Term Paper on "Oregon Death With Dignity Act Policy Analysis"

Term Paper 25 pages (7540 words) Sources: 7 Style: APA

[EXCERPT] . . . .

Oregon Death With Dignity Act

Policy Analysis

The Oregon Death with Dignity Act as has been said before can be analyzed in terms of David Gil's Policy Analysis Framework. (Gil, 1976, pp. 31-56) Gil's analysis framework consists of three main objectives: 1) issues constituting the focus of the policy, such as its nature, scope and theory, 2) the objectives, values and ideological orientation of the policy, underlying theories, target population and the manner in which it is effected, as well as the financial costs and benefits, quality of life, historical background of the policy, the size, resources and values of the group supporting the policy, and 3) alternatives to the policy. (Gil, 1992) the policy analysis is an essential aspect of understanding with regard to any moral or ethical issue that potentially has a significant impact on the public. There is a clear sense that the right to end one's own life, as a cultural ideology has evolved, just as many other social issues have. In many ways there is a sense that the nation and individual states attempt to legislate morality with such acts, but in truth the Oregon Death With Dignity Act is an affirmation of self-determination, rather than a restriction of options, that frequently go under fire with regard to the legislation of morality. A policy analysis is a first step in understanding the whole of the issue.

Though a policy analysis is a substantial informative tool in a greater understanding of any given social or legal policy, in this case the analysis is indicative of raising more questions than it answers. The policy of the Oregon "Death With Dignity" Act is illuminated and better understood, though it is also followed with ideological ethical/moral dilemmas and concerns surrounding it. Including those specific to the policy, such as the fear of Oregon, becoming a destination for death or those specific to ideology surrounding suicide and/or euthanasia, like the fear that trying to prevent suicide is counter intuitive to passing laws that legalize it and reduce culpability of anyone who participates in it, if they do so within the guidelines of the law. In short Gil's policy analysis framework will serve both purposes, to illuminate the policy and ask important social questions surrounding it.

Like prior reformers who successfully argued and mobilized for changes in abortion, gambling, or marijuana laws, the proponents of euthanasia legal reform have argued that the use of morphine at the end of life is a form of de facto decriminalization of assisted suicide. Under the "double-effect" theory, doctors are not considered to have acted unethically-nor are they subject to criminal prosecution-if they prescribe or administer potentially lethal levels of drugs with the intent to ease pain, not cause death. Activist physicians like Quill aim to bring secret practices into the open-employing a classic argument for the change of a de facto practice to a de jure legalized or decriminalized practice. In the words of a New York Times editorial, it is only a matter of sanctioning what already happens with "wink and a nod" ("Assisted Suicide and the Law" 1997:A12). As we describe in Chapter 6, even Congress's Pain Relief Promotion Act of 1999, which undermines Oregon's assisted suicide law, sanctions the principle of double effect. To date, the authority to define this distinction between killing and letting die has been kept within the boundaries of the medical profession. This is what sociologists of law mean when they refer to the "medicalized" approach, and the medicalized approach to laws regulating hastened death are very much a parallel to abortion law before Roe v. Wade (1973). (Hillyard & Dombrink, 2001, p. 22)

The foundational debate will likely continue and this work is a demonstrative example of a clear policy analysis that details many of the issues that surround the Oregon Death With Dignity Act and the overall assisted suicide and/or euthanasia movements. It is not unusual for many ethical and moral issues to achieve success in the United States through progressive legalization and in the case of healthcare through medicalization. This emphasis has both positive and negative effects that will remain a part of the fabric of any civil rights action for the whole of the existence of the United States.

Focus of the Policy, Nature, Scope and Theory

In an analysis guided by Gil's Policy Analysis Framework, the "focus" of Oregon's Death with Dignity Act is to settle the inherent potential dispute as to what the desires of a terminally ill person really are. The nature of the theory is to eradicate the questions that frequently surround prolonged periods of terminal illness, prior to the event that the terminally ill individual cannot speak for him or herself and therefore lingers past the point of what is to them considered dignified. The goal is to examine, through a structured process what an incapacitated person truly wants in their current state rather than relying upon others to decide for them. Options are limited as they must choose either to live in their current state of potentially intractable pain and lingering terminal illness, or die with the aid of anaesthetizing medication, but prior to the enactment of this law in Oregon all parties were given only the first option, as legal. The second option was not a legal option and therefore if an individual chose to end their life prematurely their choice was limited to their own ability to commit suicide, through means other than medication, and without the assistance of anyone, including loved ones or a physician. Prior to this legitimization of physician-assisted suicide there was a situation associated with prosecution of any individual who knowingly assisted in the premature death of anyone, including a terminally ill person. Euthanasia is defined in contrast to physician-assisted suicide in that Euthanasia is generally thought of as the active administration of lethal means, or what some call mercy killing. In the case of Oregon's laws, as will be seen later physician-assisted suicide deems only that the physician provide the means for death, such as an overdose of medication, not be present or give the lethal medication, in fact administration is still considered illegal. Not to be confused sometimes the removal or denial of medical care or supportive care that is known to likely cause death is titled passive euthanasia. Physician-assisted suicide stands squarely in the middle, as the physician is knowingly prescribing medication that is taken will cause death, but is not administering the medication him or herself.

Suicide is frequently a drastic measure and can be associated with prolonged periods of grief as well as significant implications of for lack of a better term, clean up, in both a psychological and physical sense, for those left behind. (Mishara, 1995, p. 19) Proponents of the Oregon law contend that if people are allowed to commit suicide, under the described legal conditions this will lesson the event of violent suicides, that frequently occur, and especially among the elderly. (Marker, 2006) the scope of the Oregon policy is to remove responsibility of care and decision from someone other than the person actually living the experience of terminal illness, and reassert the rights of the individual to make his or her own life and death decisions. In one case in 1992 the following was a portion of the legal brief. This legal brief can serve as a solid example of the intentions of the law, not only is it to allow and individual to make ultimate life and death decisions for him or herself but also it is an attempt to reduce or eliminate legal responsibility for those who participate, including health care professionals and/or loved ones. The bid in Washington State to enact laws surrounding this brief has thus far become unsuccessful.

The patient plaintiffs made two claims: first, that they had a right to seek a physician's assistance with suicide without undue government interference, and second, that Washington's ban against assisted suicide unconstitutionally discriminated between assisted suicide and withholding or terminating lifesaving medical treatment. Plaintiffs from the Compassion organization claimed that the law put their staff members in jeopardy of criminal prosecution for assisting dying persons as they exercise their constitutional rights of choice in the face of imminent death. The physician plaintiffs alleged claims on behalf of their own patients, as well as on behalf of their own right to practice medicine according to their own consciences and professional judgments. (Hillyard & Dombrink, 2001, p. 126)

The scope of the Oregon law does not transfer to other individuals, such as those who might have vested interests in the termination of an individual's life. The scope is specific to the individual terminally ill patient, though there is a clear indication that others are affected by the decision the scope of the policy is to allow the individual, through a process to determine the desire, in a legal sense to die with the aide of anesthetizing medication. The laws text is as follows:

1) the patient must make two oral requests… READ MORE

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