Death with Dignity: Capstone

Should the New York State Senate Pass Bill S3685 and Establish the End of Life Options Act?

Prepared by Alexandra Cogen Submitted to Beth Eakman Re CAPS 4360.12 Summer 2015

ABSTRACT Bill S3685, the End of Life Options Act, was introduced to the New York State Senate in February 2015 and intends to legalize death with dignity at the state level with the hopes of improving end of life care. This bill will allow a physician to give end of life medication to a patient with a terminal illness, and, unlike euthanasia, the medication would not be administered by the physician but by the patient. However, there are many opposed to the passage of this bill due to numerous factual claims and conflicting moral and ethical beliefs. Both sides contribute persuasive arguments, which is why the debate has become so highly publicized. This project considers the question of what should be done regarding death with dignity in the state of New York, and concludes that the New York State Senate should pass Bill S3685.

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Table of Contents Final Submission ……………………………………………………………………………….. 3 End Notes ……………………………………………………………………………………… 21 Works Cited …………………………………………………………………………………… 24 Bibliography …………………………………………………………………………………... 26 Previous Submissions …………………………………………………………………………. 31 Submission 1 …………………………………………………………………………... 32 Annotated Bibliography ……………………………………………………….. 39 Submission 2 …………………………………………………………………………... 46 Letter of Transmittal …………………………………………………………… 47 Introduction ……………………………………………………………………. 49 Key Terms ……………………………………………………………………... 50 Narrative ……………………………………………………………………….. 51 Plan of Present Work …………………………………………………………... 58 Submission 3 …………………………………………………………………………… 61 Submission 4 …………………………………………………………………………… 68 Interview 1 ……………………………………………………………………... 69 Interview 2 ……………………………………………………………………... 72 Field Research …………………………………………………………………. 75 Submission 5 …………………………………………………………………………... 77 Appendices …………………………………………………………………………………….. 82 Email Correspondences ………………………………………………………………... 83 Compassion & Choices Pamphlet ……………………………………………………... 87 Field Work Photographs ……………………………………………………………….. 88

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Should the New York State Senate Pass Bill S3685 and Establish the End of Life Options Act?

Capstone Final Submission

Cogen 4 It was a blistering hot July day in Texas and nobody wanted to discuss death with me. I was dressed in a cute outfit, sun dress sans Death’s scythe, and I had a non-threatening smile plastered on my face.i I swear I didn’t use the words suicide or murder once. I would like to blame the heat, or lack of passersby, but I know that wasn’t it. I was asking people to take an informational pamphlet about death with dignity and an organization called Compassion & Choices. For a while I tried to mix it up, and asked if people wanted to discuss the improvement of end of life options, but still, crickets. It turns out that death isn’t something people like to talk about, no matter how politely you ask or how politically correct you phrase it. Honestly, it isn’t something I like to talk about either, but it is something that needs to be discussed. Organizations fighting for what is more commonly known as physician-assisted suicide have coined numerous other terms in attempts to make the cause sounds less threatening. Physician-assisted suicide, physician-assisted death, death with dignity, patient-directed dying, and aid in dying all describe the same process: that of a physician providing life-ending medication to a terminally ill mentally competent patient. No matter how you phrase it, there will always be resentment, people uneager to discuss it, and people passionately fighting against it.

Previously referred to primarily as physician-assisted suicide, the term death with dignity has become one of the more preferred terms since the case of Brittany Maynard.ii Maynard, a young beautiful 29 year old woman, was diagnosed with terminal glioblastoma and chose to quickly die through medication proscribed to her by a physician rather than die slowly and naturally.iii She ended her own life, surrounded by family and close friends, on November 1st, 2014 in Portland, Oregon.iv Although physician-assisted suicide has been a heated topic of debate for a long time, the death of Maynard brought international focus to the controversy, and sparked the Death with Dignity movement, which promotes monitored physician-assisted suicide for terminally ill individuals. Although no legislation is being considered at a federal level, a couple states in the U.S. have legalized death with dignity, and 11 states are currently considering death with dignity in the 2015 session.v At present, Oregon, Washington, and Vermont are the only states where death with dignity is legal, and in Montana and New Mexico, it is legal by court decision. Although Texas, my current home, is not considering legislation, many states have introduced legislation since the death of Maynard, including New York, my place of origin, where the debate is currently heated and evenly divided.

Cogen 5 On February 3rd, 2015, a couple months after Maynard’s death, a group of physicians and terminally ill patients filed a lawsuit against the New York State Supreme Court.vi The plaintiffs argued that the current law, which considers death with dignity to be manslaughter, should be changed in order to provide more end of life options for the terminally ill. Ten days later, on February 13th, 2015, two New York State Senators, Diane Savino and Brad Hoylman, introduced Bill S3685, the End of Life Options Act. The bill sets out to legalize death with dignity in the state of New York in order to provide more end of life options for terminally ill patients who would rather preemptively die through medication rather than die naturally in excruciating pain. The bill, modeled after the active Oregon bill, lists numerous qualifications for patients who wish to procure end of life medication. It requires that the patient is a resident of New York, over the age of 18, deemed mentally competent by a psychiatrist, declared terminally ill by two physicians, and witnessed by two individuals who can attest that the patient is participating voluntarily. It states that all physician participation would be voluntary, and that the legislation would protect the physician from any criminal liability.vii Since the bill has been proposed, many in the state of New York are speaking up in favor of and against the End of Life Options Act. This topic has become a major social issue, where both sides of the argument are almost even. According to a national survey, 49% of the population disapproves of death with dignity, while 47% approves.viii Those in favor tend to be Democrats, and they primarily argue autonomy, and that a person has the right to do what they want with their body, especially if they are slowly dying in excruciating pain from an incurable illness. The opponents, who tend to be Republicans, argue that the system could be coercive and exploitative, and that it goes against religious teachings and a code of ethics to assist a patient in ending their own life. So, this poses the question: Should the New York State Senate pass Bill S3685 and establish the End of Life Options Act? There are a lot of things I will not be discussing throughout this project. I’m not going to talk about abortion, murder, or suicide; although in some cases the issues may overlap. I’m not going to talk about any sort of legislation that is active or being considered in other countries.

Topics such as hospice care, euthanasia, palliative care, and the Hippocratic Oath will be discussed, and politics and religion are a given. This is a project that will look at all the cases for and against death with dignity, and it will only look at the legislation that directly affects the New York Senate’s proposed bill. Brittany Maynard will come up time and time again, and we

Cogen 6 will look at the stories of others in order to understand the effects the legalization of death with dignity could have on the state of New York. I will attempt to reserve my opinions until the final half of this project, but I will critically examine arguments based on facts rather than my own personal opinions.

Before I go into the details and the arguments presented for and against death with dignity, it is important to know some of the history that is essential to understanding the topic.

Remember that we are not talking about euthanasia. Euthanasia is when a physician directly ends the life of a patient.ix The Hippocratic Oath, which is still considered binding by some physicians, was written during the 5th century B.C.E. and states that a physician will not give a deadly drug to a patient, even if the patient asks for it.x Since then, many physicians have debated if helping a patient that wishes to die is ethical. As Christianity began to spread in the 12th century, more began to oppose euthanasia on the basis of religion.xi In the late 19th and early 20th centuries the U.S. saw a rise in desire for euthanasia, stemming from wars and the Great Depression. The support of euthanasia greatly decreased after World War II because of the use of euthanasia by the Nazi Party. It wasn’t until the 70s that euthanasia and assisted-suicide movements began to become popular again, due to patient’s rights movements and the U.S. Senate’s first national hearing regarding euthanasia in 1972. Soon after, physician-assisted suicide became the more popular option, and euthanasia was put on the backburner. It is important to understand that we are discussing the process of a physician giving the patient a medication that the patient takes himself. The physician is not injecting the patient, and the patient is given a medication which he can take on his own time.

As previously mentioned, the euthanasia and death with dignity controversy can be traced far back to the 5th century B.C.E., and although Hippocrates was against assisting a patient in dying, many at the time were very tolerant of the practice.xii The practice has remained controversial, and debates over assisting in the death of an ill patient persisted throughout Europe and moved into the United States during colonization.xiii The debate has continued in the U.S. throughout its formation. In the early 20th century, major groups and organizations began to arise in support of euthanasia, such as the Voluntary Euthanasia Legislation Society in 1935 and the National Society for the Legalization of Euthanasia in 1938.xiv Support began to decline again in 1950 when the World Medical Association spoke out against euthanasia, and the American Medical Association stated that the majority of Doctors in the United States were against

Cogen 7 euthanasia, and that the support of the population had decreased by 10% since the 30s.xv The debate picked up again in the 70s, with the growth of the patient’s rights movement and the U.S. Senate’s first national euthanasia hearing in 1972.xvi End of life options began to improve throughout the 70s, with the formation of the Society for the Right to Die in 1974, and the opening of the first U.S. hospice in New Haven, Connecticut that same year.xvii On October 1st, 1976 California became the first state to legalize an aid in dying statute, which gave terminally ill patients the right to authorize the removal of life sustaining treatment if their death is inevitable.xviii By 1977, 8 states had aid in dying bills and in 1984 the American Medical Association gave their support to aid in dying with informed consent if the patient is near death.xix By the 90s the debate has crossed over from euthanasia to physician-assisted suicide, and news headlines were splattered with the famous case of Jack Kevorkian, or Doctor Death, the first doctor to assist a patient in suicide on June 4th, 1990.xx Legislation for death with dignity began to arise in the early-90s, with bills being introduced and rejected in states like Washington and California.xxi Then, in November 1994, Oregon’s Death with Dignity Act was passed, becoming the first state in the country to legalize physician-assisted suicide.xxii Although the bill was passed, the state of Oregon had to fight adamantly to keep the law active. On April 30th, 1997 President Bill Clinton signed the Assisted Suicide Funding Restriction Act, which prohibited the use of federal funds in any procedure that causes the death of a patient.xxiii That same year, the Supreme Court ruled in two cases, Washington v. Glucksberg and Vacco v. Quill, that there is no constitutional right to die.xxiv Other cases, such as Gonzales v. Oregon in 2006, have attempted to remove the death with dignity law in Oregon, but were unsuccessful.xxv Since then, Washington, Montana, Oregon, and New Mexico have legalized death with dignity.xxvi Many states have pursued legalizing death with dignity, and many, such as Maine and Massachusetts, have been rejected.xxvii But, as previously mentioned, since the Maynard case has brought more attention to the controversy, 11 states are currently considering legislation.

Although the fight for end of life options has changed during the past couple hundred years, moving from euthanasia to death with dignity, the arguments have not changed that drastically. Those in favor still emphasize autonomy, while arguments against death with dignity based on religion are still as strong as ever. For the first couple hundred years after the creation of the Hippocratic Oath, the majority of the population was against euthanasia, primarily because

Cogen 8 of the quick spread of Christianity and the power and influence of the Catholic Church.xxviii The opponents have made the same arguments based on religion and the Hippocratic Oath for hundreds of years. They argue that both the bible and Hippocratic Oath state that it is immoral and unethical to kill yourself or another, regardless of the mental or physical condition the person is in. But new arguments have developed that have added to their position and have contributed more interesting points to the debate. All of these new points result from the proposed legislation and skepticism regarding the provisions and assumed outcome. Those opposed argue that the system would be coercive and exploitative and take advantage of people with mental and physical disabilities.

Those in favor have gone a similar route to those opposed, and continue to make the same argument that was made hundreds of years ago. A major argument, made throughout antiquity, was that a terminally ill person has the right to die peacefully rather than endure prolonged suffering.xxix This argument has been one of the most frequently used, and is still one of the proponents’ major arguments. However, as previously mentioned, with the 70s came the patient’s rights movement and a growing desire for death with dignity. Autonomy was always valued, but with the movement came more individuals who were outspoken about their desires to do what they want with their own body. Also, like the opponents, more arguments have arisen to counteract skepticism about the proposed legislation. The proponents believe that, with the proposed policies, if implemented properly, they should work flawlessly and there would be no need for concern.

Both sides of the death with dignity argument have made strong points. But there are certain individuals and groups that have spoken out, particularly in response to the proposed New York State Senate Bill S3685. Senators, physicians, religious leaders, patients, organizations, and activists have all contributed to the arguments, and many have shown through their personal experiences why they are for or against the legislation.

Proponents in New York believe that the End of Life Options Act should be established in order to allow patients with terminal and incurable illnesses to end their life in a manner they prefer. Since death with dignity was passed in Oregon in 1997, statistics have shown that only 752 out of the 1,173 people that received the end of life medication actually took it.xxx Those in favor argue that many patients wish to get the drug so that they have the option to die if the pain

Cogen 9 becomes too much, but some end up dying naturally regardless. Patients have claimed that procuring the drug is reassuring because they like having the option available, regardless of whether or not they take it. The proponents argue that the option should be available to someone in severe pain that coherently explains why they wish to end their life, and that every individual has the right to do what they want with their own life.xxxi There are many stakeholders fighting in favor of the End of Life Options Act in New York. Democratic politicians are some the major supporters of bill S3685. The Senators that introduced the bill, Diane Savino and Brad Hoylman, as well as Assemblywoman Linda Rosenthal, who has introduced a similar bill, A02129, to the New York State Assembly, are three of the major specific stakeholders leading the way for other Democratic New Yorkers supporting the legalization of physician-assisted suicide. New York State physicians are a major group of general stakeholders fighting in support of the bill in the hopes that legalization would make their jobs easier and enable them to satisfy their patients’ wishes. A specific New York State physician, Dr. Timothy Quill, has been a major spokesman for physician-assisted suicide since the 1991 court case in which he was accused of giving a terminally ill patient life-ending medication, as per her wish.xxxii Quill was not convicted, and has since promoted the legalization of physician-assisted suicide nationwide. Terminally ill New York patients are also strong supporters of the bill, and, as previously mentioned, wish to have the option to end their suffering if they so wish. Many patients have adamantly expressed their wish to die, and argue that suffering need not be prolonged if it does not have to be.xxxiii Another specific stakeholder involved in promoting the passage of bill S3685 is the organization Compassion & Choicesxxxiv of New York, an organization that aims to improve end-of-life options nationwide.xxxv President Barbara Coombs Lee is an active participant in the debate in favor of death with dignity, and believes that the passage of bill S3685 would greatly improve end of life care for terminally ill patients.xxxvi The proponents have made numerous arguments to support their belief that bill S3685 should be passed in New York. A major argument frequently raised is that people have the right to do what they want with their own lives, especially if they are approaching imminent death and in extreme pain. In response to his 1991 court case, Quill argued that his patient, and friend, clearly and coherently expressed her wish to die, in what she believed was the humane way, because she did not want to prologue the suffering of herself and of her family.xxxvii The

Cogen 10 argument of a right to choice is made by most proponents, and Senator Savino stated that the option to end one’s suffering should be a right given to all terminally ill patients in severe pain.xxxviii Another argument made in favor of bill S3685 is that Death with Dignity has been working flawlessly in Oregon for the past 17 years, with no cited issues; and so, if done in a similar fashion, it could do the same in the state of New York. The Senators that proposed the bill have argued that they have modeled the bill after the active Oregon bill, and aim to achieve the same results.xxxix Proponents of New York legislation have seen the outcome the bill has had in Oregon, and believe the same plan, if properly regulated and implemented, would have positive results.xl The third major argument made in favor of bill S3685 is that, contrary to the common opponent belief, physician-assisted suicide would not be implemented lightly, and it could possibly take months for the approval of a patient to receive this life-ending medication.

