Do We Have The
Right To Die?
we assume that every human being born into this world
has a "right to life," then it logically follows
that every human being has a right to end their life
(or a "right to die"). Because death is a
part of life, a person's right to life logically assumes
a right to not have that life. Thus, any law upholding
a person's right to life has inherent within that same
law a person's right to die, otherwise it would not
be a right to life in the true sense of the term. But
there is a legal battle going on in America right now
over whether or not a person has a right to die (i.e.,
a right to life). In the case of
a woman who has been kept alive artificially for the
past 13 years even though she is in a "persistent
(i.e., a condition in which a person is technically
alive but brain dead), the government stepped in to
deny Terri the "death with dignity" sought
by her husband in accordance with Terri's wishes. Does
the government have the right to prolong your life by
artificial means whether you desire it or not? The following
is an article by Josh Patashnik entitled "Life
or Death: A controversial Florida case reignites the
debate over right-to-die laws" published on January
1, 2004, which clarifies the current debate.
Schiavo has spent the past 13 years in a hospital bed,
the tragic victim of massive cardiac arrest at age 26.
When her husband Michael looks at her, he sees his wife
being kept alive artificially in what doctors call a "persistent
vegetative state," against her wishes and with
no hope for recovery. By contrast, when her parents,
Bob and Mary Schindler, look at her, they see their
daughter lying motionless but aware, silent but emotionally
responsive, a testament to the endurance and sanctity
of human life.
Table of Contents
Political Fight Over Terri Schiavo
should decide Terri Schiavo's fate?
This question has been at the center of a messy, five-year
legal battle that came to a head in October, when, under
the order of Florida Circuit Judge George Greer, Terri's
feeding tube was removed, beginning the process that
would have led to her death. Greer's opinion, upheld
by a Florida appeals court, concluded that Michael Schiavo
had presented sufficient evidence that Terri was unlikely
to recover and would not have wanted to be kept alive
by artificial means.
than a week later, however, after intense lobbying by
a slew of mostly conservative interest groups, the Republican-controlled
Florida legislature passed a law giving Gov. Jeb Bush
the authority to order the reinsertion of Schiavo's
feeding tube, which he did. "We applaud the legislature's
decision," said Brewster Thackeray, vice president
of the National Organization on Disability, in an interview
with the HPR. "Our biggest concern is that in a
case like this, it needs to be 100 percent clear that
there is no hope for recovery and that this is what
the patient would have wanted. There's just too much
uncertainty here." But doctors appointed by the
courts and by Bush have found no possibility that Terri's
condition will improve and question the credibility
of the doctors hired by Terri's parents, who have concluded
otherwise. "They're pretty much just a bunch of
quacks," said Ron Cranford, a professor of neurology
at the University of Minnesota and right-to-die activist
who has been involved in the case, in an interview with
of the new law note that because it is written to apply
retroactively to only the Schiavo case, it appears to
violate the separation-of-powers provision of the Florida
Constitution. "If Terri's case means that this
issue needs rethinking, the legislature is free to do
so in an evenhanded way for future cases. But this stunt
is not a legislative act at all. It's a judicial function,"
Professor Lars Noah of the University of Florida Law
School told the HPR. Noah also noted that the law may
be in violation of Terri's federal constitutional rights
under the Fourteenth Amendment's due process clause.
Either way, the case is headed back to court, where
such concerns will be addressed.
2. A Lively Debate on the
Schiavo case highlighted an issue that has long simmered
beneath the surface in legal and political circles:
under what circumstances do terminally injured and ill
Americans have the right to choose to die? The Supreme
Court made a definitive statement in the landmark 1990
case Cruzan v. Director, Missouri Dept. of Health that
severely injured patients have a constitutional right
to refuse medical treatment and die. But the court also
ruled that states can require "clear and convincing"
evidence of a patient's intent to forgo medical treatment,
a rather high evidentiary standard to meet.
This standard has led to a
proliferation of what are termed "living wills",
legally binding documents that declare a patient's wishes
in the event of catastrophic injury. All parties agree
that the Schiavo case would be far less complicated
had Terri left a living will, and those in the medical
community hope to promote the use of living wills to
avoid situations like hers. "We need to have a
massive public education campaign to teach people about
living wills," said Cranford. "They just aren't
on most people's radar screens."
the past decade, much of the right-to-die debate has
centered on the issue of physician-assisted suicide.
In the 1997 case of Washington v. Glucksberg, the Supreme
Court ruled that the terminally ill do not have a constitutional
right to physician-assisted suicide and that states
can craft their own physician-assisted suicide laws.
Oregon has taken the lead in doing so, its citizens
voting in 1994 and again in 1997 to approve the Death
with Dignity Act, which allows physicians to prescribe
lethal drugs to terminally ill patients. More than 70
terminally ill Oregonians have made use of the law,
which has survived numerous legal challenges. One of
these challenges, the result of an ongoing effort by
Attorney General John Ashcroft to use the federal Controlled
Substances Act to override the Oregon law, is currently
pending before the Ninth Circuit U.S. Court of Appeals
and will figure prominently in future assisted-suicide
debates in Oregon and elsewhere. Other states, including
Hawaii and Vermont, are now working to mold their assisted-suicide
laws after Oregon's.
