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Restrictions/Limitations in
Physician Assisted Suicide (PAS) Laws.

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"Physician Assisted Suicide" (PAS) is also known as "Medical Aid in Dying" (MAID). They enable individuals who find life intolerable to approach their physician seeking a prescription for medication that will kill them. Some people seek death because of an intolerable level of pain. Others because a disease has profoundly limited their quality of life.

As of the end of 2018, PAS has been legalized in some countries including Australia, Belgium, Canada, Colombia. Luxembourg, the Netherlands, and Switzerland. It has also been legalized in some jurisdictions of the United States: California, Colorado, District of Columbia, Montana, Oregon, Vermont, and Washington state. 1 It was established in Montana by a court decision, in the District of Columbia by DC legislation, in states by the passage of state legislation and throughout in some countries by federal laws.

Most recently, PAS became available in Hawaii on 2019-JAN-01. The Hawaiian law, like many laws in other U.S. states, was patterned after Oregon's Death With Dignity Act.

Laws that legalize PAS/MAID generally have significant restrictions that limit who can obtain PAS and who can provide PAS. Typical limitations include:

  • An applicant must be 18 years of age or older.

  • They must be capable of expressing their wishes for PAS. Alternately, some jurisdictions allow for persons to make a signed, written statement in advance that would authorize PAS in the event that they become incompetent to verbalize their wishes in the future.

  • They must be suffering from a terminal illness -- one that is expected to eventually kill them.

  • They must have an limited life expectancy: six months or less is a common criterion.

  • The attending physician(s) must confirm that the patient is mentally capable of making the decision to request aid in dying, and is not suffering from a condition that impairs their judgment.

  • The medication that will cause death must be prescribed by a physician who is approved to practice in the jurisdiction where the patient is a resident. For example, in Oregon:

    "The physician must be a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) licensed to practice medicine by the Board of Medical Examiners for the State of Oregon." 2

  • The physician must be willing to participate in ending the live of the patient. Medical personnel are free to refuse requests for PAS for any reason.

  • A second, independent physician must interview the patient and agree with the first doctor's opinion that their patient should be given access to PAS.

  • They must give appropriate medical care to their patient during the dying process.

  • The patient must be able to self-administer and ingest the prescribed medication. It is typically in the form of a large dose of sleeping medication which must be fully consumed within two minutes. This is because the medication will put the person to sleep very quickly.

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Factors limiting access to PAS in the U.S.: 4

  • PAS is not available throughout the country: As of early 2019, it is only available in seven states and the District of Columbia. This is a major inconvenience for some individuals wanting PAS for whom travel is difficult. (This is not a factor in Canada and some other countries because PAS has been legalized there by a federal law and is effective across the country.)

  • The Applicant must often prove residency in their physicians' state or province: This is required in CA, CO, HI, OR and WA. It is a major inconvenience to those patients who go out-of-state seeking PAS. Establishing residency is easier in some jurisdictions than in others. For example, in DC, one can establish residency by providing two original documents containing their name and an address in the state. A recent utility and telephone bill would suffice. 4 (Again, this is not a factor in some U.S. states, and in countries like Canada where the PAS law is effective nationwide.)

  • The applicant must have a terminal illness and be predicted to die naturally (without PAS) quickly -- usually within six months . Some people have illnesses that reduce them to an intolerable state such as extreme pain, physical helplessness, mental degradation, etc. while not significantly shortening their lifetime.

  • One individual who was not eligible for PAS because of his life expectancy was the U.S. actor and comedian, Robin Williams. At the age of 63, he apparently attempted to terminate his life in his bedroom by slashing his left wrist. He was unsuccessful. Then, he successfully hanged himself from with a belt wedged between the door and the door frame of a clothes closet. 5 He was suffering from diffuse Lewy body dementia, which generates many different symptoms.

    Mrs. Williams issued a statement saying that her husband:

    "... struggled with his own battles of depression, anxiety, as well as early stages of Parkinson’s disease, which he was not yet ready to share publicly."

    Dave Itzkoff and Benedict Carey, writing for the New York Times, said:

    "Some 1.3 million Americans have Lewy body dementia and its symptoms are harder to live with each day, especially for relatively young people like Mr. Williams.

    The disorder is often mistaken for Alzheimer’s disease, or Parkinson’s disease: there’s an Alzheimer’s-like slippage in memory and thinking, as well as stiffness and movement problems seen in Parkinson’s. The similarities in the three disorders are extensive enough that it often takes more than a year -- and multiple visits to specialists -- to get an accurate diagnosis.

