J. Nelson – Writer

What it is and what it will do

Early voting starts tomorrow (Wednesday, Oct. 23), and along with all the candidates on the ballot, there is also a state constitutional amendment for voters to decide upon.

Amendment 1 is titled “Protection of persons against medically assisted suicide.” The full text reads as follows:

“No person, physician, or health care provider in the State of West Virginia shall participate in the practice of medically assisted suicide, euthanasia, or mercy killing of a person. Nothing in this section prohibits the administration or prescription of medication for the purpose of alleviating pain or discomfort while the patient’s condition follows its natural course; nor does anything in this section prohibit the withholding or withdrawing of life-sustaining treatment, as requested by the patient or the patient’s decision-maker, in accordance with State law. Further, nothing in this section prevents the State from providing capital punishment.”

There’s a lot happening there, so let’s break it down.

Let’s start with what this amendment is talking about. Medically assisted suicide or physician-assisted death is when a health care worker provides a terminally ill patient with a potentially lethal dose of a medication, at the patient’s request. This is related to a movement called “death with dignity” — a philosophy that individuals with chronic and ultimately fatal medical conditions should be allowed to control how and when they die. Common examples include people with terminal cancers (brain tumors or other inoperable cancers) but also degenerative diseases that steadily erode quality of life before becoming fatal.

Oregon became the first state to have a medically assisted suicide law in 1997. (It originally passed in 1994, but an injunction delayed its implementation until voters overwhelmingly reapproved it in 1997.) The “Death with Dignity Act” allows terminally ill patients to self-administer a lethal dose of medication prescribed by a physician for that purpose. In Oregon, a participating patient must be 18 years old or order, have the competence/capacity to make and communicate health care decisions for him/herself, and must have an illness or disease that will be terminal in 6 months or less.

Eight other states — California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Vermont, and Washington — as well as the District of Columbia allow for medically assisted suicide or physician assisted death, though the exact parameters vary by state.

It’s important to note that in legal terms, medically assisted suicide/death is different from euthanasia or mercy killing. According to the 2019 medical article “Pros and Cons of Physician Aid in Dying,” “Euthanasia, also called mercy killing, refers to the administration of a lethal medication to an incurably suffering patient. It may be voluntary (the patient requests it) or involuntary. Euthanasia is illegal in the United States, but voluntary euthanasia is legal in Belgium, Colombia, Luxembourg, and Canada. It is decriminalized in the Netherlands.”

Amendment 1 would be a blanket ban on all of those. To be clear, there is a difference (small though it may be) between medically assisted suicide/death and euthanasia. Medically assisted suicide/death requires the patient to administer the medication to themselves. In euthanasia, someone else administers the medication.

Now let’s talk about Amendment one itself.

The first part is the most important, but also the most confusing as far as whether you should vote yes or no: “No person, physician, or health care provider in the State of West Virginia shall participate in the practice of medically assisted suicide, euthanasia, or mercy killing of a person.”

Right now, medically assisted suicide/death is already illegal in West Virginia. This amendment wouldn’t change anything in that regard. What this amendment would do is make it virtually impossible to change that law, since repealing a constitutional amendment is significantly harder.

Euthanasia and mercy killing are already illegal. (Except within the context of the death penalty or capital punishment, in which case euthanasia by lethal injection is legal. We’ll come back to this in a minute.)

So, a vote for Amendment 1 means you agree that medically assisted suicide/death should be banned. A vote against Amendment 1 means you think that it should not be banned.

Yes = medically assisted suicide/death is BAD.

No = medically assisted suicide/death is OK.

The second part of Amendment 1 acknowledges where the amendment butts up against existing best practices for end of life care: “Nothing in this section prohibits the administration or prescription of medication for the purpose of alleviating pain or discomfort while the patient’s condition follows its natural course; nor does anything in this section prohibit the withholding or withdrawing of life-sustaining treatment, as requested by the patient or the patient’s decision-maker, in accordance with State law.”

In theory, this language should protect hospice/palliative care. Palliative care and hospice both focus on “the comfort, care, and quality of life of individuals with a serious illness,” but hospice is specifically for those at the end of their lives where palliative care can begin for at any point for someone experiencing a long-term or terminal illness.

Going on hospice means making the person comfortable for their final days, which usually administering pain medications like opioids or morphine. Many pain management medications can affect heart rates and respiration; higher doses, like those given to individuals in intense pain while on hospice, can slow breathing and heart rate. Such pain medications are never delivered in a lethal dose, but their side-effects may be more pronounced for someone whose body is already very weak.

Could end-of-life pain management, then, become prohibited if Amendment 1 passes?

One of the concerns about Amendment 1 is it could become like West Virginia’s — and many other states’ — abortion laws. In the abortion laws, technically there are exceptions for medically necessary procedures to save the life of the mother, but the uncertainty about what is and is not allowed frequently prevents health care workers from providing necessary services for fear of running afoul of the law. Similarly, this amendment could very well jeopardize hospice and palliative care in West Virginia by making health care workers worry about the legality of otherwise standard procedures.

Some have expressed concern that Amendment 1, in conjunction with the Legislature’s attempts to enshrine fetal personhood into law, could eliminate any and all exceptions to existing abortion law or prevent the state from enacting less strict abortion laws in the future.

Finally, the last part of Amendment 1: “Further, nothing in this section prevents the State from providing capital punishment.”

Capital punishment — the death penalty — has been outlawed in West Virginia since 1965, but the state Legislature made an unsuccessful push this during the last regular session to bring it back. This language in Amendment 1 keeps that door open for another attempt in the future.

I previously did some research on the death penalty and found out it actually costs the state significantly more than keeping someone in prison for life.

According to the 2016 analysis “The Death Penalty vs. Life Incarceration” (Susquehanna University Political Review): “Each death penalty inmate is approximately $1.12 million (2015 USD) more than a general population inmate.” (When adjusted for inflation, that’s $1.49 million in 2024 dollars.) The study explained, “This greater cost comes from more expensive living conditions, a much more extensive legal process, and increasing resistance to the death penalty from chemical manufacturers overseas. These costs could even become higher, pending the outcome of various lawsuits against various states for their ‘botched’ executions.”

The court costs are exponentially higher, as there is greater jury screening, much longer trials (about 6x longer than a life-sentence case), and multiple appeals. And the jail costs are also higher for a death penalty inmate: On average, death row inmates wait 15 years between sentence and execution, and most are kept in solitary confinement, which requires more resources (particularly in terms of staff) to guard.

The TL;DR: Medically assisted suicide/death or “death with dignity” for terminally ill individuals is already illegal in West Virginia, but Amendment 1 would make it virtually impossible for West Virginia to legalize it in the future. Amendment 1 could also jeopardize hospice and palliative care by making health care providers question the legality of otherwise standard end-of-life care measures. But Amendment 1 would not close the door on the death penalty, which the Legislature is trying to reinstate despite the fact it would cost taxpayers significantly more than keeping someone in prison for life.

Voting “Yes” or “For” = medically assisted suicide/death is BAD.

Voting “No” or “Against” = medically assisted suicide/death is OK.