3. FAQs About Physician-Assisted Suicide
Euthanasia Research & Guidance Organization
When and where did the modern voluntary euthanasia movement
In 1935 in Britain, in l938 in the U S A, and in l980
in Canada. The British and America groups were very
small and insignificant for the next two decades.
When did the movement start to become bigger and more
After the hugely-publicized Karen Ann Quinlan `right
to die' case in New Jersey in 1976 revealed to the public
the extent of modern medical technology to extend life
indefinitely in a persistent vegetative state. In 1980
Derek Humphry founded the Hemlock Society to campaign
for law reform on assisted dying.
How many people support voluntary euthanasia for the
Opinion polls show average support of 70 percent in
the USA, 74 percent in Canada, and 80 percent in Britain.
When actually voting in official ballot measures, the
support has been 46 percent in Washington State (1991),
46 percent in California (1992), 51 percent in Oregon
(1994), and 60 percent in Oregon (1997).
How many physicians support assisted dying?
Numerous opinion polls indicate that half the medical
profession would like to see it made law. It also appears
that about 15 percent of physicians already practice
it on justifiable occasions. The leadership of the professional
medical group, the American Medical Association, remains
What do the terms used in this FAQ mean?
'Voluntary Euthanasia' (VE) means death by lethal injection;
'Physician-assisted Suicide' (PAS) means death by oral
ingestion of prescribed lethal drugs. (It is PAS only
which Oregon has legalized.) Passive euthanasia means
the disconnection of life-supports systems from a hopelessly
Where does the main opposition to voluntary euthanasia
The hierarchy of the Roman Catholic Church. The Church
of Jesus Christ of Latter Day Saints (Mormons). Also
churches on the religious right.
Which churches officially support the principle of assisted
dying for the terminally ill?
United Church of Christ (Congregational), the Unitarian
Church, and the Methodist Church on the West coast of
America. It appears that the congregations of most churches
are divided on the issue.
How many copies have been sold of Derek Humphry's 1991
best-selling book, 'FINAL EXIT: The Practicalities of
Self-Deliverance and Assisted Suicide for the Dying'?
About 750,000 in the USA and Canada and approximately
250,000 in other major world languages. It consistently
sells roughly 1,000 copies a month in North America
There was a revised, 3rd edition published by Delta
paperbacks, New York, in 2003. It is obtainable in good
bookstores worldwide or from Amazon.com or
Is the book banned in any country?
Exit is banned in France. Attempts to ban the book in
Australia and New Zealand failed. In Britain, publishers
fearing the law do not publish it, but the imported
book is freely sold through the book trade there.
Where has assisted dying been made lawful in the world
In only one place: The American state of Oregon, where
its citizens in November 1994 voted for Ballot Measure
16 which permits physician-assisted suicide for the
terminally ill under limited conditions. Despite opponents'
attempts to block it in the courts, and a ballot initiative
in 1997 trying to repeal the law, The Death with Dignity
Act withstood all challenges and became effective in
October 1997. During the five years the Oregon law has
been operating, a total of 129 patients have used it
to end their lives -- about one in 1,000 of the state's
What about the Netherlands, which is famous for its
liberal attitudes? And the Belgians?
Voluntary euthanasia and assisted suicide were permitted
by the Dutch for some 20 years before it was actually
made legal, under strict guidelines, by the Dutch Parliament
in 2002. Later the same year the Belgian Parliament
approved a similar law. For a complete round-up of the
world's laws go to
What is the legal position in other countries?
Voluntary euthanasia is lawful in Japan (but apparently
rarely practiced); PAS has been lawful in Switzerland
since 1937. It has never been against the law in Germany,
although taboo restricts its use.
How much assisted dying goes on now in America?
Nobody really knows because, with assisted suicide a
crime, incidents are almost always kept secret to avoid
possible prosecution, although this is extremely rare.
Derek Humphry estimates that there are probably several
thousand cases in the USA each year.
suicide and attempted suicide crimes?
They used to be. The punishment for suicide was to deprive
the family of any inheritance, and imprisonment for
attempting self-destruction. But not any longer, anywhere.
It is the `assistance in suicide' which remains the
crime (excepting Oregon) which ERGO and other groups
would like to see decriminalized for the terminally
and hopelessly ill, provided that a willing physician
carries it out under supervision and with accepted guidelines.
How can I help to support choice in dying?
Running a nonprofit organization with worldwide visibility
like ERGO requires funding and support from people like
you. Find out how you can help to further the cause
of choice in dying.
4. Why I Believe In Physician Assisted
|by Derek Humphry
movement for choice in dying is dedicated to the view
that there are at least two forms of suicide. One is
'emotional suicide', or irrational self-murder, in all
of it complexities and sadness. Let me emphasize at
once that my view of this tragic form of self-destruction
is the same as that of the suicide intervention movement
and the rest of society, which is to prevent it wherever
possible. I do not encourage any form of suicide for
mental health or emotional reasons. Nevertheless, life
is a personal responsibility and we know some people
are so tormented that they cannot bear to live. In such
circumstances, understanding is called for.
believe that there is a second form of suicide -- justifiable
suicide, which is rational and planned deliverance from
a painful and hopeless disease. I don't think the word
'suicide' sits too well in this context but we are stuck
with it. I have struggled for twenty years to popularize
the term 'self-deliverance' but it is an uphill battle
with a news media which is in love with the words 'assisted
suicide' and 'suicide.' They are headline grabbers.
