A n 9 1 n 0 9 iv th 2 er 3 sa -2 r 0 y 1 Res earc her 3 Published by CQ Press, an Imprint of SAGE Publications, Inc. CQ www.cqresearcher.com Assisted Suicide Should doctors be allowed to help terminally ill patients die?

ec isions about sustaining life, allowing it to end or even hastening death are among the most difficult choices terminally ill patients and their families D can face. Such decisions also are at the heart of a debate about what is commonly called “physician-assisted suicide” — or “aid-in-dying” by supporters. Oregon and Washington — and now likely Vermont — allow physicians to write a prescription for lethal drugs if requested by someone who is terminally ill and Vermont nurse Lynne Caulfield, whose husband Jack (pictured) died of cancer, opposes physician-assisted mentally competent. A Montana court also has allowed the proce - suicide. “It is a sad day when our lawyers are asking health care professionals to help [people] die rather dure. Supporters of assisted suicide say it allows the terminally ill than extending compassionate care to ease pain and suffering,” she told state lawmakers, who approved the procedure on May 13. to avoid unnecessary suffering and meet death on their own terms, and they say safeguards in the laws prevent abuse of the procedure. I But opponents say assisted suicide devalues life, opens patients to N THIS REPORT S exploitation by relatives or others and could lead to widespread THE ISSUES ...... 451 I euthanasia of the sick and vulnerable. BACKGROUND ...... 458 D CHRONOLOGY ...... 459 E CURRENT SITUATION ...... 463 CQ Researcher • May 17, 2013 • www.cqresearcher.com AT ISSUE ...... 465 Volume 23, Number 19 • Pages 449-472 OUTLOOK ...... 466 RECIPIENT OF SOCIETY OF PROFESSIONAL JOURNALISTS AWARD FOR BIBLIOGRAPHY ...... 469 EXCELLENCE N AMERICAN BAR ASSOCIATION SILVER GAVEL AWARD THE NEXT STEP ...... 470 ASSISTED SUICIDE CQ Re search er May 17, 2013 THE ISSUES OUTLOOK Volume 23, Number 19 MANAGING EDITOR: Thomas J. Billitteri • Do the terminally ill Young Movement [email protected] 451 have a right to choose 466 The future of physician-assisted suicide will depend on med - ASSISTANT MANAGING EDITOR: Kathy Koch when to end their lives? [email protected] • Does permitting assisted ical advances, the aging of suicide lead to abuse? baby boomers and religious SENIOR CONTRIBUTING EDITOR: beliefs. Thomas J. Colin • Do physicians’ ethics [email protected] codes prevent doctors from helping patients die? SIDEBARS AND GRAPHICS ASSOCIATE EDITOR: Kenneth Jost STAFF WRITER: Marcia Clemmitt ACKGROUND B Physician-Assisted Suicides CONTRIBUTING WRITERS: Sarah Glazer, 452 Rise Under Oregon Law Peter Katel , Reed Karaim, Robert Kiener, ‘Robes of the Executioner’ Seventy-seven took their own Barbara Mantel, Tom Price, Jennifer Weeks 458 Assisted suicide has had lives in 2012. many controversial figures. SENIOR PROJECT EDITOR: Olu B. Davis Americans Slightly Divided ASSISTANT EDITOR: Darrell Dela Rosa 453 on Assisted Suicide Battle in the States FACT CHECKER: Michelle Harris 461 Several states have pushed Forty-five percent find it morally acceptable; 48 per - for right-to-die laws; cent find it morally wrong. Oregon, Washington and now likely Vermont have Cancer Most Prevalent enacted statutes. 456 Malady in Oregon Cases Three-quarters of those who An Imprint of SAGE Publications, Inc. Global Measures used assisted suicide in 2012 462 VICE PRESIDENT AND EDITORIAL DIRECTOR, The Netherlands, Switzer - had the disease. HIGHER EDUCATION GROUP: land, Belgium and Luxem - Michele Sordi bourg have legalized Chronology 459 Key events since 1967. EXECUTIVE DIRECTOR, ONLINE LIBRARY AND physician-assisted suicide. REFERENCE PUBLISHING: Researchers Seek Advances Todd Baldwin 460 in Pain Management CURRENT SITUATION Copyright © 2013 CQ Press, an Imprint of SAGE Pub - “Death isn’t a medical lications, Inc. SAGE reserves all copyright and other condition.” Landmark Legislation rights herein, unless pre vi ous ly spec i fied in writing. No part of this publication may be reproduced 463 Several states are taking At Issue: steps to pass laws similar 465 Should the terminally ill have electronically or otherwise, without prior written to Oregon’s Death With the right to assisted suicide? permission. Un au tho rized re pro duc tion or trans mis- sion of SAGE copy right ed material is a violation of Dignity Act. federal law car ry ing civil fines of up to $100,000. In the Courts FOR FURTHER RESEARCH CQ Press is a registered trademark of Congressional 464 A patient-rights group is Quarterly Inc. challenging state laws pro - For More Information 468 Organizations to contact. CQ Researcher (ISSN 1056-2036) is printed on acid- hibiting physician-assisted free paper. Pub lished weekly, except: (March wk. 5) suicide. Bibliography (May wk. 4) (July wk. 1) (Aug. wks. 3, 4) (Nov. wk. 469 Selected sources used. 4) and (Dec. wks. 3, 4). Published by SAGE Publica - Health Care Costs tions, Inc., 2455 Teller Rd., Thousand Oaks, CA 91320. 466 Supporters and opponents The Next Step Annual full-service subscriptions start at $1,054. For of physician-assisted suicide 470 Additional articles . pricing, call 1-800-818-7243. To purchase a CQ Re - disagree over whether searcher report in print or electronic format (PDF), medical costs influence Citing CQ Researcher visit www.cqpress.com or call 866-427-7737. Single 471 reports start at $15. Bulk purchase discounts and patients’ decisions. Sample bibliography formats. electronic-rights licensing are also available. Periodicals postage paid at Thousand Oaks, California, and at additional mailing offices . POST MAST ER: Send ad dress chang es to CQ Re search er , 2300 N St., N.W., Suite 800, Wash ing ton, DC 20037. Cover: AP Photo/Jason R. Henske

450 CQ Researcher Assisted Suicide BY REED KARAIM

But Clish was not the only THE ISSUES person who felt strongly about the issue. In a written state - ee Johnson, a retired ment, John Norton, a retired federal worker in Port - bus driver from Florence, L land, Ore., had started Mass., offered his own life as a second career as a furni - evidence — in opposition to ture maker. When he devel - the measure. oped terminal brain cancer, When he was 18, Norton he opted for radiation treat - said, he noticed a twitching in ments and chemotherapy to his right hand. Doctors at the extend his life, even though University of Iowa Medical the disease “was undeniably School diagnosed Norton with going to kill him,” says his the usually fatal amyotrophic daughter, Heather Clish. lateral sclerosis (ALS), com - But as his condition de - monly known as Lou Gehrig’s teriorated and he became disease. “I was told I would get e

bedridden, with blurred vi - e progressively worse, be para - L

.

sion, sores and pain, John - J lyzed and die in three to five

w

son didn’t want to go on, e years,” he wrote. h t she says. In March 2011, John - t The Mayo Clinic in Rochester, a M

son took advantage of Ore - / Minn., confirmed Norton’s di - e b

gon’s Death with Dignity Act o agnosis, and for awhile his con - l G and swallowed a lethal dose dition worsened. Twitching n o of pills prescribed by a doc - t began in his right hand and s o B

tor.* He was 66. both got weaker. Then the dis - e

Before he ended his life, h ease’s progression stopped. That T / s

Clish says, Johnson and his e was in 1960. Today Norton is g

family talked a lot about his a 75 with a wife and family. He m I values. “The essence of his enjoys singing in an amateur y t t

being was that he was a deeply e choir and still volunteers occa - G independent person who re - Opponents of a measure that would have legalized sionally as a bus driver. ally came to believe in living physician-assisted suicide for the terminally ill in None of that would have by choice,” she says. “What Massachusetts celebrate the measure’s narrow defeat on happened, he wrote, if as - he ended up doing was very Nov. 6, 2012. Religious, medical and disability groups sisted suicide had been avail - said the measure was open to manipulation and relied consciously going about on diagnoses that could be wrong. able when he was initially dying with dignity and grace. told he had the disease. “If, If this was what he needed to have when I was diagnosed with ALS, I had as an option to be the person he is, ** Supporters prefer the term “death with dig - been given an easy way out with a we understood. That was okay.” nity” or “aid in dying,” arguing that because doctor’s prescription and support, I Clish felt so strongly about her fa - the terminally ill already are dying, “assisted would have taken that opportunity,” ther’s decision that when Massachusetts, suicide” mischaracterizes their choice. Oppo - he said. “I would have missed the bulk where she lives, voted on an assisted - nents, who view the procedure as suicide, of my life.” suicide ** law modeled on Oregon’s in note that the Oregon, Washington and likely Johnson’s and Norton’s cases are a ballot initiative last November, she to be enacted Vermont laws require only a not identical. Johnson was almost cer - physician’s diagnosis that a patient is going to volunteered her family’s story in tainly in the final days of his life, where - die within six months. That is too far out to support. know when the end will occur, and thus those as Norton’s ALS stopped progressing who take lethal doses of medicine are choos - before he reached that stage. But their * The fatal prescription is most often a lethal ing to end their lives prematurely, the oppo - stories testify to the deeply personal dose of barbiturates, usually Seconal or Pen - nents contend. Physician-assisted suicide is the nature of the public debate surrounding tobarbital. term most used by the media. physician-assisted suicide, currently