Bill S3685 states that the law would require the diagnosis by multiple physicians, mental health screenings, and required wait times before obtaining the drug. The patient must be over 18 and a legal resident of the state of New York. Proponents argue that these regulations would be properly implemented and would not allow for the coercion and abuse that opponents are afraid of.

Proponents are fighting for bill S3685 in numerous ways. Brittany Maynard’s husband, Dan Diaz, has been enlisted as a spokesman for death with dignity, in order to show the support from someone that has been directly influenced by physician-assisted suicide, and still supports it although his wife is deceased.xli Senator Savino has met with Diaz, and the proponents are using the Maynard case to show the strong desire of many terminally ill people to end their lives in order to avoid prolonged suffering.xlii The proponents also wish to use Maynard’s case to show how young people are also affected by the death with dignity movement, and how people from all generations believe the legalization of physician-assisted suicide is relevant. The publicity of Maynard’s case and extensive use of social media has also been used by the proponents in order to garner for media attention in their favor, influencing segments on shows like The View and 60 minutes and articles in publications such as People Magazine and the New York Times.xliii There are also many doctors and terminally ill patients bringing their desire for the passage of the End of Life Options bill to court and to media attention. Terminally ill patients of all ages are speaking up about their wish to end their life sooner so as to avoid more suffering, and they cannot afford, like Maynard, to go to another state where physician-assisted suicide is legal.xliv

Cogen 11 The proponents do make very strong arguments, but the opponents do as well. The opponents firmly believe that it is wrong for a patient or physician to end the patient’s life before it is their time. They also argue that the system under the proposed bill would allow for patient coercion and the abuse of with disabilities, as well as the elderly. The opponents are strongly fighting to maintain physician-assisted suicide as an illegal practice in the state of New York.

One general opponent stakeholder is people with disabilities. The majority of people with disabilities in the state of New York believe that the passage of the End of Life Options act would only cause those with disabilities to think perhaps they are better off dead, and lead some to want to die because they feel they are a burden on their friends and family.xlv A specific opponent is the disability advocacy group Not Dead Yet and their CEO and founder Diane Coleman. Not Dead Yet has led many protests against the passage of bill S3685, and actively fight against physician-assisted suicide because they view it is exploitive and inhumane.xlvi Republican politicians are another general stakeholder against physician-assisted suicide. The Republican National Committee website states that they strongly oppose physician-assisted suicide, siting that they are supporters of human life and rights to life. Many New York state republicans are fighting actively in opposition of bill S3685, hoping that the republican state senators will all vote against it. Another major general stakeholder is Roman Catholic worshipers and leaders. They argue that death should come naturally and that ending a life goes against all religious teachings.xlvii Specifically, the New York State Catholic Conference and New York Archbishop Timothy Cardinal Dolan are Roman Catholic institutions and leaders, respectively, which are fighting in opposition to physician-assisted suicide. Lastly, a major specific stakeholder is the American Medical Association, which argues that assisting a patient in death only counteracts the physicians known role as a healer.xlviii They also argue that the role of a physician is to do everything they possibly can to heal a patient, and by assisting in killing, it is as if they are giving up on the patient.

One argument opponents are making in response to physician-assisted suicide is that the legalization of it would cause coercion and an abuse of the system, causing the death of individuals that could have potentially been healed. Many republicans and disability activists are using this argument because they believe, despite regulations, it would be hard to enforce who takes the medication once it leaves a physician’s office.xlix Also, sometimes people make inaccurate diagnosis, and some patients could end their lives, when they could have potentially

Cogen 12 been saved. They argue that some would also be killed without specific informed consent.l Another argument made is that physician-assisted suicide sets up a double standard. Coleman argues that if a person is healthy but wishes to die they get suicide prevention, whereas if you are sick and want to die you are considered rational, because you will die anyways. Some could potentially act sane when they are not, and take advantage of the system in order to procure the life-ending medication.li The third major argument, most commonly used by republicans and Roman Catholics, is that it goes against nature to end a life because it must happen naturally.

They argue that the bible is very adamant about not killing oneself or another, or assisting in killing. They also argue that more time should be focused on palliative medicine rather than physician-assisted suicide.lii The opponents’ major plan of action is to protest and encourage debate about whether or not physician-assisted suicide is ethical. Opponents, such as Not Dead Yet, are staging protests to try and convince politicians not to support the bill.liii Religious organizations, such as the Catholic Conference, are creating online petitions in order to show politicians how many people oppose the passage of the bill.liv Also, politicians and activists are reaching out through social media and to major news publications in order to stir debate in their favor. Honestly, the opponents don’t have to work quite as hard to gain support. As previously mentioned, a slightly larger percentage of the population sides with the opponents, and the Catholic majority have the unwavering belief that the practice goes against their religion.

There are a couple major issues present in the debate of death with dignity, and each side has addressed each issue. I mentioned all of them previously and briefly, but when examining each issue and the arguments each side presents, we can see which side gives the stronger and more logical argument. We can also see which arguments are hard to refute, and which are unable to be fully examined and solved.

The first major issue is the question of whether or not the legislation would lead to a coercive and exploitative system, without proper regulation. The proponents argue that New York State Senate Bill S3685 is modeled after the active Oregon Bill, and sets out to achieve the same results. Statistics have shown that in Oregon, since its passage 17 years ago, the system has operated without any errors, and has greatly improved end of life options in the state.lv The proponents also argue that the Bill includes numerous mandatory regulations that will be heavily

Cogen 13 implemented, such as a diagnosis by multiple physicians stating the person will inevitably die within the next 6 months, mental health screenings, and required wait times for obtaining the drug. Also, the patient must be over 18 and a legal resident of the state of New York.

The opponents argue that, regardless of what the proponents’ state, the system would be coercive and difficult to regulate. Many argue that, despite regulations, it would be hard to enforce who takes the medication once it leaves the physician’s office.lvi Some also argue that many that wish to die could take advantage of the system, and potentially act sane when they are not. Also, many disability rights activists argue that the system would be exploitative and inhumane, causing people with disabilities, who already have problems facing life, to feel they are better off dead and wish to die because they feel they are a burden on their friends and family.lvii The arguments presented on both sides have very visible strengths and weaknesses. The proponents’ argument relies heavily on the fact that they are taking the primary structure of a system implemented by another state. Although statistics have shown that the Oregon bill has been effective at preventing coercion, there can always be discrepancies. At the same time, since there is proof that a similar system has worked almost flawlessly, it is hard to argue with a system that is proved to work. But the opponents’ argument that the system could be difficult to properly regulate is also true. Once the medication is given to a patient, and kept for potential future use, it is hard to be sure that someone else will not accidentally or intentionally take the lethal medication. But, the opponents in fear of coercion and exploitation are ignoring some of the facts laid out in the proposed bill. The bill very clearly states the regulations and precise way in which they should be implemented. Also, Oregon statistics have shown that the majority of people that have participated in physician-assisted suicide have been elderly white college educated individuals, and also that all of the patients that have purchased the life ending drug and not taken it, 37 out of 155 in 2014, died shortly after naturally because they could not be cured.lviii This shows that all the people that received the life ending drug, regardless or not of whether they ingested it, were shortly going to face inevitable death.

The proponents illustrate here a value for the law and adhering to rules and regulations.

They state that they do not wish to take advantage of any parties that are in fear of the legislation, and that they are very much against taking advantage of others. The proponents and opponents

Cogen 14 both recognize the obligation that the government has to upholding the law and protecting citizens, but both view the proposed legislation as either adhering to or going against that governmental obligation. Proponents believe that the passage of the bill would protect citizens and physicians who wish to engage in physician-assisted suicide, whereas those opposed to the bill believe that the passage would go against governmental obligation and allow the passage of a bill that could coerce citizens into ending their lives. The opponents illustrate a value for safety and life by fighting for death with dignity to remain illegal so that no one may die before it is their natural time, and no one will be convinced that dying would be in their best interest.

In this case, the strongest argument comes from the proponents. There is an example of a system operating well under nearly identical legislation, and the system makes it difficult for someone to acquire the medication without jumping through numerous hoops. I spoke with a woman, Joan Tollifson, who stated that a close friend of hers tried to acquire end of life medication when she was diagnosed with cancer, and that she was required to meet with several people and fill out a lot of paperwork.lix Her friend was a resident of Oregon, the state that the New York bill is modeled after. If the Oregon system can be this careful and abide by the regulations set forward by the legislation, then I believe New York can do the same.

The second major issue that arises is whether or not death with dignity violates the Hippocratic Oath taken by physicians. The proponents argue that a physician aiding in the death of a patient that is inevitably going to die from a painful incurable disease has the right to assist in ending the patient’s life if that is the patient’s wish. Physicians in favor of physician-assisted suicide argue that it is their job to do as the patient asks, if the patient is a sane and mentally coherent individual who explicitly states they wish to end their suffering in the way they view is humane. They argue that the Hippocratic Oath states to aid the patient to the best of their abilities, and that by doing as the patient wishes, they are fulfilling their promise. They are indirectly, and not directly, ending the patient’s life, and are only doing so when it is clearly determined the patient is going to die in severe pain in the near future.lx The opponents argue that by assisting in the death of a patient the physician would be going against the Hippocratic Oath, which states that a physician must treat a patient to the best of their abilities.lxi They argue that by assisting in the killing of a patient that they are going against their known role as a healer, which is the opposite of what a physician should do.lxii They

Cogen 15 argue that even if the death of a patient seems inevitable, the physician should still do everything they possibly can to heal a patient, and that by assisting in a patient’s death, it seems as if the physician is giving up.lxiii Both sides of the argument look at the Hippocratic Oath from different perspectives. The Hippocratic Oath states that physicians will provide their services in a moral way and it prohibits a doctor from prematurely ending the life of a patient. Proponents see this in their favor, believing that it is not a premature action since the patient will inevitably die and that they are doing as the patient wishes. Opponents see physician-assisted suicide as going against the Hippocratic Oath because the physician is second handedly ending the life of a patient, and it does not matter whose choice it is.lxiv Both arguments in this case are even in strength. Both view the Hippocratic Oath in ways that make sense because although they are ending a life, they are doing it in a way that they feel is moral. The weakest argument in this case would probably still be the proponent, because the Hippocratic Oath still does specifically state aid in the death of a patient, which the physician would still be doing, regardless or not of whether they believe doing so is in the patient’s best interest.

When looking at physician-assisted suicide from an ethical and moral standpoint, we must look at the obligation of physicians to their patients. Proponents would argue that it is the physician’s responsibility to do as her patient wishes and aid in their death if that is what the patient coherently desires. Opponents would argue that it is the physician’s responsibility to the patient to take care of her to the best of their ability up until the patient’s natural death, and provide that patient with the best palliative care they can provide. Both the pro and con physicians value the wellbeing of the patient above all, although they come at it from different perspectives. Both types of physicians want to end their patient’s suffering, but the proponents value the patient’s wishes, whereas the opponents’ value religion and nature in that they believe things take their course and happen as they naturally should.

It is harder for this argument to declare which is stronger than the other. I must say they are equally strong because both take a version of the Hippocratic Oath and do not use dramatic and inaccurate interpretations. The classic version of the Hippocratic Oath states, “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”lxv The modern version does not include this, but instead states, “Most especially must I tread with

Cogen 16 care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.”lxvi Depending on the version of the Hippocratic Oath that a Physician takes, their stance on death with dignity may vary. No argument is stronger than the other when it comes to this issue, because, factually they are both right.

The final major issue is the question of whether or not individuals have the right to do what they want with their own bodies. The proponents argue that patients have the right to do what they want with their own body if they are inevitably going to die from a painful and incurable disease. All the proponents argue that the right to choose to end one’s own suffering is an option that should be given to all terminally ill patients in severe pain, who wish to die on their own time surrounded by loved ones. The patients who choose to die express that their desire to die is partly because they not only want to limit their own suffering, but the suffering of their family and friends who must watch them die.lxvii The opponents argue that the bible strongly emphasizes that one should not end a life, whether that is their own life or the life of another.lxviii They state that the 5th commandment plainly reads “thou shall not kill.”lxix They argue that although they know the person will die regardless, the focus should be on palliative care and taking care of the patient to make sure their transition from life to death is as smooth as it possibly can be. Opponents argue that it goes against nature to end one’s own life, regardless of whether the person is in severe pain, nature will take its course and the patient will die when they are meant to.lxx This argument really comes down to an appeal to religion. The proponents argue that a person has a moral authority over themselves to decide what to do with their own life. The opponents argue that everything must happen naturally and take its course. These are the most frequently used arguments in the debate for and against death with dignity. The evidence that backs up these arguments is really that of the almost even division between proponents and opponents nationwide. As shown earlier in this project, statistics show that 49% disapprove and 47% approve. This division coincides with the Republican and Democrat division, the republicans making up the 49% of opponents, and the democrats making up the 47% of proponents.

Cogen 17 An ethical analysis of this issue is much easier to do than a critical analysis, because this is really an ethical issue. This argument is rooted in religion and primarily a reading of the bible.

Although you can critically argue that the bible shouldn’t be a basis of a law, and that the separation of church and state is still incredibly important and significant, it is hard to deny the great importance of religion in people’s lives, and that it is a very present factor in this debate and others like it, such as the abortion and suicide debates. Again, the values are obvious, the proponents valuing freedom and a right to do what one wants with their own body, and the opponents’ value of religion, God, and nature following its course. Proponents believe the government has an obligation to provide services to citizens that they wish to engage in, because it is the nature of freedom to be able to participate in the services you wish to participate in and do what you want to your own body. Opponents believe the government has an obligation to its citizens as well, but that that obligation is to protect people from services they deem to be immoral and not humane. It comes down to who owns an individual: God or the individual himself?

