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Americas

US takes different path from Europe on end-of-life laws

As Germans consider end-of-life legislation, so-called "death with dignity" laws are set to expand in the United States. Miriam Widman reports from Portland, Oregon, one of the first places to allow the right to die.

Judith Meller had no control over her life during much of her key teenage years.

Born in 1930 in a small village in Czechoslovakia, she had just finished sixth grade and was 13 when the Nazis deported her and her family to Auschwitz in 1944.

When the war ended that next May, Meller was the only one of her family of seven left alive. She had avoided being chosen for the medical experiments in the camp because of her blue eyes and survived the death marches to western Germany.

So 60 years later when she was seriously ill with liver disease and living in Portland, Oregon, in the northwestern United States, Meller knew she didn't want to waste away.

"I didn't have any control over my life in the camps," she told me shortly before she died. "That is not going to happen to me again."

Meller became one of 37 people in 2004 to take advantage of Oregon's groundbreaking Death with Dignity Act, which became law in 1997. Between 1998 and 2014 859 people have died after taking advantage of the law.

Judith Meller (left) and Rikki Schoenthal

Meller (left, with daughter Rikki) wanted to keep control of her death

The Oregon law was the first in the United States and was used as a model for similar laws adopted in Washington, Vermont and

California.

At least a dozen other states have legislation in the works.

Focus on patients rather than doctors

There have been many inquiries from Europe about the Oregon law, according to Sean Crowley, the spokesman for Compassion and Choices, the national "death with dignity" organization based in Denver.

The British have been particularly interested in the statute, he said, noting that Barbara Coombs Lee, the non-profit organization's president and driving force behind the Oregon law, has testified before UK lawmakers.

Still that wasn't enough to pass a bill in the House of Commons, which resoundingly defeated a proposal this September by a vote of 330 to 118 - despite polls showing that an overwhelming majority of British voters favor the measure.

American supporters of what is known here as "death with dignity" emphasize that the Oregon law and others in the United States are fundamentally different from existing European legislation, such as laws in Switzerland and the Netherlands.

The American laws are patient-centered, said Crowley, while the European laws are physician-centered.

Young hands grip the wrists of an older person lying in a bed

Americans tend to be wary of leaving decisions to their doctors

Under the Oregon law, for example, a patient must initiate the request - it cannot come from the doctor. The patient must be of sound mind. If the physician is unsure, a psychological evaluation is required. The law calls for a second opinion.

The patient must also be capable of taking the medication by him or herself. Those who are incapacitated to the point that they are not capable of doing this are excluded from the law.

This is a problem, supporters admit, as it excludes those with dementia who are incapable of initiating the request on their own. But the "death with dignity" law was not meant to solve all problems, they say.

European legislation puts the doctor in the driver's seat

for the most part.

Cultural differences

Some of this is cultural, admits Jason Renaud, who works in research and development for the Oregon chapter of Compassion and Choices.

"It's a very different moral atmosphere over there," Renaud said. "I've talked to a lot of northern Europeans and they trust their doctors. They'll say: 'He's my friend and colleague, and if I can't make those decisions I'll let my doctor do it.'

"I don't know any American who would let any doctor do that."

The language used on the different sides of the Atlantic also varies. American supporters are quick to point out that "Death with Dignity" is not euthanasia, which remains illegal in the United States. They also don't use the term "physician-assisted suicide," which is often employed in Europe, or "dying aid," the literal translation of the German term Sterbehilfe.

Death certificates of those who have passed via the law do not give suicide as the cause of death, Crowley stressed, but rather list the underlying cause of death. For example, if a patient suffering from terminal colon cancer opted to take the drugs to end his life, the cause of death would be listed as colon cancer.

What counts in the end is the result

For Rikki Schoenthal, Judith Meller's daughter, the legal innuendos are one thing. The law in practice is another.

There was a striking difference between how her mother and father died, and Schoenthal and others firmly believe there is such a thing as a "good death."

Samuel Schoenthal

Samuel Schoenthal died half a year after Judith Meller

Her father, Samuel Schoenthal, was also Jewish and was a slave laborer during World War, ending up in the Sachsenhausen concentration camp just north of Berlin.

Once a very physically strong person, he contracted gallbladder cancer and went to an orthodox Jewish physician who believed it was a doctor's responsibility to fight the cancer, no matter how it affected his patient. Her father received chemotherapy treatment, became very sick, lost a lot of weight, lost control of some bodily functions and looked like a cadaver before his death in 2005, his daughter Rikki said.

"My mother couldn't stand that indignity," she said. "There was a huge contrast in their deaths."

For her mother Judith, taking advantage of Oregon's Death with Dignity law was like cheating death again. First in Auschwitz, then in Portland.

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