www.cqresearcher.com May 17, 2013 451 ASSISTED SUICIDE

er religious denominations such as Uni - Physician-Assisted Suicides Rise in Oregon Law tarian Universalism also support the Oregon enacted the Death With Dignity Act in 1994, allowing right of terminally ill individuals to choose assisted suicide. terminally ill adults to self-administer lethal doses of medication Despite the passion surrounding prescribed by physicians. Last year 115 people received prescriptions, the issue, physician-assisted suicide re - compared to 24 in 1998. The number of deaths involving use of the mains rare, even in the states where prescriptions has risen steadily since the law took effect in 1998, to it is legal. Oregon, which passed its 77 last year. Death with Dignity Act through a voter Prescription Recipients and Deaths Under Oregon referendum in 1994 and began allowing Death With Dignity Act, 1998-2012 the practice in 1998, has the longest track record. The number of Orego - 120 nians who choose physician- assisted 100 Prescription recipients suicide has been slowly climbing; 673 Deaths 80 cases were recorded between 1998 and 2012. In 2012, the 77 cases reported 60 to the Public Health Division amount - 40 ed to about 0.2 percent of the total 20 deaths recorded in the state. 2 (See 0 graphic, at left. ) In Washington, where 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 the law — also passed by referendum — has been in effect only since 2009, Source: “Oregon’s Death With Dignity Act — 2012,” Public Health Division, State of 70 people took lethal doses of pre - Oregon, January 2013, p. 1, public.health.oregon.gov/ProviderPartnerResources/ scription medicine in 2011. 3 EvaluationResearch/DeathwithDignityAct/Documents/year15.pdf The number of individuals re - questing the prescriptions is higher in legal in just three states: Oregon, threat to some of the most vulnera - both states, but in Oregon a little more Washington, Montana and soon likely ble Americans, including the elderly than a third haven’t used the drugs in Vermont, when Gov. Peter Shumlin and disabled, fearing some could be after obtaining them. “I think it’s a signs a bill enacted on May 13. coerced or manipulated into making peace-of-mind thing,” says Peg Sandeen, In 1997 the U.S. Supreme Court de - the decision to e nd their lives. They executive director of the Death with clined to recognize the right to as - believe physician- assisted suicide de - Dignity National Center. “You’re ter - sisted suicide but invited the states to values life, encourages a premature minally ill and you’re facing the pos - address the issue. In his majority opin - halt to medical treatment and could sibility of some pretty tremendous suf - ion, the late Chief Justice William open the door to cutting off medical fering, and just the idea that you have Rehnquist concluded, “Americans are care for other patients who aren’t ter - this [prescription] and tomorrow you engaged in an earnest and profound minally ill but may be severely dis - can take it if it gets really bad pro - debate about the morality, legality and abled or incapacitated. vides some comfort.” practicality of physician-assisted sui - The Roman Catholic Church has Montana does not spell out as cide. Our holding permits this debate been a leading, politically active op - clearly the requirements for assisted to continue, as it should in a demo - ponent of assisted suicide. But sever - suicide to occur legally. The state’s cratic society.” 1 al disability-rights groups also active - Supreme Court ruled in 2009 that a The debate is still going strong. ly oppose it. The American Medical physician helping a terminally ill pa - Supporters cast the issue as one of Association has adopted a position against tient die was protected by existing individual choice, believing the ter - the practice but does not actively lobby state law. 4 But the state has not minally ill have a right to decide against it. Two public-interest groups passed a specific law regulating the whether to obtain prescriptions that are the leading voices supporting le - practice, and it is unknown how many allow them to avoid final days strick - galization: the Denver-based Compas - people have died with the assistance en with pain or other debilitating sion & Choices, and the Portland- of their doctor. 5 conditions and choose the manner in based Death with Dignity National Supporters of assisted suicide point which they meet an inevitable death. Center, which originally organized to to national opinion polls and the fact Opponents see the practice as a work for the Oregon law. Some small - that Oregon’s and Washington’s laws

452 CQ Researcher were passed by referendum in arguing plications for society as a whole. “Pub - that the public backs their cause . 6 “I Americans Slightly lic policy is about weighing benefits think it’s fairly clear the public believes Divided on Assisted and harms,” she says. “Proponents of this is a right they have,” says Sandeen. assisted suicide would want you to But similar laws have been defeat - Suicide believe there [are] only benefits and ed by referendum or failed to advance Slightly more Americans say no harms. . . . But if you look at through legislatures in roughly half the physician-assisted suicide is everything, I think the risk of harms states, including Massachusetts, where morally wrong than acceptable. vastly overwhelm the benefits.” a ballot measure was defeated last No - By supporting the idea that there However, in another poll, when vember, 51 to 49 percent, despite lead - is a class of people whom doctors can ing in early polls. “It doesn’t gather a the question about assisted legally help die and by legitimizing one lot of attention, but there’s been a lot suicide was worded differently form of suicide, Golden and other op - of rejection of physician-assisted sui - — “Do you think people have ponents say, physician-assisted suicide cide,” says Marilyn Golden, a policy the right to end their own lives?” potentially harms many more people analyst with the Berkeley, Calif.-based — a strong majority approved. than it helps both because it makes Disability Rights Education and De - suicide more culturally acceptable and fense Fund, one of several disability because it involves doctors in the Percentage Who Say Assisted groups opposing assisted suicide. “Once process of ending lives, which ends Suicide is Morally Acceptable, the problems are brought out on le - a prohibition that could eventually 2011, by Age, Political Party galization, it’s very common for pub - make other forms of assisted-death ac - lic opinion to shift.” Overall ceptable, such as euthanasia. However, on May 13 the Vermont Supporters, however, say the rela - House gave final approval to a bill Morally acceptable 45% tively small number of people who that would make Vermont the first Morally wrong 48% choose physician-assisted suicide state to legalize physician-assisted sui - where it is legal shows the procedure cide by legislation. Democratic Gov. By Party does not threaten the larger popula - Peter Shumlin, a supporter of the mea - Democrats 51% tion. “Modern medicine, palliative care, sure, is expected to sign it into law. Republicans 32% pain release, hospice care can pro - As advocates, physicians and the vide relief for most people,” Sandeen general public debate the question of Independents 50% says. “But not all people, and the whether assisted suicide should be By Age Group Death with Dignity Act can provide legal, here are some of the questions relief for them.” they are discussing: 18 to 34 46% Sandeen, who was a social worker 35 to 54 45% before joining Death with Dignity, says Do the terminally ill have a right 55+ 43% her experience was that too many “peo - to choose when to end their lives? ple die badly in this country. The way Supporters of what they call aid in Source: Lydia Saad, “Doctor-Assisted modern medicine works is that they dying align their cause with American Suicide Is Moral Issue Dividing can keep people alive for a very long values of individual liberty and freedom Americans Most,” Gallup, May 2011, time past what any natural death would of choice. Barbara Coombs Lee, Com - www.gallup.com/poll/147842/doctor - be, and people die badly.” Individuals passion & Choices president, says the assisted-suicide-moral-issue-dividing- should have a right to escape a bad organization believes individuals should americans.aspx — in other words painful or lingering, have options as they near the end of debilitating — death, she says. their lives, including expanded hospice — not life or death, because that de - But opponents believe advances in and palliative care, which focus on re - cision has already been made — but palliative care including at the end of lieving patients’ pain and discomfort. when and how they will meet death, life, means a “bad death” need no “We don’t promote just one choice those people deserve a peaceful and longer be the case. “It is a national (in end-of-life decisions). We think peo - gentle option in the dying process.” and international scandal that so many ple deserve an entire spectrum of choic - But Golden with the Disability Rights people do not get adequate pain con - es,” says Coombs Lee. “But people Education and Defense Fund believes trol,” writes Rita Marker, the founder who are mentally alert and who are considering the issue simply as a mat - of the Patients Rights Council, a non - making a rational decision to choose ter of individual rights ignores the im - profit group in Steubenville, Ohio, that

www.cqresearcher.com May 17, 2013 453 ASSISTED SUICIDE

opposes assisted suicide. “But killing tarian Universalists advocate the right ally studied as this one,” says Coombs is not the answer to that scandal. The to self-determination in dying, and the Lee of Compassion & Choices. In all solution is to mandate better educa - release from civil or criminal penalties that examination, she says, there have tion of health care professionals.” 7 of those who, under proper safeguards, been no substantiated cases of abuse. Some opponents say that in the act to honor the right of terminally ill But opponents question the safe - most extreme cases, palliative seda - patients to select the time of their own guards in the laws, saying compliance tion, in which a patient is drugged deaths.” 9 is self-reported, so there is no way to into unconsciousness to escape pain The Oregon and Washington laws be sure what’s really happening. “Do until he dies, provides a legal alter - do not require the participation of a we have any evidence of abuse? No, native. But David Mayo, a bioethicist doctor or pharmacist who, for religious but we have a lot of circumstances and professor of philosophy emeritus or any other reason, objects to physi - that show that abuse is very possible,” at the University of Minnesota, Duluth, cian-assisted suicide. “The underpin - says Golden of the Disability Rights who is on the Death with Dignity ning of this law is the concept of self- Education and Defense Fund. board, believes such an intervention determination,” says Sandeen. “There Opponents note the laws don’t re - amounts to assisted dying. ( See “At is no way we would want someone quire an independent witness present Issue,” p. 465. ) “The practice of ter - who believes this is wrong to have when a person is taking the pre - minal [palliative] sedation — which is, to participate. My struggle with the scription, so there is no way to be ‘now I can’t give you the drugs to kill religious-based opposition is that they sure every dose is self-administered or yourself, but we can put you in a want everybody else not to be able taken by free will. Opponents also coma while you starve to death’ — to participate because of their [own point out that the law does not re - the idea that’s somehow better is just religious] beliefs.” quire an outside psychological evalu - crazy,” Mayo says. ation of patients who request the drugs. In their statement on the issue, the Does permitting assisted suicide “It’s bad psychiatry and bad medi - United States Conference of Catholic lead to abuse? cine,” says Dr. Herbert Hendin, a pro - Bishops rejects the idea that assisted Oregon’s Death with Dignity Act fessor of psychiatry at New York Med - suicide represents an expression of and the Washington law that followed ical College and executive officer of freedom. “The assisted-suicide agenda have safeguards that supporters be - Suicide Prevention Initiatives, a non - promotes a narrow and distorted no - lieve clearly prevent abuses of the profit group. “The weakness of the tion of freedom, by creating an ex - process. (Vermont’s pending law has laws is that they don’t enforce the pectation that certain people, unlike similar provisions.) practice of ordinary medical standards. others, will be served by being helped The laws require that a physician They could insist on a palliative care to choose death,” the statement de - diagnose a terminally ill patient as hav - [discussion with the patient as an al - clares. “One cannot uphold human ing a life expectancy of six months or ternative to assisted suicide]. They could freedom and dignity by devaluing less. A second doctor must concur with insist on a psychiatric consult.” human life. A choice to take one’s life the diagnosis. Patients must request the The idea that hundreds of people is a supreme contradiction of freedom, lethal prescription twice verbally and have received aid in dying without for - a choice to eliminate all choices.” 8 once in written form with a waiting mal psychiatric evaluation or counsel - Orthodox Judaism, Islam and most period of at least two weeks between ing undercuts the claim the law is major Protestant denominations also the first and last request, and the doc - being used solely by people making oppose physician-assisted suicide, al - tor who writes the prescription must competent choices, Hendin says. “An though they generally have not been believe the patient is mentally compe - awful lot of people who are physi - as active politically as the Catholic tent to make the decision. The law also cally ill are also depressed, and if you Church on the issue. Some Christian requires that patients be able to take relieve their depression, they’re no denominations, however, have not the pills on their own. longer interested in ending their life taken a position, or they support the State health agencies are required early,” he says. practice as one end-of-life option. to provide annual reports on how often But Dr. Marcia Angell, a senior lec - The United Church of Christ, for in - physician-assisted suicide is used, and turer in social medicine at Harvard stance, considers the right to choose by whom. Outside researchers also Medical School, says the terminally ill aid in dying a legitimate decision have conducted several studies on the are in a different situation from other under certain circumstances. The Uni - laws’ impact. “There has never been seriously ill patients. “This is not a ques - tarian Universalist Association adopt - a medical treatment that has been so tion of life versus death,” she says. “It’s ed a resolution in 1988 stating, “Uni - closely, comprehensively and continu - often misconstrued that way. These

