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North Carolina's End of Life Option Act

North Carolina is considering a death with dignity law that would allow terminally ill patients to request life-ending medication.

In recent years there has been a dramatic increase in the number of states considering death with dignity laws. Sometimes called "assisted suicide" or "right to die" initiatives, these laws make it possible for terminally ill patients to use prescribed medication to end their lives peacefully rather than suffering a painful and protracted death.

The catalyst for greater national attention to this issue was 29-year-old Brittany Maynard, a woman diagnosed with terminal brain cancer who moved from California to Oregon to end her life in 2014. Maynard chose Oregon because California had not yet passed its death with dignity law, and Oregon was one of the few states that allowed terminally ill patients to receive aid in dying.

Spurred by Maynard's decision and the resulting publicity, North Carolina legislators introduced a death with dignity bill for the first time in 2015. That bill and others introduced in 2017 and 2019 failed to pass. Now in the 2021-2022 legislative session, the General Assembly is considering another aid-in-dying bill, HB780, called the North Carolina End of Life Option Act, that would allow terminally ill patients who meet certain requirements to request life-ending medication.

This article first clarifies some confusing language related to death with dignity laws and then sets out the basics of North Carolina's proposed law.

Death With Dignity, Assisted Suicide, Right to Die: What's In a Name?

"Death with dignity" is one of the most commonly accepted phrases describing the process by which a terminally ill person ingests prescribed medication to hasten death. Many people still think of this process as "assisted suicide" or "physician assisted suicide." However, proponents of death with dignity argue that the term "suicide" doesn't apply to terminally ill people who would prefer to live but, facing certain death within months, choose a more gentle way of dying. In fact, North Carolina's proposed law states that terminating one's life under the law is not suicide. (See HB780, Section 90-326.10.)

Increasingly, health organizations are turning away from the term "suicide" to describe a terminally ill patient's choice to reduce the suffering of an inevitable death. The phrase "aid in dying" is becoming a more accepted way to refer to this process.

You may also see the phrase "right to die" used in place of "death with dignity." However, "right to die" is more accurately used in the context of directing one's own medical care—that is, refusing life-sustaining treatment such as a respirator or feeding tubes when permanently unconscious or close to death. You can provide your own health care directions by completing a North Carolina advance health care directive. (See the end of this article for more information.)

An Overview of North Carolina's End of Life Option Act

North Carolina's proposed law is modeled closely on Oregon's Death With Dignity Act, which took effect in 1997. If North Carolina's law passes, a patient requesting aid-in-dying medication will have to be:

  • at least 18 years old
  • a North Carolina resident
  • mentally capable of making and communicating health care decisions, and
  • diagnosed with a terminal disease that will result in death within six months.

A patient who meets the requirements above will be prescribed aid-in-dying medication only if:

  • The patient makes a verbal request to their doctor.
  • At least seven seven days after making the verbal request, the patient gives a written request to the doctor, signed in front of two qualified, adult witnesses. (The law sets out the specific form that the patient must use.)
  • The patient undergoes an evaluation to determine their eligibility for hospice care.
  • The prescribing doctor confirms the patient's diagnosis and prognosis.
  • The prescribing doctor determines that the patient is capable of making medical decisions.
  • The patient has a psychological examination, if the prescribing doctor feels the patient's judgment is impaired.
  • The prescribing doctor confirms that the patient is not being coerced or unduly influenced by others when making the request.
  • The prescribing doctor informs the patient of any feasible alternatives to the medication, including care to relieve pain and keep the patient comfortable.
  • The prescribing doctor asks the patient to notify their next of kin of the prescription request.
  • The prescribing doctor offers the patient the opportunity to withdraw the request for aid-in-dying medication before granting the prescription.

To use the medication, the patient must be able to ingest it on their own. A doctor or other person who administers the lethal medication may face criminal charges.

In addition, no other person—such as a health care agent, attorney-in-fact, surrogate, or conservator—may make a request for aid-in-dying medication on behalf of the patient. And the proposed law prohibits patients from including a request for aid-in-dying medication in an advance health care directive or power of attorney.

You can read the full text of North Carolina's End of Life Option Act on North Carolina's General Assembly website.

Learn More

To find out more about the history and current status of death with dignity laws in the United States, visit the website of the Death With Dignity National Center.

For information about appointing a health care agent and making known your own wishes for medical care at the end of life, see the Living Wills & Medical Powers of Attorney section of Nolo.com.

Updated May 7, 2021

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