    'It took almost three years for us,' said Norma Loeb, a board member of the Lewy Body Dementia Association, whose mother, Lillian, died of the disorder in 2014-SEP. 'I had to go online and research it myself; that’s the norm'." 6

  • A more common degenerative disease is Alzheimer's. 7
    • Deaths from this disease increased by 123% between 2000 and 2015.

    • 1 in 3 seniors will die of Alzheimers or another dementia.

    • 5.7 million people are currently living with Alzheimers, This is expected to increase to almost 13 million by mid-century if no effective treatment is found.

    • Women are almost twice as likely to develop Alzheimers then men.

    • African-Americans are about twice as likely to have Alzheimers or another dementia than whites.

    • 50% more Hispanics develop Alzheimers or another dementia than whites. 7

    • The website alzheimers.net has a useful description of the seven stages of Alzheimer's disease.

David Goodall, a 104-year-old scientist from Australia suffered with Alzheimer. PAS was not allowed in that country. He flew to Switzerland where an assisted dying agency enabled him to die. He said:

"I'm not happy. I want to die. It's not sad particularly. What is sad is if one is prevented. My feeling is that an old person like myself should have full citizenship rights including the right of assisted suicide." 8

Josh Bloom, writing for the American Council on Science and Health (ACSH) said:

"Alzheimer's Disease (AD) is arguably the worst of all possible afflictions. Its progression and outlook are predictable and gruesome; there are no effective drugs to prevent or treat it; and it takes an enormous physical, emotional, and financial toll on both the patient and his or her family. It kills slowly, forcing victims and their families to go through different stages, each marked by a decrease in cognitive function. By the end, the victim barely resembles the person he or she once was." 8

Some people live for 20 years with AD! 8

Persons with Alzheimers and other forms of dementia are generally denied PAS. They are caught in a Catch-22 situation:

  • Early in the progress of the disease, people cannot access PAS because they have a life expectancy longer than 6 months.

  • Later -- sometimes after as many as 20 years suffering with AD -- when their life expectancy is finally less than 6 months, their mental facilities are so degraded that they are not sufficiently mentally competent to request PAS.

"Jmkillingnyc" added her comment to the article on the ACSH web site. She wrote:

"Josh, very thought provoking article. I’m assuming you deliberately kept your personal beliefs regarding the topic out of it but I’m a bit opinionated lately. I think being forced to live when you know for absolute certainty you don’t want is a form of torture. The end-of-life qualification seem to cater to mostly Cancer much like the CDC opiate guidelines. The majority of our society has a new form of collective dementia when it comes to all the other horrible incurable diseases besides Cancer. I don’t know if it’s because Cancer has been shoved down our throats as the guaranteed tear jerker in films since the blockbuster success of Love Story and Ryan’s Song but we are torturing incurables that don’t make the cut over misconception regarding diseases, the complexity of the human body and quality of life." 8

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Webmaster's personal comment:

I am 82 years of age. This is is significantly beyond the age at death for a male in the U.S. and is quickly approaching the age in Canada. I have recently noticed a slight degeneration in my mental facilities. Sometimes, I cannot immediately recall a word that I have routimely accessed instanly in the past. I sometimes cannot immediately recall a rarely used editing procedure when working with Dreamweaver, the program that I use to write reports like this one. The prospect of a major decline in mental sharpness terrifies me. I don't want to be caught in the type of Catch-22 situation that Alzheimers patients experience.

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References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. "Assisted suicide," Wikipedia, as on 2019-JAN-17, at: https://en.wikipedia.org/
  2. "Physician-Assisted Suicide Fast Facts," CNN, 2019-JAN-03, at: https://www.cnn.com/
  3. "Ethics guide" Regulation of euthanasia," BBC, 2014, at: http://www.bbc.co.uk/
  4. The national Death with Dignity group published a helpful "Frequently Asked Questions" article during 2018 on their website concerning PAS at: https://www.deathwithdignity.org/
  5. "Official: Robin Williams hanged himself with belt," Weschester News, undated, at: http://westchester.news12.com/
  6. Dave Itzkoff and Benedict Carey, "Robin Williams’s Widow Points to Dementia as a Suicide Cause," New York Times, 2015-MAY-03. at:
  7. "Alzheimer's Disease Facts and Figures," Alzheimer's Association, 2019-JAN, at: https://www.alz.org/
  8. Josh Bloom, "Should Alzheimer's Patients Have The Right To Choose Physician-Assisted Suicide?," American Council on Science and Health (ACSH), 2018-AUG-18, at: https://www.acsh.org/

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Copyright 2019 by Ontario Consultants on Religious Tolerance
Originally written: 2019-JAN-20
Latest update: 2019-JAN-21
Author: B.A. Robinson
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