454 CQ Researcher people are going to die. Who are we ‘reasonable,’ to unburdening others, to the situation in Oregon,” says Coombs to tell them they must soldier on?” ‘letting go,’ ” he wrote. 10 Lee of Compassion & Choices. Critics, however, believe the laws’ Opponents also raise the possibili - Supporters point to a study of cases lax definition of terminally ill invites ty that the nature of the health care published in the Journal of Clinical abuse of the intent to limit assistance system could lead to abuse. “The Ethics that found no unreported cases to those in their last weeks of their frightening potential for profit-driven of physician-assisted suicide in Ore - lives. “Terminal illness is a meaning - health care organizations to drive peo - gon. In addition, the researchers found less term,” says Dr. Rex Greene, a long - ple toward assisted suicide for cost that terminally ill people in Oregon time oncologist now were no more likely to con - semi-retired in Elida, sider assisted suicide than Ohio. “The law in Ore - people in states where the gon says a six-month procedure was illegal. 11 prognosis. There’s no Supporters also cite a physician on Earth study led by Margaret Bat - [who] can make a six- tin, a distinguished pro - month prognosis. The fessor of philosophy and best we can do is in an adjunct professor of in - the last weeks of life ternal medicine in the Di - we can be pretty close.” vision of Medical Ethics, at The issue strikes a the University of Utah in nerve with disability Provo. The study found no groups. “Anytime I’m evidence that physician- doing training on this assisted suicide has had a issue within the dis - disproportionate impact on ability community, I patients in vulnerable ask, ‘Who of you here groups, including the phys - were first diagnosed ically disabled, the poor, as terminally ill and are individuals with low edu - still going strong?’ ” says cational status or racial mi - Golden, “and every norities. “Those who re - time, hands go up.” ceived physician-assisted Advocates for the dying in the jurisdictions y d disabled are among the r studied appeared to enjoy a C most vocal in arguing comparative social, eco - t t that the laws could en - a nomic, educational, pro - M / courage some people s fessional and other privi - e g to end their lives to save a leges,” Battin and her team m

I 12 loved ones trouble. Ben concluded. y t t

Matlin, an author born e G with a neuromuscular Australian physician Philip Nitschke, a supporter of voluntary Does the Hippocratic condition so debilitat - euthanasia, displays a drug kit used in assisted suicides following Oath ethics code pre - ing that he has never a workshop he gave on May 5, 2009, in Bournemouth, England. vent doctors from been able to stand helping patients die? and now is unable to hold a pencil, control is something we can’t ignore,” Physicians have been pledging them - explained his opposition to the laws. says Golden. selves to the principles of the Hippo - “I’ve lived so close to death for so But supporters respond that all these cratic Oath, named after an ancient long that I know how thin and porous concerns have proved unfounded Greek physician, since the 4th century the border between coercion and free through years of experience with the BC. The classical version of the oath choice is, how easy it is for someone Oregon law. “When we talk about aid includes this prohibition, “I will never to inadvertently influence you to feel de - in dying, a tactic of those who op - give a deadly drug to anybody who valued and hopeless — to pressure you pose end-of-life choice is to raise un - asked for it, nor will I make a sug - ever so slightly but decidedly into being reasonable doubt, to cast aspersions on gestion to this effect.” 13

www.cqresearcher.com May 17, 2013 455 ASSISTED SUICIDE

the physician’s role as healer, would Cancer Most Prevalent Malady in Oregon Cases be difficult or impossible to control, and would pose serious societal risks,” Of the 77 people who died last year under Oregon’s Death With 15 Dignity Act, 75 percent suffered from cancer. The median age for the code states. Some bioethicists, however, believe all deaths under the law was 69. More than 90 percent said they medical care must include recog niz - were concerned about losing autonomy and finding life’s activities ing when death is inevitable and re - no longer enjoyable. specting a patient’s wishes at that time. “While doctors in general want Characteristics of Deaths Under Oregon’s and should work to extend life, sup - Death With Dignity Act, 2012 pose that’s no longer possible?” says Angell of Harvard’s medical school. Male...... 50.6% “That’s the case here, and if that’s Female...... 49.4% the case, then they must shift their S objective to relieving suffering in ac - ex 18-34...... 0% cordance with the patients’ wishes.” 35-44...... 1.3% But many physicians believe assist - 45-54...... 10.4% ing in death, even of a terminally ill Ag 55-64...... 20.8% patient, undermines their essential e 65-74...... 29.9% covenant with the public. “It’s in the 75-84...... 23.4% seminal code of medicine, that physi - 85+...... 14.3% cians are not to do anything to take the patient’s life,” says Greene, the re - Married...... 42.9% tired oncologist, referring to the Hip - Widowed...... 29.9% pocratic Oath. “One of the reasons Never married...... 7.8% medicine has endured all these cen - Divorced...... 19.5% turies is that we have remained trust - M a worthy in that regard. I personally don’t ri st ta Cancer...... 75.3% see any way physicians can maintain at l us Amyotrophic lateral sclerosis...... 6.5% that trust if they’re involved [in] end - Chronic lower respiratory disease...... 2.6% ing people’s lives.” Heart disease...... 2.6% Greene is the current chairman of U HIV/AIDS...... 1.3% the AMA Council on Ethical and Ju - nd Other...... 11.7% er dicial Affairs but emphasizes that he i ly is expressing his personal opinion. He ll in ne g Losing autonomy...... 93.5% spent more than 30 years as an on - ss Activities no longer enjoyable...... 92.2% cologist and now consults on pallia - Loss of dignity...... 77.9% tive care. Losing control of bodily functions...... 35.1% The AMA, along with most oppo - E Burden on loved ones and caregivers...... 57.1% nents of assisted suicide, supports the nd c -o Inadequate pain control...... 29.9% removal of life-sustaining devices in on f-l Financial implications of treatment...... 3.9% the last stages of life, if patients have ce ife rn indicated such a preference. But Greene Source: “Oregson ’s Death With Dignity Act — 2012,” Public Health Division, State of sees a crucial distinction between re - Oregon, January 2013, pp. 4-5, public.health.oregon.gov/ProviderPartnerResources/ moving life-sustaining medical equip - EvaluationResearch/DeathwithDignityAct/Documents/year15.pdf ment and actively assisting patients in killing themselves. Most graduating U.S. medical stu - The American Medical Association By removing devices such as ven - dents still swear to some form of the (AMA) code of ethics, however, rejects tilators or respirators, in accordance oath, although the modern version used the idea of doctors providing deadly with their wishes, a physician is allow - by most medical schools does not in - prescriptions. “Physician-assisted sui - ing the patient to assume the natural clude that prohibition. 14 cide is fundamentally incompatible with risk of dying that is part of their con -

456 CQ Researcher dition, he says. The physician is not taking action that has the specific in - tent of killing the patient, he says. “That’s not the intent,” Greene says. “If we take on the responsibility of de - ciding who lives and who dies, we have so overstepped the bounds of human experience.” Other physicians, however, believe fulfilling a patient’s wish to end his or her suffering at the end of life is part of the responsibility a doctor as - sumes when caring for the person. Dr. Eric Kress, who practices family l l medicine and hospice care in Mis - i H

soula, Mont., says an experience with a c i s

one particular patient persuaded him s e J of that. / o t

The patient was terminally ill with o h P

ALS; he had lost 100 pounds, couldn’t P walk and was being fed through a A tube. “He used to be a vigorous guy, but now he was wasting away, and there was no question where he was headed,” Kress recalls. His patient, whom Kress considered of sound mind, felt very strongly that he did not want to wait a few more weeks for the dis - ease to end his life. He requested lethal medication.

Kress told him he couldn’t provide k a p

it. A few weeks later the patient had a r a

stockpiled enough pain medication to h D

kill himself anyway. But before he s e l died, Kress says, “He called me a cow - r a h

ard and said, ‘Who are you treating C / o here? Are you treating yourself or are t o h

you treating me?’ And he got me think - P

P

ing, what kind of doctor am I? Am I A going to do what I want or what my patients needs?” To Assist or Not to Assist Kress became one of the few doc - Cathy Ludlum, a disabled-rights activist in Manchester, Conn., is tors to speak openly about providing concerned that physician-assisted suicide is being considered by her lethal prescriptions when testifying be - state’s legislature. Lawmakers should focus more on “giving people a fore the Montana state legislature. He good life than giving people a good death,” says Ludlum, who has spinal says several patients have raised the muscular atrophy (top). Opponents of the measure to permit assisted possibility of assisted suicide with suicide in Connecticut succeeded in April in derailing the proposal. him, but he has ended up providing Supporters of Oregon’s physician-assisted suicide law demonstrate in front of the U.S. Supreme Court (bottom) on Oct. 5, 2005, as the court medication to only three patients. In heard Bush administration attorneys argue that the law violated the each case, Kress says, he obtained a Controlled Substances Act. The court later ruled against the administration, written second opinion from another allowing the law to stand. doctor that the patient’s condition was

www.cqresearcher.com May 17, 2013 457 ASSISTED SUICIDE

terminal and would The contemporary result in death “in movement in support of a few months or assisted suicide can be less.” He also says traced to Derek Humphry, he met with the pa - a British j ournalist, who tients several times in 1978 wrote the best - over extended peri - selling memoir, Jean’s ods to make sure Way , about assisting the they understood suicide of his cancer-

what they were o stricken wife. In 1991, n a

doing. Moreover, he i Humphry published l g

says, he sought to u Final Exit , a how-to P

l l

make sure they i guide on assisted sui - B /

could self-administer s cide that became a e g

the drugs. a bestsel ler and has been m

Kress says he I translated into 12 lan -

y t checked with attor - t guages. e neys to make sure G Humphry, now 83, he was in accor - Physician-assisted suicide supporter Jack Kevorkian talks to college remains controversial. students about prison reform at Detroit’s Wayne State University on dance with Montana Nov. 29, 2007, not long after his release from prison. Nicknamed Critics charged that Final law, but he says his Dr. Death, the controversial pathologist spent eight years in prison Exit could be used by primary concern following his conviction in 1999 for second-degree murder for anyone to commit sui - was fulfilling his helping in an assisted suicide. He died in 2011, cide, not just the ter - obligation to care for at age 83, of natural causes. minally ill. Humphry re - his patients. “This is really an issue sponded that many commonly known about aiding people in the dying means of suicide existed and there process. It’s not about letting people BACKGROUND was no evidence that the book had commit suicide,” Kress says. “One of raised the suicide rate. The suicide of the questions I asked everyone was, Humphry’s second wife, Ann, after a ‘If you didn’t have this [terminal] dis - ‘Robes of the Executioner’ bitter divorce in which she denounced ease, would you want to die, and they him and the assisted-suicide move - all universally said no.” ssisted suicide has been part of ment she had previously supported, Even with all such steps, some A human culture since antiquity, and led to further controversy. 17 bioethicists believe legalizing physi - so have prohibitions against it, as Hip - Humphry believes assisted suicide cian-assisted suicide places too much pocrates’ oath shows. A forerunner of should be available to more than just power in the hands of doctors. Compassion & Choices was the Hem - those with advanced terminal illness - Daniel Callahan, president emeritus lock Society, named after the poison es, but also for those with what he of the Hastings Center, a leading the ancient Greek philosopher Socrates terms “hopeless illness,” meaning de - bioethics research institution in Gar - drank to fulfill his death sentence. bilitating and without cure, but not rison, N.Y., says he become opposed In 1870, schoolteacher Samuel D. necessarily terminal. He acknowledges to physician-assisted suicide after Williams was one of the first U.S. pro - his position puts him on “the radical studying the situation in the Nether - ponents of using an overdose of mor - left” of the movement. 18 Many of the lands, where it is legal. phine, then a new pain-relieving drug, leading organizations, now focused on An anonymous survey of doctors to assist death “in all cases of hope - physician-assisted suicide for the ter - there revealed abuses, he says, in - less and painful illness.” 16 Williams’s minally ill, have distanced themselves cluding the euthanasia of patients euthanasia proposal was reprinted in from his views. without their permission. “I don’t like newspapers and magazines over the Still, Humphry, who co-founded the the idea of empowering physicians to years, creating enough of a stir that Hemlock Society and is a past presi - do this sort of thing,” Callahan says. in 1885 the Journal of the American dent of the World Federation of Right “They’re too good at it.” Medical Association attacked the idea, to Die Societies, continues to promote saying it made “the physician don the assisted suicide publicly and through robes of the executioner.” Continued on p. 460

