Will Assisted Dying Now Become the New Norm?

Arthur L. Caplan, PhD


November 19, 2015

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Hi, I'm Art Caplan from the Division of Medical Ethics at the New York University (NYU) Langone Medical Center.

California is often said to lead the way in the United States, and recently they enacted a bill allowing assisted dying in the state. Oregon has had this policy for 20 years, Washington State has had it for many years, and Vermont passed it last year. When California enacts a policy like this, it means that 1 out of every 10 Americans will have assistance in dying available to them.

It's likely that this legislation is going to reignite interest in many other states around the country. Is it a good idea? Is it something that physicians can be in favor of? Is it something that physicians can participate in ethically?

"Assisted dying" means helping someone who is going to die—someone who is terminally ill—die when they want to. Ethically, it's not quite the same as a suicide, because in suicide, you were not going to die anyway. For assistance in dying, you are going to die, and the questions are how, when, and who will be there.

Assistance in dying is still very, very controversial. Some people say, "If we don't watch out, the disabled and the frail elderly will be rushed to choose this because they cost money." People sometimes do not want to take care of them, and sometimes people are after their money if they have an estate.

Another concern is that palliative care and hospice care are not available to everyone. If you legalize assisted dying in a state or a location that does not have good palliative or hospice care, are you kind of nudging them toward saying, "Why don't you end your life?"

These objections are important. Nevertheless, this legislation signed by Governor Jerry Brown after going through the California legislature is ethical. Doctors can participate if they so choose. It is something that doctors need to talk to their terminally ill patients about.

Why is it ethical? It is restricted to competent people: You have to have your wits about you. Someone with Alzheimer disease or a stroke cannot use this. You have to make the choice whether you will. It's up to you to decide whether you want to do this.

Two doctors have to declare that you are terminally ill. It is restricted to a tiny number of people who are dying—people who are imminently dying or soon to die. They are required to put the request in writing, and do it again 2 weeks later.

It's not going to be easy to bully anybody into doing this. If we look at Oregon, which has had this law for 20 years, there are no cases of people being rushed or bullied to choose death, or to choose this form of assistance in dying. Critics sometimes say there are a few cases from Oregon, and the authorities in Oregon who issue a report on how this legislation is working every year just do not seem to find any problems. Nor is there any effort in Oregon to overturn the law. Worry about coercion is not there, as long as we restrict this to terminally ill people who are competent and who make the request more than once.

It is true that you should be offered hospice care. It is true that palliative care—having your pain and suffering controlled—should be an option. But, there are people who just do not want that. Once they know that they are dying and soon to die, some say, "I don't want to go through hospice care. I want to leave under my own terms, and this is how I want to go." It may not be for everybody, but it's a choice that those who want to take it should have. Probably the biggest issue around assistance in dying is whether we can continue to improve support, palliative care, and hospice care for all Americans.

I think California has shown leadership in saying they are going to offer this option to those—and there will not be many—who decide they want to end their life on their own terms.

I'm Art Caplan at the Division of Medical Ethics at the NYU Langone Medical Center. Thanks for watching.


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