Democrats & Liberals Archives

Initiatives in our Republic & Dignity in Death

Citizens’ Initiatives have become a regular feature on our ballots in many states. When our republic was established, the founders took a dim view of this or any form of direct democracy. Mandating the rights of dying patients to manage their own demise may best exemplify an appropriate use of this tool of democracy.

In my home state of Washington, there is a campaign to bring such a Death with Dignity initiative to a vote of the people this year. If it qualifies for the ballot and is approved, Washington would join Oregon--currently the only state where mentally competent patients facing a terminal illness can legally obtain prescriptions for ending their own lives when they choose.

Lawmakers generally don't like to push such controversial measures, in spite of the broad support they might have among the electorate, as opposition is often virulent and moralistic. Without the fear of being removed from office, citizens are free to follow their common sense when considering these measures. There remain excellent arguments both for and against the use of the initiative process. Thomas Cronin wrote a whole book on the subject. I know in my state voters have approved measures against taxation and for specific spending, tying the hands of lawmakers who must find ways to balance the budget. In other cases voters may approve measures limiting the rights of minorities, one of the founders' fears.

A pure democracy can admit no cure for the mischiefs of faction. A common passion or interest will be felt by a majority, and there is nothing to check the inducements to sacrifice the weaker party.
- James Madison

My own tendency, when there's any doubt whatsoever, is never to sign initiative petition drives, and to vote against those which do make the ballot. Initiative 1000, in contrast, is a measure for which I am actively gathering signatures. It does not attempt to control the budget, and rather than constraining rights, it expands them.

Foremost, I find it offensive that someone facing a terminal illness and the prospect of suffering and indignity for the remainder of their lives, should not legally have the option to end their own suffering at the time of their choosing. Whose life is it anyway? Arguments to the contrary are grounded in religious beliefs not shared by all Americans.

People do have reasonable concerns about whether allowing physicians to prescribe life-ending medications might open the door to patients feeling pressure to end their own lives due to feeling a burden to their loved ones. Nine years after the enactment of Oregon's law, which is the model for this initiative, little evidence has emerged to suggest this is a problem. While it is impossible to say that did not play into some patients' decisions, the total number of people taking advantage of the plan is relatively small according to Oregon's mandated reports, and the law requires that two physicians be convinced that the request is the free will of the patient. The worst case scenarios predicted by those who opposed Oregon's law simply have not come to pass. A conservative Supreme Court would not strike it down, and evidence suggests support for the law in Oregon has grown over time.

Certainly it is important that those suffering from depression are not given too easy a route for ending their lives prematurely, and the measure's many safeguards mitigate that concern.

At the heart of the argument for providing this option, are the personal stories of those who would otherwise be trapped in a medical culture which values the prolonging of life over compassion for the life which is being sustained. Far more numerous that those who have taken advantage of Oregon's law, are those whose peace of mind has been enhanced simply by knowing the option was available to them. It is the prospect of facing a debilitating terminal illness without any control of how it ends which robs multitudes of sufferers of that peace. Read the comparison of terminal patients in Miami, Florida with those in Portland, Oregon toward the end of this article

The initiative process is likely overused, and sometimes abused, but expanding the rights of patients to more fully control their end of life medical care to include ending that life when they choose is long overdue.

Some resources:

chronology of assisted dying
Derek Humphrey (founder of Hemlock Society blog
I-1000 Yes website
I-1000 No website

Posted by Walker Willingham at April 30, 2008 5:40 PM
Comment #251822

i don’t really have a problem with this as long as all possibility of abuse is adressed. you have to wonder though if a law of this kind is actually needed, what with all the pain drugs, and other avenues available, if someone chooses to end thier life whats to stop them ? so it’s illegal who’s going to prosecute a dead guy ? the only up side i could see is that it would hold someone harmless for helping someone who wasn’t actually capable of commiting the act themselves. could we also adress the same issue with a living will ?

Posted by: dbs at April 30, 2008 7:45 PM
Comment #251826

End of life issues can often be more complex than what can be proposed in legislation, and the government should stay out of this area, as much as possible.

If a person has no life threatening condition, they may be looking forward to the end of their life, especially if they are isolated from other people. This can just be depression. A large percentage of the elderly are prescribed antidepressants.

Doctors try to keep billing insurance for anything possible, coming up with more ways they claim might extend a persons life for a short period of time, including medical experimentation or torture. Eventually, if the person is able, they may decide to refuse further treatments, and go on a hospice program.

When the program is set up for the client, a package containing controlled substances is delivered, such as Haloperidol, Morphine, Lidocane, and others depending on the clients level of pain.

At some point, they are no longer able to eat. When a person is about to die, they become unconcious, then there is usually difficult breathing, and eventually breathing stops. The family is kept posted on the condition of the patient. The hospice agency has all the contact information, including funeral arrangements. The medicines are disposed of, with a witness, and a death certificate is issued by a phone call to the person’s physician.