458 CQ Researcher Chronology

1997 1960s As medicine ad - 1980s Right-to-die move - U.S. Supreme Court rules there is vances, the question of how long ment gains strength; Catholic no constitutional right to die, but and under what circumstances Church issues objections. invites states to continue debating life should be sustained by med - the issue. ical means gains new urgency. 1980 Humphry helps form the Hemlock • 1967 Society to support assisted suicide. After watching a friend die a slow, . . . Pope John Paul II opposes painful death, human-rights attorney “willful suicide,” but supports the 2000-Present Luis Kutner writes the first “living use of pain-relieving medicines and Three more states join Oregon will,” specifying under what condi - the right to refuse extraordinary in allowing physician-assisted tions a patient should be taken off means to sustain life. suicide, but opponents win in life-sustaining devices. . . . A right- Massachusetts. to-die bill fails in Florida. 1988 Unitarian Universalist Association 2005 1969 becomes first religious body to sup - Terri Schiavo, a Florida woman The Hastings Center is founded in port a right to die and call for who doctors say is in a persistent New York to study ethical problems those who assist in that act to be vegetative state, dies after her in biology and medicine, including free from criminal or civil penalties. feeding tube is removed, ending a end-of-life decisions. controversial seven-year battle be - • tween her husband and parents • that generates international debate on end-of-life decisions. 1990s The first state 1970s The idea that approves physician-assisted 2008 patients have a right to refuse suicide; Detroit physician Jack Washington voters make the state treatment gains acceptance. In Kevorkian further spurs debate the second to allow physician- England, a best-selling memoir over the procedure. assisted suicide. starts a debate about assisted suicide. 1990 2009 Kevorkian helps Alzheimer’s patient Montana Supreme Court effectively 1973 Janet Adkins commit suicide, he will allows physicians to provide lethal American Hospital Association rec - help more than 130 others die before prescriptions to terminally ill patients ognizes the right of patients to being convicted of murder in 1999. who request it. refuse treatment. 1991 2012 1976 Washington state voters reject Massachusetts voters reject physician- California Gov. Jerry Brown signs physician-assisted suicide. assisted suicide. nation’s first law giving terminally ill people the right to authorize 1992 2013 withdrawal of life-sustaining medical California voters defeat a similar Vermont House and Senate pass treatment when death is imminent. measure. differing version of a physician- Eight other states pass similar laws assisted suicide measure (April); within a year. 1994 governor indicates willingness to American Medical Association op - sign a final bill modeled on 1978 poses physician-assisted suicide. . . . Oregon’s law. . . . Vermont House British journalist Derek Humphry Oregon voters approve nation’s first approves bill legalizing physician- writes a best-seller, Jean’s Way , a law permitting terminally ill patients assisted suicide (May 13). Democ - memoir about helping his terminally to obtain a prescription to end their ratic Gov. Peter Shumlin is ill wife commit suicide, kicking off life; challenged in court, the law expected to sign the measure international debate. doesn’t go into effect for four years. into law.

www.cqresearcher.com May 17, 2013 459 ASSISTED SUICIDE

Researchers Seek Advances in Pain Management “Death isn’t a medical condition.”

edicine is making advances in pain management and care experienced less depression and survived an average of end-of-life care that some say may eliminate one of 2.7 months longer than those who did not receive the same M the reasons patients may choose assisted suicide. kind of care. 2 Medical researchers also have been exploring Advances in the relatively new discipline of pain manage - new approaches to pain management that go beyond the typi - ment known as palliative care can go a long way toward re - cally prescribed drugs such as Oxycontin, Vicodin or morphine. lieving unbearable pain and making people more comfortable Researchers at the University of Colorado in Boulder are study - in their last days, according to researchers. ing the glial cells, which wrap around the neurons that trans - “When we talk about palliative care, we’re talking about re - mit pain sensations and are thought to amplify chronic pain. lief of suffering,” says Nancy Berlinger, who teaches ethics at the Scientists are working on drugs that could block that effect. 3 Yale School of Nursing and is co-author of The Hastings Center At Stanford University and other institutions, researchers are ex - Guidelines for Decisions on Life-Sustaining Treatment and Care ploring the use of magnetic fields to cause electrical changes in Near the End of Life. “The field of palliative care and hospice the brain. The process, called “transcranial magnetic stimulation,” care has greatly taken off in the last 20 years. There are now involves putting an eight-inch electrical coil around the head. Orig - specialized palliative care units in children’s hospitals and adults’ inally developed to treat severe depression, the procedure can also hospitals. It’s still a work in progress, but it’s growing.” reduce pain, most probably by disrupting the pain signals traveling The Center to Advance Palliative Care, based in New York along the neurons in the brain, early results indicate. 4 City, reports that more than 1,500 hospitals now have palliative Less intrusive pain management techniques being studied care teams — twice as many as six years ago. 1 A palliative care focus on mental activity and biofeedback. A project at Stanford team includes doctors, nurses and other specialists who provide allows patients to see on a screen when the part of the brain relief from the symptoms, pain and stress of serious illness. that handles pain is activated. “They then use this information A 2010 New England Journal of Medicine study found pal - to learn to control their brain activation in a specific region as - liative care can make a significant difference in the life of pa - sociated with the processing and perception of pain,” according tients. The study found that patients receiving early palliative to an article on a Stanford website. 5

Continued from p. 458 Kevorkian was brought to trial four participated in a review of Kevorkian’s the Final Exit Network, which provides times on various cases, but was ac - cases. counseling and support to individuals quitted three times and the fourth case The next highly public battle over considering assisted suicide. 19 was declared a mistrial. Eventually, he the life and death of a critically ill pa - If Humphry was the movement’s in - was found guilty of second-degree mur - tient did not involve direct physician spiration, Dr. Jack Kevorkian was its der in a case in which he was shown assistance, but it galvanized Americans first American celebrity. Kevorkian, a on CBS’ “60 Minutes” administering a about end-of-life decisions. Terri Schiavo, pathologist dubbed “Dr. Death,” attracted lethal injection to a patient himself, after a young woman from St. Petersburg, national attention in the 1990s when he had lost his license to practice med - Fla., originally suffered extensive brain he built devices that allowed the icine. 21 He served eight years in prison, damage in 1990 and doctors had di - patient to self-administer lethal injec - and the conditions of his parole pre - agnosed her condition as a “persistent tions. At least 130 people used the de - vented him from participating in other vegetative state” by the time her hus - vices, which allowed people to kill assisted suicides. Kevorkian died of band sought to have her feeding tube themselves by pulling a trigger that natural causes in 2011 at age 83. 22 removed in 1998. 24 sent either a lethal dose of drugs or After-the-fact examinations of Her parents objected, believing her carbon monoxide into their blood. Early Kevorkian’s patients found that many condition was not beyond hope, and on, Kevorkian tried to advertise in De - did not have terminal diseases, and five went to court to have the feeding tube troit newspapers for volunteers. Janet did not have any diseases at al l. 23 His reinserted. The ensuing legal and politi - Adkins, who had been a college in - actions are cited by opponents of cal battle lasted seven more years and structor, was the first. Adkins decided physician -assisted suicide as an ex - eventually involved several court rulings, to kill herself on the day she was di - ample of the dangers of allowing the the Florida legislature, the U.S. Congress agnosed with Alzheimer’s disease and practice to spread. “He was just, in my and President George W. Bush, who flew later did so in Dr. Kevorkian’s van. 20 opinion, a serial killer with an M.D.,” back to Washington from a vacation to She was 54. says Greene, the retired oncologist, who sign a law giving Schiavo’s parents one

460 CQ Researcher Dr. Ray Barfield, a pediatric oncologist who directs the Pe - an end in itself and lose track of the larger needs of patients diatric Quality of Life/Palliative Care Program at Duke Univer - and their families. “Death isn’t a medical condition,” Barfield sity’s Medical Center, says many new approaches being stud - says. “Death is experiential. Your last day is still a day mean - ied have great potential, especially those involving techniques ingful things can happen.” to mentally manage one’s own pain. “Some of the advances Combining careful attention to a patient and family’s larger that we’re making in hypnosis, biofeedback and medication needs with proper palliative care and pain management, Barfield that some people scoff at are tremendously effective,” he says. says, can “go a long way to reducing the need for [physician- A major problem in managing pain, says Barfield, is the re - assisted suicide] as an option.” If palliative medicine contin - luctance many doctors feel about prescribing pain drugs for ues to advance, he believes, that’s where end-of-life care is fear of potential negative effects or of the patient becoming headed. addicted. And patients often resist taking drugs they feel will dull their senses. — Reed Karaim “One of the biggest advances that we need is not coming up with new medicines; we need to get people educated about 1 “Palliative Care FACTS AND STATS,” Center to Advance Palliative Care, the stuff we already have,” Barfield says. “We have some good www.capc.org/news-and-events/press-kit/. 2 Jennifer S. Temel, et al. , “Early Palliative Care for Patients with Metastatic pain medicines and good experiences with them, and we still Non-Small-Cell Lung Cancer,” The New England Journal of Medicine , 2010, can’t get people to use them the right way.” www.nejm.org/doi/pdf/10.1056/NEJMoa1000678. Barfield is a leading advocate for an end-of-life approach 3 Michelle Andrews, “Advances Against Chronic Pain,” U.S. News & World that focuses on medical interventions, pain management and Report , Sept. 5, 2012, http://health.usnews.com/health-news/articles/2012/09/ 05/advances-against-chronic-pain. careful attention to the physical and mental journey the pa - 4 Ibid. tient is taking — the questions they need answered and the 5 Sean Mackey, “The Strain in Pain Lies Mainly in the Brain,” Stanford Systems help they need facing what is happening to them. Neuroscience and Pain Lab, http://med.stanford.edu/snapl/research/. Doctors, he believes, can get too focused on treatment as

last attempt to appeal their case. 25 the public learned from that as well overturn the measure — but it failed Schiavo’s feeding tube was removed, that this type of decision shouldn’t 60 percent to 40 percent. There have then reinserted on a judge’s order, re - be political; it’s personal.” been no serious repeal efforts since. moved again on another judge’s order, In 2001 U.S. Attorney General John then reinserted once again after the Ashcroft attempted to block the law Florida Legislature passed “Terri’s Law,” Battle in the States by declaring that he had the authori - which gave Gov. Jeb Bush authority ty to prevent doctors from prescribing to order the tube reinserted. The tube efore the Schiavo case became lethal drugs through the Controlled was removed a final time when the B public, Oregon voters had made Substances Act. But in 2006 the U.S. U.S. Supreme Court decided not to their state the nation’s first to allow Supreme Court ruled against Ashcroft’s hear a final appeal of the case. 26 She physician-assisted suicide. In 1993, Ore - claim, allowing the Oregon law to died on March 31, 2005, but by then gonians organized Oregon Right to continue. 28 the battle had become a touchstone Die to lobby for an assisted-suicide Oregon’s initiative, however, was not both for right-to-life and right-to-die law, led by Portland attorney Eli the first attempt by supporters of advocates around the world. 27 Stutsman, whom Sandeen and others physician-assisted suicide to get vot - Coombs Lee of Compassion & Choic - cite as its principal author. ers to back a law. Similar efforts in es believes it also had an impact on The state’s Death with Dignity Act Washington and California failed in the public view of physician-assisted was adopted after voters approved a 1991 and 1992, respectively. The Hem - suicide. “We were all privy to the very referendum on the issue by a 51 to lock Society of Oregon also backed a difficult battle that family was going 49 percent margin in 1994. Because bill in the state legislature in 1990 that through and how our politicians re - of legal challenges, however, it did not failed to get out of committee. Bills acted, how completely tone-deaf they go into effect until 1998. introduced in several other states also were to the real views and concerns In 1997, opponents placed another failed to gain sufficient support through - of the public,” she says. “And I think initiative on the ballot — one that would out the 1990s.

