A living will (a.k.a. advance directive) spells out a person's wishes for terminal care and takes effect when the person is no longer able to communicate those wishes.28 Living wills are a product of the patients' rights movement of the twentieth century, some highlights of which are charted above. Patients' rights include the right to demand or refuse medical treatment when one is faced with inevitable death and the right to secure a doctor's help in ending suffering (sometimes called euthanasia or doctor-assisted suicide). These rights have legal, moral, medical, and ethical components, as reflected in the time- line above. Since the early twentieth century, courts of law, religious bodies, the medical establishment, voters, and newly-formed societies have weighed in on the emotional issue of appropriate end-of-life care and the patient's role in it.
The timeline shows that the right of the terminally ill to refuse treatment is now established — by 1994 all states had recognized some type of advance directive. Physician-assisted suicide is another matter entirely. Except in Oregon, it is illegal to choose a physician-assisted, peaceful death over a life of unbearable pain and suffering.
Oregonians Choosing Death With Dignity: 1998-2001
| Item | Number (%) |
| Age— Median, years (range) | 69 (25-94) |
| Race | |
| White, non-Hispanic (%) | 88 (97) |
| Asian (%) | 3 (3) |
| Sex | |
| Male (%) | 44 (48) |
| Marital status | |
| Married (%) | 40 (44) |
| Widowed (%) | 22 (24) |
| Divorced (%) | 23 (25) |
| Never married (%) | 6 (7) |
| Education | |
| Less than high school grad (%) | 10 (11) |
| High school grad/some college (%) | 42 (46) |
| College graduate (%) | 27 (30) |
| Post-baccalaureate education (%) | 12 (13) |
Oregon became the first state to legalize physician-assisted suicide in 1994. The Death With Dignity Law29 requires an annual report on the year's experience with the law. The first report stated that 23 people received legal prescriptions for lethal medications; 15 of them used the medication.30 Six people died before using the drug and two others were still alive at the time the report was filed. Non-use of the drug has been interpreted to mean that people want a choice, whether or not they take advantage of it.
By 2001 a total of 91 Oregonians were reported to have availed themselves of a physician's assistance in dying. The table shows some demographics of that population of 91. Median age was 69, the majority were white, female, married, and had attended college. Seventy percent of those who died had cancer.
The American Medical Association holds that physician-assisted suicide is "fundamen- tally incompatible with the physician's role as a healer." Anonymously, many doctors will concede that there have been times when they assisted someone to die. Sometimes the assisted death has been notorious rather than anonymous, as in the deaths presided over by Jack Kevorkian (Michigan's Dr. Death). A 2002 ABC News poll found 48% of Americans opposed and 40% in favor of physician-assisted suicide. However the patient's rights movement plays out, appropriate end-of-life care is an issue that will no longer be ignored. Next we look at how patients' rights are handled in Holland.
Sources: Chart: Doctor-Assisted Suicide: A Chronology," Longwood University, http://www.lwc.edu/administrative/library/death.htm. Small chart: "Oregon's Death with Dignity Act — Annual Report 2001," http://www.ohd.hr.state.or.us/chs/pas/ar-tbl-1.htm. National Center for Health Statistics, Health, United States, 1998, www.cdc.gov/nchswww/products/pubs/pubd/hus/hus.htm. National Institutes of Health, "Quality of Life for Individuals at the End of Life, August 2, 2000, http://grants1.nih.gov/grants/guide/pa-files/PA-00-127.html. Faye Girsh, "Death With Dignity: Choices and Challenges," USA Today, March 2000/. Data retrieved September 13, 2002.
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