Again, this is another issue that is completely based on matter of opinion. It would be impossible not to address the religious aspects of the arguments, since they are the most frequently made, but they are the hardest to base an opinion on since they are almost always unwavering. But, I am a firm believer in the separation of church and state, so I don’t believe it is right to deny someone something on the basis of religion alone. Since death with dignity would be a personal choice, a spiritual or religious physician or individual that is strongly against death with dignity would not be obligated to participate.

Throughout their arguments, both sides illustrate their core values. The proponents’ value liberty above all else, while the opponents’ value religion. The proponents believe in the right individuals have to their own bodies, while the opponents believe in honoring the bible and religious teachings by not engaging in actions that lead to death. The opponents also value safety, and believe the system is dangerous and wish to protect the public from being coerced and taken advantage of. The proponents also value health, and the right to numerous health care options and end of life options. They believe that citizens should be given access to health options that could potentially better their lives, or help their lives in some way. Both value justice and believe the government has obligations to its citizens. The proponents’ believe the government has an obligation to honor their individual freedom, while the opponents’ believe the

Cogen 18 government has an obligation to protect their citizens from legislation that could be coercive and harmful.

All of the arguments made by the proponents and opponents demonstrate their previously mentioned values. These arguments also lead to numerous fallacies that either question or support their beliefs. The opponents make arguments using the fallacy of the slippery slope, stating that by passing the bill numerous people will be coerced into dying. The opponents also appeal to the common belief of God and use the faith people have in religious teachings to try and gain support against death with dignity. The proponents are guilty of using fallacies of presumption and making hasty generalizations, believing that, if the system works for some states, it must work for New York.

I’ve tried my best to remain unbiased throughout my research, but my opinions are now fully formed and can be supported through my research. I believe that New York State Senate should pass bill S3685. I am a firm believer in autonomy and the right individuals have to their own bodies. If someone is already dying and in excruciating pain, then why shouldn’t they be able to take control and end their lives free of pain, at the time they feel is appropriate? I think the arguments of religion are understandable, but since I am not religious, I do not feel the same way. However, I do think religion should not have a place in politics or in health care, and that people should have a variety of options when it comes to end of life care. Religious individuals need not participate in practices they do not agree with, but I see no need to try and put a stop to a practice that nearly half of the population may be interested in.

The effectiveness of the Oregon bill is one of the main reasons why I support the passage of the New York Senate bill. I showed the statistics, and the arguments made that the system would not be coercive. The bill is modeled after the Oregon bill, and there is evidentiary support that shows a system currently implemented that is running smoothly. The provisions are all logical, and the process of procuring the medication seems difficult and thorough. I don’t believe that the system would be coercive, because there is evidence that shows that it is not. Disability activists arguing that they would be taken advantage of are in fear of a system they have not seen operate firsthand. Joan Tollifson, a woman I previously mentioned, is a woman with a disability living in Oregon. She is a supporter of death with dignity, and she knows that, if she decided life wasn’t worth living, the current legislation would not allow her to procure medication because

Cogen 19 she is not terminally ill. She reiterates some of the common arguments against death with dignity; that it’s a slippery slope that will lead to the murder of disabled newborns and the mass extermination of old folks homes. Joan expresses doubt that any of these situations would be allowed to occur through the current and proposed legislation and, she states, even if it did occur, it would be stopped immediately because, and who would actually sit back and watch something like that happen?

I also spoke with Roland Halpern, the Regional Campaign and Cultivation Manager of Compassion & Choices. I asked him numerous questions about Compassion & Choices, and he elaborated on some of the arguments he believes are the strongest in support of death with dignity. Halpern stated, “Studies have shown that the families of loved ones who used aid in dying laws report being less distressed over the death, may have shorter grieving periods, and have fewer reservations about their own future death.”lxxi He explains, like Tollifson, that having the option to die, even if one doesn’t go through with it, is incredibly comforting. Patients like having a fall back option if the pain becomes too much to bear. Halpern stated that, like Brittany Maynard, many feel empowered rather than afraid at the end of their lives, because they approach death rather than wait for it to take them. Maynard did some traveling in her finals months and spent her final healthy days with those she loved. These people have felt comfort knowing that their loved ones do not have to watch them deteriorate, but they can watch them leave the world as the better versions of themselves. Tollifson stated something similar about having your loved ones watch you die, saying, “I wouldn’t want any of them to have to dedicate their remaining time and energy to taking care of me when recovery is not an option and the quality of my life is miserable.”

Both Halpern and Tollifson share my opinions regarding death with dignity, but the other person I interview, Dr. Mark Cherry of St Edwards University, had very different opinions.

Cherry questioned why physicians and taxpayer dollars had to get involved in “suicide” and argued that people want physician assistance in death because “it just makes it look pretty.”lxxii Halpern indirectly responded to this statement, and said, “Any one of us can find the means to end our own life; guns, hanging, drowning, jumping, driving into a tree, or slashing our wrists. A person who is already close to death should not have to resort to such violent means to end his or her suffering.”lxxiii Although Cherry is a supporter of autonomy and refers to himself as an “anarcho-libertarian”, he does not believe anyone should have to be involved in the death of

Cogen 20 another. He does not argue against suicide, if someone wants to die then that is their choice, but he does not believe a physician should be obligated to assist a patient in death if that goes against the physician’s beliefs. I agree with this, and after speaking with him doubled checked that the legislation would not force physicians to participate if it goes against their beliefs. This provision is present in all death with dignity legislation, and emphasized again and again that all participation is voluntary for both patients and physicians.lxxiv After speaking with my interview subjects, I passed out pamphlets for Compassion & Choices and, as I mentioned earlier, it didn’t run so smoothly. Most people ignored me and were uninterested, and I couldn’t manage to spark any interest. On Thursday July 23rd and Friday July 24th I passed out pamphlets in Austin, Texas at the State Capitol and at the University of Texas Campus. I chose these locations based on the kinds of people I wanted to try and gain some support from: politicians and students. I was hoping that, by gaining support from these groups, that the word would trickle through the capitol and University and spark some interest where there was previously none. My goal was to pass out all of my pamphlets and discuss the organization to those that were interested in stopping and taking the time to talk to me. I spent around 2 hours at each location, and only managed to pass out around 45 of my 100 pamphlets.

Many of those pamphlets were tossed in the trash, and very few people looked me in the eyes, let alone stopped to talk to me. I want to say people were uneager to talk to me about death, but I think no one wanted to talk to me in general. Perhaps that is just the common attitude towards people passing out pamphlets on the street, but I think my topic may have steered some away.

But, then again, Texas is one of the states where the fight for death with dignity is not even on their radar.

I think, if the bill S3685 were legalized, the system would work. No one would be coerced and people would have more end of life options to comfort them before they die.

However, just because the system would work does not mean people will be happy about it. As long as death with dignity is a topic, there will always be people fighting against it. In a country where the debate is evenly divided, there will always be people who believe the process is immoral and unethical. It is a controversy that cannot be avoided. Death is tricky, and when involving oneself in another’s death, you are bound to anger many. No matter how you analyze the arguments and no matter what solutions you propose, death with dignity will always be considered a controversy.

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End Notes i

Proof of overall pleasant demeanor, see in appendices Field Work Photographs In order to limit confusion, I will primarily use the term death with dignity for the entirety of this project, despite the numerous names used. iii A highly malignant, rapidly growing type of brain tumor. Early symptoms may include sleepiness, headache, and vomiting, see “Definition of Glioblastoma.” iv Most of the Maynard story taken from People Magazine’s coverage, see Egan and Maynard. v See “Death with Dignity Around the U.S.” vi More information on the filed lawsuit and initiation of the bill, see Hartocollis vii All information taken from the New York State Senate’s official proposed legislation, see “Bill S3685.” viii See “Views on End-of-Life Medical Treatments.” ix See “Physicians’ Frequently Asked Questions.” x The classic version states, “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” see “Definition of Hippocratic Oath.” xi All historical euthanasia and death with dignity facts, see “Historical Timeline.” xii “Although the Hippocratic Oath prohibited doctors from giving 'a deadly drug to anybody, not even if asked for,' or from suggesting such a course of action, few ancient Greek or Roman physicians followed the oath faithfully.”

Excerpt from Ian Dowbiggin’s A Merciful End: The Euthanasia Movement in Modern America, See “Historical Timeline.” Many historical euthanasia facts were taken from Dowbiggin’s book, but obtained online. Dowbiggin’s book was unfortunately not read by me. xiii “These events dovetailed with the Second Great Awakening of intense evangelical fervor in the first years of the nineteenth century and strengthened the condemnation of suicide and euthanasia that stretched back to the earliest days of colonial America,” excerpt from Ian Dowbiggin’s A Merciful End: The Euthanasia Movement in Modern America, see “Historical Timeline.” xiv For more information on the Voluntary Euthanasia Legislation Society and the National Society for the Legalization of Euthanasia, see “Historical Timeline,” excerpts from "The History of Euthanasia Debates in the United States and Britain” and “Potter and Euthanasia," respectively. xv “When an opinion poll in 1950 asked Americans whether they approved of allowing physicians by law to end incurably ill patients' lives by painless means if they and their families requested it, only 36 percent answered 'yes,' approximately 10 percent less than in the late 1930s,” excerpt from Ian Dowbiggin’s A Merciful End: The Euthanasia Movement in Modern America, see “Historical Timeline.” xvi From "The History of Euthanasia Debates in the United States and Britain," and Ian Dowbiggin’s A Merciful End: The Euthanasia Movement in Modern America, respectively, see “Historical Timeline.” xvii From Ian Dowbiggin’s A Merciful End: The Euthanasia Movement in Modern America, and Bryan Hillard’s "The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the Patient-Physician Relationship," respectively, see “Historical Timeline.” xviii “California Governor Edmund G. Brown Jr. signs the California Natural Death Act into law and California becomes the first state in the nation to grant terminally ill persons the right to authorize withdrawal of life-sustaining medical treatment when death is believed to be imminent,” excerpt from 1976 New York Times article "California Grants Terminally Ill Right to Put an End to Treatment," see “Historical Timeline.” xix 8 states with right to die bills in 1977: California, New Mexico, Arkansas, Nevada, Idaho, Oregon, North Carolina, and Texas, from Sue Woodman’s Last Rights: The Struggle over the Right to Die. American Medical Association report, “"Opinion 2.20: Withholding or Withdrawing Life-Sustaining Medical Treatment," see “Historical Timeline.” xx “Assists Janet Adkins, a Hemlock Society member, in committing suicide in Michigan. Adkins' death is the first of many suicides in which Dr. Kevorkian assists,” excerpt from Wesley J. Smith’s The Slippery Slope From Assisted Suicide to Legalized Murder, see “Historical Timeline.” xxi Washington ballot Initiative 119 rejected in 1991, from John Dombrink and Daniel Hillyard’s Dying Right: The Death with Dignity Movement, and Proposition 161 rejected in California in 1992, from Wesley J. Smith’s Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder, see “Historical Timeline.” xxii Oregon Death with Dignity Act, see “Historical Timeline.” xxiii Assisted Suicide Funding Restriction Act of 1997, see “Historical Timeline.” ii

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xxiv

See “Historical Timeline.” Case of Quill will be further discussed later.

See “Gonzales v. Oregon.” xxvi Washington and Montana passed in 2008, Vermont and New Mexico passed in 2014, see “Historical Timeline.” xxvii Maine bill defeated in 2000, Massachusetts bill defeated in 2012, see “Historical Timeline.” xxviii "No serious discussion of euthanasia was even possible in Christian Europe until the eighteenth-century Enlightenment. Suddenly, writers assaulted the church's authoritative teaching on all matters, including euthanasia and suicide... While writers challenged the authority of the church with regard to ethical matters, there was no real widespread interest in the issues of euthanasia or physician-assisted suicide during that time,” excerpt from Michael Manning’s Euthanasia and Physician-Assisted Suicide: Killing or Caring? See “Historical Timeline.” xxix “Throughout classical antiquity, there was widespread support for voluntary death as opposed to prolonged agony, and physicians complied by often giving their patients the poisons they requested,” excerpt from Ian Dowbiggin’s A Merciful End: The Euthanasia Movement in Modern America, See “Historical Timeline.” xxx See Weaver xxxi See Richnick xxxii See Weaver xxxiii See Hartocollis xxxiv The organization I volunteered for, mentioned in the introduction. xxxv For more information on Compassion & Choices, see “Increasing Momentum for Death with Dignity Seen in New York.” xxxvi Advocacy push, see Nahmias. xxxvii To read more on the story of Dr. Quill, see Altman and Quill. xxxviii “The option to end one’s suffering when facing the final stages of a terminal illness should be a basic human right, and not dependent upon one’s zip code,” See Richinick. xxxix See “Increasing Momentum for Death with Dignity Seen in New York.” xl “The Oregon law’s 17-year, completely transparent record of practice shows that the medical option of aid in dying improves end-of-life care overall, and benefits those who access it.” See “Increasing Momentum for Death with Dignity Seen in New York.” xli “’Having aid in dying as an end-of-life option provided great relief to Brittany,’ Diaz said in a statement. ‘It enabled my wife to focus on living her last days to the fullest, rather than living in fear of dying in agony from terminal brain cancer.’” See Richnick. xlii See Weaver, and Bever. xliii “Arthur Caplan, of New York University’s Division of Medical Ethics, wrote that because Maynard was ‘young, vivacious, attractive … and a very different kind of person’ from the average patient seeking physician-assisted suicide, she ‘changes the optics of the debate.’ In Oregon, the median age of someone who uses the state’s law to die is 71. Only six people younger than 34, like Maynard, have used it.” See Bever. xliv Quotes from New Yorkers who wish to engage in death with dignity, See Feeny. xlv See Toth. xlvi See Toth xlvii See Weaver xlviii See Opinion 2.211. xlix See Weaver. l See Weaver. li See Weaver. lii See Gallagher. liii See Toth. liv See Weaver. lv See “Increasing Momentum of Death with Dignity Seen in New York.” lvi See Weaver. lvii See Toth. lviii See “Oregon’s Death with Dignity Act -- 2014.” lix Information taken from blog post and author approved the use of her story for this project, see Tollifson. lx See Altman. lxi See “Definition of Hippocratic Oath.” lxii See “Opinion 2.211.” lxiii See “Opinion 2.211.” xxv

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lxiv

Second handedly not first handedly, because the physician gives the patient the medication rather than administering it herself. lxv See “Definition of Hippocratic Oath.” lxvi See “Definition of Hippocratic Oath.” lxvii See Richnick. lxviii See Gallagher. lxix See interview with Mark Cherry. lxx See Gallagher. lxxi See Halpern interview. lxxii See Cherry interview. lxxiii See Halpern interview. lxxiv “Participation by doctors would be fully voluntary.” See “Bill S3685.”

