Synopsis
Death With Dignity: Legalized Physician-Assisted Death in the United States 2011 by Stuart C. Goldberg is a detailed legal analysis of physician-assisted death as it existed in the United States at the time of the book’s publication, with a particular focus on the Oregon and Washington Death with Dignity Acts. Written by Goldberg, a former Assistant United States Attorney with three law degrees and extensive experience in securities law, the book reflects his personal interest in the subject, sparked by his diagnosis with aggressive prostate cancer. The work targets four distinct audiences: residents of Oregon and Washington seeking to understand their states’ laws, individuals in other jurisdictions interested in adopting similar legislation, those curious about the practical implementation of these laws based on Oregon’s 13 years and Washington’s two years of experience, and legislators looking for a template to craft Death with Dignity laws. Through a rigorous legal lens, Goldberg examines the scope, implementation, and broader implications of these acts, while also addressing the legal, ethical, and societal debates surrounding physician-assisted death.
The book begins by outlining the legal framework of the Oregon Death with Dignity Act, passed by voters in 1994 and implemented in 1997 after surviving legal challenges, and the Washington Death with Dignity Act, enacted in 2008. Goldberg details the specific requirements of these laws, which allow terminally ill adults with a prognosis of six months or less to live to request and self-administer lethal medication prescribed by a physician. He emphasizes the safeguards embedded in these statutes, such as the need for patients to be mentally competent, make voluntary requests, and undergo evaluations by two physicians, with mandatory waiting periods to prevent impulsive decisions. Drawing on his legal expertise, Goldberg explains how these laws were shaped by state-level advocacy and voter initiatives, and he provides a historical overview of their development, including the role of organizations like the Death with Dignity National Center in defending and promoting such legislation.
Goldberg then delves into the practical administration of these acts, offering insights into Oregon’s 13-year track record and Washington’s two-year experience by 2011. He analyzes data from annual reports, such as those from the Oregon Health Authority, to highlight trends in patient demographics, motivations (e.g., loss of autonomy, dignity, or unbearable pain), and the types of medications used, typically barbiturates like secobarbital. He notes the relatively low utilization rates—less than 1% of deaths in Oregon annually—underscoring that the option is rarely exercised but highly valued by those who choose it. Goldberg also addresses the procedural aspects, such as the requirement for patients to self-administer the medication, distinguishing physician-assisted death from euthanasia, which is illegal in the U.S. His analysis includes real-world challenges, such as ensuring access to willing physicians and navigating objections from medical professionals or institutions, particularly given the American Medical Association’s opposition to the practice at the time.
A significant portion of the book is devoted to the legal and ethical arguments for and against physician-assisted death, with a focus on U.S. Supreme Court cases that have shaped the debate. Goldberg discusses Washington v. Glucksberg (1997) and Vacco v. Quill (1997), where the Court ruled that there is no constitutional right to physician-assisted death but left the issue to state discretion, paving the way for laws like Oregon’s. He also examines Gonzales v. Oregon (2006), where the Court upheld Oregon’s law against a challenge by the federal government, which sought to penalize physicians under the Controlled Substances Act. Goldberg presents the arguments of proponents, who emphasize patient autonomy and relief from suffering, and opponents, who raise concerns about potential abuse, coercion, or a “slippery slope” toward broader euthanasia practices, drawing parallels to experiences in the Netherlands. His legal background shines through in his careful dissection of these arguments, grounding them in judicial opinions and constitutional principles.
Finally, Goldberg offers a roadmap for other states interested in adopting Death with Dignity laws, using Oregon and Washington as models. He provides a template for legislation, outlining key provisions like eligibility criteria, procedural safeguards, and reporting requirements to ensure transparency and accountability. He also addresses the broader societal implications, such as the need for improved palliative care and public education to destigmatize end-of-life choices. While acknowledging opposition from religious groups and some medical professionals, Goldberg argues that the Oregon and Washington experiences demonstrate that physician-assisted death can be implemented safely and ethically, with minimal evidence of abuse. Written in a clear, accessible style, the book combines legal scholarship with practical guidance, making it a valuable resource for advocates, policymakers, and individuals navigating terminal illness. Its focus on real-world data and legal precedents provides a compelling case for expanding access to physician-assisted death while respecting the complexities of the issue.