www.cqresearcher.com May 17, 2013 461 ASSISTED SUICIDE

In Oregon, a key to understand the lack of figure in helping to safeguards in the law. overcome resis - “The ballot question was tance to the refer - defeated last year in large endum was Dr. Peter part by the antidiscrimi - Goodwin, a physi - nation and social justice cian who spoke up arguments of progressives on behalf of the idea in the disability commu - at a meeting of the nity,” says Denise Karuth, Oregon Medical As - a spokesperson for Sec - sociation. ond Thoughts, a group Goodwin argued that opposed the measure. in part that doctors “We described — with s

already were taking e examples from our per - g actions to help t er - a sonal experience — how m I

minally ill patients y misdiagnosis, inaccurate t t die but were acting e terminal diagnoses and co - G “often without the The case of Terri Schiavo, a severely brain damaged young woman in ercion could cause peo - family knowing Florida, galvanized Americans about end-of-life decisions. After ple to lose years of their enough, without the doctors said she was in a persistent vegetative state, her husband lives,” says Karuth, a peer patient knowing sought to have her feeding tube removed in 1998. Her parents went to counselor for people with court to have the tube reinserted, and during a seven-year court battle enough because it’s Florida’s legislature enacted Terri’s Law, which gave Florida Gov. disabilities who is, herself, all illegal,” he told Jeb Bush authority to have the tube reinserted. Ultimately, the state a blind wheelchair user. ABC News. “I want - Supreme Court ruled the law unconstitutional, and the U.S. Supreme “We were adamant that ed the patient in Court declined to hear a final appeal of the case. no one should ever have control, not the Schiavo died on March 31, 2005. to die to have dignity.” doctor.” 29 Goodwin later recalled that after he suicide measure. After its defeat, sup - spoke, the medical association’s in - porters blamed heavy outspending by Global Measures coming president met his eyes as he opponents. “I think it was four to one returned to his chair. The president- or even six to one,” says Steve Craw - he Netherlands, Switzerland, Bel - to-be then took the podium and sug - ford, who was a spokesman for the T gium and Luxembourg all allow gested to the association that they “let Massachusetts Death with Dignity Coali - assisted suicide. In all but Luxem - the people of Oregon tell us what tion during the campaign. bourg, people who are not terminal - they want.” Goodwin said, “What hap - Public campaign-finance records in - ly ill are eligible for an assisted death pened then was that the Oregon Med - dicate Catholic dioceses and organi - if doctors agree their suffering is last - ical Association was neutral through - zations from around the country con - ing and unbearable. out the campaign, and I think that had tributed heavily to opposition efforts, In Belgium and the Netherlands, a huge influence on the outcome.” 30 and supporters of the proposed law euthanasia, in which a doctor puts a The argument that assisted-suicide say they believe Catholic opposition patient who requests it to death by laws merely illuminate what has been made a crucial difference. “It’s a very directly administering drugs, is legal going on in the shadows all along has Catholic state,” Crawford says. “I’m under certain conditions. 31 continued to be an important one for Roman Catholic myself, and I knew The request must be made volun - supporters. But despite their success in early on, based on some of the reac - tarily by a patient once again suffering Oregon, proponents of similar laws did tion we were getting from the Church, from a condition considered lasting and not win in another state until Wash - that they saw this as a red line [that unbearable. In the Netherlands, ac - ington residents approved a law based could not be crossed] and they were ceptable conditions include an incur - on Oregon’s in November 2008. going to put everything they could able disease or “hopeless psychologi - Supporters were optimistic that Mass - into defeating this question.” cal problems,” according to the Radio achusetts would provide a similar vic - But opponents, especially disability- Netherlands website. 32 A second doc - tory in 2012, and pre-election polls rights activists, believe Massachusetts vot - tor must concur in a written opinion showed majority support for an assisted- ers changed their minds as they came that the patient meets the criteria.

462 CQ Researcher The Netherlands law is generally tions against assisted suicide remain death-inducing drugs. The law also re - considered the most liberal. U.S. op - strong in predominantly Islamic and quires two requests for the drugs by ponents of assisted suicide often cite Catholic countries, however, and the patient, with 15 days separating it as an example of how allowing physician-assisted suicide or eu - the first and second requests. doctors to assist in suicide can lead thanasia remain against the law in The patient must have less than six to more and more conditions being most of the world . 36 months to live, and must self-administer considered acceptable for requesting the drugs. death. Furthermore, drugs would have to The Netherlands has a series of be prescribed by doctors in Vermont guidelines intended to ensure that eu - CURRENT for state residents only, and the pa - thanasia meets the wishes and is in tient’s request for drugs would have the best interest of patients. 33 But to be witnessed by two disinterested Callahan, the Hastings Center presi - SITUATION people who are not relatives or po - dent emeritus, says a survey that pro - tential heirs, employees of health care vided doctors anonymity found the facilities where the patient is being rules were widely ignored and that Landmark Legislation treated, nor the patient’s doctor. “somewhere near a thousand people The Roman Catholic Diocese of had been euthanized without their ermont is set to become the first Burlington fought the legislation and permission.” V state to approve physician-assisted urged residents to press lawmakers to Hendin, of Suicide Prevention Ini - suicide by legislation, following action defeat it. “Physician-assisted suicide will tiatives, also spent time in the Nether - lands studying its system. “The more I was there, the more I saw that end- of-life care was abysmal . . . there was no interest in end-of-life care,” he says. Vermont is set to become the first state to approve Netherlands doctors, he says, had come to see assisted suicide and euthanasia physician-assisted suicide by legislation. Bills modeled as “a quick solution” when dealing with the dying. after Oregon’s law also have been introduced this year U.S. supporters of physician-assisted suicide respond that the situations are in Connecticut, Hawaii, Kansas, Montana, not comparable. “The Netherlands is a completely different culture,” says Massachussetts and New Jersey. Sandeen. “The 15 years of stability with Oregon’s Death with Dignity Act is what we need to look at. The law has stood the test of time. It works by the state House on May 13. Demo - forever transform the role of physician as written.” cratic Gov. Peter Shumlin, who support - from one who preserves life to one Political leaders in several other ed the measure, has pledged to sign it. who takes life,” the diocese said in a Western nations do not seem to share “I am grateful that the legislature had statement earlier this year. 38 the same concerns about the record such a thoughtful, respectful debate on Vermont’s action would represent a in the Netherlands or other countries this deeply personal issue,” Shumlin said. landmark in the battle over physician- where assisted suicide is legal. A re - “We will now offer Vermonters who assisted suicide. No such law has cent poll i n the United Kingdom face terminal illness at the end of life made it through any other state leg - found strong support for legalization, a choice to control their destiny and islature since the effort to legalize as - and a member of Parliament is ex - avoid unnecessary suffering. I believe sisted suicide in the United States began. pected to introduce such a bill later this is the right thing to do.” 37 Vermont, however, is considered one in the year . 34 Other nations, includ - Several safeguards are built into the of the nation’s most liberal states, and ing New Zealand, along with parts of measure. Two doctors, the patient’s Shumlin pledged to sign the law after Australia, are contemplating similar primary physician and a second doc - it is reviewed. measures. 35 tor, must agree the patient has a ter - Bills modeled after Oregon’s law Cultural and religious prohibi - minal illness and is able to request also have been introduced this year

www.cqresearcher.com May 17, 2013 463 ASSISTED SUICIDE

in Connecticut, that of the Death with Hawaii, Kansas, Dignity National Center. Montana, Massa - Death with Dignity chusetts and New supports replicating the Jersey. Similar bills Oregon law in other r

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After the Ver - G statute are a Holy Grail mont House voted Patrick the hospice dog visits a resident on Sept. 12, 2012, at the in any sense.” The ruling Kaplan Family Hospice House, a 20-bed facility run by the Hospice of on May 13, Coombs the North Shore & Greater Boston. The facility provides end-of-life care, in Montana established Lee of Compassion along with grief resources, for terminally ill patients and their families. “three bright lines” that & Choices said “this must be legally respect - historic legislative ed, she says. “The patient victory proves that the aid-in-dying ico case is expected to get a hearing must be mentally competent and also issue is no longer the third rail of pol - in December. terminally ill, and physician involvement itics. In fact, it’s a winning issue on In Hawaii, the state chapter of Com - is limited to providing a prescription.” which Gov. Shumlin campaigned.” passion & Choices is arguing the state’s But within these lines, Compassion & existing laws on patient rights and ad - Choices argues that doctors should be vance medical directives, along with able to work out the parameters of In the Courts the privacy clause in the state consti - physician-assisted suicide within their tution, effectively mean that physician- professional standards, as they would awyers for Compassion & Choic - assisted suicide already is legal in the any other procedure. L es served as co-counsel in the case state. 39 “We contend in Hawaii that “Medicine is not typically governed that finally led the Montana Supreme patients can choose aid in dying there,” by statute,” says Tucker. “I think what Court to declare physician-assisted sui - says Tucker. is happening in Montana is reflecting cide legal under certain conditions in In 2011, Hawaii Attorney General the normalization of aid in dying, and the state. The organization is pursu - David M. Louie issued an opinion to that’s the direction it’s appropriate to ing a case in New Mexico that could the contrary, saying that physicians go at this point in time. Will Montana similarly result in legalization. “This is who wrote lethal prescriptions with doctors incorporate all the procedures a case brought by two physicians and the intention of assisting in death there are in Oregon and Washington a terminally ill patient that asks the could be c harged with manslaughter. state? Probably not. There will be court to clarify that an old criminal In 2012, however, several physicians in some organic evolution.” statute [applying to suicide] does not the state indicated their willingness to That evolution is one of the things have application to the conduct of a offer assisted suicide to patients to test that most worry opponents, who fear it physician providing aid in dying,” says the ruling . 40 will become too easy for people to re - Kathryn Tucker, Compassion & Choic - Compassion & Choices’ emphasis on ceive medical assistance in killing them - es director of legal affairs. “The argu - fighting in court to establish the legali - selves, even crossing the line to allow ment of the case is that the choice of ty of assisted suicide in states where the non-terminal cases to request and re - a dying patient for a peaceful death group believes existing laws make it ceive such help. is no kind of suicide.” The New Mex - possible reflects a different strategy than Continued on p. 466

464 CQ Researcher At Issue:

Shoyes uld the terminally ill have the right to assisted suicide?