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Maynard, Brittany. "My Right to Death with Dignity at 29." CNN. Cable News Network, 02 Nov. 2014. Web. 20 July 2015.

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Tollifson, Joan. "Death with Dignity and People with Disabilities." Weblog post. Death with Dignity. Death with Dignity National Center, 19 June 2015. Web. 27 July 2015.

Tollifson, Joan. "Re: Death with Dignity." Message to the author. 27 July 2015. E-mail.

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Nahmias, Laura. "Advocates Plan Push for Assisted-Suicide Bills." Capital New York. N.p., 10 Apr. 2015. Web. 04 June 2015.

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Previous Submissions

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Submission 1

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Alexandra Cogen Professor Eakman Re Submission 1 4 June 2015

I. Topic Question: Should the New York State Senate Pass Bill S3685 and Establish the End of Life Options Act? II. Underlying Social Problems: A. Social Problems: There is a nation-wide debate as to whether physician-assisted suicide should be legalized. In New York, the Senate has proposed Bill S3685, the End of Life Options Act, which allows physicians to either administer or give a patient the medication that would end his/her life. Proponents argue that this bill should be passed because a patient has a right to do what he/she wants to do with his/her own body, especially if the person is already dying and in excruciating pain. Opponents argue that this system would be flawed and could be taken advantage of, killing patients that could have potentially been saved. Proponents argue against the opponent’s major argument, stating that the system would be heavily regulated, leaving no room for mistakes or false termination. The opponents argue that the proponents can’t base the passage of the bill on personal liberty, because it is an unnatural act and the person could also not be sane.

B. Scope of the Problem: Many are arguing against the bill, believing that passing it will lead to the death of many terminally ill patients before it is their time. According to statistics, in Oregon, since death with dignity was passed in 1997, 1,173 people diagnosed with terminal illnesses have requested prescriptions to end their lives and only 752 actually took the drugs (Weaver). Many people have received the drug as an option, because they like the idea of having the choice. It was also estimated that in Washington, after the act was passed in 2013, 173 people requested the drug, but only 119 took them; and in the same year 11,812 people in the state died of cancer (Weaver). Many still

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choose to die naturally, and death with dignity is not being forced on people, but it is reported that most are happy to have the option to end it themselves (Weaver).

III. Proponent Stakeholders A. Proponents Position: The proponents believe that the End of Life Options Act should be established in New York so as to allow physician-assisted suicide if the patient is in extreme pain and able to coherently express their desire to end their life.

B. General Pro Stakeholders a. New York State Physicians: Many doctors in the state of New York are advocating for the bill to be passed so they have the option to assist their patients if that is their wish, because it is believe many already assist patients illegally (Weaver). b. Democratic Politicians: Most in favor of establishing death with dignity and the end of life options are Democrats. c. Terminally Ill New York Patients: Although not all patients would desire to end their lives, most wish to have end of life options.

C. Specific Pro Stakeholders a. Dr. Timothy Quill: A strong advocate for physician-assisted suicide, Quill brought attention to the problem in 1991 when he gave a patient a life-ending drug. He is to this day an active proponent for the end of life options act. b. Senators Diane Savino & Brad Hoylman: The two Senators that introduced the End of Life Options Act to the Senate in February 2015, and the major spokesmen for death with dignity. c. Barbara Coombs Lee, President of Compassion and Choices of New York: Compassion and Choices is an organization that aims the improve end-of-life care and legalize physician-assisted suicide nationwide. They are currently very active in New York, trying to establish the End of Life Options Act. IV. Proponents’ Issues, Arguments, Evidence, and Plans/Actions

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A. Issue 1: People have the right to do what they want with their own life, especially if they are dying and in extreme pain. a. Dr. Timothy Quill argued, in response to his 1991 case, that the patient, Diane, wanted her life to end in what she viewed as the humane way, and did not want to live her last months in pain, while her family watched her die. They believed, since she was competent, she had the right to decide how she wanted to die (Altman).

B. Issue 2: Death with dignity has worked well in Oregon for the last 17 years, and so, if done properly, it could do the same for New York. a. Senators Savino and Hoylman have been working with Compassion and Choices to form legislation nearly identical to that of Oregon, and believe this legislation is the best way to give terminally ill coherent people a viable option (“Increasing Momentum�).

C. Issue 3: Physician-assisted suicide would not be done lightly, and it could take months for a patient to be approved. a. The law would require that the patient see multiple physicians, mental health screenings, and there would be required waiting times before obtaining the drug.

A person must be over 18 and a New York resident to qualify. Proponents argue against opponents, such as Diane Coleman, who fears coercion and abuse of senile patients (Weaver).

D. Examples of Pro Plans/Actions a. The proponents have enlisted Brittany Maynard’s husband as a spokesman for death with dignity, to show the example of a young person who was happy with how she chose to end her life. b. Doctors and terminally ill patients are going to court to fight for the right to physician-assisted suicide, and these fights are making headlines and showing many people positive reasons to pass the bill.

V. Proponents Values

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A. Liberty: the right to choose for yourself B. Health: if one is not healthy, they have the right to take care of themselves as they please, and ask a doctor for assistance in all matters of care.

C. Justice: proponents, especially physicians, believe it is unjust that they can be convicted for carrying out the wishes of a sane person who desires to end his/her life.

VI. Opponent Stakeholders A. Opponents’ Position: The opponents argue that it is wrong for a person to end their own life, and that the system would allow for coercion and abuse of the disabled and elderly.

B. General Con Stakeholders a. People with Disabilities: Most disabled individuals, and disability advocacy groups argue that many believe they are better off dead, and legalize physicianassisted suicide will only lead people to want to die because they feel like they are a burden (Toth). b. Roman Catholics: There are many religious persons arguing against death with dignity because they believe death should occur naturally, and that purposefully ending one’s life goes against religious teachings (Weaver). c. Republican Politicians: most politicians fighting against death with dignity are republican senators who believe physician-assisted suicide is immoral.

C. Specific Con Stakeholders a. Diane Coleman, Founder and CEO of Not Dead Yet: Not Dead Yet, a disability activist group, is strongly against death with dignity and have held protests in response. b. The American Medical Association: The AMA believes that have physicians aid in suicide counteracts their known role as a healer, and is not something that should be engaged, because physicians should be trying their best to heal not kill.

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c. New York Archbishop Timothy Cardinal Dolan and the New York State Catholic Conference: Cardinal Dolan has been working with the Catholic Conference in New York to fight against physician-assisted suicide. Both believe that it is immoral to aid in ending a life, or end your own life.

VI. Opponents’ Issues, Arguments, Evidence, and Plans/Actions A. Issue 1: Legalizing physician-assisted suicide would cause coercion and abuse of the system, causing death to people that could have been healed. a. Disability activists and most opponents argue that even under regulation, lives would be ended that could potentially have been saved. They also argue that some would be killed without specific informed consent (Weaver).

B. Issue 2: Physician-assisted suicide sets up a double standard. a. Coleman argues that if you are healthy and wish to die you get suicide prevention, but if you are sick and want to die you are considered rational. Some believe it would be hard to truly diagnose someone as sane or not, which could lead to people taking advantage of the system (Weaver).

C. Issue 3: It goes against nature to end a life because it must happen naturally. a. Many of the religious opponents emphasize this point, and they argue that the bible is very adamant about not killing. They also argue that more time should be spent promoting palliative medicine rather than physician-assisted suicide (Gallagher).

D. Examples of Opponents’ Plans/Actions a. Some opponents, such as the Not Dead Yet group, are staging protests and trying to convince politicians not to pass the bill. b. Religious organizations such as the Catholic Conference have begun online petitions to show how many people are opposed to the bill.

VIII. Examples of Opponents’ Values A. Religion: abiding by the bible and religious teachings, which go against ending a life.

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B. Safety: not participating in an act that could be misleading and cause death when you could potentially be saved.

C. Security: protecting patients from legislation that would end their life.

IX. Definitions/Explanations: n/a, no complicated terminology as of now.

X: Limits: There have been many articles on specific cases, but I will be limiting myself to cases that pertain to stakeholders, and the Brittany Maynard case since it was the most publicized and brought the debate to where it is. Also, I will focus primarily on Senate Bill S3685, though I will also talk about Assembly Bill A02129.

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Annotated Bibliography Altman, Lawrence K. "Doctor Says He Gave Patient Drug to Help Her Commit Suicide." The New York Times. The New York Times, 06 Mar. 1991. Web. 03 June 2015.

This article was published in the New York Times in 1991 when physician-assisted suicide was beginning to become a topic of debate. Lawrence K. Altman is a famous Times reporter who retired in 2009 after working at the paper for 40 years. In this article he follows the case of Dr. Timothy E. Quill, who proscribed a terminally ill patient with a pill that ended her life.

I will use this article briefly in my paper to give a background of Dr. Timothy E. Quill and his long history as a proponent of physician-assisted suicide. Since he is a major specific pro stakeholder, this article will be very important in showing how his opinions have not changed over the past 20 years, and that the topic is currently even more relevant. Dr. Timothy E. Quill is also one of my potential interview subjects. It looks like he participates in many interviews, so I could potentially have a shot speaking with him. “Bill A02129.� Assembly.state.ny.us. New York State Assembly, 15 Jan. 2015. Web. 03 June 2015.

This is the New York State Assembly website that shows the full bill A02129. It lists the goals of the bill, which is to establish the death with dignity act in New York. It lays out exactly what the bill would change, and goes in to great detail.

This is one of the proposed bills that my entire paper is based around, so it is essential to its entirety. I would use the provisions in the bill to explain the pro stakeholders position and reasoning, and counter certain provisions and points laid out based on claims by con stakeholders.

"Bill S3685." Open.nysenate.gov. New York Senate, 13 Feb. 2015. Web. 03 June 2015.

This is the proposed bill in the New York Senate, S3685. It was proposed after bill A02129 in the New York State Assembly. The goal of the bill is to amend the public health law and establish the New York end of life options act.

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This bill is one of the two major bills for physician-assisted suicide proposed in the state of New York. It has caused a great deal of debate, and my paper will revolve around this bill, as well as bill A02129. The New York State Senate website shows the bill’s entirety which will help me in explaining what it will do if passed, and which aspects are under the most scrutiny.

Coleman, Diane. "Why Disability Rights Advocates Oppose Assisted Suicide (Commentary)."

Syracuse. Syracuse Media Group, 11 May 2015. Web. 03 June 2015.

This article is a commentary on physician-assisted suicide written by Diane Coleman, CEO of the organization Not Dead Yet. Coleman explains some of the history of physician-assisted suicide and why disability activist groups across the country are so against making it legal in New York.

This article is very important to my paper because it is a commentary from one of my major specific con stakeholders. A firsthand account of why this cause is so important to Diane Coleman is essential to my paper, and I will reference this article often when discussing Coleman’s position. Coleman is one of my potential interview subjects, and I will be contacting Not Dead Yet to see if I can speak with her or another representative about their opposition to the proposed bills.

Gallagher, Kathleen M. "Assisted Suicide Is an Invitation to Abuse." Nyscatholic. New York State Catholic Conference, 6 May 2015. Web. 3 June 2015.

Kathleen Gallagher is the director of pro-life activities for the New York State Catholic Conference and a strong opponent of physician-assisted suicide. In this article she explains why she believes assisted-suicide is an invitation to abuse.

This article will be helpful because Kathleen Gallagher is one of my specific con stakeholders, and having a personal account of why she is opposed will greatly help me to explain her argument against physician-assisted suicide. Gallagher is also one of my potential interview subjects, and I plan to contact the New York State Catholic Conference. If I cannot speak to her I will try and find another opponent from the organization.

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Hartocollis, Anemona. "Lawsuit Seeks to Legalize Doctor-Assisted Suicide for Terminally Ill Patients in New York." The New York Times. The New York Times, 03 Feb. 2015. Web. 03 June 2015.

Anemona Hartocollis is a metro reporter for the New York Times and specializes in Hospital and Healthcare. This article discusses the lawsuit filed by doctors and terminally ill patients who wish to legalize doctor-assisted suicide. The article illustrates the opinions of various proponents and opponents of the lawsuit and proposed bill.

This article is very important because it was influenced by the Maynard case and brought the debate of physician-assisted suicide to the forefront in the state of New York. It gives the opinions of some of my specific stakeholders, such as Dr. Timothy E. Quill (pro) and Kathleen M. Gallagher, director of pro-life activities for the New York State Catholic Conference (con). There are example and opinions from numerous patients and doctors who support the practice of physician-assisted suicide.

"Increasing Momentum for Death with Dignity Seen in New York." Compassion and Choices.

N.p., 4 Feb. 2015. Web. 3 June 2015.

This article, found of the Compassion and Choices website, comments on the death-withdignity lawsuit brought by doctors and terminally ill New Yorkers. It explains what Compassion and Choices is, and how they are going to help activists fight for a patient’s right to physician-assisted suicide.

Compassion and Choices is an organization that aims the improve end-of-life care and legalize physician-assisted suicide nationwide. Many from the organization are currently in Albany fighting for the death with dignity act. This article is very important because Compassion and Choices, and their President Barbara Coombs Lee, discuss why they support death with dignity and their plans to help get it passed in New York. They give reasons why they support this act, and their reaction to the lawsuit from doctors and terminally ill New York residents.

Lovett, Kenneth. “Timothy Cardinal Dolan Will Fight Bill for Assisted Suicide.” NY Daily News. N.p., 09 Feb. 2015. Web. 03 June 2015.

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This article was written by Albany Bureau Chief for the New York Daily News, Kenneth Lovett, who previously wrote for the New York Post. This article was written after an interview with Timothy Cardinal Dolan, the archbishop of New York State. Dolan discusses the reasons why his colleagues and he strongly disapprove of the death with dignity act.

I will use this source when discussing Timothy Cardinal Dolan, since he is one of my specific con stakeholders. This article has numerous direct quotes and explains why he is so strongly against the death with dignity act, which will be essential in my paper. It also discusses religions besides Catholicism that oppose the passage of physician-assisted suicide legislation.

Manning, Michael, M.D. Euthanasia And Physician-Assisted Suicide: Killing Or Caring?. n.p.: New York : Paulist Press, c1998., 1998. ST EDWARDS UNIV's Catalog. Web. 3 June 2015.

This book by Michael Manning was published in 1998, and discusses the religious aspects and opinions of physician-assisted suicide and euthanasia. It comes primarily from a Roman Catholic position, but also looks at arguments from philosophical and medical perspectives. Manning was a Medical Practitioner and is a member of the American College of Physicians.

I will use this book when showing the arguments of some of my specific and general con stakeholders, and show how religion influences their opinions on the subject. This source will probably be the most helpful in describing one of my general con stakeholders, the Roman Catholic Church, as well as the New York State Catholic Conference, and New York’s Archbishop Timothy Cardinal Dolan.

