from the hospital because she no longer needed inpatient care (Cummins).

Also, in California, a 49-years-old injured man was disabled in 1993, both mentally and physically and depended on artificial feeding and hydration to survive. His wife requested the right to turn off his life support in 1995, saying he would not have wanted to live in this condition. However his mother and sister objected and a long fight ensued (Eisenberg, 2002,). The man died before the case was decided, but the California law was narrowed to cover only conscious patients who had left no formal directions for healthcare who would die without life support, but did not affect patients permanently unconscious, including those in a comatose or vegetative state, or those who had left legal instructions regarding healthcare or who had appointed another to make such decisions.

In 2003, Terri Schiavo, her husband and family faced a similar situation. Terri collapsed in 1990 at her home in Florida and had been in a coma since then, supported by feeding tubes. Emotions ran high… [END OF PREVIEW] . . . READ MORE

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