EUTHANASIA AND ASSISTED SUICIDE IN PERSONS WITH ACQUIRED IPIMUNODEFICXENCY SYNDROME (AIDS) OR HUMAN IMMUNODEFICIENCY VIRUS (HIV) Russel D. Ogden B.G.S. Simon Frasar University 1986 B.S.W. University sf Victoria 1991 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF' THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in the School of Criminology (c) Russel D. Ogden SIMON FRASER UNIVERSITY February 1994 A11 rights reserved. This work may not be reproduced in whole or in part, by photocopy or other means, without permission of the author. 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AUTORISATION. - ISBN 0-612-01102-X APPROVAL NAME: Russel David Ogden DEGREE : Master sf Criminology TITLE OF THESIS: Euthanasia and Assisted Suicide in Persons with Acquired Immunodeficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) Examining Committee: Chair: Robert J. Menzies, Ph.D. Professor William Glackman, Ph.D. Associate Professor Eike-Henner Kluge, Ph.dl. External Examiner Professor of Philosophy University of Victoria Date Approved: &A 6?/w I hereby grant to Sirm Fraser University the right to lenC my thesis, project or extended sssay <the title of w:icb is shem helow) to users of the Simon fraser Llniversity Library, and to make partial or single copies only for such users or in response to a reqbest fr~mthe library of any other university, or other educational institution, 011 its own behalf or for one of its users. I further agree that pzrmissi~n for multiple copying of this wcrk for scholarly purposes nay be granted by me or the Cean of Graduate S+ddies. It is understood that copying or publication of this work for financizl gain shall not be allowed without ny written pzrmission. T i t I e of T 5 e s i s/f[fljm//rnflf~fl/45/5/~,~/ Euthanasia and Assisted Suicide in Persons who have Acquired Immunodeficiancy Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) Russel David Ogden ( neme ABSTRACT The AIDS epidemic is confronting the euthanasia debate in an unprecedente , fashion. That euthanasia is almost never prosecuted in Canada suggests that the practice is rare. Nevertheless, the lay press, medical, legal, and psychological literature indicate that euthanasia occurs among persons with AIDS, with and without the assistance of physicians. This study investigated the views, attitudes, and experiences regarding euthanasia held by persons with HIV/AIDS and those who have been involved in assisting the deaths of persons with AIDS. A snowball sampling technique was used to gather data from two self-selected sample populations: i) persons with HIV/AIDS (N = 18); and ii) persons who have been involved in AIDS-related euthanasia (N = 17). Using an open-ended semi-structured interview, variables such as personal experiences with AIDS, terminal illness, moral and philosophical beliefs, legal and ethical issues, and practical considerations related to euthanasia were explored. Fifteen (83.3%) of the persons in the HIV/AIDS sample said that euthanasia or assisted suicide was a choice for themselves, and eight (44.4%) had developed plans for their iii suicide or assisted death, Concerns regarding loss of control as their health deteriorates were expressed by 14 (78%) of the sample. The euthanasia participant group identified 34 deaths by euthanasia or assisted suicide. Ten participants in the sample had been directly involved in performing at least one act of euthanasia or assisted suicide (E = 17 deaths), Six had either been present at, or involved in the planning of assisted deaths (a = 10 deaths), and six had reliable information regarding cases of euthanasia (Q = 7 deaths). Although the practice of euthanasia is illegal in Canada, the data show that it occurs with regularity in the AIDS population--at least 2.7% of all AIDS deaths in British Columbia involve euthanasia or assisted suicide. It is estimated that the real figure may be as high as 10 to 20 percent. Prescription medications and Hemlock-type techniques were the methods of choice. In this study, many of the acts of eathanasia occurred in such appalling circumstances that they may make the case for state regulation of voluntary euthanasia and assisted suicide. "Imagine yourself in your own private holocaust, facing certain death. Your captor offers you a choice: a slow death by physical and psychological torture; or a quick death, medically supervised, via a painless overdose. Which would you choose? Which would you choose for your mother? Which would your God choose for you/her?" Dave Bosomsworth, (Vancouver Sun, July 31, 1993, p. D13). "Making someone die in a way that others approve, but he believes a horrifying contradiction of his life, is a devastating, odious form of tyranny." Ronald Dworkin, (Life's Daminion, 1993, p. 217). I would like to thank the members of my supervisory committee for guiding me through this thesis. I am indebted to Professor Simon Verdun-Jones for his scholarly expertise, and above all, his compassion and kindness during some difficult moments. I thank Professor Bill Glackman for sharing his discerning skills in social science methodology, and for involving himself in this project during a crisis, Professor Eike-Henner Kluge was a formidable external examiner, and gave me much to consider should I continue in academe. Thank you. Professor Patricia Brantingham provided thoughtful criticism with the development of the research proposal. Dr. Peter Harmon was a consid~ratefriend and resource person, without whom this work could never have been completed. Dr. Peter Jepson-Young offered practical advice and referrals that fostered a wara reception of this work by the AIDS population. Dr. David Kuhl contributed his insight and expertise as a palliative case physician. Irene Goldstone of the B.C. Centre for Excellence in HIV/AIDS was quietly encouraging and supportive. Hamo Geukdjian was tireless and generous in his role as computer wizard. Arn Schilder, Chair of the Vancouver Persons With AIDS Society, offered sober criticism and encouragement. Dr. Michael Priest also gave significant support at a critical time. The B.C, Health Research Foundation's generous financial support for this study was most appreciated. Above all, I am deeply indebted to all who participated in the study. You have my admiration for your strength in living with AIDS, or for your meaningful assistance to those who have AIDS. I am in awe of your courage, compassion, and selflessness. It is your views, perspectives, and experiences that make this thesis largely a consultative work. I will remember you all. Finally, I thank my wife Judith, and daughter Alexandra. You both sacrificed so much with scarcely a complaint or whimper of self-pity. Your love, understanding, resilience, and compassion were of immeasurable sustenance to me. vii TAgLE OF CONTENTS Page I . INTRODUCTION AND BACKGROUND .....................1 Definitions ...................................5 Theories of Suicide ..........................6 Criminological Theories Classical Theory of Suicide ...........*.....7 Positivist Individualistic Theory of Suicide ................................ 10 Social Structure (Subculture) Theory of Suicide.......................... ,.... .l1 Learning Theory of Suicide ................12 Social Control Theory of Suicide ..........13 Social Reaction (Labeling) Theory of Suicide................................... 14 Social Conflict Theory of Suicide .........15 Conclusion ................................16 The Euthanasia Debate .......................A 7 Supporters of Euthanasia ..................l8 Opponents of Euthanasia ...................19 Euthanasia Law. Policy. and Practice .........25 Canada .................................... 25 Parliamentary Initiatives................. 33 B.C. Royal Commission Recommendations .....35 The Sue Rodriguez Case .................... 36 Erwin Krickhahn ...........................39 Euthanasia Cases in Canada Dr . Natchum Gal .........................40 Dr . Peter Graff .........................40 Dr . Tom Perry ...........................41 Nancy B .................................43 Carolyn Goguen ..........................45 Scott Mataya ............................46 Andrew Sikorski .........................47 Dr . Alberto de la Rocha .................49 AIDS-Related Euthanasia Cases.. .........50 Conclusions .............................52 International Perspectives Britain .................................53 United States ...........................56 Switzerland ............................. 59 The Netherlands .........................60 Summary .................................63 Euthanasia and Public Opinion