End of Life Care in the District: Campus Reacts to Death With Dignity Act

End of Life Care in the District: Campus Reacts to Death With Dignity Act

By:
03/17/2017

More than two years after it was introduced, Washington, D.C.’s B21-0038, titled the “Death with Dignity Act of 2015,” became law in the District last month.

With its passage, adult residents of the District who have been diagnosed with an illness, the prognosis of which gives them less than six months to live, may request from their physician a prescription for a lethal dose of medicine which allows them to end their own lives.

Given the additional choices the law presents to patients and their physicians for end-of-life care, the Medstar Georgetown University Hospital, Georgetown University School of Medicine, and Georgetown student body face a new set of ethical considerations in deciding what medical procedures they practice, teach, and learn.

Those who oppose the legislation have remained vocal across the nation, the Hilltop being no exception. Georgetown Right to Life, which describes itself on its website as “a student organization dedicated to protecting human life from conception to natural death,” has taken an active stance against the law since its introduction.

Georgetown Right to Life opposes abortion, the death penalty, and allowing terminally ill patients to end their own lives, according to the group’s mission statement. “We clump these together as our three main issues because we believe that, [in each case]death is being used as an answer to society’s problems, instead of finding more life-affirming ways,” Vice President MyLan Metzger (COL ‘19) said. “Better Medicaid options and better palliative end-of-life care are things that we would see as a better response.”The group is a perpetual sponsor of the Cardinal O’Connor Conference on Life, the largest student-organized pro-life conference in America, which includes speakers and breakout sessions that cover topics including terminally ill patients ending their own lives.

Additionally, in 2015 and 2016, Georgetown Right to Life organized Georgetown students to call Ward 2 Councilman Jack Evans, urging him to vote against the bill. Evans eventually voted in favor of the final version.

B21-0038 was introduced by Ward 3 Councilwoman Mary Cheh on Jan. 14, 2015. The bill passed after two amendments, on Nov. 15, 2016 by a vote of 11-2, and Mayor Muriel Bowser signed it on Dec. 19, 2016. The act was then submitted to the U.S. Congress, which, under the federal “Home Rule Act of 1973,” can review any legislation passed by the D.C. Council.

Only three bills have been formally rejected over the last 45 years, but the House Oversight and Government Reform Committee, led by chairman Jason Chaffetz, R-Utah, tried to make Death with Dignity Act the fourth. However, the attempt to block the legislation ran short on time, as the motion would have needed to clear the House floor and the Senate, as well as be signed by President Donald Trump within 30 legislative days of being submitted to Congress.

At a White House press conference, Press Secretary Sean Spicer declined to comment on what action Trump would have taken if presented with the disapproval legislation.

The law’s use of the phrase “death with dignity” roots in the wider national advocacy movement. Those who oppose the law, however, prefer the language “physician-assisted suicide.”

The association of the death penalty, abortion, and terminally ill patients ending their own lives often comes from the Catholic theological principle of the consistent life ethic. Pope John Paul II wrote about this ethic and “the sacred value of human life from its very beginning until its end” in the Evangelium Vitae in 1995.

Given Georgetown’s Catholic identity, the university and its associated institutions have considered how to respond to the law with their founding ideals in mind.

Georgetown University sold the Georgetown University Hospital to MedStar in 2000. Despite the merger, the hospital retains its Catholic identity, and still provides care in accordance with the Ethical and Religious Directives for Catholic Health Care Services, a guide published by the United States Conference of Catholic Bishops.

In accordance with these principles, the hospital does not provide services such as in vitro fertilization and abortion, nonprofit organization Catholics for Choice wrote on their website. According to Kevin Donovan, M. D., director of the Edmund D. Pellegrino Center for Clinical Bioethics, the hospital will not provide means for terminally ill patients to end their own lives as part of their care. Services that indirectly shorten the life of the patient are still permitted, but only with the intent to ease suffering, keeping with the Ethical and Religious Directives.

“The medical profession has never been encouraged or allowed to actually kill patients who are suffering. We certainly will stop treatments that are no longer benefiting them, we allow people to die under those circumstances, but we don’t push them over the edge,” Donovan said. “Physicians have a long-standing principle, long-standing being 2500 years, that we should not harm our patients.”

The American Medical Association, the leading association of physicians in the United States, does not support laws that allow terminally ill patients to end their own lives.While MedStar permits the Georgetown University Hospital to set limits on care to meet the Ethical and Religious Directives, many of the medical professionals at the hospital are not employees of the hospital itself, but rather doctors who only practice there. Many also practice in other locations in the District that are not subject to the guidelines that the Church sets forth. As a result, a patient receiving care at the hospital still could be cared for by a physician willing to provide services permitted by the Death with Dignity Act at another facility.

Outside MedStar, students grapple academically with the issue of terminally ill patients ending their own lives at the Georgetown University Medical Center, the umbrella organization that includes the School of Medicine, the School of Nursing and Health, the Georgetown Lombardi Comprehensive Cancer Center, and Biomedical Graduate Research and Education programs.

Medical students and residents at Georgetown are subject to the Ethical and Religious Directives in their educations, however, those who study bioethics, from the undergraduate to the graduate level, continue to discuss the issue, Donovan said.

Donovan also noted that many arguments against the law are not rooted in Catholic theology.

“Physician assisted suicide is still suicide,” Donovan said. “It’s a very scary proposition, to say that basically we are going to carve out people who we recognize no longer have lives worthy of living, and as a matter of law, we can help in their suicide even though we shouldn’t be doing that for the population at large.”

Donovan worries that the six-month cutoff is too arbitrary. “Why should that be the restricting factor of the law?” he said. “If we want to respect autonomy, then why shouldn’t it be nine months? Why shouldn’t it be 12 months? In fact, if you want to respect autonomy, then why do we tell these patients they have to be terminally ill?”

Despite resistance, this legislation comes as a relief to many in D.C. Mary Klein, a retired journalist who lives in the District, has been diagnosed with terminal ovarian cancer. Since the introduction of the bill, she has become one of its most outspoken proponents.

“I will die either from the effects of additional treatments or from treatment side effects combined with the cancer,” Klein wrote in an essay published by the Death with Dignity National Center, a leading national nonprofit that advocates for legislation that allows terminally ill patients to end their own lives. “I will suffer, probably a lot, and I’m unlikely to have a peaceful death. … The treatment will be continuous for the rest of my life. Because of the drugs’ side effects, I will never feel completely well again. If I had the option of a peaceful death, a death with dignity, I might not use it, but it would bring me great comfort to know it is there.”

Advocates across the country share Klein’s sentiments: patients should have the freedom to make personal medical decisions and alleviate suffering. Klein wrote that she and other patients should have the right to choose if they wish to die without suffering caused by illness.

“By adding a voluntary option to the continuum of end-of-life care, these laws give patients dignity, control, and peace of mind during their final days with family and loved ones,” the Death with Dignity National Center published on their website.Many outside the District agree with Klein. In 2015, a Gallup poll found that 68 percent of Americans believe that the terminally ill should be allowed to end their lives.

H*yas for Choice, a self-described “pro-choice” organization that has supported D.C. statehood and home rule in the past declined to comment on the law, as they have not specifically focused on the issue of terminally ill patients ending their own lives.

Despite mixed reactions, the Death with Dignity Act opens new options within D.C. As it stands, residents of all corners of the District will have to engage with this topic and come to a conclusion that meets their own moral code.

Image Credits: Graphic by Jake Glass

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Alex Lewontin

Alex Lewontin Award-winning journalist, apparently.


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