Let’s talk about assisted suicide

Jack Kevorkian made headlines and inspired policy in the 1990s when he aided the deaths of over 130 terminally ill patients. Kervorkian, a medical doctor, created a machine that allowed patients to administer a lethal dose of drugs to themselves. Three times he was taken to court and acquitted. The fourth time, he represented himself and was sentenced to 10 to 25 years, of which he served eight. The world knew his name. “Assisted suicide,” “euthanasia” and “death with dignity” were discussed at dinner tables. The conversation was so common that by the end of the decade, the Michigan Legislature had banned assisted suicide. 

It is time to reconsider Public Act 296.

Then-Gov. John Engler signed it into law in 1998. It prohibits anyone from providing “the means by which the individual attempts to kill himself or herself,” from participating “in an act by which the individual attempts to kill himself or herself” or from helping “the individual plan to attempt to kill himself or herself or kills him or herself.” It does not apply to withholding or withdrawing treatment. It does not negate advance directives (living wills) that describe the personal wishes concerning medical treatment that should be honored at a time when an individual is no longer able to express them.

Technology, culture and opinions have changed since 1998. If you look up “death with dignity,” you will come up with over 100 million hits. The conversation is again a common one for a multitude of reasons. Baby boomers are concerned about the suffering of loved ones and themselves. Technology can prolong certain imminent death at great emotional and financial expense. Several popular books have been written on the subject, such as “In Love: A Memoir of Love and Loss,” by Amy Bloom, and the novel “Lone Wolf Americans,” by Jodi Picoult. Americans are talking about dying.

The physician-assisted death movement is growing worldwide. In Canada, where it has been legal since 2016, it accounted for more than 3% of deaths in 2021.  Austria, Belgium, Germany, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland and all six states of Australia are among the places it has become legal.

Oregon became the first state to approve it, back in 1997, while Michigan was going in the opposite direction. Since then, seven other states (Colorado, Hawaii, Maine, New Jersey, New Mexico, Vermont and Washington) and the District of Columbia have legalized it by statute, and courts have made it legal in Montana and California. In those states and D.C., physicians may provide medications to cause death to patients with a prognosis of up to six months to live. Doctors are obliged to inform patients that they have the option of assisted death, but they are not required to participate. 

It’s important to differentiate euthanasia from “physician-assisted dying.” Euthanasia is the deliberate act of taking a life, what you may refer to as a mercy killing. It is illegal in every state and most countries. “Physician-assisted dying” allows doctors to prescribe a prescription to terminal patients for self-administration that will end their life. 

Much has changed since 1998. Back then, the nation was caught up in the Florida battle between the husband and parents of Terri Shiavo, who had no living will and had been on life support since 1990. In 1998, her husband sought to have her feeding tube removed and allow her to die. Her parents fought in court for seven years until finally he was granted permission in 2005.

Now, providing high doses of morphine to reduce pain that also acts to hasten a patient’s death is common practice in every state and not considered euthanasia. This acceptance is based on the “Double Effect” theory established by Thomas Aquinas. Basically, it means that if a drug was given to address undue pain, and it also hastens death, it is morally acceptable. There is a distinction made between the intention of providing a drug that comforts, even with the knowledge that it will hasten death. 

Living wills or patient directives are common. They allow removal of life-sustaining treatment when it appears death is imminent. This includes dialysis, and ventilators, as well as feeding tubes and hydration. All states have laws regarding advanced directives and appointments of a health care proxy.

Assisted suicide is a logical next step. Some opponents to assisted-death statutes are concerned that vulnerable groups will be abused by the law; it’s part of a “slippery slope” argument. Research in Oregon and the Netherlands showed no evidence of this in the elderly, women, the uninsured, the poor, racial and ethnic minorities, people with chronic pain, and more. People with AIDS did have a heightened risk, although in nine years a total of six persons with AIDS died with an assisted death in Oregon. 

Proponents of death with dignity place great value on autonomy — that is, an individual’s values and beliefs should determine when to end life. Opponents value life above all, just like opponents to abortion rights. But the difference with assisted suicide is that the person who will die is making the choice of ending his or her own existence, not that of a fetus.

Michigan has not looked seriously at its ban on assisted suicide since it was made permanent 25 years ago. Former state Rep. Tom Cochran, D-Mason, introduced a death-with-dignity law in 2017, but Republicans did not allow it out of committee. Now, Democrats control both chambers and the Governor’s Office. This is precisely the time for a legislator to pick up where Cochran left off and introduce a bill. It is also time to organize behind a ballot proposal for the next general election in 2024.

Michigan should have this discussion. It’s a complicated one, as complicated as abortion, with well-intended people holding strong feelings on both sides, but with most people somewhere in the middle. Let’s enter into a statewide conversation and see where Michigan wants to be.