How Does Assisted Suicide Work?

A guide to “Death With Dignity” in Oregon.

The U.S. Supreme Court took up the issue of assisted suicide on Wednesday as it heard arguments in the case of Gonzales v. Oregon. The Bush administration has challenged an Oregon law that lets physicians prescribe lethal medication to terminally ill patients. How does assisted suicide work?

The patient has to ask for it three times. According to Oregon’s “Death With Dignity” law, only certain people can ask for lethal medication from their doctors. You must be at least 18 years old, an Oregon resident, and the victim of a terminal disease that will kill you within the next six months. You also have to be able to make and communicate a clearheaded decision to your doctor.

The first step is to make a “formal oral request.” Advocacy groups that work with terminal patients suggest something like, “Doctor, will you assist me in using Oregon’s Death With Dignity law?” At least 15 days later, you need to make another oral request. The doctor still won’t be able to prescribe lethal drugs until you file a written request form signed by two witnesses.

Many people who are considering assisted suicide contact a patient-advocacy group for help with the procedure and paperwork. Such a group can help to screen out people who are ineligible for assisted suicide, but a doctor makes the final decisions. If she thinks the patient may have a psychiatric or psychological disorder, she can refer him for evaluation and treatment. The doctor also must tell him about alternatives like hospice care, advise him to confer with his family or next of kin, and remind him that it’s OK to change his mind at any time. By law, a second physician must review the case and sign off on the first doctor’s diagnosis.

A doctor can prescribe lethal drugs two days after receiving a written request, but under no circumstances can she administer them herself. That would be euthanasia, which is illegal in Oregon. The state’s assisted-suicide laws mandate that the patient take the drugs himself. Almost all assisted suicides take place in the home, with at least one health-care worker present. The patient takes one of two kinds of barbiturates. Seconal costs about $125 for a lethal 10 gram dose, which comes in the form of 100 individual caplets that must be broken apart to produce about three tablespoons of powder. Nembutal comes in a more convenient liquid form. It costs more than $1,000 for a dose, though, and insurance almost never covers lethal drugs.

If the patient is using Seconal, it’s either mixed in water to create a bitter drink or stirred into pudding or applesauce to hide the taste. The patient will slip into a coma about five minutes after taking the drug, with death coming within about half an hour. If you’re in pretty good shape, or if you’re especially fat, death can be delayed for up to 48 hours. In most cases, the time of death is determined by a health-care provider who checks your pulse every few minutes until you pass away.

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Explainer thanks George Eighmey of Compassion in Dying of Oregon.