Talks legalization, Canada and politics

BY DANIEL GAITAN daniel@lifemattersmedia.org

OREGON – Death with Dignity executive director Peg Sandeen credits growing acceptance of physician-assisted suicide to the aging population and increased awareness about the controversial practice.

Support for physician-assisted suicide is proliferating in state legislatures across the nation; proponents contend the practice enhances patient freedom at the end of life and guarantees terminally ill adults a way out of pain and suffering.

Physician-assisted suicide is legal in only a handful of states, including Washington, Oregon, Vermont and Montana. California Gov. Jerry Brown was the latest governor to sign a “right-to-die” proposal into law in October. There is also legislation being considered in several states regarding the legality of the practice.

Right-to-die advocates credit the recent high-profile death of 29-year-old Brittany Maynard for generating support among “millennials.” In 2014, Maynard was diagnosed with glioblastoma; doctors predicted that she would survive only six months. Maynard moved to Oregon to obtain doctor-prescribed barbiturates. Her death made headlines across the world.

Despite calls for legalization, the American Medical Association remains firmly opposed to such policy. The Chicago-based AMA is the nation’s largest organization of physicians, representing nearly 200,000 doctors, medical students and residents.

Many doctors, bioethicists and religious leaders caution that physician-assisted suicide is incompatible with physicians’ primary role as healer and would foster resentment towards sick people hoping to live as long as possible, no matter the costs.

Sandeen spoke with Life Matters Media about the controversial practice.

Why do you think the practice is becoming more accepted?

I think when Brittany Maynard shared her story with Americans and so bravely went forward with the fact that she had to move to Oregon to have a dignified death, I think that really reminded folks that this is an issue that can impact all of us. That story was a year-and-a-half ago, but people haven’t forgotten it. People understand that this is an issue they need to get involved with.

What about Maynard’s story touched upon so many people? Was it just her age?

I would not say her age, but her stage of life.

She was just starting out – she was newly married, she was a teacher, she was a young person that we don’t think about being terminally ill and suddenly she has this horrible cancer that was going to kill her – there was no question that was going to happen.

I think the vibrancy with which she lived her life was very compelling.

Many major medical organizations, including the AMA, do not support ‘Death with Dignity’ legislation. Do you see them changing their stance anytime soon?

I think so.

Physicians are, notoriously, on some issues in medicine some of the last ones to come around.

You might look at supporting the Affordable Care Act, they did not support early efforts to bring health care to all Americans until this most recent effort. They weren’t necessarily supportive when Bill Clinton tried to do it, so they tend to come around last. So, I’m not surprised that they are not with us, but I’m pretty sure that they will be in the next 10 to 15 years.

What part of the nation do you see legalizing the practice in coming years?

I still think it’s New England.

I thought before California went, I really thought that New England would see a swing towards ‘Death with Dignity.’ In California, we had the opportunity with the special session to secure a victory when it all looked failing in the regular session.

California Gov. Jerry Brown is a Roman Catholic and went against Church teachings on physician-assisted suicide. What do you make of his decision?

I was pleased, and I would say that we did not know which way he would go on the issue.

I thought his signing statement was so thoughtful; he signed the bill and really had this really thoughtful, studied approach to whether-or-not he would support ‘Death with Dignity.’

He didn’t start out as a supporter – I wouldn’t even say that his signed statement suggested he was a supporter – but he felt like it was not his place to deny Californians the right to ‘Death with Dignity.’

I think what’s most compelling is the care and study that went into whether-or-not he would support it for the people of California.

Speaking of politics, Bernie Sanders is the only presidential candidate to voice support for the practice.

While we enjoy tremendous popular support, we are an issue that is just beginning to get traction in terms of legislators and in legislative bodies.

We really only truly won in two legislative bodies – California and Vermont – and both were long-fought wins.

I think that politicians are still afraid of our issue. Even though there is tremendous public support, I don’t think until we see a number of wins in state legislatures we’re probably not going to see candidates stepping out on our issue.

If a mainstream candidate came out in support of ‘Death with Dignity’ would it sink his or her campaign like it would have 20 years ago?

I’m not even sure it would have doomed the campaign 20 years ago, with our issue enjoying 70 percent plus public support. I don’t think supporting our issue ten years ago would have hurt a candidate, let alone today. I think there’s a perception out there that it will. Every legislator who voted with us in Vermont got re-elected.

Is there anything you like to see changed or updated about Oregon’s ‘Death with Dignity’ law? It’s almost 20 years old.

What is amazing about the Oregon law is that we got it right the first time.

We have data that demonstrate that it works appropriately, that vulnerable populations are protected. And yet, a certain small group of terminally ill individuals are granted the right to use the law.

Proponents recently published a report in the Journal of Palliative Medicine in support of national standards based on Oregon’s ‘Death with Dignity Act’ of 1997. What do you think?

The practice of medicine in the United States is governed by the states, that is the tradition, that each state and each state’s board of medical examiners establish for each state what the practice of medicine is.

‘Death with Dignity’ laws require people looking to obtain the drugs be screened by two physicians. Should a third individual, perhaps a psychologist or psychiatrist, work with people seeking life-ending drugs to ensure they are not depressed and of sound mind?

The way the law works is that both physicians who are involved with the patient have to determine that the patient is not suffering from anything that impairs their ability to make health care decisions. So they are not suffering from depression so great that it impairs their health care decisions.

The patient has to demonstrate that to two physicians, not just one. If he or she has any sort of thing that’s going on with them that makes it look like they have impaired decision-making, they have to be referred to a counselor or therapist for an assessment to determine whether-or-not their decision-making is impaired.

What are we going to add, a third? That’s way overboard. How many times in medicine do we have someone go through three assessments? Two assessments I think is enough.

In Canada, Prime Minister Justin Trudeau introduced legislation to legalize physician-assisted suicide for Canadians with a “serious and incurable illness.” Thoughts?

We watch the Canadian case very closely. It is very interesting with their Supreme Court ruling and the bill that was introduced.

We had worked with a task force from Canadian Parliament. They were instructed by their Supreme Court to come up with guidelines for ‘Death with Dignity.’

We worked with them to help them think about what their guidelines would be. It was really interesting because they were not necessarily all supporters – it was a delegation from Parliament – but they were tasked with coming together to putting ‘Death with Dignity’ legislation down on paper.

We worked with them to help them think about how the Oregon model would work there. Their Supreme Court decision suggested that it would be bigger than the Oregon model, that it would be more permissive than what Oregon allows.

That is the bill that you see from the Prime Minister, it has some facets of the Oregon law but it is slightly different, mostly because the Supreme Court has told them that they have to have a pretty comprehensive law.

– Image Brittany Maynard in Compassion & Choices video