Assisted suicide in the United States

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A map showing the states that allow assisted suicide

Physician-assisted suicide in the United States is legal in the states of Oregon, Washington, and Vermont. In the state of Montana, the Baxter v. Montana (2009) court decision created a defense for a physician who is prosecuted should he or she be charged in assisting a suicide. Prosecutions for assisted suicide remain possible in Montana and conviction remains possible in Montana. New Mexico doctors can help terminal patients die according to a 2014 court decision[1]; doctors could not be prosecuted under the state's assisted suicide law, which classifies helping with suicide as a fourth-degree felony. The plaintiffs in the case did not consider physicians aiding in dying a form of suicide. The New Mexico Attorney General's Office said it is discussing the possibility of an appeal but needs to fully analyze the judge's opinion before commenting further.

The process is set forth in law, including the requirements that the patient must be of sound mind when requesting assisted suicide, as confirmed by a doctor and other witnesses, and the patient must be diagnosed with a terminal illness.

Legal requirements[edit]

The Oregon Death with Dignity Act, and the Washington statute modeled after it, set certain requirements and safeguards before a person may commit suicide with a doctor's assistance. The patient must be of sound mind when they request a prescription for a lethal dose of medication. Two doctors must confirm a diagnosis of terminal illness with no more than six months to live. Two witnesses, one non-doctor unrelated to the patient, must confirm the patient's request, and the patient must make a second request after 15 days.

History[edit]

Assisted suicide movement of 1906[edit]

The first significant drive to legalize assisted suicide in the United States arose as part of the eugenics movement in the early years of the twentieth century. In a 2004 article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. In Ohio, the legislation was inspired by the campaign of heiress Anna S. Hall, whose mother had died a painful death from cancer.[2] Despite Hall’s efforts, the bill was rejected by the Ohio legislature by a vote of 79 to 23.[2][3]

Dr. Kevorkian[edit]

Assisted suicide in the United States was brought to public attention in the 1990s with the highly publicized case of Dr. Jack Kevorkian. Dr. Kevorkian assisted over 40 people in committing suicide in Michigan.[4] His first public assisted suicide was in 1990, of Janet Adkins, a 54-year-old woman diagnosed with early-onset Alzheimer’s disease in 1989. He was charged with murder, but charges were dropped on December 13, 1990 because there were no Michigan laws outlawing suicide or the medical assistance of it so he was not in violation of a law.[5]

Years later, Kevorkian crossed the line from assisting the patient to actively killing the patient himself. Kevorkian videotaped himself giving a man a lethal injection and aired the tape on 60 Minutes. He was found guilty of second-degree murder and served eight years of a 10–25 year sentence. He was released in 2007, and died on June 3, 2011.[6]

California's Proposition 161[edit]

In 1992, the group Californians against Human Suffering proposed Proposition 161 to allow patients with less than six months to live the right to receive assistance from physicians in dying. This proposition offered more safeguards against abuse by physicians than Washington’s Initiative 119, such as special protections for patients in nursing facilities. This measure also did not pass with only 46 percent of the vote.[7]

Subsequent efforts were tried to pass assisted suicide legalization through the California State Legislature in 1999, 2005 and 2006. All of which failed due to bipartisan opposition including major disability rights organization across the state, the California Medical Association and the California League of United Latin American Citizens.

New York cases[edit]

In 1994, a suit was filed in New York claiming that the anti-assisted suicide statute was a violation of equal protection and liberty guarantees of the Fourteenth Amendment. This claim was rejected by the District Court on the basis that there is no right to assisted suicide given by the U.S. Constitution. In 1996, the U.S. Court of Appeals overturned this ruling with the reasoning that the criminalization of assisted suicide violates the Equal Protection Clause. However, the U.S. Supreme Court unanimously reversed the U.S. Court of Appeals decision in Vacco v. Quill, 521 U.S. 793 (1997).