Mitchell, John B. Understanding Assisted Suicide: Nine Issues To Consider. n.p.: Ann Arbor : University of Michigan Press, c2007., 2007. ST EDWARDS UNIV's Catalog. Web. 3 June 2015.

This book by John B Mitchell, a professor at the Seattle University School of Law, explains numerous perspectives on assisted suicide. The book is organized into 9 issues

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with assisted suicide and asks fundamental questions about the topic. In regards to physician-assisted suicide, it discusses medical autonomy and the moral claims.

Since Mitchell is a lawyer, his take on the topic has a lot of details about the legal aspects of the assisted suicide debate. He also asks interesting questions that will help me explain the con sides of certain arguments very well. Since he looks at all perspectives, this book will help me with some pro arguments as well.

Nahmias, Laura. "Advocates Plan Push for Assisted-suicide Bills." Capital New York. N.p., 10 Apr. 2015. Web. 04 June 2015.

Laura Nahmias is a journalist writing for Capital New York. This article discusses numerous advocates for the death with dignity and aid-in-dying acts. One nonprofit advocacy group, Compassion and Choices, is discussed frequently in the article as a major fighter in favor of physician-assisted suicide.

This article will be very important when discussing proponents for physician-assisted suicide. As mentioned, it talks a lot about Compassion and Choices, which is one of my specific pro stakeholders. It also discusses more about the proposed legislation, which will be important to my entire paper. This article also gave me more examples of proponents and specific cases that strongly support the bill.

"Not Dead Yet Disability Activists Oppose Assisted Suicide As A Deadly Form of Discrimination." Not Dead Yet. N.p., 25 May 2012. Web. 03 June 2015.

This article is on the Not Dead Yet official website and illustrates their views on physician-assisted suicide and explains how this is an issue that affects people with disabilities. Not Dead Yet describes itself as, “a national, grassroots disability rights group that opposes legalization of assisted suicide and euthanasia as deadly forms of discrimination.�

I would use this article to outline the views of my specific con stakeholder, the CEO of Not Dead Yet Diane Coleman, and why the organization is so strongly against physicianassisted suicide. I will show the reasons they think physician-assisted suicide is wrong and why this is so important to people with disabilities.

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"Opinion 2.211 - Physician-Assisted Suicide." AMA. American Medical Association, June 1994.

Web. 04 June 2015.

This statement was issued by the American Medical Association in 1994 and has not changed since. Their website explains they have maintained their position against physician-assisted suicide, and list a couple of their reasons.

The AMA is one of my stakeholders, and this source is important in showing the reasoning behind their position on the topic. Since they are a very credible group in the medical field, they are a strong stakeholder and will make a very interesting argument.

Quill, T E. "A Physician's Position On Physician-Assisted Suicide." Bulletin Of The New York Academy Of Medicine 74.1 (1997): 114-118. MEDLINE. Web. 3 June 2015.

This journal article from the Bulletin of the New York Academy of Medicine was written

by Doctor Timothy E. Quill. Quill is a major advocate or physician-assisted suicide and made the news in 1991 when he helped a patient die. This was a testimony before the Subcommittee on the Constitution of the House of Representatives Committee on the Judiciary.

This article is very important because it is from the perspective of one of my primary specific pro stakeholders. He explains in detail why he believes physician-assisted suicide should be legal. This will be an essential source in explaining Quill’s reasoning for his past actions and strong beliefs.

Richinick, Michele. “New York Lawmakers Introduce ‘Death with Dignity’ Bill.” Msnbc.com.

NBC News Digital, 18 Feb. 2015. Web. 03 June 2015.

Michele Richinick was a staff writer at MSNBC when this article was published, and she is currently a staff writer at both Newsweek and the Boston Globe. Article discusses the bills introduced in New York, the Maynard case, and lawsuits pertaining to the death with dignity act.

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Would use this article for my proponent argument, to give reasons for wanting to pass the bill from a specific pro stakeholder, Senator Diane Savino, who is a main sponsor of the bill. This article is important because it has also lead me to even more helpful articles.

Toth, Katie. "Protesting Assisted Suicide, Activists Crash NYC Assemblywoman's Office...In Albany." The Village Voice Blogs. The Village Voice, 12 Feb. 2015. Web. 03 June 2015.

Katie Toth is a news reporter for the Village Voice in New York, and graduated from Columbia University. In this blog post she follows the protest of disability rights activists from the organization Not Dead Yet. In this protest they traveled to New York State assembly-woman Linda Rosenthal's Albany office on February 11th where they asked for a meeting to argue against physician assisted suicide.

I will use this blog post in the discussion of one of my major specific con stakeholders, Diane Coleman, CEO of Not Dead Yet. This gives an example of how serious they are about not letting this bill pass. The blog post also gives many quotes from disability activists and the response of Linda Rosenthal to this protest.

Weaver, Teri. “Physician-Assisted Suicide: Could it Become Legal in NY?” Syracuse. The Syracuse Media Group, 25 Feb. 2015. Web. 03 June 2015.

This article was printed in the Post Standard of Syracuse, NY and later published online at Syracuse.com. It was written by Teri Weaver, a State and Government Reporter at the Post Standard and Syracuse Media Group. This article gives examples of people that both gave and received life-ending medication. It discusses the political figures that are fighting for the advocacy of death by dignity. It mentions numerous opponents of the act and reasons why they are against it.

I will primarily use this source for the opponent’s arguments. It mentions some of my major opponent stakeholders, such as the New York State Catholic Conference and Diane Coleman of the disability group Not Dead Yet. It also gives rational reasons why some would oppose this bill, which will make a stronger and more interesting argument between both sides. It also talks about Dr. Timothy Quill, who is one of my specific pro stakeholders, and the reasons why he believes the bill should be passed.

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Submission 2

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Alexandra Cogen 1401 St. Edwards Drive Austin, TX 78704 631.418.5772

6.18.2015

Beth Eakman Re St. Edward’s University 3001 South Congress Ave, Austin, 78704

Dear Beth,

Senators Diane Savino and Brad Hoylman of The New York State Senate introduced Senate Bill S3685 this past February. This bill, called The End of Life Options Act, sets out to legalize physician-assisted suicide in the state of New York, with the hopes of improving end of life care.

This bill will allow a physician to give end of life medication to a patient with a critical disease or ailment, and, unlike euthanasia, the medication would not be administered by a physician, but by the patients themselves.

For this particular project, I have researched the proposed bill, and considered the arguments for and against legalizing physician-assisted suicide in the state of New York. Both sides contribute persuasive arguments, which is why the debate has become so highly publicized. Primarily, the proponents consist of Democrats, and the opponents consist of Republicans, which has caused the percentage of proponents and opponents to be relatively even.

Although I find this topic incredibly interesting, it has definitely tested my patience through the research process, and challenged me as a writer. Since my writing focus is generally poetry and literature, writing a paper that does not involve a novel or poem has been difficult, as I had

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initially anticipated. However, as my research progresses, I find myself growing more comfortable with the format, which I hope is apparent throughout my paper.

I believe I am on schedule and, overall, I am satisfied with my current proposal. I hope this subject interests you, and I look forward to presenting you with my finished product.

Sincerely,

Alexandra Cogen

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Alexandra Cogen Professor Eakman Re Capstone Sub 2 June 18, 2015

Introduction There is currently a heated debate worldwide about the morality of physician assisted suicide.

The state of New York is split on whether or not Senate Bill S3685, which would establish the End of Life Options Act, should be passed. This Bill would legalize physician assisted suicide in the state of New York, allowing terminally ill mentally competent individuals to receive lifeending medication from a physician. Proponents argue that this bill should be passed because a terminally ill patient has the right to do what they want with their body. Opponents argue that this law could lead to a flawed system where patients are taken advantage of and regulations are not closely monitored. This Capstone project will look into the question of: Should the New York State Senate pass Bill S3685 and establish the End of Life Options Act? Exigence The fight for physician-assisted suicide has grown greatly since the start of the pro euthanasia movement which began in the 70s. It lead to the Gonzales v. Oregon case in 2006 and then to the Brittany Maynard case of 2014 (Smith, Fass). Since the Maynard case, the physician assisted suicide debate has reached every state, and caused many to rethink their laws against the practice (Bever). Being a young woman with a strong social media presence, Maynard brought the debate to the forefront, which has only become more heated since her death in 2014 (Bever). Currently, 3 states have death with dignity laws, 2 states have death with dignity laws that are only legal by court decision, and 11 states are considering death with dignity legislation in the 2015 session (“Death with Dignity”). The National Death with Dignity Center states that 1 in 5 physicians will get a request for physician-assisted suicide in their career (“Physicians’ Frequently”). A survey conducted by the Pew Research Center stated that nationally, 49% disapprove of physician-

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assisted suicide, and 47% approve. Because the country is almost evenly divided on the issue, it is very relevant and important to understand both sides of the argument.

Key Terms -Antiemetic: Agent that prevents nausea and vomiting, which must be taken one hour before ingesting a lethal dosage of a barbiturate so as to prevent throwing it up (“Antiemetic”, Fass).

-Barbiturates: Any of a group of drugs that act as depressants of the central nervous system, are highly addictive, and are used primarily as sedatives and anticonvulsants. Slows the activity of the brain and nervous system, large dosages are lethal (“Barbiturate”, Barone).

-Euthanasia: When the physician acts directly in ending a patient’s life, and administers the lethal medication without the backing of a legal authority (“Physicians’ Frequently”, Fass).

-Glioblastoma: A highly malignant, rapidly growing type of brain tumor. Early symptoms may include sleepiness, headache, and vomiting (“Definition of Glioblastoma”).

-Hippocratic Oath: An oath taken by physicians and primarily states that a physician will provide their services in a moral way and forbids medical doctors from prematurely ending the lives of their patients (“Definition of Hippocratic”, Smith).

-Hospice: Care for people facing a life-limiting illness or injury. Involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support (“Hospice”).

-Osteopathy: Therapeutic system; current osteopathic physicians use the diagnostic and therapeutic techniques of conventional medicine as well as manipulative measures (“Osteopathy”). In states where physician-assisted suicide is legal, doctors of osteopathy (D.O.) are one of the few types of doctors that can legally provide the lethal drugs (Fass).

-Palliative: Patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and facilitates patient autonomy, access to information and choice. (“Palliative”).

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-Pentobarbital: In a liquid form, historically the most common barbiturate, but no longer produced by United States pharmaceutical companies because it was used by prison officials for executions (Barone).

-Physician-Assisted Suicide: When a physician provides a patient with lethal mediation, but does not administer it themselves.

-Secobarbital: Often comes in red capsules, the most common medication used for physicianassisted suicide deaths (Barone).

Scope In this project I will be covering New York State Senate bill S3685 and the views of its general and specific pro and con stakeholders. I will also discuss New York State Assembly Bill A02129, but not as extensively. This paper will focus on the state of New York and I will not discuss specific legislation being considered in other states. I will briefly discuss legislature passed in Oregon and other states where physician-assisted suicide is legal, but only in comparison to the proposed legislature in New York. I will discuss the Brittany Maynard case, and although it did not take place in New York, it did spark the current national debate. I will not discuss any countries besides the United States, and not mention their debates regarding physician-assisted suicide. I will discuss Democratic and Republican opinion, and religious opposition as it pertains to physician-assisted suicide, but I will not discuss issues such as abortion, murder, and suicide although some concepts overlap. Although I will discuss Christian opposition in depth, I will only briefly touch on the opinions of people of other religious backgrounds. I will discuss the New York State Palliative Care Information Act of 2011, but only how it has helped lead to Bill S3685. I will mention end of life care as it pertains to Bill S3685, and I will only mention hospice care if I am comparing it to palliative care.

Narrative "My glioblastoma is going to kill me, and that's out of my control. I've discussed with many experts how I would die from it, and it's a terrible, terrible way to die." 29 year old Brittany Maynard, described as an adventurous, fun-loving individual, chose to quickly die through medication proscribed to her by a physician rather than die slowly and naturally (Egan).

She ended her own life, surrounded by family and close friends, on November 1st, 2014 in

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Portland, Oregon (Egan). Although physician-assisted suicide has been a topic of debate for many years, the death of Maynard has brought international focus to the controversy, and sparked the “Death with Dignity” movement, which promotes monitored physician-assisted suicide for terminally ill individuals (“Death with Dignity”). Currently, Oregon, Washington, and Vermont are the only states where physician-assisted suicide is legal, and in Montana and New Mexico, it is legal by court decision (“Death with Dignity”). Many states have proposed legislation since the death of Maynard, including New York, where the debate is currently heated and evenly divided.

In reaction to the Maynard case, a group of physicians and terminally ill patients filed a lawsuit against the New York State Supreme Court on February 3rd, 2015 (Hartocollis). The plaintiffs argued against New York State, stating that the law should be changed in order to aid in dying and provide more end of life options for the terminally ill (Hartocollis). Ten days later, on February 13th, 2015, two New York State Senators, Diane Sevino and Brad Hoylman, introduced Bill S3685, the End of Life Options Act (“Bill S3685”). This bill sets out to legalize physician-assisted suicide in the state of New York in order to provide end of life options for terminally ill patients with irreversible illnesses, who would otherwise die slowly in excruciating pain (“Bill S3685”). The bill also states that, if the patient is coherent enough to make an informed decision, and there is a qualified individual as well as two witnesses, then the patient is eligible to receive the life-ending medication (“Bill S3685”). Since the bill has been proposed, many in the state of New York are speaking up in favor of and against the End of Life Options Act. Proponents argue that a person has the right to do what they want with their body, especially if they are slowly dying in excruciating pain from an incurable ailment. Opponents argue that the system could be coercive to patients that could have potentially been cured, and that it goes against a code of ethics to assist a patient in ending their own life. So, this poses the question: Should the New York State Senate pass Bill S3685 and establish the End of Life Options Act? Proponents in New York believe that the End of Life Options Act should be established in order to allow patients with terminal and incurable illnesses to end their life in a manner they prefer. Since death with dignity was passed in Oregon in 1997, statistics have shown that only 752 out of the 1,173 people that received the end of life medication actually took it (Weaver).

Proponents argue that many patients wish to get the drug so that they have the option to die if the

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pain becomes too much, but some end up dying naturally regardless (Weaver). Patients have claimed that even having the drug, regardless of whether they will take it or not, like having the option available. The proponents argue that the option should be available to someone in severe pain that coherently explains why they wish to end their life, and that every individual has the right to do what they want with their own life (Richinick).