DAVID J. MAYO , PHD . DANIEL CALLAHAN PROFESSOR OF PHILOSOPHY EMERITUS , PRESIDENT EMERITUS , T HE HASTINGS UNIVERSITY OF MINNESOTA , D ULUTH ; CENTER ; C O-DIRECTOR , Y ALE -H ASTINGS BOARD MEMBER , D EATH WITH DIGNITY PROGRAM IN ETHICS AND HEALTH POLICY ; AUTHOR , THE TROUBLED DREAM OF LIFE : WRITTEN FOR CQ RESEARCHER , MAY 2013 IN SEARCH OF A P EACEFUL DEATH WRITTEN FOR CQ RESEARCHER , MAY 2013 y father, 93 and dying of colon cancer, remarked to the nurse enrolling him in hospice care that “the sooner this is over with, the better.” At that ew of us want to die, and no one wants to die a m poor death, one marked by pain and suffering. But point, his final life-projects were closing down. His only remain - ing fundamental interest and concern were the time and cir - f modern medicine has brought us to a difficult place: cumstances of his death. In Oregon or Washington state — and We now live longer than earlier generations, but there probably soon in Vermont — he could have ended his life are ever more clever technological ways to prolong our dying, peacefully, with dignity and on his own terms. As it was, he well beyond what we may desire. One solution to that kind of quit eating. Self-starvation struck him as his least-worst option. end is physician-assisted suicide, giving us the power to end Two arguments for death with dignity leap from this experi - our life on our own terms. And it has a common-sense attrac - ence. The most intuitive derives from compassion: What possi - tion: “It’s my body, isn’t it?” ble good is served by denying escape from those final weeks I believe it is a bad solution to an unnecessary problem. of slow decline and suffering? And what horrible fear haunts We now have good home and hospital palliative care pro - many more terminal patients, not brave or determined enough grams, effectively able to eliminate or greatly reduce pain and to starve theymselves but teerrified of hows their final days might suffering. Makinng good use of those medical skills is the hos - play out as circumstances strip them of every shred of control? pice program, now helping more than a million persons a This suggests the second argument: The supreme value we year receive sensitive care in dying. Physician-assisted suicide place on self-determination in matters that are both private and is thus rarely needed, as the citizens of Oregon and Washing - also of fundamental concern to the individual. ton state, where it is legal, have demonstrated. They make use Critics argue that embracing death with dignity would be a of it in exceedingly small numbers. risky departure from the value we in general, and medicine in But what of that minority who believe they can’t be helped particular, place on prolonging human life — that allowing and who even reject hospice care? By and large, research death with dignity would invite horrible abuses. But consider: shows, they are those mainly drawn to physician-assisted sui - • Current law and medical practice already recognize the cide by a loss of autonomy and self-control in their dying — right of competent adults to refuse life-prolonging therapies, that is, not by a medical problem but by a set of values however trivial (for example, an antibiotic to end a life-threatening about what they consider a life worth living. Doctors should pneumonia), and even feeding tubes and hydration via IV. not be empowered to provide that kind of relief, which never • The law also recognizes a terminal patient’s right to ade - was and is still not a valid goal of medicine. Nor is the im - quate palliative care, even if this requires doses of powerful plicit message of physician-assisted suicide one our society analgesics high enough to hasten death by suppressing respi - needs: that suicide is a good way to deal with the suffering ration. The fundamental proviso is that the earlier death must life can bring. not be intended, but merely foreseen by the physician. In We all die. Death is not an indignity. It is simply our practice this often means the line between “optimal palliative human fate. With the help of advance directives or the ap - care” and culpable homicide is drawn in terms of the invisible pointment of a surrogate — and a final enrollment in hospice intentions of the physician (on which even he may not be care — the odds of dying in a really bad way have been ex - clear). Few patients or family are informed (or ask) whether traordinarily reduced, even if not to the vanishing point. The lethal doses are administered. If ever there was a situation most important need is to greatly reduce the present aggres - ripe for abuse, surely this is it. sive medical war against death. Greater prognostic candor on • The question of risk is always an empirical one. It’s our the part of doctors is needed with those clearly on the way good fortune that Oregon’s 15-year experience with legalized to death even if not yet clearly dying. The good doctor is one death with dignity provides such conclusive data: The threat - who balances the goal of saving life and seeking a patient’s ened abuses simply have not materialized. peaceful death. As these considerations become more widely understood I expectn o death with dignity to gain wider acceptance.

www.cqresearcher.com May 17, 2013 465 ASSISTED SUICIDE

Continued from p. 464 Center, National Institutes of Health, knowledgement that this is a medical and the University of Utah’s Battin con - treatment, just like disconnecting feeding Health Care Costs cluded, “Physician-assisted suicide is tubes or providing palliative sedation.” not likely to save substantial amounts But Callahan, the Hastings Center pponents of physician-assisted of money in absolute or relative terms, president emeritus, notes that resis - O suicide argue that pressure to cut either for particular institutions or for tance to assisted suicide based on re - costs could make assisted-suicide more the nation as a whole.” 42 ligious beliefs remains strong in much attractive to health of the United States, care providers. In the and he doesn’t see that Massachusetts de - changing. “It’s certainly bate, “We said, ‘If not going anywhere private insurance very fast,” he says. “If it n companies and o has trouble in places like h t [health-maintenance r a Massachusetts, it’s not M organizations] have e going to fly in places D

a choice between ex - s like Louisiana or Mis - e pensive care or a u sissippi down in the Re - q c a cheap lethal pre - J ligious Belt.” / s scription, what do e However, Sandeen of g you t hink they will a Death with Dignity m I

be tempted to y contends the effort to t t choose?’ ” says Karuth e legalize assisted suicide G / of Second Thoughts. P nationwide is just get - F

But supporters A ting started: “We are a counter that there is Demonstrators in Paris lie in simulated body bags on Jan. 25, 2011, to protest a bill that would legalize euthanasia in France. The protest in very young social move - no evidence med - front of the Luxembourg Gardens was organized by the Right to Life ment,” she says. “We can ical costs have Alliance. The French Senate defeated the bill the next day, 170-142. really trace our roots played a role in en - back to 1990, and if you couraging assisted look at movements sur - suicide in either Oregon or Washing - rounding things like gay marriage or ton. “In 15 years there’s not been one abortion, they go back way farther incidence of coercion,” says Sandeen OUTLOOK than that. . . . We look like we haven’t of the Death with Dignity National Cen - had as many accomplishments, but ter, “for the disabled or any other vul - give us 20 years, and we’ll be there.” nerable population.” She adds that doc - Karuth of Second Thoughts says tors who participated in such lobbying Young Movement people close to her and close to those pressure would risk losing their license. she has counseled have asked, “If you Analysts differ over whether cost oombs Lee of Compassion & really are this sick, why don’t you just savings would be significant enough C Choices thinks the aging of the kill yourself and get it over with?” If to encourage the practice. In a 2011 baby boom generation is likely to boost assisted suicide becomes more wide - study, the New York State Depart - support for physician-assisted suicide ly available in coming years, Karuth ment of Health concluded, “Under in coming years. As the generation has says, more people who are seriously any new system of health care de - watched its parents struggle at the end ill or living with disabilities will face livery, as at present, it will be far of their lives, “too many of us have those kinds of questions. less costly to give a lethal injection witnessed really horrific deaths, and Hendin of Suicide Prevention Initia - than to care for a patient through - from those experiences comes a vow tives believes the future of the assisted- out the dying process.” 41 that this will not be how I’m meeting suicide movement depends on whether However, in a 1998 article pub - my death,” she says. “I think there’s the nation makes further advances in lished in The New England Journal of sort of a determination to make it dif - pain management and palliative care. “If Medicine , Ezekiel Emanuel, chair of ferent for ourselves.” end-of-life care improves, I think the the Department of Clinical Bioethics In 10 or 15 years, Coombs Lee con - issue [of assisted suicide] is going to be - at the Warren G. Magnuson Clinical tends, “There will be a growing ac - come irrelevant,” he says. “If you had