Oregon ballot measures[edit]

Ballot Measure 16, a citizen initiative sponsored by Oregon Right to Die Political Action Committee,[8] was presented to Oregon voters in 1994. It asked if terminally ill patients with less than 6 months to live should be able to receive a prescription for lethal drugs and included many provisions to protect against misuse, such as two oral requests and a written request from the patient. The patient must also be referred to counseling if a mental illness is suspected. This ballot measure passed by a narrow margin with 51.3 percent of the vote. This was seen as a victory for supporters of assisted suicide. The passage of this measure became very controversial. Many feared that people would flock to Oregon to take advantage of this law.[9]

Ballot Measure 16 provided for enactment of the Oregon Death with Dignity Act. That law requires that patients of sound mind may request a prescription for a lethal dose of medication. Two doctors must confirm a diagnosis of terminal illness with no more than six months to live. Two witnesses, one non-doctor unrelated to the patient, must confirm the patient's request, and the patient must make a second request after 15 days. The 2008 Washington law is closely modeled on the Oregon law.

In 1997, the Oregon Legislative Assembly sent a ballot measure to the voters, Measure 51, which sought to repeal the Death with Dignity Act. The measure was introduced because of the controversy surrounding the passage of Ballot Measure 16 and the slow implementation of it. Measure 51 was defeated by 60 percent of the vote.[9]

77 people used this law to hasten their deaths in 2012. A total of 61 doctors participate.[10]

For participants, the death certificate lists the terminal disease as the cause of death.[10]

Washington[edit]

In 1991, the Washington state chapter of the Hemlock Society (which later merged with another organization to become Compassion & Choices) introduced Initiative 119 as an amendment to Washington’s 1979 Natural Death Act. The ballot question asked if terminally ill adults should be allowed to receive physician aid-in-dying. This initiative was controversial. Supporters of the initiative advertised cancer patient’s statements of wanting a dignified death. Opponents argued that the initiative would enable doctors to kill patients. The initiative failed, receiving 46 percent of the vote.[7]

However, the Washington Death with Dignity Act was approved on the November 4, 2008 election by 57.82% of Washington state voters. The provision allows an adult Washington resident who has a six month predicted survival to self-administer lethal medication prescribed by a physician.

Florida: Krischer v. McIver[edit]

This case was brought to the Florida Supreme Court in 1997 by the Florida chapter of the Hemlock Society in an attempt to overturn the state’s anti-assisted suicide law. The question was if AIDS patient Charles Hall had this right, and the case was appealed to the Florida Supreme Court. This court upheld the constitutionality of Florida’s law against assisted suicide.[11]

Alaska: Sampson and Doe v. State of Alaska[edit]

In 1999, two terminally ill patients, Kevin Sampson and Jane Doe, sued for an order to exempt their physicians from being charged with manslaughter for assisting them in committing suicide. The superior court ruled against them, and they appealed to the Alaska Supreme Court. This court upheld the previous ruling with the reasoning that the Alaska Constitution’s right to privacy and liberty does not allow terminally ill patients to be assisted by physicians in committing suicide.[11]

Montana[edit]

In Montana, a physician may now raise a defense of consent if charged with assisting in a suicide through a trial court ruling on December 6, 2009 in the case of Baxter v. Montana. The Attorney General of the state of Montana sought an appeal from the Montana Supreme Court, but the court, by a decision of five to two, affirmed the lower court's ruling on the state law. The Court did, however, limit the scope of the decision by not determining if the state's constitution protected the right.[12]

Massachusetts[edit]

Voting results for the 2012 Massachusetts Death with Dignity Initiative

The Massachusetts Death with Dignity Initiative, a ballot measure to legalize physician-assisted suicide, was narrowly defeated in a remarkable come-from-behind effort in the state's 2012 general election, with 51% of voters against the proposal.

A poll taken by the Boston Globe and the University of New Hampshire between September 21 and September 27th found Massachusetts residents supporting Question 2 68%, with only 20% opposed. Another public poll by the University of Massachusetts and YouGov American found similar results as late as October 8th with 65% in support and 19% opposed.