There are many stakeholders fighting in favor of the End of Life Options Act in New York. Democratic politicians are some the major supporters of bill S3685. The Senators that introduced the bill, Diane Sevino and Brad Hoylman, as well as Assemblywoman Linda Rosenthal, who has introduced a similar bill, A02129, to the New York State Assembly, are three of the major specific stakeholders leading the way for other Democratic New Yorkers supporting the legalization of physician-assisted suicide. New York State physicians are a major group of general stakeholders fighting in support of the bill in the hopes that legalization would make their jobs easier and enable them to satisfy their patients’ wishes. A specific New York State physician, Dr. Timothy Quill, has been a major spokesman for physician-assisted suicide since the 1991 court case in which he was accused of giving a terminally ill patient life-ending medication, as per her wish (Weaver). Quill was not convicted, and has since promoted the legalization of physician-assisted suicide nationwide. Terminally ill New York patients are also strong supporters of the bill, and, as previously mentioned, wish to have the option to end their suffering if they so wish (Hartocollis). Many patients have adamantly expressed their wish to die, and argue that suffering need not be prolonged if it does not have to be (Hartocollis). Another specific stakeholder involved in promoting the passage of bill S3685 is the organization Compassion and Choices of New York, an organization that aims to improve end-of-life options nationwide (“Increasing Momentum�). President Barbara Coombs Lee is an active participant in the debate in favor of physician-assisted suicide, believing the passage of bill S3685 would greatly improve end of life care for terminally ill patients (Nahmias).

The proponents have made numerous arguments to support their belief that bill S3685 should be passed in New York. A major argument frequently raised is that people have the right to do what they want with their own lives, especially if they are approaching imminent death and in extreme pain (Altman). In response to his 1991 court case, Quill argued that his patient, and friend, clearly and coherently expressed her wish to die, in what she believed was the humane

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way, because she did not want to prologue the suffering of herself and of her family (Altman).

The argument of a right to choice is made by most proponents, and Senator Sevino stated that the option to end one’s suffering should be a right given to all terminally ill patients in severe pain (Richinick). Another argument made in favor of bill S3685 is that Death with Dignity has been working flawlessly in Oregon for the past 17 years, with no cited issues; and so, if done in a similar fashion, it could do the same in the state of New York. The Senators that proposed the bill have argued that they have modeled the bill after the active Oregon bill, and aim to achieve the same results (“Increasing Momentum”). Proponents of New York legislation have seen the outcome the bill has had in Oregon, and believe the same plan, if properly regulated and implemented, would have positive results (“Increasing Momentum”). The third major argument made in favor of bill S3685 is that, contrary to the common opponent belief, physician-assisted suicide would not be implemented lightly, and it could possibly take months for the approval of a patient to receive this life-ending medication. Bill S3685 states that the law would require the diagnosis by multiple physicians, mental health screenings, and required wait times before obtaining the drug (“Bill S3685”). The patient must be over 18 and a legal resident of the state of New York (“Bill S3685”). Proponents argue that these regulations would not allow for the coercion and abuse that opponents are afraid of (Weaver).

Proponents are fighting for bill S3685 in numerous ways. Brittany Maynard’s husband, Dan Diaz, has been enlisted as a spokesman for death with dignity, in order to show the support from someone that has been directly influenced by physician-assisted suicide, and still supports it although his wife is deceased (Richnick). Senator Savino has met with Diaz, and the proponents are using the Maynard case to show the strong desire of many terminally ill people to end their lives in order to avoid prolonged suffering (Richinick). The proponents also wish to use Maynard’s case to show how young people are also affected by the death with dignity movement, and how people from all generations believe the legalization of physician-assisted suicide is relevant (Weaver). The publicity of Maynard’s case and extensive use of social media has also been used by the proponents in order to garner for media attention in their favor, influencing segments on shows like The View and articles in publications such as People Magazine and the New York Times (Bever, Weaver). There are also many doctors and terminally ill patients bringing their desire for the passage of the End of Life Options bill to court

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and to media attention. Terminally ill patients of all ages are speaking up about their wish to end their life sooner so as to avoid more suffering, and they cannot afford, like Maynard, to go to another state where physician-assisted suicide is legal (Feeny, Hartocollis).

Throughout their arguments and stance on bill S3685, the proponents have illustrated their core values. They value liberty, and their right to choose for themselves how they wish to die. They also value health and healthcare, and the right to certain medical procedures and the right to ask physicians for the type of care they desire. The third major value the proponents hold is justice, and the right to certain services that are available in other parts of the country.

Physicians value justice and the desire to carry out patients’ wishes without the threat and fear of conviction.

The proponents do make very strong arguments, but the opponents do as well. The opponents firmly believe that it is wrong for a patient or physician to end the patient’s life before it is their time. They also argue that the system under the proposed bill would allow for patient coercion and the abuse of with disabilities, as well as the elderly. The opponents are strongly fighting to maintain physician-assisted suicide as an illegal practice in the state of New York.

One general proponent stakeholder is people with disabilities. The majority of people with disabilities in the state of New York believe that the passage of the End of Life Options act would only cause those with disabilities to think perhaps they are better off dead, and lead some to want to die because they feel they are a burden on their friends and family (Toth). A specific opponent is the disability advocacy group Not Dead Yet and their CEO and founder Diane Coleman. Not Dead Yet has led many protests against the passage of bill S3685, and actively fight against physician-assisted suicide because they view it is exploitive and inhumane (Toth).

Republican politicians are another general stakeholder against physician-assisted suicide. The Republican National Committee website states that they strongly oppose physician-assisted suicide, siting that they are supporters of human life and rights to life. Many New York state republicans are fighting actively in opposition of bill S3685, hoping that the republican state senators will all vote against it. Another major general stakeholder is Roman Catholic worshipers and leaders. They argue that death should come naturally and that ending a life goes against all religious teachings (Weaver). Specifically, the New York State Catholic Conference and New York Archbishop Timothy Cardinal Dolan are Roman Catholic institutions and leaders,

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respectively, which are fighting in opposition to physician-assisted suicide. Lastly, a major specific stakeholder is the American Medical Association, which argues that assisting a patient in death only counteracts the physicians known role as a healer (Opinion 2.211). They also argue that the role of a physician is to do everything they possibly can to heal a patient, and by assisting in killing, it is as if they are giving up on the patient (Opinion 2.211).

One argument opponents are making in response to physician-assisted suicide is that the legalization of it would cause coercion and an abuse of the system, causing the death of individuals that could have potentially been healed. Many republicans and disability activists are using this argument because they believe, despite regulations, it would be hard to enforce who takes the medication once it leaves a physician’s office (Weaver). Also, sometimes people make inaccurate diagnosis, and some patients could end their lives, when they could have potentially been saved (Weaver). They argue that some would also be killed without specific informed consent (Weaver). Another argument made is that physician-assisted suicide sets up a double standard. Coleman argues that if a person is healthy but wishes to die they get suicide prevention, whereas if you are sick and want to die you are considered rational, because you will die anyways (Weaver). Some could potentially act sane when they are not, and take advantage of the system in order to procure the life-ending medication (Weaver). The third major argument, most commonly used by republicans and Roman Catholics, is that it goes against nature to end a life because it must happen naturally. They argue that the bible is very adamant about not killing oneself or another, or assisting in killing (Gallagher). They also argue that more time should be focused on palliative medicine rather than physician-assisted suicide (Gallagher).

The opponents’ major plan of action is to protest and stir debate about whether or not physician-assisted suicide is ethical. Opponents, such as Not Dead Yet, are staging protests to try and convince politicians not to support the bill (Toth). Religious organizations, such as the Catholic Conference, are creating online petitions in order to show politicians how many people oppose the passage of the bill (Weaver). Also, politicians and activists are reaching out through social media and to major news publications in order to stir debate in their favor.

The opponents’ values are emphasized through their arguments and fight against physician-assisted suicide. Religion is a major value illustrated, because some of the most common arguments cite the bible and religious teachings that emphasize the value of human life

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and sin of murder. Safety is also a major core value, shown through the protest of an act that they believe to be coercive and dangerous. Security is also a major value, because they support the current law that makes physician-assisted suicide illegal, and passing the law enables a practice they deem unsafe.

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Alexandra Cogen 1401 St. Edwards Drive Austin, Tx, 78704 631.418.5772

6.18.2015

Beth Eakman Re St. Edward’s University 3001 South Congress Ave, Austin, 78704

Dear Beth,

Listed here is my schedule for the completion of my Capstone paper for the summer semester of 2015. There are 7 weeks left to complete my paper, and this submission contains my introduction, narration, exigence, key terms, and most up-to-date work cited. Within the next 7 weeks I plan on conducting interviews with experts on the topic, analyzing my research and arguments presented on both sides, and illustrating my own opinions on the subject taken from the facts I’ve acquired. My paper will be completed on time and handed in on Thursday August 6th, 2015.

Project Overview This capstone paper is about physician-assisted suicide, specifically in the state of New York, where there is currently a heated debate. It will look at proposed Senate Bill S3685, which sets out to establish the End of Life Options Act. It will explore previous cases that sparked the debate, and the current major arguments of the proponents and opponents. I will briefly compare

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it to current legislature implemented in states where physician-assisted suicide is legal, and show how establishing this law in New York could have both positive and negative effects.

Objectives -Research -Draft -Contact potential interview subjects -Formulate interview questions -Conduct interviews -Combine interviews with research -Revise & edit -Present & submit

Work Completed -Research -Draft -Contacted potential interview subjects

Work Remaining -Conduct interviews -Combine interviews with research -Revise & edit -Present & submit

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Discussion I am currently on schedule and still attempting to contact potential subjects to interview. I have reached out through twitter and email, and so far have received a response from one of my major stakeholders, New York Democratic Senator Brad Hoylman, whom I hope to conduct an interview with by next week. I am hoping to get more responses from other potential interview subjects soon so that I may get my interviews done within the next two weeks. I am on schedule with my research and sources, and have a draft completed. I hope to have a revision done, with interviews included, within the next three weeks.

Conclusion I believe, with the plan I have implemented, I will finish my Capstone paper on time. With my extensive research, long list of potential interview subjects, and interview soon to be underway with one of the Senators who introduced the bill, I will have an interesting paper which fulfills the Capstone requirements. I look forward to continuing this assignment and showing you the end product in the near future.

Sincerely,

Alexandra Cogen

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Submission 3

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Sub 3 Worksheet Name: Alexandra Cogen Normative question: Should the New York State Senate pass Bill S3685 and establish the End of Life Options Act? Issue #1 Could the legislation lead to a coercive and exploitative system, without proper regulation?

Proponent argument: Proponents argue that New York State Senate Bill S3685 is modeled after the active Oregon Bill, and sets out to achieve the same results. Statistics have shown that in Oregon, since its passage 17 years ago, the system has operated without any errors, and has greatly improved end of life options in the state (“Increasing Momentum”). The proponents also argue that the Bill includes numerous mandatory regulations that will be heavily implemented, such as a diagnosis by multiple physicians stating the person will inevitably die within the next 6 months, mental health screenings, and required wait times for obtaining the drug (“Bill S3685”).

Also, the patient must be over 18 and a legal resident of the state of New York (“Bill S3685”).

Opponent argument: Opponents believe that, regardless of what it says in the legislation, the system would be coercive and difficult to regulate. Many argue that, despite regulations, it would be hard to enforce who takes the medication once it leaves the physician’s office (Weaver).

Some also argue that many that wish to die could take advantage of the system, and potentially act sane when they are not (Weaver). Also, many disability rights activists argue that the system would be exploitative and inhumane, causing people with disabilities, who already have problems facing life, to feel they are better off dead and wish to die because they feel they are a burden on their friends and family (Toth).

Critical analysis: The arguments presented on both sides have very visible strengths and weaknesses. The proponents’ argument relies heavily on the fact that they are taking the primary structure of a system implemented by another state. Although statistics have shown that the Oregon bill has been effective, there can always be discrepancies. At the same time, since there is proof that a similar system has worked almost flawlessly, it is hard to argue with a system that is proved to work. But the opponents’ argument that the system could be difficult to properly

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regulate is also true. Once the mediation is given to a patient, and kept for potential future use, it is hard to be sure that someone else will not accidentally or intentionally take the lethal medication. But, the opponents in fear of coercion and exploitation are ignoring some of the facts laid out in the proposed bill. The bill very clearly states the regulations and precise way in which they should be implemented. Also, Oregon statistics have shown that the majority of people that have participated in physician-assisted suicide have been elderly white college educated individuals, and also that all of the patients that have purchased the life ending drug and not taken it, 37 out of 155 in 2014, died shortly after naturally because they could not be cured (“Oregon’s”). This shows that all the people that received the life ending drug, regardless or not of whether they ingested it, were shortly to face inevitable death.

Ethical analysis: The proponents illustrate here a value for the law and adhering to rules and regulations laid out. They state that they do not wish to take advantage of any parties that are in fear of the legislation, and are very much against taking advantage of others. The proponents and opponents both recognize an obligation that the government has to upholding the law and protecting citizens, but both view the proposed legislation as either adhering to or going against that governmental obligation. Proponents believe that by passing the bill that citizens and physicians who wish to engage in physician-assisted suicide would be protected, whereas those opposed to the bill believe that the passage would go against the governmental obligation by allowing the passage of a bill that could coerce citizens into ending their life. The opponents illustrate a value for safety and life by fighting for physician-assisted suicide to remain illegal so that no one may die before it is their natural time, and no one will be convinced that dying would be in their best interest.

Issue #2 Does physician-assisted suicide go against the Hippocratic Oath taken by physicians?

Proponent argument: Proponents argue that a physician aiding in the death of a patient that is inevitably going to die from a painful incurable disease has the right to assist in ending the patient’s life if that is the patient’s wish (Altman). Physicians in favor of physician-assisted suicide argue that it is their job to do as the patient asks, if the patient is a sane and mentally

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coherent individual who explicitly states they wish to end their suffering in the way they view is humane. They argue that the Hippocratic Oath states to aid the patient to the best of their abilities, and that by doing as the patient wishes, they are fulfilling their promise. They are indirectly, and not directly, ending the patient’s life, and are only doing so when it is clearly determined the patient is going to die in severe pain in the near future (Altman).

Opponent argument: Opponents argue that by assisting in the death of a patient the physician would be going against the Hippocratic Oath, which states that a physician must treat a patient to the best of their abilities (“Definition of Hippocratic”). They argue that by assisting in the killing of a patient that they are going against their known role as a healer, which is the opposite of what a physician should do (Opinion 2.211). They argue that even if the death of a patient seems inevitable, the physician should still do everything they possibly can to heal a patient, and that by assisting in a patient’s death, it seems as if the physician is giving up (Opinion 2.211).