466 CQ Researcher proper palliative care, I’m persuaded at 7 Rita L. Marker and Kathi Hamlon, “Isn’t eu - 16 Ezekiel J. Emanuel, “Whose Right to Die?” least half of [the patients who have cho - thanasia or assisted suicide sometimes the The Atlantic , March 1997, www.theatlantic.com/ sen physician-assisted suicide] would not only way to relieve excruciating pain?” Eu - magazine/archive/1997/03/whose-right-to-die/ have dreamed of going that way.” thanasia and Assisted Suicide: Frequently Asked 304641 /. 17 Although she found the narrow de - questions, the Patients Rights Council, www. Trip Gabriel, “A Fight to the Death,” The feat in Massachusetts disappointing, patientsrightscouncil.org/site/frequently-asked- New York Times Magazine , Dec. 8, 1991, www. questions /. nytimes.com/1991/12/08/magazine/a-fight-to- Clish, the Massachusetts woman 8 “To Live Each Day with Dignity: A Statement the-death.html?pagewanted=all&src=pm . whose father chose assisted suicide in on Physician-Assisted Suicide,” United States 18 Biography page, Derek Humphry, www. Oregon, thinks that because the ref - Conference of Catholic Bishops, adopted June derekhumphry.com/derek_humphry_biography. erendum focused attention on the issue 16, 2011, www.usccb.org/issues-and-action/ html . it will benefit the cause in the com - human-life-and-dignity/assisted-suicide/to-live- 19 “Our Mission,” Final Exit Network, www.final ing years. “People had to go and mark each-day/upload/bishops-statement-physician- exitnetwork.org /. a box for something that most peo - assisted-suicide-to-live-each-day.pdf . 20 “Jack Kevorkian,” The Economist , June 9, 2011, ple don’t even want to talk about,” 9 “The Right to Die with Dignity, 1988 Gen - www.economist.com/node/18802492 . Clish says. “It definitely opened up a eral Resolution,” Unitarian Universalist Associ - 21 Joe Swickard, Patricia Anstett and L. L. conversation, and I believe more will ation, www.uua.org/statements/statements/144 Brasier, “Jack Kevorkian sparked a debate on come of that conversation, now that 86.shtml . death,” The Detroit Free Press , June 4, 2011, 10 Ben Matlin, “Suicide by Choice? Not So fast,” www.freep.com/article/20110604/NEWS05/106 we’re finally talking about it.” The New York Times , Oct. 31, 2012, www.ny 040427/Jack-Kevorkian-sparked-debate-death . times.com/2012/11/01/opinion/suicide-by-choice- Also see “Nov. 22, 1998: Kevorkian,” “60 Min - not-so-fast.html . utes,” CBS News, www.cbsnews.com/video/ Notes 11 Susan W. Tolle, et al. , “Characteristics and watch/?id=4462047n . Proportions of Dying Oregonians Who Per - 22 Ibid. sonally Consider Physician Assisted Suicide,” 23 “Jack Kevorkian,” op. cit. 1 “Washington v. Glucksberg,” 521 U.S. 702 The Journal of Clinical Ethics , Summer 2004, 24 Abby Goodnough, “Schiavo Dies, Ending (1997), Legal Information Institute, Cornell www.ncbi.nlm.nih.gov/pubmed/15481162 . Bitter Case Over Feeding Tube,” The New York University School of Law, www.law.cornell. 12 Margaret P. Battin, et al. , “Legal physician- Times , April 1, 2005, www.nytimes.com/2005/ edu/supct/html/96-110.ZO.html . assisted dying in Oregon and the Netherlands: 04/01/national/01schiavo.html . 2 “Oregon’s Death with Dignity Act — 2012,” evidence concerning the impact on patients 25 Ibid. Oregon Public Health Division, January 2013, in ‘vulnerable’ groups,” Journal of Medical Ethics , 26 “A Timeline in the Terri Schiavo Case,” The http://public.health.oregon.gov/ProviderPart October 2007, www.ncbi.nlm.nih.gov/pubmed/ New York Times , April 1, 2005, www.nytimes. nerResources/Evaluationresearch/deathwith 17906058 . com/imagepages/2005/04/01/national/200504 dignityact/Pages/index.aspx . 13 Peter Tyson, “The Hippocratic Oath Today,” 01schiavo_graphic.html . 3 “Washington State Department of Health 2011 “Nova,” March 27, 2001, www.pbs.org/wgbh/ 27 “Terri Schiavo dies, but battle continues,” Death with Dignity Act Report, Executive Sum - nova/body/hippocratic-oath-today.html . NBCnews.com, March 31, 2005, www.nbcnews. mary,” Washington State Department of Health, 14 Ibid. com/id/7293186/ns/us_news/t/terri-schiavo- February 2012, www.doh.wa.gov/portals/1/ 15 “Opinion 2.211 — Physician-Assisted Sui - dies-battle-continues/#.UYNHzHArzww . Documents/5300/DWDA2011.pdf . cide,” American Medical Association Code of 28 “The Assisted Suicide Decision,” The New 4 Some lawyers disagree that the Montana Ethics, www.ama-assn.org/ama/pub/physician- York Times , Jan. 19, 2006, www.nytimes.com/ Supreme Court decision made physician- resources/medical-ethics/code-medical-ethics/ 2006/01/19/opinion/19thu1.html?_r=1&hp&oref assisted suicide legal in the state. Most promi - opinion2211.page . =slogin . nent is Margaret Dore, an attorney in Wash - ington state who heads Choice is an Illusion, an organization opposed to physician-assisted About the Author suicide. However, many legal analysts have char - acterized the ruling as allowing the practice. Reed Karaim , a freelance writer in Tucson, Ariz., has writ - 5 Kirk Johnson, “Montana Ruling Bolsters ten for The Washington Post , U.S. News & World Report , Doctor-Assisted Suicide,” The New York Times , Smithsonian , American Scholar , USA Weekend and other Dec. 31, 2009, www.nytimes.com/2010/01/ publications. He is the author of the novel, If Men Were 01/us/01suicide.html . Angels , which was selected for the Barnes & Noble Dis - 6 “Large Majorities Support Doctor Assisted cover Great New Writers series. He is also the winner of Suicide for Terminally Ill Patients in Great the Robin Goldstein Award for Outstanding Regional Re - Pain,” Harris Interactive, Jan. 25, 2011, www. porting and other journalism honors. Karaim is a graduate harrisinteractive.com/NewsRoom/HarrisPolls/ tabid/447/mid/1508/articleId/677/ctl/ReadCust of North Dakota State University in Fargo. om%20Default/Default.aspx .

www.cqresearcher.com May 17, 2013 467 ASSISTED SUICIDE

29 Susan Donaldson James, “Dr. Peter Good - win, Father of Oregon Suicide Law, Takes Own Life,” ABC News, March 13, 2012, (interview FOR MORE INFORMATION in video link), http://abcnews.go.com/blogs/ Center to Advance Palliative Care , 1255 Fifth Ave., Suite C-2, New York, NY health/2012/03/13/dr-peter-goodwin-father-of- 10029 ; 212-201-2670 ; www.capc.org . Works to increase the availability of quality oregon-suicide-law-takes-own-life /. palliative care services for people facing serious, complex illness. Website includes 30 Ibid. Years later, when he was terminally ill, information for health care professionals and the general public. Goodwin took advantage of the state’s assisted suicide law. Compassion & Choices , P.O. Box 101810, Denver, CO 80250 ; 800-247-7421 ; 31 “Assisted suicide: Over my dead body,” The www.compassionandchoices.org . Advocates legalization of “assisted dying” and Economist , Oct. 20, 2012, www.economist.com/ other end-of-life options; has 60 chapters nationwide. news/international/21564830-helping-terminally- ill-die-once-taboo-gaining-acceptance . Death with Dignity National Center , 520 S.W. Sixth Ave., Suite 1220, Portland, 32 Belinda van Steijn, “Nine myths about eu - OR 97204 ; 503-228-4415 ; www.deathwithdignity.org /. Leads the defense of Oregon’s Death with Dignity Act; promotes education about the law and supports passage thanasia in the Netherlands,” Radio Nether - and implementation of similar laws in other states. lands Worldwide, Feb. 29, 2012, www.rnw.nl/ english/article/nine-myths-about-euthanasia- Disability Rights Education and Defense Fund , 3075 Adeline St., Suite 210, netherlands . Berkeley, CA 94703 ; 510-644-2555 ; http://dredf.org . Disability-rights group opposed 33 “FAQ — Euthanasia in the Netherlands,” to legalizing physician-assisted suicide. Radio Netherlands Worldwide, Sept. 29, 2009, www.rnw.nl/english/article/faq—-euthanasia- The Hastings Center , 21 Malcolm Gordon Rd., Garrison, NY 10524 ; 845-424-4040 ; netherlands . www.thehastingscenter.org . Nonpartisan research center that studies ethical issues 34 Ruth Gledhill and Francis Gibb, “Christians in health, medicine and the environment. back change in assisted suicide law, poll finds,” The Times (U.K.), May 1, 2013, www.thetimes. Patient Rights Council , P.O. Box 760, Steubenville, OH 43952 ; 740-282-3810 ; co.uk/tto/faith/article3752991.ece . www.patientsrightscouncil.org/site /. Provides information on end-of-life decisions 35 “Assisted Suicide: Over my dead body,” op. and works with other groups to oppose physician-assisted suicide. cit. 36 “The legality of assisted suicide around the world,” The Associated Press ( The Detroit Free CITING CQ RESEARCHER Press ), June 4, 2011, www.freep.com/article/ Sample formats for citing these reports in a bibliography include the ones listed 20110604/NEWS07/110604004/The-legality- below. Preferred styles and formats vary, so please check with your instructor or pro - assisted-suicide-around-world . 37 “Vermont Legislature Approves Assisted- fessor. Suicide Bill,” NPR, May 14, 2013, www.npr.org/ 2013/05/14/183896062/vermont-legislature- MLA STYLE approves-assisted-suicide-bill?sc=nd . Jost, Kenneth. “Remembering 9/11.” CQ Researcher 2 Sept. 2011: 701-732. 38 Jacob Gershman, “Vermont Lawmakers Ap - prove Assisted Suicide Bill,” The Wall Street APA S TYLE Journal , Law Blog, May 14, 2013, http://blogs. Jost, K. (2011, September 2). Remembering 9/11. CQ Researcher, 9 , 701-732. wsj.com/law/2013/05/14/vermont-lawmakers- approve-assisted-suicide-bill . CHICAGO STYLE 39 Kevin B. O’Reilly, “5 Hawaii doctors offer Jost, Kenneth. “Remembering 9/11.” CQ Researcher , September 2, 2011, 701-732. assisted suicide to terminally ill patients,” American Medical News , April 17, 2012, www. amednews.com/article/20120417/profession/ euthanasia.procon.org/view.answers.php?ques New England Journal of Medicine , July 16, 304179996/8 /. tionID=000207 . 1998, www.scribd.com/doc/18428440/What- 40 Ibid. 42 Ezekiel Emanuel and Margaret P. Battin, Are-the-Potential-Cost-Savings-From-Legalizing- 41 “When Death is Sought,” The New York “What Are the Potential Cost Savings from Physician-Assisted-Suicide . State Department of Health, April 2011, http:// Legalizing Physician-Assisted Suicide?” The

468 CQ Researcher Bibliography Selected Sources

Books York Times , April 10, 2012 , www.nytimes.com/roomfor debate/2012/04/10/why-do-americans-balk-at-euthanasia-laws . Ball , Howard , At Liberty to Die: The Battle for Death In a series of short opinion pieces, supporters and oppo - with Dignity in America , NYU Press , 2012 . nents of physician-assisted suicide and euthanasia examine why A professor of political history and law considers whether it is more controversial in the United States than in Europe. it is appropriate, legally and ethically, for a competent indi - vidual to have the liberty to decide how and when to die Hafner , Katie , “In Ill Doctor, a Surprise Reflection of Who when faced with a terminal illness. Picks Assisted Suicide,” The New York Times , Aug. 11, 2012 , www.nytimes.com/2012/08/12/health/policy/in-ill- Berlinger , Nancy , Bruce Jennings and Susan M. Wolf , doctor-a-surprise-reflection-of-who-picks-assisted-suicide. The Hastings Center Guidelines for Decisions on Life- html?pagewanted=all . Sustaining Treatment and Care Near the End of Life, Opponents of right-to-die laws suggest they might be used to Revised and Expanded Second Edition , Oxford University pressure poorer people to kill themselves to save money, but Press , 2013 . a review of patients who have used the laws finds they over - Three scholars connected to the Hasting Center, a bioethics whelmingly were well educated and financially comfortable. institution in Garrison, N.Y., update a guide intended to help health care professionals navigate the ethical and medical Lloyd , Janice , “Support grows in Vermont for end-of-life decisions they might face in treating terminally ill patients. bill,” USA Today , March 22, 2013 , www.usatoday.com/ story/news/nation/2013/03/21/death-with-dignity-vermont- Hendin , Herbert , Seduced by Death: Doctors, Patients, laws/2003365 /. and Assisted Suicide , W. W. Norton & Co. , 1998 . A reporter examines the efforts of supporters of physician- A psychologist and expert on suicide shares his experiences assisted suicide to get a bill through the Vermont legislature. studying assisted suicide in the Netherlands and argues against legalizing the practice in the United States. Pickert , Kate , “A Brief History of Assisted Suicide,” Time , March 3, 2009 , www.time.com/time/nation/article/0,85 Rollin , Betty , Last Wish , Public Affairs , August 1998 . 99,1882684,00.html . A veteran television correspondent writes about her struggle The writer provides an overview of some of the most sig - to come to terms with her terminally ill mother’s wish to nificant moments in the debate over assisted suicide, in - die and how she finally helped fulfill her wish. cluding the actions of Dr. Jack Kevorkian and the decision to remove Florida’s Terri Schiavo from life support. Smith , Wesley J. , Forced Exit: Euthanasia, Assisted Sui - cide and the New Duty to Die , Encounter Books , 2006 . Swickard , Joe , Patricia Anstett and L. L. Brasier , “Jack A prolific author and journalist who writes about bioethics Kevorkian sparked a debate on death,” The Detroit Free argues against assisted suicide and euthanasia as denigrations Press , June 4, 2011 , www.freep.com/article/20110604/ of the value of human life. NEWS05/106040427/Jack-Kevorkian-sparked-debate-death . The controversial life of Kevorkian, known as “Dr. Death,” Wazner , Sidney , and Joseph Glenmullen , To Die Well: Your is reviewed by his hometown newspaper upon his death. Right to Comfort, Calm and Choice in the Last Days of Life , De Capo Press , 2008 . Reports and Studies The former director of Harvard Law School health services reviews the options available for making a patient’s final days “Oregon’s Death With Dignity Act — 2012,” Oregon Public as comfortable as possible and defends physician-assisted Health Division , January 2013 , http://public.health.oregon. suicide as one of those options. gov/ProviderPartnerResources/EvaluationResearch/Death withDignityAct/Documents/year15.pdf . Articles The Oregon law requires the state to release an annual re - port on patients who have requested lethal medication and “Over my dead body: Helping the terminally ill to die, once on how many have subsequently used the pills. taboo, is gaining acceptance,” The Economist , Oct. 20, 2012 , www.economist.com/news/international/21564830-help “Washington State Department of Health 2011 Death ing-terminally-ill-die-once-taboo-gaining-acceptance . with Dignity Act Report,” Washington State Department The British business magazine examines the international of Health , Feb. 29, 2012 , www.doh.wa.gov/portals/1/ right-to-die movement and the effort to spread acceptance. Documents/5300/DWDA2011.pdf . Washington provides an executive summary of its latest re - “Why Do Americans Balk at Euthanasia Laws?” The New port on the state’s Death with Dignity Act.

