Just how Terminal is Terminal?

Recent admissions by the Oregon Health Authority suggest that that State’s physician-assisted suicide law may have wider parameters that has been hitherto supposed.

An article has been published by a Swedish researcher which casts doubt on whether Oregon’s so-called Death with Dignity Act (DWDA) is as restrictive as is often supposed.  The DWDA restricts eligibility for physician-assisted suicide to persons who have been diagnosed as having what it calls a “terminal disease”, which is defined as “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgement, produce death within six months”.  This sounds on the face of it to restrict assistance with suicide to people who have been told that they will unavoidably die of an incurable illness in the near future.  But does it?

In 2017 Swedish researcher Fabian Stahle approached the Oregon Health Authority (OHA), which is responsible for overseeing the DWDA, and asked whether someone would qualify under the law to receive lethal drugs if he or she had a chronic and incurable illness, such as (for example) diabetes, which could be managed with medication but who chose to stop taking the medication and as a result was likely to die within six months.  Or what about a patient with another illness which was incurable but, with treatment, offered a longer prognosis?  If that patient refused treatment and as a result was thought likely to die within six months, would he or she qualify for assisted suicide under the DWDA?   Mr Stahle was told by the OHA Yes, those patients would qualify.  The criterion that the person concerned has less than six months to live is, it seems, based on an assumption that the illness takes its course without further treatment.

What this means is that a person with a chronic but managed medical condition – of whom there are many – could transform that condition into a terminal illness with a prognosis of less than six months simply by stopping taking medication or refusing life-extending treatment.  Of course, no patient can be treated without his or her consent.  A patient is free to refuse or discontinue treatment, including treatment that is life-sustaining or life-extending.  However, it is one thing to refuse treatment and to accept that death may result.  But that treatment refusal should open a legal door to physician-assisted suicide is quite another matter.

Was this what Oregon’s legislators intended – or indeed forsesaw – when they enacted the DWDA?  Is this apparent loophole being exploited?  Are those doctors who provide assistance with suicide required to state, when they notify the OHA of the prescriptions for lethal drugs they have issued, whether the recipients fell within the terms of the law becaise they were on an unavoidable downward path to death within six months or because they had chosen to discontinue treatment?  These are serious questions to which answers are needed.

Nearer to home, admirers of the DWDA, whose own notions of legalised assisted suicide are modelled on the DWDA, should take note.