Oregon Death With Dignity Act: A Policy Analysis

Introduction

The Oregon Death With Dignity Act can be analyzed through David Gil's Policy Analysis Framework (Gil, 1976, pp. 31–56). Gil's framework consists of three main objectives: (1) issues constituting the focus of the policy, including its nature, scope, and theory; (2) the objectives, values, and ideological orientation of the policy, including underlying theories, the target population and the manner in which it is affected, financial costs and benefits, quality of life, historical background, and the size, resources, and values of the group supporting the policy; and (3) alternatives to the policy (Gil, 1992). Policy analysis is an essential tool for understanding 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 has evolved as a cultural ideology, 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. A policy analysis is a first step in understanding the issue as a whole.

Though policy analysis is a substantial informative tool for understanding any given social or legal policy, in this case the analysis raises as many questions as it answers. The Oregon Death With Dignity Act is illuminated and better understood through this framework, yet it also gives rise to ideological, ethical, and moral dilemmas. These include concerns specific to the policy itself — such as the fear of Oregon becoming a destination for death — and concerns specific to the ideology surrounding suicide and euthanasia, such as the apparent contradiction between efforts to prevent suicide and laws that legalize it and reduce culpability for those who participate within the law's guidelines. In short, Gil's policy analysis framework serves both purposes: to illuminate the policy and to raise important social questions surrounding it.

Like prior reformers who successfully argued and mobilized for changes in abortion, gambling, or marijuana laws, proponents of euthanasia legal reform have argued that the use of morphine at the end of life constitutes 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 rather than cause death. Activist physicians such as Quill aim to bring secret practices into the open, employing a classic argument for converting a de facto practice into a de jure legalized or decriminalized one. In the words of a New York Times editorial, it is only a matter of sanctioning what already happens with a "wink and a nod" ("Assisted Suicide and the Law," 1997, p. A12). Even Congress's Pain Relief Promotion Act of 1999, which undermined Oregon's assisted suicide law, sanctioned the principle of double effect. To date, the authority to define the distinction between killing and letting die has been kept within the boundaries of the medical profession — what sociologists of law call the "medicalized" approach — and this medicalized approach to laws regulating hastened death closely parallels abortion law before Roe v. Wade (1973) (Hillyard & Dombrink, 2001, p. 22).

The foundational debate will likely continue, and this work demonstrates how a clear policy analysis can detail many of the issues surrounding the Oregon Death With Dignity Act and the broader assisted suicide and 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 carries both positive and negative effects that will remain part of the fabric of any civil rights action throughout the nation's history.