Prof. comments on medically assisted death

February 28, 2020

Medically assisted death is the path of most resistance for individuals looking to die with dignity in the United States, Professor Anita Hannig (ANTH) wrote in a commentary with WBUR

Out of all the countries in the world that allow medically assisted death, the United States has the most restrictive policies, which vary state to state. At the time of publishing, there are nine states and the District of Columbia (DC) that allow medically assisted death, according to the WBUR commentary

Oregon’s Death with Dignity Act, which was passed in 1994, was the first law in the United States that legally allowed medically assisted death. Under the law, “patients would have to ingest the lethal dose themselves—a final protection meant to ensure the absolutely voluntary nature of their death,” according to Hannig’s comment. “The act also introduced a 15-day waiting period between a patient’s first and second request, intended as a period of reflection.”

Hannig told the story of Marieke Vervoort, a paralympic Belgian medalist who had a degenerative muscle disease, who brought medically assisted death to light when she elected to medically die in October 2019. 

According to Hannig, Belgium is the most liberal country in the world with their assisted dying legislation. Vervoort qualified for assisted death 11 years before her actual death, which “afford[ed] her time to carefully ponder her decision—and time to achieve the pinnacle of her athletic career. Knowing she had the right to die gave her an exit strategy if things took a turn for the worse. And they did.” 

Unlike in Belgium, individuals in the United States that seek medically assisted death must be within six months of death, as certified by two different physicians, according to Hannig. Because euthanasia is forbidden in the United States, individuals that elect medically assisted death must be able to administer the drug on their own. However, Hannig explains that, oftentimes, they may be unable to administer the drug. 

Terminally-ill patients in the U.S. who seek out assisted death have similar motivations to Veroort. “The desire to reclaim a modicum of control, in a situation that has caused them to feel utterly powerless and disenfranchised. When illness has taken away as much from a person as it took from Vervoort, the idea of having a say over the timing and manner of your death can bring enormous relief.”

“Those who pursue [medically assisted death] face a range of barriers, at a time when their health is rapidly declining,” Hannig wrote in commentary with “The Conversation.” “Some patients navigate these waters successfully and manage to secure the coveted bottle of life-ending medication. Others give in to the opposition or simply run out of time.”

“As I learned during my research, the stress over their ability to swallow can provoke a great deal of anxiety in patients, particularly when it comes to correctly timing their death,” Hannig explained in commentary. “Taking the medication too early means cutting short a life still worth living; waiting too long means possibly missing their chance. To have the kind of death they prefer, some patients choose to die earlier than they would have liked.” 

Hannig believes that cultural roadblocks are one of the main reasons why medically assisted death is not more accepted in the United States. Even though seven in 10 Americans support the process, ”the cultural stigma and moral ambivalence around these laws remain potent,” wrote Hannig in a commentary with The Conversation. “Across the country, many religiously owned health systems decline to participate in their state’s assisted dying law.”

She wrote that especially in rural parts of Oregon and the rest of the coastal corridor, where Catholic health systems are the only ones that individuals have access to, patients looking for medical aid-in-dying oftentimes are unable to find two physicians that would approve their request or a pharmacist that would fill their prescription. 

Many assisted living and nursing facilities in these areas also prohibit the procedure under their roof, which forces patients to make an alternative arrangement. 

“In trying to reclaim control over the way they die, these patients often are being stripped of some of that control in the process,” wrote Hannig in a commentary with The Conversation

Hannig said that she sees medically assisted dying as an opportunity for society to recognize the potential of medicine as a way to “mitigate the process of dying.”

“Patients who endure intractable, painful diseases sometimes reach a moment when the prospect of staying alive feels worse than the prospect of dying,” she explained in a commentary with The Conversation. “At that point, the idea of having a say over the timing and manner of their death can bring enormous comfort.” 

Hannig is a medical anthropologist that “explores the field of medicine from a cultural angle, focusing primarily on birth and death,” she wrote in a commentary with The Conversation. She is currently studying how access to medically assisted death is helping to transform the way that Americans die. Hannig has had the opportunity to join patients, their families and physicians on the paths of medically assisted death and has witnessed some deaths firsthand. 

Hannig is currently taking a year-long sabbatical to work on her book and was unavailable for an interview.

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