With D.C. and California laws in jeopardy, a fresh debate over medical aid in dying
The following article appeared in USA Today on June 25, 2018:
Debbie Gatzek Kratter, a California attorney with Stage 4 pancreatic cancer, wants to die on her own
terms. She’s had chemotherapy treatment, but at a point, it will stop working.
She doesn’t know if she’ll be able to.
Under current California law, Kratter will soon qualify for medical aid in dying — a procedure by
which physicians prescribe lethal medications to patients with terminal illnesses who are at least 18
years old and have a prognosis of six months or less to live.
But that law is in jeopardy. So is a similar law in Washington, D.C. And medical aid in dying — a
controversial subject that’s sparked contentious debate since the first law allowing it was passed in
1997 — is back in the spotlight.
In California, an appeals court put the End of Life Option Act temporarily back in place after a trial
judge ruled it constitutional in May. But opponents of the act have until July 2 to file objections, so
while the legal process plays out in the coming weeks, the law’s future is uncertain.
In Washington, a government appropriations bill includes a policy rider — a provision added to a bill
that’s unconnected to the subject matter of the bill and probably wouldn’t pass on its own — that
would repeal medical aid in dying in the District.
The repeal is in the version of the bill that a House subcommittee approved but not in the Senate
subcommittee version. It’s unclear whether it will make it into the final bill.
For patients counting on access to the procedure, not knowing their options during an already-trying
time is deeply frustrating.
“People who have a diagnosis like I have, I’m effectively on death row,” Kratter said. “But someone
is saying, ‘When your time comes, we want you to suffer.'”
A decades-old debate
Current battles over these laws are only the latest iterations of a debate that dates to 1997 when
Oregon passed the first medical aid in dying law.
A key turning point in the debate came with Brittany Maynard, a 29-year-old with terminal brain
cancer who moved to Oregon to voluntarily end her life. Before she died in November 2014, she
became a public advocate for the cause of legalizing medical aid in dying.
When Maynard died, only Oregon, Vermont, Montana and Washington had laws that permitted
medical aid in dying. Since then, California, Colorado, Hawaii and Washington, D.C., have legalized
the procedure. And movements in several other states, including New York and New Jersey, are
pushing for similar laws.
Sentiment on both sides runs high.
Advocates argue that medical aid in dying allows terminally ill patients to avoid prolonged suffering
by ending their lives voluntarily. Opponents worry that the procedure could take advantage of certain
vulnerable groups — the elderly and people with disabilities — and could lead to voluntary death for
people with mental illnesses as well as physical ones.
The debate doesn’t necessarily break down along partisan lines: Disability rights groups on the left
and religious groups on the right have been some of the strongest voices against medical aid in
“Vulnerable people know that assisted suicide puts them at risk of deadly harm, so any push-back
on this dangerous public policy is a win. People who live with terminal illness, economic
disadvantage and disabilities are the first to experience the adverse effects of these laws and
deserve protection from them,” said Matt Valliere, the executive director of the Patients’ Rights
Action Fund, in a statement. Patients’ Rights Action Fund is a group advocating against medical aid
Doctors themselves don’t agree on whether the procedure should be allowed.
The American Medical Association’s current position on medical aid in dying holds that such
procedures are “fundamentally incompatible with the physician’s role as healer,” though delegates at
an AMA meeting in Chicago voted narrowly to continue “studying that position” — a process that
could lead to an official change to neutrality.
“Many doctors think that they just should not and can’t kill a patient, that it’s a fundamental violation
of the Hippocratic Oath,” said Art Caplan, a bioethics professor at New York University, referencing
the ancient oath sworn by physicians that, in part, promises to “do no harm.”
Other doctors disagree. Omega Silva, a Washington, D.C., doctor and former president of the
American Women’s Medical Association, has practiced medicine for more than 50 years. Her
decades of medical work as well as her personal battles with three cancer diagnoses have
convinced her that ending a terminally ill patient’s suffering through medical aid can often be the right
thing to do.
“We shouldn’t keep patients alive just to keep them alive; we have to find out what they want out of
life,” Silva said. “We have to make their dying not as bad as it could be.”
The current battles
In Washington, D.C., the debate is particularly contentious because the city’s situation is unique:
Congress has the authority to control the District’s budget and local laws if it chooses to do so.
Similar laws in states cannot be repealed through a federal appropriations bill.
“The repealing of the law in D.C. does not impact any other state; however, anytime Congress is
acting on something you want to pay attention to it,” said Kim Callinan, the CEO of Compassion &
Choices, a group that advocates for legalization of medical aid in dying.
Public support is largely in favor of laws that legalize the procedure. A May Gallup poll found that 72
percent of respondents believe doctors should be able to help terminally ill patients die. The group
with the highest support was people identifying as liberal at 89 percent. The only group below
majority was weekly churchgoers, at 37 percent.
“We are on both the right side of history and the right side of morality,” Callinan said, arguing that as
Baby Boomers age, the option to receive medical aid in dying will gain support. “I have no doubt that
in time this is going to be an option that’s available in all 50 states.”
But while the legal and political battles rage, patients seeking the procedure are left without the
control they were looking for in the first place.
“It is frightening,” Kratter said. “Because to the extent that I am able, I do not intend to have my poor
family stand around and feel badly for me.”