Critical analysis: Both sides of the argument look at the Hippocratic Oath from different perspectives. The Hippocratic Oath states that a physician will provide their services in a moral way and prohibits a doctor from prematurely ending the life of a patient (“Definition of Hippocratic”). Proponents see this in their favor, believing that it is not prematurely since the patient will inevitably die and that they are doing as the patient wishes. Opponents see physicianassisted suicide as going against the Hippocratic Oath because the physician is second handedly ending the life of a patient, and it does not matter whose choice it is. Both arguments in this case are even in strength. Both view the Hippocratic Oath in ways that make sense because although they are ending a life, they are doing it in a way that they feel is moral. The weakest argument in this case would probably still be the proponent, because the Hippocratic Oath still does specifically state aid in the death of a patient, which the physician would still be doing, regardless or not of whether they believe doing so is in the patient’s best interest.

Ethical analysis: When looking at physician-assisted suicide from an ethical and moral standpoint, we must look at the obligation of a physician to their patient. Proponents would argue that it is the physician’s responsibility to do as their patient wishes and aid in their death if that is what they coherently desire. Opponents would argue that it is the physician’s responsibility to the patient to take care of them to the best of their ability up until the patient’s natural death, and provide that patient with the best palliative care they can provide. Both the pro and con

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physicians value the wellbeing of the patient above all, although they come at it from different perspectives. Both types of physicians want to end their patient’s suffering, but the proponents value the patient’s wishes, whereas the opponents value God and nature in that they believe things take their course and happen as they naturally should.

Issue #3 Does a person have the right to do what they want with their own body and end their own life?

Proponent argument: Proponents argue that patients have the right to do what they want with their own body if they are inevitably going to die from a painful and incurable disease. All the proponents argue that the right to choose to end one’s own suffering is an option that should be given to all terminally ill patients in severe pain, who wish to die on their own time surrounded by loved ones (Richinick). The patients who choose to die express that their desire to die is partly because they not only want to limit their own suffering, but the suffering of their family and friends who must watch them die (Richinick).

Opponent argument: Opponents argue that the bible strongly emphasizes that one should not end a life, whether that is their own life or the life of another (Gallagher). They state that the 5th commandment plainly reads “thou shall not kill” (Cherry). They argue that although they know the person will die regardless, the focus should be on palliative care and taking care of the patient to make sure their transition from life to death is as smooth as it possibly can be (Gallagher).

Opponents argue that it goes against nature to end one’s own life, regardless of whether the person is in severe pain, nature will take its course and the patient will die when they are meant to (Gallagher).

Critical analysis: This argument really comes down to a man vs God debate. The proponents argue that a person has a moral authority over themselves to decide what to do with their own life. The opponents argue that everything must happen naturally and take its course. These are the most frequently used arguments in the debate for and against physician-assisted suicide. The evidence that backs up these arguments is really that of the almost even division between proponents and opponents nationwide. 49% disapprove and 47% approve (“Views”). This

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division coincides with the republican and democrat division, the republicans making up the 49% of opponents, and the democrats making up the 47% of proponents.

Ethical analysis: An ethical analysis of this issue is much easier to do than a critical analysis.

This argument is rooted in religion and primarily a reading of the bible. Although you can critically argue that the bible shouldn’t be a basis of a law, and that the separation of church and state is still incredibly important and significant, it is hard to deny the great importance of religion in people’s lives, and that it is a very present factor in this debate and others like it, such as the abortion and suicide debates. Again, the values are obvious, the proponents valuing freedom and a right to do what one wants with their own body, and the opponents’ value of religion, God, and nature following its course. Proponents believe the government has an obligation to provide services to citizens that they wish to engage in, because it is the nature of freedom to be able to participate in the services you wish to participate in and do what you want to your own body. Opponents believe the government has an obligation to its citizens as well, but that that obligation is to protect people from services they deem to be immoral and not humane.

Discussion and Conclusion: In this debate the main arguments made by both sides are the arguments laid out in issue 3 regarding right to one’s body and religion. These are the same arguments frequently stated in debates regarding abortion, etc, where there are key values shown by both side, and there are both unwavering values that will keep the debate relatively even.

Once looking into the other two major issues, it is shown that both sides present strong arguments about potential coercion, regulating the system, and the ethical role of the physician’s involved. It would be impossible not to address the religious aspects of the arguments, since they are the most frequently made, but they are the hardest to base an opinion on since they are almost always unwavering. But, after looking at the numerous other arguments, I feel the proponents make the strongest cases. The system in Oregon has shown that it is possibly to successfully implement the system, and that people have truly only participated that were eligible. Although no one has mentioned this yet in any of the arguments, the aspect I would have been most concerned about would be if physicians and hospitals would be required to participate in physician-assisted suicide if legalized. Although I think a physician should act in the patient’s best interest and do as they wish, I do think that if it violates the physician’s beliefs or religion

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that they should not be required to assist a patient in suicide. Bill S3685 states that participation is completely voluntary, and so I don’t see why, if certain people want a service and many physicians don’t mind providing this service, it shouldn’t be legalized.

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Submission 4

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Alexandra Cogen Professor Eakman Submission 4 21 July 2015

Interview 1: On July 2nd, 2015 I met with Dr. Mark Cherry, the Dr. Patricia A. Hayes Professor in Applied Ethics and Professor of Philosophy at St. Edward’s University. I have met Mark Cherry before, so I anticipated unanswered questions and long passionate rants. Luckily I planned on asking 9 questions rather than 6 because I felt some would be barely touched on while others would receive the majority of his attention. His opinions were not difficult to decipher, and at points I felt as if I was the one being interviewed. However, I did manage to get a strong understanding of his position on physician-assisted suicide. Some flaws and issues that needed to be addressed, which were very apparent to him, were issues that I beforehand had not noticed.

He gave me a new perspective on the topic, and although my position has not altered, I was given a great deal more to consider. Although he politely refused to be recorded, he did repeat opinions he wanted to stress, so I was able to get some direct quotes.

When we met, I first explained the purpose of New York State Senate Bill S3685, and all that it strives to achieve. Although the focus of my paper is the proposed bill in New York, my goal was to first hone in on Dr. Cherry’s stance and then see what he believes the future of physician-assisted suicide looks like in Texas and the rest of the country. Before I could get to my questions, Dr. Cherry stopped me at the word “terminal” and asked, “What is this terminal stuff?” Before I could get the chance to ask if he believes the regulations seem adequate, he proposed that the word terminal is not as concrete as it may seem. Although legislation determines that a patient may only obtain the life-ending medication if they are terminally-ill, or have 6 months left to live, some patients are receiving this medication when they could potentially have more time. Dr. Cherry stated that it is difficult to give an exact amount of time that someone has left to live, so terminal could be 6 months or even 4 years. At this moment he

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brought up the Brittany Maynard case, a point, might I add, that I planned to ask him about during question number 6. He said that the media made it seem as if she had only 6 months left to live, which she stated in interviews (Maynard), but through chemo and other treatments she could have lived longer. Although Cherry did not deny that Maynard would have inevitably died regardless, he argued that the Maynard case was portrayed as a “Cinderella Story death” in which the situation was glamorized and made to encourage young people to want to support the cause. Cherry also stated that he believed Maynard was potentially encouraged to die through physician-assisted suicide in order to become the spokesperson and face of the fight. He argued that this young beautiful woman was the face the cause needed in order to show that physicianassisted suicide is not only relevant to older generations, but the younger ones as well.

After the Maynard discussion, we got into Cherry’s reasoning against physician-assisted suicide. Dr. Cherry first asked me a question about the proposed New York legislation, which I shamefully could not answer at the time. He asked, regarding the New York legislation, “Are doctors obligated to participate or can they opt out?” At the time, I was unsure of the answer, but I have reread the proposed legislation, which states that no physician or hospital is obligated to participate if it goes against their beliefs. Cherry argued that it should be one of the most important aspects of any physician-assisted suicide legislation, and that all should have built in conscience clauses. He stated that it is essential in the framing of a physician-assisted suicide law that it should “never require taxation to support it or a doctor to participate in it.” He argued that you could also look at one of the main argument in the abortion debate, that if it goes against someone’s religion they should not be obligated to pay taxes or participate in the act in any way.

But, Cherry is a believer in doing what a person wants with their own body, as long as it doesn’t violate the beliefs of another.

Another argument Cherry emphasized was the topic of suicide. He stated that, when defining suicide, “the last act has to be the individuals.” He argued that, many people kill themselves all the time, and that it is very easy to die. Although committing suicide is not legal, attempted suicide is no longer a criminalizing offence. He argued that the legalization of physician-assisted suicide is just a way to make aiding and abetting suicide a non-punishable offence. Cherry asked, “What does medicine have to do with it? It just makes it look pretty.” He argued that the reason people want to get doctors involved is because people trust doctors and

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that it does not change their morality. Patients feel less guilty and doctors will not fear incarceration. I then asked Dr. Cherry whether or not he knows any physicians that have participated in assisted-suicide and if he could tell me about their experience with it. He responded that he probably knows some but, “none that would be honest about it.” Cherry stated that, when asking anonymously, a high number of physicians admitted to participating in assisted-suicide, but commonly in the manner known as slow code. Cherry defined slow code as when the heart of a patient stops beating and the physician makes it look as if they attempted to save the patient. He argued that it is considered fraud, but it is very difficult to catch.

After slightly touching on the illegal aspects of physician-assisted death, we talked about the arguments of coercion frequently made by the disability rights activists. I asked Dr. Cherry why he believes disability rights activists were so strongly against physician-assisted death, and he compared it to an experience he had when at a lecture on the topic. Cherry stated that at a physician-assisted suicide lecture, a woman made an argument and stated that, “the problem is woman will be pushed into it because women are taught not to be a burden, so more women will engage than men.” Dr. Cherry, amongst other colleagues, argued that women are just as smart as men and they don’t need any protection. Cherry argued that this same argument could be applied to disability rights activists, in that wouldn’t it be degrading them if people kept trying to protect themselves from things rather than do it themselves?

But, Cherry argues that coercion will be present if physician-assisted suicide is legalized.

He believes that many will be pressured to end their lives and that, for some, the process would disvalue life. Those that feel they are a burden will try and die, and the law will encourage people to die. He frequently mentioned the bible passage, “thou shalt not kill”, and made the argument that the bible does not say, “thou shalt not always save.” He argues that by giving the medication, it is an act of killing, even if the physician does not kill the patient directly. But, he believes that the slow code and other methods do not go against the bible, so physicians perform these actions without any moral shame.

Although I am a proponent of physician-assisted suicide, I do agree with many of the arguments made by Dr. Cherry. I have incorporated a focus on non-mandatory participation, because I do agree that no one’s beliefs should be violated. I also agree with Dr. Cherry that a person has the right to do what they want with their body, as long as it doesn’t violate the beliefs

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of another. That is a belief that I have held since the beginning of my research. But, I do not believe that the Maynard case was as immoral as he made it out to be. Perhaps I am naïve, but I do think she decided to be a spokeswoman for physician-assisted suicide on her own, and although the activists for the cause took advantage of the media attention, I do not believe they were manipulating Maynard in any way. I also believe that Cherry’s argument asking why people don’t just kill themselves, why get a doctor involved was slightly insensitive. Although I agree it is easy to kill oneself, I think it would be cruel to shoot yourself because of pain rather than take a pill and say a proper goodbye to your loved ones. Cherry is clearly a brilliant man, and makes excellent points that many haven’t made, but I still stand by my original belief that physician-assisted suicide should be legalized.

Interview 2: Roland Halpern is a very busy man. As the Regional Campaign and Cultivation Manager of Compassion & Choices, a non-profit organization fighting for the legalization of Death with Dignity, Halpern is tasked with reaching out and creating support across the country. He is the only one of the three Compassion & Choices speakers that interacts with groups fewer than 50 individuals, and he is a known expert in the aid in dying movement. I was fortunate enough to get in contact with Mr. Halpern, but I must admit, I did not catch him at the best time. We were unable to interview in person because, not only does he live in Denver, Colorado, but he was taking his well-deserved vacation at the time the interview needed to be conducted. Thankfully, Mr. Halpern was gracious enough to answer my questions through email, and took the time to give me eloquent and passionate answers. The following shows the questions and answers to and from Roland Halpern through his response sent on August 3rd, 2015.

Firstly, could you tell me which arguments you believe are the strongest that support death with dignity?

There is a liberty interest - every competent adult should have a right to control what happens to his or her own body as long as exercising that right does not directly harm someone else.

Religion and government have no right to interfere with inviolate personal autonomy.

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No one should have to suffer a painful death if they do not wish to. Mercy and compassion require that when medicine and technology are no longer effective, then the physician's duty should be to relieve the patient's suffering.

Aid in dying (and euthanasia) already occurs on a regular basis without any safeguards or guidelines. As a result, there is the risk a patient may end up worse off owing to a botched attempt.

Studies have shown that what most patients really want is the assurance that they will not suffer at the end of life. Empowered by knowing that they have control over their illness, rather than their illness controlling them, they are able to live what life they have left to its fullest.

Because control rests solely with the patient, the patient can plan when and where he or she wishes to die. This allows family and friends to come to closure on any unresolved issues and lets loved ones say their goodbyes while the patient is still lucid.

Studies have shown that the families of loved ones who used aid in dying laws report being less distressed over the death, may have shorter grieving periods, and have fewer reservations about their own future death.

Patients who use the law are very sick, with possibly only hours or days to live. They should not have to endure, and their families should not have to witness, a painful and protracted death when a humane alternative is possible.

Any one of us can find the means to end our own life; guns, hanging, drowning, jumping, driving into a tree, or slashing our wrists. A person who is already close to death should not have to resort to such violent means to end his or her suffering.

Do you believe there are any compelling arguments against it?

No. There are lots of arguments that have been made: Distraught teenagers will use the law because they failed their exams or broke up with a girl or boyfriend, the law will be used by greedy kids who want to get their inheritance, adult children will coerce their parents into using the law because they don’t want to care for them, insurance companies will pressure people to use the law to save money or treatment or care, the law will be used to eliminate the undesirable

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in society, etc. These arguments are intended to scare people, and they do scare some. However, 17 years of Oregon data show none of this has occurred. Additionally, there have been independent reviews of the data which similarly conclude: “Where assisted dying is already legal, there is no current evidence for the claim that legalized PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.� (http://www.ncbi.nlm.nih.gov/pubmed/17906058)

How would you counteract those arguments?

With the truth. Opponents make claims that are unsubstantiated and there has yet to be a single documented case of abuse under the Oregon law.

How would you respond to the disability rights activists that are arguing the legislation could lead to a coercive system?

