What Is Physician-Assisted Dying, and How Does It Differ From Euthanasia?
Key takeaways:
Assisted dying is legal in several states in the U.S., and it’s an option for people with terminal illness if they meet certain criteria.
In the U.S., the only form of assisted dying that has been legalized is physician-assisted dying. This means the individual who requests assisted death must administer the lethal dose of medication to themselves.
Assisted-dying statues allow an individual to ease suffering and choose the circumstances of their death in a way that aligns with their life and values.
Assisted dying is a term that includes both physician-assisted dying (PAD) and euthanasia. In the U.S., PAD is legal in some states. PAD allows an individual with a terminal illness to choose a humane and comfortable manner of death. Still, PAD is a relatively uncommon choice, accounting for only 0.3% to 4.6% of all deaths in the places where it’s legal. And because it’s not legal in all states, and few people in those states exercise this option, many people are not familiar with PAD. So we’ll discuss the difference between PAD and euthanasia, explain the reasons why someone may choose PAD, and the details of the process.
Assisted-dying terminology and definitions
There are two main types of assisted dying: physician-assisted dying (PAD) and euthanasia. The main difference between PAD and euthanasia is who administers the lethal dose of medication.
1) Physician-assisted dying
PAD is when a healthcare provider prescribes medication to help someone choose the time and circumstances of their death. But the person who chooses this option must administer the medication to themselves. In the U..S, this is only legal for people with a terminal illness.
PAD is sometimes called physician-assisted suicide, which is an inaccurate and misleading term. Using the term “suicide” incorrectly implies that someone with a terminal illness is choosing to die. But because people who choose PAD already have a terminal illness, they are not choosing to die — instead, they are choosing how they die.
2) Euthanasia
Euthanasia is a form of assisted dying in which a healthcare provider (or someone else) administers the lethal medication to the person who chooses assisted death. This is not currently legal in the U.S., but it’s legal in a few other countries.
Who is eligible to seek assisted death?
The first state in the U.S. to legalize PAD was Oregon, where the state legislature approved the Oregon Death with Dignity Act in 1994. The Act went into effect in 1997. Among states in the U.S. where PAD is legal, the laws are modeled after the original Oregon statute, which set the precedent for the eligibility criteria. These criteria are in place to protect people from misusing PAD.
Read more like this
Explore these related articles, suggested for readers like you.
A person can legally pursue PAD if they:
Are over the age of 18
Have a terminal illness with a prognosis of fewer than 6 months to live
Have two separate healthcare providers confirm their diagnosis and prognosis
Are a resident of a state where it is legal (they cannot cross state lines for a prescription)
Have the capacity to make this decision (more on this below), and provide informed consent without any evidence of coercion
Have the ability to self-administer the medication
The use of the word “capacity” above has a very specific meaning. It basically means an individual has the cognitive ability to understand PAD and their decision. More specifically, a person is determined to have capacity when they can:
Explain the reasons behind their decision in a rational and logical way
Demonstrate they understand the possible alternatives to their decision
Demonstrate they understand the potential risks and consequences of their decision
In some cases, a mental health provider may be consulted to make sure someone who is choosing PAD has clear judgment — and to make sure their decision isn’t affected by an untreated mental illness like depression.
The reasons why some people choose physician-assisted dying
When someone chooses PAD, it is usually made after they have considered all other treatment options available. And it’s not a decision that someone makes lightly. But people who make the decision to proceed with PAD may wish to:
Have the ability to choose the time, location, and circumstances of their death
Ease further suffering
Prevent further deterioration of their mental or physical health, which has an impact on their quality of life
Approach death with a feeling of empowerment and dignity
The choice to pursue PAD is a personal one, and each individual situation is unique.
How are palliative and hospice care different from assisted dying?
Anyone with a terminal illness has the option to pursue palliative care and hospice care. And these are different from PAD. But someone who is receiving palliative and hospice care can choose PAD alongside those treatment options.
Palliative care: This refers to treatments that help to decrease someone’s suffering from a medical illness. This type of care can be part of someone’s treatment whether or not they have a terminal illness.
Hospice care: This is a form of end-of-life care that focuses on comfort instead of prolonging someone’s life. Anyone with a terminal illness with fewer than 6 months to live can choose hospice care.
