Professor Anita Hannig (ANTH) was joined by members of the Brandeis community to discuss her ongoing research in medical aid-in-dying. Hannig went on sabbatical last semester to pursue her research, mainly residing in Oregon and parts of the West Coast, interviewing and interacting with patients, physicians and lawyers to learn more about medical aid-in-dying and its anthropological significance.
She began this research in 2015 as a project that “asks how legislation that sanctions medically assisted deaths in several U.S. states is transforming the ways North Americans view and manage the process of dying,” according to Hannig’s website.
Currently in the U.S., there are eight states that legally allow physicians to prescribe a lethal cocktail of medication for patients to take in order to end their life. Among one of the strictest laws in the world, the U.S. requires that the individual must be able to administer the medication either orally or through a feeding tube by themselves. The medication cannot be administered intravenously.
Hannig went on to describe the cultural values that attest to this type of treatment, especially “by protecting the cultural image of doctors as healers,” stated Hannig in her talk. This reflects the contradictory work of physicians, who ride a fine line between medical ethics and ending one’s life and how lives are ultimately deemed liveable.
The idea of assisted dying goes back to the early 20th century with “Chloroform Bills” that were enacted in Ohio and Iowa in 1906. These bills allowed physicians to give chloroform to terminally-ill patients to end their lives using a quick and painless method. However, these bills did not last long due to protests by local communities. “Something was unpalatable to voters for physicians to end the life of their patient” was the main argument, according to Hannig.
Hannig explained that physicians, after the revoking of the Chloroform Bills, carefully worked with opposers of assisted death, and Oregon passed the first official assisted dying law, the “Death with Dignity Act,” in 1994. Since then, six other states (Washington, Vermont, California, Colorado, District of Columbia and Hawaii) have passed similar ones to Oregon which allow for physicians to prescribe medication for assisted death. Montana does not have a law that allows physicians to practice this, but with a decriminalized aid-in-dying law, physicians that do assist in assisted death will not be prosecuted.
The largest proponent that keeps opponents at bay, according to Hannig, are the strict criteria that patients need to meet in order to be accepted in an assisted death. “You must physically be able to administer the medicine yourself,” explained Hannig. This is why so many people are unable to partake in assisted death because their ailments are too disabling to allow them to administer the medication themselves. Hannig recalled talking to an individual whose spouse, who suffered from ALS, rammed their wheelchair into a wall in order to push the syringe with the medication into their system. Physicians and lawmakers use this strict requirement to ensure that vulnerable individuals were not coerced into assisted death.
However, the definition of “self-administration” is extremely vague. Family members and physicians are able to mix the medication, hold straws up to the patients and even fill the syringes, but the patient must be able to inject or swallow the medication without any assistance.
Along with self-administration, patients that qualify for assisted death must have a terminal diagnosis of less than six months, be at least 18 years of age, have the ability to make healthcare decisions, be mentally sound, have approval from two different physicians and two oral requests for medication that are at least 15 days apart and one written request, according to Hannig.
While conducting her research, Hannig noticed that a lot of the patients that decided to utilize assisted death did so relatively quickly after making up their mind. With many terminal illnesses, the patients will have the best chance of administering their medication during their “good days,” when their symptoms are less severe. And since it is impossible to predict the number of “good days” remaining, many terminally ill patients choose to die very soon after obtaining the medication.
Studies also found that since the passing of the “Death with Dignity Act,” almost 2,000 prescriptions have been written by physicians for terminally ill patients. However, almost one third of the prescriptions were not filled, either from individuals dying before they had the chance to take the medication or deciding not to take it at all. Hannig cited that some patients liked having the medication as backup just in case their symptoms got worse.
In terms of medical ethics, the Hippocratic Oath taken by all physicians states “Above all, I must not play at God.” However, Hannig states that this line of active and passive medical intervention is extremely thin. She questioned when the act of assistance in assisted death is actually helpful.
Hannig went on to state that there is often a misconception about physicians who are prescribing these medications. “Doctors don’t learn how to kill patients in medical school,” said Hannig. Many of these physicians who prescribe the medications are teaching themselves the pharmacology of drugs in order to find the perfect cocktail to have the most painless passing. With major pharmaceutical companies jacking up the price of common medications used to end life, physicians have found alternatives at cheaper costs. However, these combinations of medications oftentimes lead to prolonged death, sometimes taking up to 36 hours for the patient to die.
As legislation, and medicine, continue to advance, supporters of assisted death are working to loosen the criteria for assisted death. They are attempting to extend the terminally ill diagnosis from six months to one year, to allow patients some relief without suffering for a few months until their diagnosis has reached six months. Physicians are also attempting to allow for intravenous administration of the medication. However, this hits roadblocks as people think it is too close to euthanasia, which is the painless killing of a patient suffering from an incurable disease or in an irreversible coma.
Hannig contradicts this with the idea of “independent ethos” and cited manners in which “involuntary euthanasia” is present in our current hospice system in the form of terminal sedation, which can be implemented without legal supervision. This practice is limited to patients who are in a continuous state of pain with no chance at relaxation.
This event was the second in the “Bridging the Two Cultures Lecture Series” held by the university.