There is a difference between being disabled, and having a terminal illness that is likely to cause death within six months or less. Two physicians must concur that the patient has a terminal illness and two witnesses must sign an affidavit stating that in their opinion the person is making a rational decision and does not appear to be acting under coercion or duress. If a person is not terminally ill (having a life expectancy of six month or less) they would not be eligible to use the law and if someone were terminally ill and being coerced it would be hard for such a person to fool two doctors and two witnesses about their motive for wanting to use the law.

Do you believe that the systems that are operating in places such a Belgium, where even people with non-terminal illnesses can receive life-ending medication, are immoral and go too far?

Belgium and the Netherlands are a different culture and different morals, beliefs and values may apply. As an organization Compassion & Choices does not support those practices as we believe access should be limited to competent, terminally ill adults who are capable of self-administering the life-ending medication.

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Which states could you see death with dignity legislation becoming legalized in the near future?

That’s anyone’s guess, but California, Colorado, Maine, Massachusetts, New York, New Jersey, and Connecticut are all possibilities. The less progressive states in the south, like Alabama and Mississippi may be the last to adopt aid in dying laws.

Field Research: Compassion & Choices is a non-profit organization fighting for the legalization of physician-assisted death across the country. They are one of the biggest names in the debate, and partnered with Brittany Maynard in promoting the cause. Their President, Barbara Coombs Lee, was featured on 60 minutes, and has actively fought for death with dignity. Knowing the importance of this organization, I contacted their volunteer coordinator in the hopes that I could help make a difference and spread the word of physician-assisted death in Texas, a state where legislation is not even being considered. I was soon in contact with Sarah Brownstein, the national volunteer manager at Compassion & Choices, and we discussed ways in which I could help benefit their organization. I offered to lend my creative talents by creating a pamphlet or something of the like, and Sarah told me about the difficult process of approval for such things.

So, I offered to hand out pamphlets already made by Compassion & Choices, and within a couple days I had 100 pamphlets at my doorstep.

On Thursday July 23rd and Friday July 24th I passed out pamphlets for Compassion & Choices around my home of Austin, Texas. On Thursday I went to the state capitol building at the heart of the city, and on Friday to the campus of the University of Texas. I chose these locations based on the kinds of people I wanted to try and gain some support from: politicians and students. I was hoping that, by gaining support from these groups, that the word would trickle through the capitol and University and spark some interest where there was previously none. My goal was to pass out all of my pamphlets and discuss the organization to those that were interested in stopping and taking the time to talk to me. During the process, I felt a new sympathy towards the people I constantly pass on the street that offer me fliers and pamphlets.

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Usually, I would deny them without a second thought, but now I understand how discouraging it is to be ignored by people that are walking right in front of you.

The capitol was the first stop, and it was a blistering day in the Texas heat. In the two hours I managed to stand in front of the capitol, I passed out less than 20 pamphlets. Most of those pamphlets were taken by foreign tourists, and many were tossed a block away from where I handed them out and, may I add, they were not thrown away discretely. Everyone that did take a pamphlet did not bother to ask questions about what the organization stood for and no one that remotely resembled a politician or member of the Texas Government took a pamphlet. I was feeling defeated, but had high hopes for my next stop.

Again, let me reiterate, this took place in a blistering summer day in Texas. I should have anticipated that the campus would be a ghost town. Luckily, some students, besides myself, are attending summer classes, but still, not as many as I had initially hoped. I stood at the center of campus for two hours and managed to pass out about 30 pamphlets. Around 5 people asked me questions about Compassion & Choices and I was able to have very brief conversations with some students and professors that were around the campus. Although brief, those conversations gave me some hope that what I was doing really was reaching people and making a difference.

After a while, I found some bulletin boards and put some pamphlets on there, hoping some people I couldn’t reach would be intrigued and grab one to read.

Roland Halpern, the regional campaign and cultivation manager of Compassion & Choices, told me through email that there are around 3,000 volunteers for Compassion & Choices across the country. I asked if he could get me statistics about the kind of volunteers, and he replied that most of the volunteers tend to be older or retired, people that are more likely to face death in the near future, or that have witnessed more people die than a younger person would. Although I would have liked to reach more people, I am glad that I was able to help a little and spread to word to people of my generation who could help fight for the cause. Although we are less likely to die as soon, this is something that should be garnering attention from people of all ages, and it is something that will affect us more in the future.

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Submission 5, Revision 1

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Alexandra Cogen Professor Eakman Submission 5 28 July 2015 Death with Dignity and the Disabled’s Dilemma Physician-assisted suicide is not the proper term. Apparently, I have been getting it wrong. The term suicide is too negative. Although it is an accurate term, given that the medication is taken by oneself, it is a gateway word that leads to “murder” and “damnation”. It isn’t euthanasia, because that implies death at the hands of a physician. The American Academy of Hospice and Palliative Medicine believes that physician-assisted death is alright, as long as the word suicide is omitted. The American Public Health Association argues that patient-directed dying is a better option. Compassion and Choices, a nonprofit organization, explains that the terms aid in dying and death with dignity are the appropriate choices. Basically, there are a lot of options to describe one practice, and every new addition to the death with dignity vocabulary solely hopes to decrease negative attention. It’s not really working.

A whole lot of people don’t love death with dignity. They really hate it. The term, as politically correct as it may sound, still manages to speed up passersby and raise voices to an unpleasant level. If the bible doesn’t say that it is okay to end a life prematurely, than you can bet the majority of the American population is against it. But, the debate is pretty evenly divided, and it is daily taking up more and more of the news headlines. Anderson Cooper and Katie Couric brought the debate to 60 minutes and Brittany Maynard graced the cover of people magazine. Every major news channel and publication has reported on the debate, showing the variety of stances taken for and against death with dignity.

Liberal atheist pro-choice Democrats are the steadfast fighters for the cause. Some are elderly, some are in college, some are physicians, some are dying, and some are watching people they care about die. Most know that one day, if they are one of the 1,600,000 people in the United States diagnosed with Cancer each year, they will want the option to end their suffering on their own terms. But the conservative religious pro-life Republicans are firm believers in

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letting time and life take its course, and argue that palliative and hospice care should be the physician’s priorities at the end of a patient’s life.

Although not as progressive as some European legislation, three states, Washington, Oregon, and Vermont have legalized the practice of physician-assisted death, along with New Mexico and Montana, in which the practice is legal by court decision. Washington, Oregon, and Vermont have created legislation to remove the fear of conviction from participating physicians and provide the service to mentally competent terminally ill patients who wish to end their lives rather than prolong their suffering. 23 other states are currently considering legislation, leading the debate to become heated nationally and locally. In states such as California and New York, the debate is attracting a lot of attention and the proponents are bringing in organizations, such as Compassion and Choices, to help promote the cause.

The opponents have their fair share of organizations fighting on their behalf as well.

Although Religious affiliated organizations and the American Medical Association are taking over the majority of the headlines, a disability rights activist group, Not Dead Yet, is moving to the forefront of the debate. Not Dead Yet is fighting nationally on behalf of the disabled Americans who believe that physician-assisted death is not to their benefit. The group, led by CEO Diane Coleman, argues that the legalization of physician-assisted death would lead to a coercive system that would exploit the disabled by causing those that feel they are already a burden on their family to believe they would be better off dead and try and convince them to engage in physician-assisted death. Many echo her argument, and protests are being led by disabled activists fighting against the legislation that they believe to be inhumane. But, there are some disabled individuals that do not feel the same way.

Joan Tollifson was born with one hand. The day she was born, her father was offered the chance to smother her. Although she was spared from such a cruel death, Joan was selfconscious of her condition but, despite everything, grew into a strong willed woman and became an avid supporter of disability rights. In 1977 she participated in the month-long 504 Occupation in San Francisco for disability rights, and fought for both the Independent Living Movement and Disability Rights movement. She still believes in equality for the disabled and in the better treatment of people with conditions similar to and worse than hers. And, in spite of all of this, Joan Tollifson believes in death with dignity.

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Now in her mid-60s, Joan has lived through many years with her condition and in no way believes she could be coerced into dying. She thinks the argument that people want to off disabled individuals is overused and growing redundant. “Some people with disabilities hear in the right-to-die movement the old message that we disabled folks would be better off dead and that our lives are not worth living.” she argues, “But in the case of right-to die legislation, I feel that these concerns are enormously exaggerated and actually quite paranoid and misinformed.”

She reiterates some of the common arguments against death with dignity; that it’s a slippery slope that will lead to the murder of disabled newborns and the mass extermination of old folks homes. Joan expresses doubt that any of these situations would be allowed to occur through the current and proposed legislation and, she states, even if it did occur, it would be stopped immediately because, and who would actually sit back and watch something like that happen?

Joan’s remarks expose her belief that the whole argument is a bit ridiculous. The debate that the system would be coercive and not run smoothly is also mentioned, and Joan discusses how she sees the legal system of physician-assisted death operating in her current home of Oregon. She argues that in Oregon people have the right to die, but under very limited conditions. In Oregon, death with dignity legislation requires that the patient be over 18, a legal resident of the state, endure long wait periods, receive a diagnosis of terminal illness that will lead to death within 6 months’ time, and proven mentally competent by a psychiatrist. Joan argues that the safeguards are foolproof, and that this is all about a patient having more options at the end of their life.

Joan hasn’t experienced the threat of terminal illness or gone through the process of acquiring end of life medication. But, she was there when a close friend was diagnosed with terminal cancer and chose to procure end of life medication. She said that her friend had to go through a lot to acquire the medication. She had to consult with numerous physicians and psychiatrists and fill out a lot of paperwork. She was diagnosed with less than 6 months to live, and ended up dying naturally. Joan stated that, “In the end, she didn’t use the drugs to end her life. She kept saying it was so interesting how everything was falling away, and she ended up letting the dying process take its course. But she was very glad she had the choice.”

For Joan, dying is a part of life, and an aspect that gives her peace rather than grief. As a practicing Buddhist, Joan is in touch with her mind, body, and soul and accepts death and

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questions why it is in human nature to try and prolong life at all costs. She explains that, by watching family members and friends slowly die from debilitating illnesses, that she knows she would rather not prolong the process. After enduring the pain of watching loved ones die, Joan states that she would not wish that on the people she has left, and says “I wouldn’t want any of them to have to dedicate their remaining time and energy to taking care of me when recovery is not an option and the quality of my life is miserable.”

The perspective of someone like Joan is important to the debate of such a heated topic.

She has seen death with dignity in action in her home, and saw how it gave peace to a friend before her unfortunate death. She has lived life with a disability and knows that nobody could coerce her or force her to die when she has no intention of dying. “Those disability groups who are siding with the religious right on this issue don’t speak for all of us with disabilities.” Joan stated, “Many elders and people with disabilities very much want physician-assisted dying to be legalized.”

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Appendices

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Email Correspondences Correspondence with Joan Tollifson Author and Proponents of Disability Rights and Death with Dignity 07/27/2015

Hello Alexandra, You’re welcome to quote from my article in your paper. I can’t really tell you anything more about my friend other than what’s in the piece I wrote. This is the organization we dealt with here: https://www.compassionandchoices.org/. They were great. You might want to see the wonderful documentary called How to Die in Oregon if you haven’t seen it yet…it is very informative. Good luck with your project.

All the best, Joan

On Jul 27, 2015, at 2:49 PM, Alexandra Rose Cogen <acogen@stedwards.edu> wrote: Hi Joan, My name is Alexandra Cogen and I am a student at Saint Edwards University. I am currently writing a research paper on death with dignity and I found your post on the death with dignity national center website to be very inspiring. I was hoping I could use your story to form a narrative for my paper to show the perspective of someone with a disability that is a supporter of death with dignity. If you could also give me more information on your friend who passed away and pursued end of life medication, as well as more of your personal experiences with death with dignity, that would also be helpful. Thank you for taking the time to read this, I greatly appreciate it.

All the best, Alexandra Cogen

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Correspondence with Sarah Brownstein National Volunteer Manager at Compassion & Choices 07/14/15 â&#x20AC;&#x201C; 07/21/15

Re: volunteer Austin, Texas July 21, 2015 6:25 PM From: "Sarah Brownstein" <sbrownstein@compassionandchoices.org> Hi Alexandra, Thanks again for your inquiry regarding who you might interview at Compassion & Choices for your research paper about physician-assisted death. I am cc'ing Roland Halpern, Compassion & Choices' Regional Campaign & Outreach Manager for the region that includes Texas.

Feel free to contact him directly, and let me know if I can provide you with any additional information or resources.

All the best, Sarah

On Tue, Jul 21, 2015 at 8:52 AM, Alexandra Rose Cogen <acogen@stedwards.edu> wrote: Hi Sarah, I meant to thank you earlier, I received the pamphlets and I am planning on distributing them tomorrow morning. I was also wondering if you could answer a question for me for the research paper I am conducting. How many volunteers do you currently have and what is the median age of your volunteers? I was also hoping, if it is not too much trouble, if you could get me in touch with someone I could potentially interview for my paper? I think it would be helpful to have some quotes from an executive or advocacy manager to make my paper more stimulating. Please let me know!

All the best, Alexandra Cogen

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On Wed, Jul 15, 2015 at 9:34 AM, Alexandra Rose Cogen <acogen@stedwards.edu> wrote: Thank you Sarah for getting back to me so quickly. I would be very interested in passing out pamphlets for you guys. If you could send 100 to the address below I will get those passed out around Austin!

Best, Alexandra Cogen 607 Woodward apt 204 Austin, tx 78704

From: Sarah Brownstein <sbrownstein@compassionandchoices.org> Sent: Wed, 15 Jul 2015 10:41:49 -0500 (CDT) Subject: Re: volunteer austin, texas Good morning Alexandra!

Thanks for your interest and advocacy on behalf of the death with dignity movement. Because we are such a big organization, getting approval to add our name to a flyer can be a laborious process. I would be happy, however, to send you some of our literature to hand out at the same time, if you would be interested. If so, let me know roughly how many pamphlets to send, and where to send them to.

Thanks so much again!

Sarah

On Tue, Jul 14, 2015 at 1:31 PM, Alexandra Rose Cogen <acogen@stedwards.edu> wrote: Hello,

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I am a student at Saint Edwards University in Austin, Texas and I am currently writing a research paper on physician-assisted death. Although I am supposed to remain unbiased, I am on the proponent side of physician-assisted death, and would be interested in helping spread the word around Austin in any way that I can. For my class I have created a flier of important information, mostly from the Oregon legislation, that I think speaks strongly in favor of the cause. I will be passing these fliers around the city, and I would love to add the name Compassion and Choices to my fliers in order to notify more people of your organization. Of course I would send them to you for approval before I do so. If this is something that your organization would be interested in please get back to me.

All the best, Alexandra Cogen

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Compassion & Choices Pamphlet

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Field Work Photographs