Also, we have to face the fact that the law calls all
forms of self-destruction 'suicide.' Additionally, all
medical journals today refer to 'assisted suicide' in
me point out here for those who might not know it that
suicide is no longer a crime anywhere in the English-speaking
world. (It used to be in many places, punishable by
giving all the dead person's money and goods to the
government.) Attempted suicide, which hundreds of years
ago in Europe was punishable by execution, is no longer
a crime. Do not confuse this decriminalization with
health laws where a suicidal person can in most states
be forcibly placed in a psychiatric wing of a hospital
for three days for evaluation.
But giving assistance in suicide
remains a crime, except in the Netherlands in recent
times under certain conditions, and it has never been
a crime in Switzerland and Germany, although the taboos
there are strong. The rest of the world punishes assistance
in suicide even for the terminally ill; although the
American State of Oregon recently (1994) passed by citizens'
ballot measure a limited physician-assisted suicide
law. After court battles initiated by the pro-life movement,
the Oregon law took effect at the beginning of l998,
a year during which there were 16 lawful assisted suicides,
while in 1999 there were 27. Not exactly the stampede
our critics were predicting!
Even if a hopelessly ill person
is requesting assistance in dying for the most compassionate
reasons, and the helper is acting from the most noble
of motives, any form of direct euthanasia remains a
crime in the remainder of the Anglo-American world.
You cannot ask to be killed. Punishments for this are
usually 'life' and for assisted suicide, fines or up
to fourteen years in prison. It is this catch-all prohibition
which ERGO and other right-to-die groups wish to change.
In a caring society, under the rule of law, we claim
that there must be exceptions for the hopelessly ill
after all other avenues have been exhausted.
Dr. Jack Kevorkian was guilty
in law but morally innocent (in my view) of helping
a terminal man to die by lethal injection. A Michigan
jury found him guilty of second-degree murder and he
was jailed for 10-25 years. In recent years two spouses
in New York State have been imprisoned for assisting
their sick wives to die. Exactly there is the huge law
reform problem we have to surmount.
5. Word Origins and
word 'euthanasia' comes from the Greek -- Eu, "good",
and Thanatos, "death". Literally, "good
death". But the word 'euthanasia' has acquired
a more complex meaning in modern times -- it is generally
taken nowadays to mean taking action to achieve a good
death. Suicide, self-deliverance, auto-euthanasia, aid-in-dying,
assisted suicide, physician-assisted suicide, physician-assisted
dying - call it what you like - can be justified by
the average supporter of the right to die movement for
the following reasons:
Advanced terminal illness that is causing unbearable
suffering - combined physical and psychic -- to the
individual despite good medical care. This is the most
common reason to seek an early end. (And as Oregon research
has shown, being a burden to others is an additional
Total loss of quality of life due to protracted, incurable
Grave physical handicap which is so restricting that
the individual cannot, even after due consideration,
counseling and re-training, tolerate such a limited
existence. This is a fairly rare reason for suicide
-- most impaired people cope remarkably well with their
afflictions -- but there are some disabled who would,
at a certain point, rather die.
6. The Ethical Parameters
for Physician-Assisted Suicide
The person is a mature adult. This is essential. The
exact age will depend on the individual but the person
should not be a minor, who comes under quite different
The person has clearly made a considered and informed
decision. An individual has the ability nowadays to
indicate this with a "Living Will" (which
applies only to disconnection of life supports) and
can also, in today's more open and tolerant climate
about such actions, discuss the option of a hastened
death with health professionals, family, lawyers, etc.
But they may not demand it.
c. The euthanasia has not
been carried out at the first knowledge of a life-threatening
illness, and reasonable medical help has been sought
to try to cure or at least slow down the disease. The
pro-choice movement does not believe in giving up on
life the minute a person is informed of a terminal illness,
a common misconception spread by our critics. Life is
precious, you only pass this way once, and is worth
a fight. It is when the fight is clearly hopeless and
the agony - physical and mental - is unbearable that
a final exit is an option.
The treating physician has been informed, asked to be
involved, and the response taken into account. What
the physician's response will be depends on the circumstances,
of course, but we advise people that as rational suicide
is not a crime, there is nothing a doctor can do about
it. But it is best to inform the doctor and listen to
the response. For example, the patient might be mistaken
- perhaps the diagnosis has been misheard or misunderstood.
In the last century, patients raising this subject were
usually met with a discreet silence, or meaningless
remarks, but in this century's more accepting climate
of personal freedoms most physicians will discuss potential
end of life actions, however cautiously.
e. The person has made a Will
disposing of worldly possessions and money. This shows
evidence of a tidy mind, an orderly life, and forethought
-- all something which is paramount to an acceptance
of rational suicide.
The person has made plans to exit that do not involve
others in criminal liability or leave them with guilt
feelings. As I have mentioned earlier, assistance in
suicide is a crime in most places, although the application
of the law is growing more tolerant. Few cases actually
come to court. But care must still be taken and discretion
is the watchword.
