Jack Kevorkian, also known as "Dr Death," was a controversial pathologist who claimed to have helped 130 people commit suicide when terminally ill. ​To help his “patients,” Kevorkian built a suicide machine called the Mercitron or Thanatron, which he operated out of a Volkswagen van to inject a lethal drug dose for people seeking his help in dying. ​

Not surprisingly, Dr. Kevorkian's services were not well-received and considered criminal virtually everywhere. As a result, he was prosecuted and served eight years in jail for murder after one of his injections was shown on national television. However, he lived long enough (until 2011) to see his life made into an award-winning HBO movie starring Al Pacino. ​

Kevorkian's actions sparked a national debate in the United States on assisted suicide and today, eight states and Washington, D.C. have passed legislation which allow mentally competent adults with terminal illnesses to receive prescription medication to assist in their death.

What are "Right to Die" Laws?

Death with dignity or the right to die by physician-assisted suicide refers to the practice where a terminally ill patient, who is mentally competent, seeks the assistance of a physician to end their own life. ​ It involves the prescription of medication by a doctor that the patient can self-administer to bring about a peaceful death.and subject to specific conditions and safeguards to prevent misuse.

It is said that the purpose of death with dignity laws is to provide terminally ill individuals with the option to end their lives in a peaceful and dignified manner, with the assistance of a physician. ​ These laws aim to respect the autonomy and personal choice of individuals who are facing unbearable suffering and have a limited life expectancy. The primary goals of death with dignity laws include: ​

1.      Patient autonomy: Death with dignity laws recognize and uphold the principle of individual autonomy, allowing terminally ill patients to have control over their own bodies and the decision to end their lives. These laws aim to respect the personal choices and values of patients, empowering them to make decisions about their own end-of-life care.

2.      Alleviating suffering: The laws aim to address the suffering experienced by terminally ill patients who are facing severe pain, loss of dignity, and a diminished quality of life. By providing the option of physician-assisted suicide, death with dignity laws seek to offer a compassionate choice for those who are enduring unbearable suffering and have exhausted all other available treatment options. ​

3.      Safeguards and regulations: Death with dignity laws include strict safeguards and regulations to ensure that the decision to pursue physician-assisted suicide is made voluntarily, with informed consent, and without coercion or undue influence. ​ These safeguards typically involve multiple physicians confirming the diagnosis and prognosis, waiting periods, and assessments of mental competency to ensure that the decision is well-considered and free from external pressures. ​

4.      Legal clarity and protection: By enacting death with dignity laws, states provide legal clarity and protection for physicians who choose to participate in physician-assisted suicide. ​ These laws establish a framework within which physicians can ethically and legally engage in end-of-life care, ensuring that they are not subject to criminal prosecution or disciplinary action for providing assistance in accordance with the law.

The states that have death with dignity laws are California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, Oregon, Vermont, and Washington. ​ Oregon was the first state to pass such laws in 1994 and 1997, while the most recent laws were passed in 2018 and 2019.

Safeguards are in place in these states to prevent misuse of the laws, including the requirement of two physicians to confirm the patient's diagnosis and prognosis, waiting periods before the prescription is filled, and confirmation of the patient's mental competency. To be eligible for physician-assisted suicide, a person must have a terminal illness and be given six months or less to live. ​ The decision to pursue this option rests with the patient. ​

Why do states adopt "Right to Die' Laws?

Various arguments in favor of, and against for death with dignity laws have been made. The case in favor of such legislation lists the following: ​

1.      Autonomy and personal choice: Supporters argue that individuals should have the right to make decisions about their own lives, including the choice to end their suffering and die with dignity. They believe that terminally ill patients should have control over their own bodies and the timing of their death. ​

2.      Alleviating suffering: Advocates argue that death with dignity laws provide a compassionate option for those who are experiencing unbearable pain and suffering due to a terminal illness. They believe that allowing individuals to choose when and how to end their lives can provide relief and prevent unnecessary suffering. ​

3.      Safeguards and regulations: Supporters of death with dignity laws emphasize that these laws come with strict safeguards and regulations to prevent abuse and ensure that the decision is made voluntarily and with informed consent. ​ They argue that the presence of multiple physicians, waiting periods, and mental competency assessments help protect vulnerable individuals.

Why are "Right to Die" Laws Opposed by the majority of states?

Arguments against death with dignity laws are based on the following: ​

1.      Sanctity of life: Opponents often argue from a religious or ethical standpoint, asserting that life is sacred and should not be intentionally ended, regardless of the circumstances. They believe that human life has inherent value and that intentionally causing death is morally wrong.

2.      Slippery slope: Critics express concerns about the potential slippery slope effect, suggesting that legalizing physician-assisted suicide could lead to a broader acceptance of euthanasia or involuntary euthanasia. They worry that vulnerable populations, such as the elderly or disabled, may be coerced or pressured into choosing death.

3.      Medical ethics and role of physicians: Some opponents argue that physician-assisted suicide goes against the fundamental principles of medical ethics, which prioritize preserving life and providing care. ​ They believe that doctors should focus on providing palliative care and improving the quality of life for terminally ill patients, rather than assisting in their death.

Death with dignity or the right to die laws will continue to be a controversial topic for the legal as well as the medical community for years to come.