www.cqresearcher.com May 17, 2013 469 The Next Step: Additional Articles from Current Periodicals

Ethics physician-assisted suicide, society should determine what it owes the suffering and dying members of a community, says Altimari , Daniela , “Catholics and Conscience,” Hartford a Delaware Catholic priest. (Conn.) Courant , March 27, 2012 , p. A1 , articles.courant. com/2012-03-26/news/hc-catholics-death-penalty-0325- Knickerbocker , Brad , “Jack Kevorkian Drove the Debate 20120326_1_capital-punishment-death-penalty-repeal-bill . on Physician-Assisted Suicide,” The Christian Science A Catholic Connecticut state representative says she opposes Monitor , June 3, 2011 , www.csmonitor.com/USA/Society/ euthanasia because it involves the killing of innocent people 2011/0603/Jack-Kevorkian-drove-the-debate-on-physician- but supports the death penalty because it punishes offenders. assisted-suicide . Dr. Jack Kevorkian is widely regarded as the most con - Brannigan , Michael , “Finding a Tidy End to Our Lives,” troversial figure who confronted the ethical issues involving Times-Union (N.Y.), April 27, 2012 , p. A11 , www.times euthanasia. union.com/opinion/article/Finding-a-tidy-end-to-our-lives- 3513986.php . Manning , Michael , “Decision to End Life Should Be God’s Legalizing physician-assisted suicide may not set the best Alone,” Asbury Park (N.J.) Press , Nov. 25, 2012 , p. B1 , example for future generations on how people should die www.app.com/article/20121125/NJOPINION06/3112 501 with dignity, says a professor of ethics and morals at the 18/Decision-end-life-should-God-s-alone . College of St. Rose, a Catholic institution in New York state. Physician-assisted suicide cannot be recommended from either a faith-based or secular perspective, says a New Jersey pastor. Conaboy , Chelsea , “Is Debate Really on ‘Assisted Dying’?” The Boston Globe , July 16, 2012 , p. B6 . Nichols , Arland K. , “Suicide: The Way to Go?” Arlington Supporters of legislation that would permit physician-assisted (Va.) Catholic Herald , March 6, 2013 , www.catholicherald. suicide say the practice isn’t really “suicide” if it involves com/stories/Suicide-The-way-to-go,22098 . people who are already dying. Suicide is a direct offense against God because God is the creator of life, says the director of a Catholic organization. Draper , Electa , “ ‘Final Exit’ Leads to Fork in the Road,” The Denver Post , June 15, 2011 , p. B4 , www.denverpost. Pacholczyk , Tadeusz , “Please Step Back From the Assisted- com/commented/ci_18274748 . Suicide Ledge,” The Wall Street Journal , Oct. 7, 2012 , on The U.S. Conference of Catholic Bishops acknowledges the line.wsj.com/article/SB1000087239639044422310457803 need for medical care to lessen the suffering of terminally 8703017615898.html . ill patients but firmly opposes physician-assisted suicide. Physician-assisted suicide creates ethical dilemmas for loved ones left behind and society in general, says a Massachusetts Jenkins , Logan , “Law Should Remove ‘Criminals’ From priest. Suicide,” San Diego Union-Tribune , Aug. 30, 2012 , p. NC1 , www.utsandiego.com/news/2012/aug/30/tp-law-should- Hippocratic Oath remove-criminals-from-suicide . Assisted suicide generally remains a crime in the United Bosley , Craig , “Avoiding Consequences,” Kearney (Neb.) States because of the influence religion has in the country, Hub , Jan. 11, 2012 , www.kearneyhub.com/news/opinion/ says a columnist. avoiding-consequences-today-we-re-never-wrong/article_ a7648408-3c75-11e1-995f-001871e3ce6c.html . Kincaid , Joseph E. , “Medical Personnel Need Protection The Hippocratic Oath was “modernized” in the 1970s to of Conscience Clauses,” Kalamazoo (Mich.) Gazette , Dec. remove prohibitions against abortion and euthanasia to better 26, 2011 , p. A10 , www.mlive.com/opinion/kalamazoo/ reflect modern values, says a Nebraska physician. index.ssf/2011/12/medical_personnel_need_protect.html . The United States needs a conscience clause to protect Jacoby , Jeff , “What About Do No Harm?” The Boston Globe , medical personnel from performing procedures they find Oct. 17, 2012 , p. A17 , www.bostonglobe.com/opinion/ morally offensive, such as abortion or euthanasia, says a 2012/10/17/what-would-hippocrates/3TbEEvaWvKSbK7 Michigan physician. gqld9L4J/story.html . Suicide is not a form of health care, and doctors who pre - Klein , Leonard R. , “Dying Need Care and Comfort, Not scribe it would be in violation of the Hippocratic Oath, says Assisted Suicide,” News Journal (Del.), June 8, 2011 , www. a columnist. delawareonline.com/article/20110608/OPINION07/1060 80307/Dying-need-care-comfort-not-assisted-suicide . Shotwell , John M. , “Maybe Now, Nation Can Discuss Instead of asking whether people should have the right to Reasonableness of Assisted Suicide,” Lexington (Ky.)

470 CQ Researcher Herald Leader , June 19, 2011 , p. D1 , www.kentucky.com/ end their own lives, while supporters say it would prevent 2011/06/19/1780778/maybe-now-nation-can-discuss-rea elder abuse. sonableness.html . Some supporters of physician-assisted suicide say it does Pain Management not violate the Hippocratic Oath because they believe ex - tending life beyond its normal parameters is a worse medical Emanuel , Ezekiel J. , “Four Myths About Doctor-Assisted violation. Suicide,” The New York Times , Oct. 28, 2012 , p. SR4 , opinionator.blogs.nytimes.com/2012/10/27/four-myths- Wright , Jim , “Doctors’ Role Is Not to Enable Suicides,” about-doctor-assisted-suicide . Richmond (Va.) Times Dispatch , July 16, 2011 , p. 1 , www. Most patients who undergo physician-assisted suicide do timesdispatch.com/entertainment-life/faith-values-physi not experience excruciating pain during the process, says a cians-role-is-not-to-assist-with-suicides/article_44ee1d4f- University of Pennsylvania oncologist. fdc2-58b2-81a6-2ccc0f4b15eb.html . Medicine has nothing to do with physician-assisted suicide Lambert , Frank , “Manage Pain, Don’t Kill People,” Green other than a confused and misplaced notion of providing Valley (Ariz.) News & Sun , Nov. 17, 2012 , www.gvnews. compassion and preserving dignity, says a Virginia doctor. com/opinion/letters_to_editor/in-my-view-manage-pain- don-t-kill-people/article_0f1f7cde-30e9-11e2-86a7-0019bb Legislation 2963f4.html . Physician-assisted suicide is not necessary to get rid of pain Dwyer Jr. , Thomas E. , and James C. King , “Making a because of medical advances in pain management, says a Case Against Physician-Assisted Suicide,” Massachusetts retired hospital administrator. Lawyers Weekly , Nov. 1, 2012 , masslawyersonline.com/ massachusetts-lawyers/blog-attorney/directory/author/ Right to Die thomas-e-dwyer-jr-and-james-c-king . Massachusetts should not legalize physician-assisted suicide Caudill , Lindsay , “Give Me Liberty, or Give Me Physician- because the language in current proposals is too ambiguous Assisted Death,” Business Lexington (Ky.), May 23, 2012 , to determine a physician’s responsibility, say two attorneys bizlex.com/2012/03/give-me-liberty-or-give-me-physician- in the state. assisted-death . People should be allowed to free themselves from the pain Heagney , Meredith , “Assisted-Suicide Debate Hasn’t Eased,” and suffering that comes with a terminal illness and to do Columbus (Ohio) Dispatch , June 10, 2011 , www.dispatch. it with dignity, says a columnist. com/content/stories/faith_and_values/2011/06/10/assisted- suicide-debate-hasnt-eased.html . Crowley , Kieran , and Josh Saul , “Parents Ordered to Let Only a few states allow physician-assisted suicide, but the Paralyzed Gal Die,” New York Post , Oct. 6, 2012 , p. 15 , practice has been considered in legislatures and courts in www.nypost.com/p/news/local/queens/decease_desist_ several others. OJwb50NsCLIE4CnZPbeGCO . A New York City woman won a legal battle against her Nakaso , Dan , “Doctor Says 1909 Law Allows Assisted parents when a court decided she has the right to remove Suicide,” Honolulu Star-Advertiser , Oct. 23, 2011 , www. a respirator that is keeping her alive. staradvertiser.com/s?action=login&f=y&id=132399628&id= 132399628 . Jolly , David , “Push for the Right to Die Grows in the An obscure 1909 law allows assisted suicides to be per - Netherlands,” The New York Times , April 3, 2012 , p. D1 , formed in Hawaii for certain diseases, says a physician in www.nytimes.com/2012/04/03/health/push-for-the-right- the state. to-die-grows-in-the-netherlands.html?pagewanted=all&_r=0 . An overwhelming majority of Dutch residents believe eu - Singer , Peter , “The Ethics of Death,” The Denver Post , thanasia should be made available to suffering patients who Aug. 19, 2012 , p. D6 , www.denverpost.com/opinion/ci_ want it. 21331137/canadian-als-says-dying-is-her-right . There are conflicting views over whether the legalization Ring , Dan , “ ‘Right to Die’ Up for Debate,” The Repub - of physician-assisted suicide in Oregon makes certain groups lican (Mass.), Aug. 20, 2012 , p. A1 , www.masslive.com/ vulnerable. poli tics/index.ssf/2012/08/northampton_woman_seeks_ death. html . Wipf , Briana , “Emotions Flow Over Assisted Suicide,” Critics of “right to die” initiatives say hospice and palliative Great Falls (Mont.) Tribune , March 26, 2013 . care are better choices for terminally ill patients than physician- Opponents of a proposed Montana ban on physician- assisted suicide. assisted suicide say it would take away patients’ freedom to

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