The person leaves a note saying exactly why he or she
is taking their life. This statement in writing obviates
the chance of subsequent misunderstandings or blame.
It also demonstrates that the departing person is taking
full responsibility for the action. If the aim is to
attempt to allow the death to be seen as 'natural' and
not suicide, this note should be kept in a private,
secure place and only shown later if necessary.
7. Suicide is Not
A great many cases of self-deliverance
or family-assisted suicide, using drugs and/or a plastic
bag, or inert gases, go undetected by doctors, especially
now that autopsies are the exception rather than the
rule (only 10 percent, and only when there is a mystery
about the cause of death).
if a doctor asked for a death certificate knows that
the patient was in an advanced state of terminal illness
then not much fuss will be made over the precise cause
paramedics, medical examiners, and coroners put a low
priority on investigation of suicide, particularly when
evidence comes before them that the person was dying
The Need For Both Methods
claim that it is sufficient to legalize physician-assisted
suicide and not voluntary euthanasia as well. I have
never taken that halfway view. Here's why:
suicide (drinking prescription lethal medication) is
not as efficient as voluntary euthanasia (lethal injection).
Even using the best barbiturates, the oral route takes
much longer - up to 11 hours in a few cases - which
is a terrible strain on family present. In the Netherlands,
doctors will only let such a case linger for four hours
before administering a lethal injection. Injection into
a vein always ends of the life of the patient within
about ten minutes.
terminally ill patients are unable to drink, or keep
down, the lethal fluid because of invasive surgery.
If help in dying is restricted to those who can take
oral fluids, then a great many patients who most need
help are sidelined.
the constant attacks on the Oregon law show, the pro-life
movement will seek to destroy any and all laws on assisted
dying, no matter how moderate and limited. So the right-to-die
movement should fight to legalize what is best for the
patient - both methods - and make no concessions to
the religious right. But let us see what their main
9. Some Arguments Against
Having considered the logic
in favor of euthanasia, a person should also contemplate
the arguments against it:
Should the person go instead into
a hospice program and receive not only first-class pain
management but also comfort care and personal attention?
Hospices by and large do a great job with skill and
love. The right-to-die movement supports their work.
But not everyone wants a lingering death; not everyone
wants that form of care. Today many terminally ill people
take the marvelous benefits of home hospice programs
and still accelerate the end when suffering becomes
too much. Some 60 percent of those who took advantage
of the Oregon physician-assisted suicide law the first
two years were in hospice care.
b. A few hospice leaders claim
that their care is so excellent that there is absolutely
no need for anyone to consider euthanasia. They
are wrong to claim perfection. Neither hospice nor euthanasia
has the universal answer to all dying. Fortunately most,
but not all, terminal pain can today be controlled with
the sophisticated use of drugs, but the point these
leaders miss is that personal quality of life is vital
to some people. If one's body has been so destroyed
by disease that it is not worth living, then that is
an intensely individual decision which should not be
thwarted. In some cases of the final days in hospice
care, when the pain is very serious, the patient is
drugged into unconsciousness ('terminal sedation').
If that way is acceptable to the patient, fine. But
some people do not wish their final days to be spent
in that drugged limbo.
ought not to be conflict between hospice and euthanasia
- both are valid options in a caring society. Both are
appropriate to different people with differing medical
needs and ethical values. Later in the 21st century,
I am confident that hospice will become a place where
people go either for comfort care, terminal sedation,
or for assisted suicide. It is the appropriate place
for a dignified end.
Another consideration is theological:
does suffering ennoble? Is suffering, and relating
to Jesus Christ's suffering on the cross, a part of
preparation for meeting God? Are you merely a steward
of your life, which is a gift from God, and which only
He may take away? My response is this: if your answer
to these questions is 'Yes, God is my master in all
things,' then you should not be involved in any form
of euthanasia. It just does not fit.
There are millions of atheists
and agnostics, as well as people of various religions,
degrees of spiritual beliefs, and they all have rights
to their choices in abortion and euthanasia, too. Many
Christians who believe in euthanasia justify it by reasoning
that the God whom they worship is loving and tolerant
and would not wish to see them in agony. They do not
see their God as being so vengeful as refusing them
the Kingdom of Heaven if they accelerated the end of
their life to avoid prolonged, unbearable suffering.
consideration must be that, by checking out before the
Grim Reaper routinely calls, is one depriving oneself
of a valuable period of quality life? Is that last period
of love and companionship with family and friends worth
hanging on for? Our critics heavily use the argument
that this is the case.
necessarily so! In my twenty years in this movement,
and being aware of many hundreds of self-deliverances,
I can attest that even the most determined supporters
of euthanasia hang on until the last minute -- sometimes
too long, and lose control. The wiser ones gather with
their families and friends to say good-byes; there are
important reunions and often farewell parties. There
is closure of wounds and familial gaps just the same
as if the person was dying naturally - perhaps more
so since the exact timing of the death is known.
supporters enjoy life and love living, and their respect
for the sanctity of life is as strong as anybody's:
sanctity as distinct from sacredness. They are willing,
if their dying is distressing to them, to forego a few
weeks or a few days at the very end and expire at a
time of their choice. Moreover, they are not the types
to worry what the neighbors will think.