The end of a person’s life is a natural process, and the medicines do not interfere with or help speed up the process. The governement shouldn’t interfere either.

Posted by: ohrealy at April 30, 2008 9:22 PM
Comment #251828

these initatives are not about the government interfering in end of life decisions.. in fact it is quite the opposite, the initatiaves are there to provide people with more choices in end of life decisions. How is this in any way government interference?

Posted by: napajohn at April 30, 2008 9:49 PM
Comment #251833

As a long time resident of Oregon I can tell you with a lot of confidence that this law is not being used by depressed people, or people with minor medical issues. You have to be diagnosed with a MAJOR LIFE ENDING event and also be MENTALLY COMPETENT. This is difficult for people who have had a stroke to meet, or people with dimentia/altimers (sp.) The safegaurds are in place this law is about people who know they are going to die a long slow horrible death and do not want to go through it or put their family through it. I have lived through both of my mothers parents dieing of strokes 4-7 years of suffering after the first stroke. and the last 9 months of my grandmothers life was spent enriching the medical centers at taxpayers expense. In the end she effectively killed herself by removing her feeding tube and giving up the fight. Understand she lived a long a full life, she really didn’t need to die a slow painful death. The last 5 months of her life were quantity of life, their was not QUALITY of life. Glad to hear that another state is following along with OR and providing the ability for a small percent of people to choose how and when they die, because at that point that is all they have control over.

Posted by: timesend at May 1, 2008 12:45 AM
Comment #251847

The medical ethics challenges are only beginning. At some point we will have to make up some rules re when to give medical care and when not. We can now extend life in almost any circumstance, but should we.

One of my sisters was born with part of her brain literally outside her head. She would have been permanently retarded and hardly able to function at all. Fortunately, in those days nothing could be done to save her life and she went the natural way that was appropriate. Today, heroic efforts would be employed to save her and unfortunately, they might succeed.

Most of our health care costs go to save people in these extreme conditions or in the last year of their lives. At lower technology levels, doctors could simply always try to save lives knowing that they would be unable to do it in extreme situations. Now it is a choice.

I think eventually we will have to make something like an economic decision. Is it worth it to spend a million dollars to save the life of a 90 year old man? What about a baby who will never be able to walk, talk or speak? Helen Keller analogies aside, should be take this route?

Our morality about this issue is way out of whack in that we just don’t know what to do. Our society allows abortion on demand, but decries abortion of fetuses with disabilities. We spend thousands to preserve life that none of us would consider remotely acceptable if it was imposed on us. Burdened with the memories of eugenics based on misguided Darwinist theories, most of us refuse even to contemplate the types of decisions technological and medical innovations will force on us. It will soon get unpleasant.

What about medical procedures that enhance our abilities? Because of the chances of birth, great athletes are much more able to do physical feats than average. What if we could enhance the abilities of an average guy? What is the normal man? Most of us would be eager to allow medical treatment to restore the function of a man’s legs. We would restore to his previous level. What if we went beyond restoration? My daughter had Lasik eye surgery. She now has 20/15 vision, i.e. she sees better than most people born with “perfect” vision. What if a person with 20/20 just wants to reach that better level? How about old guys? I used to be able to run a mile in under 5 minutes. Now I am lucky to do it in under 9. What if we could “restore” my earlier condition? What do we think about a guy who was never able to run that fast being enabled through technology?

Pandora’s medical box is wide open We have only begun to perceive it and we certainly have not started to address the concerns.

Posted by: Jack at May 1, 2008 8:41 AM
Comment #251850

Good for Washington. Diginity in Death. I agree there should be checks and balances but if the person is sane, at the time the decision is made and the doctors agree then let them pass on the way they want to.

How many times have you heard, well this didn’t work lets try this, or there is a new miracle drug coming out lets try that.
My mother pass away from altzeheimers and lung cancer. The doctors wanted to do a biopsy of the lung to see if they could take care of the cancer. My first question was it going to make her quality of life better, and they told me no. My answer was no. Signing a DNR for a loved one is not an easy thing to do or live with, but it is what my mother wanted.

Posted by: KT at May 1, 2008 9:01 AM
Comment #251930

James Madison’s quote is spot on. It’s why we are a republic and not a pure democracy. Unfortunately:
Most people think it’s a majority rule government.
Most politicians have a wet finger and no backbone.
Most people don’t understand the electoral college and how it protects them against themselves.
Most people ride a one trick political pony.

Most politicians steer clear of highly controversial, polarizing and morally subjective legislation. In this instance, they may be the smarter participants of the discussion.

Posted by: cliff at May 2, 2008 11:21 AM
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