Unlike assisted dying, the goal of palliative and hospice care is not to hasten death, but to ease suffering. In some cases, palliative care and hospice care may be an alternative to assisted dying.
How does the process of physician-assisted dying work?
If someone chooses PAD, a healthcare provider will prescribe a dose of medication for the individual to administer to themselves at a time of their choosing. The prescription is usually an oral dose of a barbiturate — a sedative medication that’s sometimes used to stop seizures or for surgical anesthesia. And in high enough doses, it will shut down the part of the brain that is responsible for breathing.
The process may differ slightly from state to state, but there are several general steps that are similar in most states.
Requesting the medication
Most states have measures in place to ensure someone’s intent with their decision. This includes the following:
There’s a mandatory waiting period after someone requests the medication.
The person must make 2 spoken requests — usually at least 15 days apart — and 1 written request.
The written request must be witnessed by two people, at least one of whom is not related to or caring for the individual making the request.
Once the waiting period is complete, the provider can send a prescription for the medication to a participating pharmacy. Then the individual or someone of their choosing can pick up the script.
Administering the medication
After someone gets the medication, it’s up to them when (or if) they want to take the medication. The decision to take the medication is not binding, and the individual can change their mind at any time. But they must administer the medication to themselves.
Providers often prescribe barbiturate in powdered form that needs to be dissolved in liquid before ingestion. Barbiturates slow down activity in the brain. So their effect causes a person to fall asleep and eventually stop breathing.
After someone takes the medication, it usually takes about 10 minutes for them to fall asleep. Many people choose to do this at home, surrounded by their loved ones, and in a comfortable environment. Death usually occurs between 1 to 3 hours after the individual falls asleep — though it can take more than 6 hours in about 5% of cases.
The grieving process for loved ones
Someone pursuing assisted dying is encouraged — but not required — to discuss their decision with their family or social support network. This is ultimately the individual’s choice. But many people find it helpful to be open about their decision with those who are closest to them. And both the person seeking PAD and those close to them will likely need some time to process this decision.
While everyone’s experience is different, support persons of those seeking PAD often accept their decision over time — even if they may not fully understand it initially. Having time to prepare for someone’s death can bring a comforting sense of peace and control. Many people find it comforting that their loved one was able to make this decision for themselves.
Where is assisted dying currently legal?
Physician-assisted dying is currently legal in the following U.S. states and jurisdictions:
California
Colorado
District of Columbia
Hawaii
Maine
New Jersey
New Mexico
Oregon
Vermont
Washington
Montana (no official statue, but PAD is legal due to a State Supreme Court ruling)
In the future, other states may consider legalization, and this list may expand.
A few European countries, as well as Canada and New Zealand, have also legalized some form of PAD. And euthanasia is legal in a few parts of the world in certain cases. But assisted dying is still controversial in the U.S. and in much of the world, so it’s not widely available as an option for most people.
The bottom line
In several U.S. states, people with a terminal illness have the legal right to choose physician-assisted dying. Sometimes people choose this as an option to relieve their suffering and die on their own terms. An individual who chooses physician-assisted dying must meet very specific criteria. They are then prescribed a lethal dose of medication that they must administer to themselves. The decision to pursue this option is ultimately a personal one. But someone with a terminal illness who is considering this option will often benefit from the support and understanding of those who care for them.
Why trust our experts?
References
Death with Dignity. (2021). Death with dignity acts.
Death with Dignity. (2021). How death with dignity laws work.
Death with Dignity. (2021). How do aid in dying laws protect patients?
Death with Dignity. (2021). Terminology of assisted dying.
Emanuel, E. J., et al. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA.
Fontalis, A., et al. (2018). Euthanasia and assisted dying: What is the current position and what are the key arguments informing the debate? Journal of the Royal Society of Medicine.
Holmes, S. (2018). Exploring the experience of supporting a loved one through a medically assisted death in Canada. Canadian Family Physician.
National Institute on Aging. (2021). What are palliative care and hospice care?
Pereira, J. (2011). Legalizing euthanasia or assisted suicide: The illusion of safeguards and controls. Current Oncology.