Should voluntary euthanasia
be your doctor's choice? There is another rightist
argument that the acceptance of euthanasia practices
will quickly destroy the traditional bond of trust between
doctor and patient; that the patient will never know
if the doctor is going to kill them or not; that commercialized
medical practices will jump at the chance to get rid
of long-term patients who are short of insurance funding.
arguments have been answered by the 20 years euthanasia
has been practiced in the Netherlands, and by the nearly
three years physician-assisted suicide has been available
in Oregon. No evidence of a breakdown in relationships
has emerged. Those doctors who are ethically opposed
to hastening the end of life just don't do it.
laws in the Netherlands, Oregon, and the ones which
have failed to pass, all give medical professionals
the right to refuse to be involved -- a conscience clause.
This exemption will always be so as far as I am concerned.
fact, many patients hold their medical advisors in higher
regard if they know that he or she will go to great
lengths to keep them from terminal suffering, even to
the extent of providing, if necessary, a gracious final
Comfort of Physician-Assisted Suicide Knowledge
people often do not realize is that, for many, just
knowing how to kill themselves is itself of great comfort.
It gives them the assurance to fight harder and therefore
often extends lives just a bit longer. Many people have
remarked to me that my book, "Final Exit"
is the best insurance policy they've ever taken out.
Once such people know how to make a certain and dignified
deliverance, with loved ones supporting them, they will
often renegotiate the timing of their death.
example, a man in his 90s called to tell me his health
was so bad he was ready to terminate his life. I advised
him to read "Final Exit," which he did and
he called me back. He had managed to get hold of lethal
drugs from a friendly doctor and so everything was in
what are you going to do now?" I asked him.
I'm not ready to go yet," he replied. "I've
got the means, so I can hold on a bit longer."
he had the knowledge, the drugs, and encouraged by the
control and choice now in his grasp, he had negotiated
new terms with himself concerning his fate. Surely,
for those who want this way, this is commendable and
is in fact an extension rather than a curtailment of
to the work in the last century of a forceful right-to-die
movement, a hidden reality has emerged about terminal
suffering, indicating that the time has come for change.
What are needed now are laws permitting voluntary euthanasia
and physician-assisted suicide surrounded with a bodyguard
of rules -- but not so many that the patient in unable
to jump through all the hoops.
With the inevitability of
gradualness, as the idea takes hold amongst rising generations,
reform will undoubtedly come. We who believe must ceaselessly
work for it.
2000 Derek Humphry. All rights reserved.
The History of
Oregon's Death With Dignity Law
Measure 16 of 1994 established the U.S.
state of Oregon's Death with Dignity Act
physician-assisted suicide with certain
restrictions. Passage of this initiative
made Oregon the first U.S. state and one of
the first jurisdictions in the world to
permit some terminally ill patients to
determine the time of their own death.
The measure was approved in the November
8, 1994, general election. 627,980 votes
(51.3%) were cast in favor, 596,018 votes
(48.7%) against. An injunction delayed
implementation of the Act until it was
lifted on October 27, 1997. Measure 51,
referred in the wake of
Washington v. Glucksberg by the state
legislature in November 1997, sought to
repeal the Death with Dignity Act, but was
rejected by 60% of voters. The act was
challenged by the George W. Bush
administration, but was upheld by the
Supreme Court of the United States in
Gonzales v. Oregon in 2006.
the law, a competent adult Oregon resident
who has been diagnosed, by a physician, with
a terminal illness that will kill the
patient within six months may request in
writing, from his or her physician, a
prescription for a lethal dose of medication
for the purpose of ending the patient's
life. Exercise of the option under this law
is voluntary and the patient must initiate
the request. Any physician, pharmacist or
healthcare provider who has moral objections
may refuse to participate.
request must be confirmed by two witnesses,
at least one of whom is not related to the
patient, is not entitled to any portion of
the patient's estate, is not the patient's
physician, and is not employed by a health
care facility caring for the patient. After
the request is made, another physician must
examine the patient's medical records and
confirm the diagnosis. The patient must be
determined to be free of a mental condition
impairing judgment. If the request is
authorized, the patient must wait at least
fifteen days and make a second oral request
before the prescription may be written. The
patient has a right to rescind the request
at any time. Should either physician have
concerns about the patient's ability to make
an informed decision, or feel the patient's
request may be motivated by depression or
coercion, the patient must be referred for a
protects doctors from liability for
providing a lethal prescription for a
terminally ill, competent adult in
compliance with the statute's restrictions.
Participation by physicians, pharmacists,
and health care providers is voluntary. The
law also specifies a patient's decision to
end his or her life shall not "have an
effect upon a life, health, or accident
insurance or annuity policy."
the act's passage through the end of 2015, a
total of 1,545 people have had prescriptions
written and 991 patients have died from
ingesting medications prescribed under the
The median age of the 991
patients who died from ingesting medication
was 71, with 77.1 percent of patients
suffering from malignant neoplasms (cancer).