Vermont[edit]

In May 2013, the Vermont Legislature passed the Patient Choice and Control at End of Life Act. Governor Peter Shumlin signed it into law. The law is based on, but is less restrictive than, the Oregon model.[13]

Patients must have the ability to administer the life-ending medicine to themselves. They must be capable of making sound decisions. They must be 18 years old or more. They must have a doctor's diagnosis of a terminal illness with less than six months to live. They must make multiple requests with specific waiting times and be given the opportunity to rescind at any time. After three years, these requirements are void. Medical personnel are granted immunity for assisting terminally ill patients to die. There are no reports to the government at any time.[10]

Hospitals, doctors, and pharmacists may opt out of the program. However, all doctors are obliged to inform terminal patients of the program.[10]

State power to allow and regulate[edit]

States have the power to allow and regulate assisted suicide, or to prohibit it.

In 1997, in the cases of Washington v. Glucksberg and Vacco v. Quill, the U.S. Supreme Court ruled unanimously that there is no Constitutional right to assisted suicide, and that states therefore have the right to prohibit it. Advocates of assisted suicide saw this as opening the door for debate on the issue at the state level.[11]

Gonzales v. Oregon was brought to the United States Supreme Court in 2006. The court ruled that the United States Attorney General could not enforce the federal Controlled Substances Act against physicians who prescribed drugs, in compliance with Oregon state law, for the assisted suicide of the terminally ill.

See also[edit]

References[edit]

  1. ^ http://www.nytimes.com/2014/01/14/us/new-mexico-judge-affirms-right-to-aid-in-dying.html?_r=0
  2. ^ a b Appel, JM (2004). "A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906". Bulletin of the History of Medicine 78 (3): 610–34. doi:10.1353/bhm.2004.0106. PMID 15356372.  edit
  3. ^ Emanuel, E. (November 1994). "History of Euthanasia Debates in the United States and Britain". Annals of Internal Medicine 121 (10): 793–802. doi:10.1059/0003-4819-121-10-199411150-00010. PMID 7944057.  edit
  4. ^ Angell, M. (1997). "The Supreme Court and Physician-Assisted Suicide — the Ultimate Right". The New England Journal of Medicine 336 (1): 50–53. doi:10.1056/NEJM199701023360108. PMID 8970940.  edit
  5. ^ "People v. Kevorkian; Hobbins v. Attorney General". Ascension Health. 2007. Ascension Health. 7 April 2009.
  6. ^ "Kevorkian Case: Kevorkian sentenced to 10 to 25 years". CNN 31 Dec 2007 1. 7 April 2009.
  7. ^ a b Annas, G. (1994). "Death by Prescription. The Oregon Initiative". The New England Journal of Medicine 331 (18): 1240–1243. doi:10.1056/NEJM199411033311822. PMID 7935680.  edit
  8. ^ "Oregon's Fight over the Right to Die". Courtney S. Campbell; The Hastings Center Report, Vol. 24, 1994.
  9. ^ a b "Ballot Measures". Death with Dignity National Center 2008 1. 7 April 2009.
  10. ^ a b c d Hallenbeck, Terri (July 14, 2013). "Vermont adjusts to new way of dying". The Burlington Free Press (Burlington, Vermont). pp. 6B–9B. Retrieved July 20, 2013. 
  11. ^ a b c Marker, Rita L. (2009). "Assisted Suicide: The Continuing Debate". International Task Force 1-18. 1 March 2009.
  12. ^ "Mont. court: State law doesn’t prevent assisted suicide". The Spokesman-Review. 2009-12-31. Archived from the original on 3 January 2010. Retrieved 2009-12-31. 
  13. ^ Hallenbeck, Terri (May 14, 2013). "Vermont end-of-life bill heads to governor". USA Today (Burlington, Vermont). Retrieved May 14, 2013. 

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