And that raises an interesting catch-22 when it comes to death-with-dignity laws: Maynard might not have seemed, to some, like she was ready to die, because most terminally ill people who seek assisted suicide are depressed. But depression also makes physicians less likely to prescribe the lethal medications that would allow terminally ill patients to die by their own hand.
Oregon has the longest-standing aid-in-dying law in the U.S., but since it was enacted in 1997, just 752 people have taken their own lives under the law, or .2 percent of all deaths in the state during that time, as Vox points out. For a patient to receive the lethal medication in Oregon, he or she must have a terminal diagnosis, confirmed by two doctors, and have only six months to live. The patient can't have an underlying mental-health issue, and his or her request must be verified by two witnesses. Patients must make one request for the medications in writing and one orally, and there's a 15-day waiting period in between the two requests.
Oregon physicians reject five out of six requests for the lethal medication.
One reason: Physician-assisted suicide requests are less likely to be honored if the patient sees themselves as a burden or if they're depressed. But because feeling unwanted and suicidal ideation can be two symptoms of depression, physicians may have difficulty knowing whether the patient would have a change of heart if their mental state improved. Does the patient want to die because they're depressed, or because they're terminally ill—or some combination?
In a study that compared 55 Oregonians who had requested physician-assisted suicide with 39 terminally ill people who did not request the medications, those seeking suicide were more likely to be depressed, hopeless, not spiritual, and self-reliant. As the bioethicist Ezekiel Emanuel wrote in The Atlantic in 1997, patients who are depressed are likely to seek physician-assisted suicide; patients who are in pain are not.
"More than a third of the patients requested assistance with suicide because they perceived themselves as a burden to others, but only three of these patients received prescriptions for lethal medications," a 2000 study of the Oregon law found, "suggesting that the physicians were reluctant to accede to requests for assistance under these circumstances."
The doctors' selectiveness is merited: 11 percent of the patients who were either medicated for depression or evaluated by a mental health expert changed their minds about wanting to kill themselves. That's a small percentage, in terms of a clinical study. It's a large percentage, in terms of an irreversible, life-or-death decision.
Then again, while depression can be treated, things like a lack of spirituality or a self-reliant lifestyle can't exactly be medicated away.