Of the 991, 51.4% were male (48.6% female);
45.5% had a Baccalaureate degree or higher;
45.3% were married; primary end of life
concerns were loss of autonomy (91.6%),
inability to make life enjoyable (89.7%),
and loss of dignity (78.7%).
independent study published in the October
2007 issue of the
Journal of Medical Ethics reports there
was "no evidence of heightened risk for the
elderly, women, the uninsured, people with
low educational status, the poor, the
physically disabled or chronically ill,
minors, people with psychiatric illnesses
including depression, or racial or ethnic
minorities, compared with background
The Death with Dignity
Act was the basis of the
Washington Death with Dignity Act in
2008. In 2011 the documentary film
How to Die in Oregon was released. It
won the Grand Jury prize for documentary
film at the
27th Sundance Film Festival.
Dignity in Dying,
Lord Falconer's Assisted Dying Bill,
first tabled in the
House of Lords in June 2014, "draws on
the experience" of the Death with Dignity
12. A 20th Century Chronology of Physician-Assisted
First euthanasia bill drafted in Ohio. It does not succeed.
World's first euthanasia society is founded in London,
The Euthanasia Society of America is founded by the
Rev. Charles Potter in New York.
Joseph Fletcher publishes Morals and Medicine, predicting
the coming controversy over the right to die.
Pope Pius XII issues Catholic doctrine distinguishing
ordinary from extraordinary means for sustaining life.
Oxford law professor Glanville Williams publishes The
Sanctity of Life and the Criminal Law, proposing that
voluntary euthanasia be allowed for competent, terminally
Lael Wertenbaker publishes Death of a Man describing
how she helped her husband commit suicide. It is the
first book of its genre.
The first living will is written by attorney Louis Kutner
and his arguments for it appear in the Indiana Law Journal.
A right-to-die bill is introduced by Dr. Walter W. Sackett
in Florida's legislature. It arouses extensive debate
but is unsuccessful.
Doctors at Harvard Medical School propose redefining
death to include brain death as well as heart-lung death.
Gradually this definition is accepted.
Voluntary euthanasia bill introduced in the Idaho legislation.
Elisabeth Kubler-Ross publishes On Death and Dying,
opening discussion of the once-taboo subject of death.
The Euthanasia Society (US) finishes distributing 60,000
American Hospital Association creates Patient Bill of
Rights, which includes informed consent and the right
to refuse treatment.
Dr. Gertruida Postma, who gave her dying mother a lethal
injection, receives light sentence in the Netherlands.
The furore launches the euthanasia movement in that
The Euthanasia Society in New York renamed the Society
for the Right to Die. The first hospice American hospice
opens in New Haven, Conn.
Deeply religious Van Dusens commit suicide. Henry P.
Van Dusen, 77, and his wife, Elizabeth, 80, leaders
of the Christian ecumenical movement, choose to die
rather than suffer from disabling conditions. Their
note reads, "We still feel this is the best way
and the right way to go."
Dutch Voluntary Euthanasia Society (NVVE) launches its
Members' Aid Service to give advice to the dying. Receives
25 requests for aid in the first year.
The New Jersey Supreme Court allows Karen Ann Quinlan's
parents to disconnect the respirator that keeps her
alive, saying it is affirming the choice Karen herself
would have made. Quinlan case becomes a legal landmark.
But she lives on for another eight years.
California Natural Death Act is passed. The nation's
first aid in dying statute gives legal standing to living
wills and protects physicians from being sued for failing
to treat incurable illnesses.
Ten more U.S. states pass natural death laws.
First international meeting of right-to-die groups.
Six are represented in Tokyo.
Doris Portwood publishes landmark book Commonsense Suicide:
The Final Right. It argues that old people in poor health
might justifiably kill themselves.
Whose Life Is It Anyway?, a play about a young artist
who becomes quadriplegic, is staged in London and on
Broadway, raising disturbing questions about the right
to die. A film version appears in 1982. Jean's Way is
published in England by Derek Humphry, describing how
he helped his terminally ill wife to die.
Artist Jo Roman, dying of cancer, commits suicide at
a much-publicized gathering of friends that is later
broadcast on public television and reported by the New
Two right-to-die organizations split. The Society for
the Right to Die separates from Concern for Dying, a
companion group that grew out of the Society's Euthanasia
Advice column Dear Abby publishes a letter from a reader
agonizing over a dying loved one, generating 30,000
advance care directive requests at the Society for the
Right to Die.
Pope John Paul II issues Declaration in Euthanasia opposing
mercy killing but permits the greater use of painkillers
to ease pain and the right to refuse extraordinary means
for sustaining life.
Hemlock Society is founded in Santa Monica, California,
by Derek Humphry. It advocates legal change and distributes
how to die information. This launches the campaign for
assisted dying in America. Hemlock's national membership
will grow to 50,000 within a decade. Right to die societies
also formed the same year in Germany and Canada.
World Federation of Right to Die Societies is formed
in Oxford, England. It comprises 27 groups from 18 nations.
Hemlock publishes how-to suicide guide, Let Me Die Before
I Wake, the first such book on open sale
Famous author (Darkness at Noon etc.) Arthur Koestler,
terminally ill, commits suicide a year after publishing
his reasons. His wife Cynthia, not dying, chooses to
commit suicide with him.
Elizabeth Bouvia, a quadriplegic suffering from cerebral
palsy, sues a California hospital to let her die of
self-starvation while receiving comfort care. She loses,
and files an appeal.
Advance care directives become recognized in 22 states
and the District of Columbia.
The Netherlands Supreme Court approves voluntary euthanasia
under certain conditions.
