By Gov. Booth Gardner
Earlier this year (2006), when I said I would work to pass a Washington aid-in-dying law, letters and calls offering to help came cascading in. I shouldn't have been surprised.
As in the rest of the country, Washington residents strongly favor giving terminally ill people the choice to get a prescription for life-ending medication. A 2005 national Gallup poll showed as many as 75 percent would support making this choice legal. A 2006 Field Poll in California gave the numbers supporting aid-in-dying legislation as 70 percent of all adults and 69 percent of registered voters. Both Gallup and Field polls, which have tracked this issue over many years, have documented growing support for this type of legislation.
These numbers should attract a lot of support by politicians. Ballot measures for aid-in-dying laws should face easy sledding. But this has not been the case. Efforts to enact measures that would provide legal access to such assistance have been rare and, with the exception of Oregon's effort, unsuccessful.
In 1991 Washington was the first state in which the issue appeared on a ballot. It lost narrowly. Since then, voters in four other states (California, Michigan, Oregon and Maine) have considered the issue and-except in Oregon-defeated it. In addition, serious efforts to enact aid-in-dying legislation have been made in legislatures, including those in Vermont, Hawaii and California, but have failed to reach a final vote.
What's going on here? Why is a seemingly winning idea so unsuccessful in the political realm?
Part of the problem, of course, is that the opposition to such measures is determined and well financed. When it chooses to act on matters such as this, the Catholic Church brings its vast resources to bear very effectively. While proponents of providing this choice may resent the church's vigorous involvement in these campaigns, there is no doubt of the deeply held religious convictions behind its actions.
But polling shows that a large majority of Americans do not agree with the church on this matter. In fact, polls show that majorities or near majorities of people who identify themselves as Catholics do not agree with church doctrine on this issue. This fact is evident in the opposition campaigns financed by the church that do not rely on religious arguments but, rather, on sowing doubt in the minds of voters and politicians about how such laws would actually work.
This makes sense to me.
Nearly everyone knows someone who has suffered terribly as certain death relentlessly approached. This is the major reason why people favor giving such individuals and their doctors the legal option to prescribe life-ending medications. It is a humanitarian thing to do. This widespread, practical knowledge of the suffering faced by dying people explains the strong initial support given to aid-in-dying measures.
Yet these same humanitarian impulses lead to erosion of support when opponents publicize scenarios that suggest the measure could be used in exploitive or abusive ways. It is not hard to understand the power of opposition commercials that feature apparently vulnerable individuals who plead with voters to reject the law because they fear it could be used to kill them. These images do not have to be grounded in reality to raise doubts and worries.
People will not vote for a law that might be used by greedy heirs to pressure elderly people to end their lives early or that might be used to end the burden of caring for people with disabilities. The opposition is expert at raising doubts about whether such abuses might occur, persuading enough people to change their minds that strong supportive majorities are reduced, and the measures either win or lose by the slimmest margins. Essentially, the campaigns for and against aid-in-dying measures play themselves out with competing versions of what is right from a humanitarian point of view. the 'it could happen' ARgument
As we prepare for another attempt in Washington to adopt an aid-in-dying law, we have to anticipate and deal with the concerns we know will be raised by opponents. We have to show how safeguards will prevent abuse and provide a realistic picture of how and when the provisions of the law will be used.
Fortunately, we can look to the experience in Oregon to know that concerns about opening a suicide floodgate are not grounded in real-life experience. In its eight years on the books, Oregon's Death with Dignity law has been used by fewer than 300 people who actually received and used prescriptions for life-ending medicines.
We can also look at the details of how the law has been applied in individual cases. Each case is documented and reported to the state. Year after year, these reports show that the law is being used as intended.
Unfortunately, even if we take the Oregon statute word for word and cite chapter and verse of its actual use, we would still face an opposition using the same tactics to raise doubts. They may find a case or two in Oregon in which surviving family members believe their dying relative should not have been allowed to use the law. They may argue that the Oregon reporting system is not adequate to know what is really happening. They may raise the same basic doubts, even if it means distorting the Oregon experience, about an aid-in-dying law for Washington.
Whether the provisions of a Washington aid-in-dying law are the same as those of the Oregon Death with Dignity Act or somewhat different, the proposed law must provide a credible approach to preventing abuse. But we cannot expect that any safeguards we include will be immune from the opposition's "it could happen" scenarios, which are intended to raise fear and doubt.
Staying Focused
I believe a successful campaign for an aid-in-dying law must be primarily focused on the problems it will solve.
We need to focus on what end-of-life suffering means for the individuals and their families who are experiencing it. The focus on suffering should not be confined simply to pain but extend to other factors that could lead a dying individual to seek assistance in hastening his or her end. When people get ready to vote, they should be thinking about how people they know have suffered at the end of their lives so these voters may understand that their support is a gift of choice to others who may end up in the same situation.
We also need to have an honest conversation about what is really happening today in these situations. We know, for example, that it is commonplace for physicians to be asked by dying patients for assistance in ending their suffering. While such assistance is rarely acknowledged, we know it is given as a merciful act by some physicians. Because such acts are considered illegal, they are not spoken about openly, even with family members and friends.
By comparison, in Oregon, where a patient has the choice to request life-ending medication, patients and their families can have open discussions with doctors, hospice workers and others without worrying that they are doing something wrong.
It is not surprising that surveys show a lower number of terminally ill people receiving assistance in hastening their death in Oregon than elsewhere in the country. Confidential surveys of physicians suggest that the rate may be as little as half as high in Oregon, where the act is legal, as in other states where it is not.
Again, this makes sense. An aid-in-dying law gets everything on the table for patients, families and medical providers. A patient is given the chance to describe his or her needs. When families and providers work with patients to meet these needs, it shouldn't be a surprise that options other than a hastened death are often pursued.
An Inclusive Approach
I believe the best way to craft a Washington aid-in-dying law is to involve as many individuals and groups as possible with an interest in making sure it will work properly.
This will mean reaching out to seniors' organizations to make sure the concerns of elderly people will be heard and incorporated in safeguards against abuse.
It will mean having conversations with organizations such as those that represent people with disabilities to make sure the law is written so that no third party could ever use its provisions to end another person's life.
We will need to work with hospice-care providers and patient advocates to be certain that patients have access to every kind of palliative care to ease their suffering and do not feel that ending their lives is their only option.
Following this path, I believe we can and will develop a humane, carefully drawn proposal that will withstand the scare tactics and distortions that will inevitably be used by the opposition. Whether it is a mirror image of Oregon's law or somewhat different, I am confident Washington state will soon provide this important choice to its residents when they are suffering at the end of their lives. L&P
-Booth Gardner, who was governor of Washington state from 1985 to 1993, was diagnosed 14 years ago with Parkinson's disease. He announced last February that he had one more charge to lead: a campaign for an aid-in-dying law in Washington state, most likely through a citizens initiative. Gardner, 70, recently underwent brain surgery in an attempt to control his symptoms.
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