Karen Ann Quinlan dies.
Betty Rollin publishes Last Wish, her account of helping
her mother to die after a long losing battle with breast
cancer. The book becomes a bestseller.
Roswell Gilbert, 76, sentenced in Florida to 25 years
without parole for shooting his terminally ill wife.
Granted clemency five years later.
Elizabeth Bouvia is granted the right to refuse force
feeding by an appeals court. But she declines to take
advantage of the permission and is still alive in l998.
Americans Against Human Suffering is founded in California,
launching a campaign for what will become the 1992 California
Death with Dignity Act.
The California State Bar Conference passes Resolution
#3-4-87 to become the first public body to approve of
physician aid in dying.
Journal of the American Medical Association prints It's
Over, Debbie, an unsigned article describing a resident
doctor giving a lethal injection to a woman dying of
ovarian cancer. The public prosecutor makes an intense,
unsuccessful effort to identify the physician in the
Unitarian Universalist Association of Congregations
passes a national resolution favoring aid in dying for
the terminally ill, becoming the first religious body
to affirm a right to die.
Washington Initiative (119) is filed, the first state
voter referendum on the issue of voluntary euthanasia
and physician-assisted suicide.
American Medical Association adopts the formal position
that with informed consent, a physician can withhold
or withdraw treatment from a patient who is close to
death, and may also discontinue life support of a patient
in a permanent coma.
Dr. Jack Kevorkian assists in the death of Janet Adkins,
a middle-aged woman with Alzheimer's disease. Kevorkian
subsequently flaunts the Michigan legislature's attempts
to stop him from assisting in additional suicides.
Supreme Court decides the Cruzan case, its first aid
in dying ruling. The decision recognizes that competent
adults have a constitutionally protected liberty interest
that includes a right to refuse medical treatment; the
court also allows a state to impose procedural safeguards
to protect its interests.
Hemlock of Oregon introduces the Death With Dignity
Act into the Oregon legislature, but it fails to get
out of committee.
Congress passes the Patient Self-Determination Act,
requiring hospitals that receive federal funds to tell
patients that they have a right to demand or refuse
treatment. It takes effect the next year.
Dr. Timothy Quill writes about "Diane" in
the New England Journal of Medicine, describing his
provision of lethal drugs to a leukemia patient who
chose to die at home by her own hand rather than undergo
therapy that offered a 25 percent chance of survival.
Nationwide Gallup poll finds that 75 percent of Americans
approve of living wills.
Derek Humphry publishes Final Exit, a how-to book on
self-deliverance. Within 18 months the book sells 540,000
copies and tops USA bestseller lists. It is translated
into twelve other languages. Total sales exceed one
Choice in Dying is formed by the merger of two aid in
dying organizations, Concern for Dying and Society for
the Right to Die. The new organization becomes known
for defending patients' rights and promoting living
wills, and will grow in five years to 150,000 members.
Washington State voters reject Ballot Initiative 119,
which would have legalized physician-aided suicide and
aid in dying. The vote is 54-46 percent.
Americans for Death with Dignity, formerly Americans
Against Human Suffering, places the California Death
with Dignity Act on the state ballot as Proposition
Health care becomes a major political issue as presidential
candidates debate questions of access, rising costs,
and the possible need for some form of rationing.
California voters defeat Proposition 161, which would
have allowed physicians to hasten death by actively
administering or prescribing medications for self administration
by suffering, terminally ill patients. The vote is 54-46
Advance directive laws are achieved in 48 states, with
passage imminent in the remaining two.
Compassion in Dying is founded in Washington state to
counsel the terminally ill and provide information about
how to die without suffering and "with personal
assistance, if necessary, to intentionally hasten death."
The group sponsors suits challenging state laws against
President Clinton and Hillary Rodham Clinton publicly
support advance directives and sign living wills, acting
after the death of Hugh Rodham, Hillary's father.
Oregon Right to Die, a political action committee, is
founded to write and subsequently to pass the Oregon
Death with Dignity Act.
The Death with Dignity Education Center is founded in
California as a national nonprofit organization that
works to promote a comprehensive, humane, responsive
system of care for terminally ill patients.
More presidential living wills are revealed. After the
deaths of former President Richard Nixon and former
first lady Jacqueline Kennedy Onassis, it is reported
that both had signed advance directives.
The California Bar approves physician-assisted suicide.
With an 85 percent majority and no active opposition,
the Conference of Delegates says physicians should be
allowed to prescribe medication to terminally ill, competent
adults self-administration in order to hasten death.
All states and the District of Columbia now recognize
some type of advance directive procedure.
Washington State's anti-suicide law is overturned. In
Compassion v. Washington, a district court finds that
a law outlawing assisted suicide violates the 14th Amendment.
Judge Rothstein writes, "The court does not believe
that a distinction can be drawn between refusing life-sustaining
medical treatment and physician-assisted suicide by
an uncoerced, mentally competent, terminally ill adult."
In New York State, the lawsuit Quill et al v. Koppell
is filed to challenge the New York law prohibiting assisted
suicide. Quill loses, and files an appeal.
Oregon voters approve Measure 16, a Death With Dignity
Act ballot initiative that would permit terminally ill
patients, under proper safeguards, to obtain a physician's
prescription to end life in a humane and dignified manner.
The vote is 51-49 percent.
U.S. District Court Judge Hogan issues a temporary restraining
order against Oregon's Measure 16, following that with
an injunction barring the state from putting the law
Oregon Death with Dignity Legal Defense and Education
Center is founded. Its purpose is to defend Ballot Measure
16 legalizing physician-assisted suicide.
Washington State's Compassion ruling is overturned by
the Ninth Circuit Court of Appeals, reinstating the
anti suicide law.
U.S. District Judge Hogan rules that Oregon Measure
16, the Death with Dignity Act, is unconstitutional
on grounds it violates the Equal Protection clause of
the Constitution. His ruling is immediately appealed.
Surveys find that doctors disregard most advance directives.
Journal of the American Medical Association reports
that physicians were unaware of the directives of three-quarters
of all elderly patients admitted to a New York hospital;
the California Medical Review reports that three-quarters
of all advance directives were missing from Medicare
records in that state.
Oral arguments in the appeal of Quill v. Vacco contest
the legality of New York's anti-suicide law before the
Second Circuit Court of Appeals.
Compassion case is reconsidered in Washington state
by a Ninth Circuit Court of Appeals panel of eleven
judges, the largest panel ever to hear a physician-assisted
The Northern Territory of Australia passes voluntary
euthanasia law. Nine months later the Federal Parliament
The Ninth Circuit Court of Appeals reverses the Compassion
finding in Washington state, holding that "a liberty
interest exists in the choice of how and when one dies,
and that the provision of the Washington statute banning
assisted suicide, as applied to competent, terminally
ill adults who wish to hasten their deaths by obtaining
medication prescribed by their doctors, violates the
Due Process Clause." The ruling affects laws of
nine western states. It is stayed pending appeal.
A Michigan jury acquits Dr. Kevorkian of violating a
state law banning assisted suicides.
The Second Circuit Court of Appeals reverses the Quill
finding, ruling that "The New York statutes criminalizing
assisted suicide violate the Equal Protection Clause
because, to the extent that they prohibit a physician
from prescribing medications to be self-administered
by a mentally competent, terminally ill person in the
final stages of his terminal illness, they are not rationally
related to any legitimate state interest." The
ruling affects laws in New York, Vermont and Connecticut.
(On 17 April the court stays enforcement of its ruling
for 30 days pending an appeal to the U.S. Supreme Court.)
The U.S. Supreme Court announces that it will review
both cases sponsored by Compassion in Dying, known now
as Washington v. Glucksberg and Quill v. Vacco.
Oral arguments set for the New York and Washington cases
on physician assisted dying. The cases were heard in
tandem on 8 January but not combined. A ruling is expected
ACLU attorney Robert Rivas files an amended complaint
challenging the 128 year-old Florida law banning assisted
suicide. Charles E. Hall, who has AIDS asks court permission
for a doctor to assist his suicide. The court refuses.
On 13 May the Oregon House of Representatives votes
32-26 to return Measure 16 to the voters in November
for repeal (H.B. 2954). On 10 June the Senate votes
20-10 to pass H.B. 2954 and return Measure 16 to the
voters for repeal. No such attempt to overturn the will
of the voters has been tried in Oregon since 1908.
On 26 June the U.S. Supreme Court reverses the decisions
of the Ninth and Second Circuit Court of Appeals in
Washington v. Glucksberg and Quill v. Vacco, upholding
as constitutional state statutes which bar assisted
suicide. However, the court also validated the concept
of "double effect," openly acknowledging that
death hastened by increased palliative measures does
not constitute prohibited conduct so long as the intent
is the relief of pain and suffering. The majority opinion
ended with the pronouncement that "Throughout the
nation, Americans are engaged in an earnest and profound
debate about the morality, legality and practicality
of physician-assisted suicide. Our holding permits this
debate to continue, as it should in a democratic society."
Dutch Voluntary Euthanasia Society (NVVE) reports its
membership now more than 90,000, of whom 900 made requests
for help in dying to its Members' Aid Service.
Britain's Parliament rejects by 234 votes to 89 the
seventh attempt in 60 years to change the law on assisted
suicide despite polls showing 82 percent of British
people want reform.
On 4 November the people of Oregon vote by a margin
of 60-40 percent against Measure 51, which would have
repealed the Oregon Death with Dignity Act, l994. The
law officially takes effect (ORS 127.800-897) on 27
October l997 when court challenges disposed of.
Dr. Kevorkian assists the suicide of his 92nd patient
in eight years. His home state, Michigan, passes new
law making such actions a crime. It took effect September,
1 1998, but Kevorkian carries on helping people to die
-- 120 by November.
Oregon Health Services Commission decides that payment
for physician-assisted suicide can come from state funds
under the Oregon Health Plan so that the poor will not
be discriminated against.
16 people die by making use of the Oregon Death With
Dignity Act, receiving physician-assisted suicide in
its first full year of implementation.
Measure B on the Michigan ballot to legalize physician-assisted
suicide defeated by 70 - 30%.
Dr. Kevorkian sentenced to 10-25 years imprisonment
for the 2nd degree murder of Thomas Youk after showing
video of death by injection on national television.
26 people die by physician-assisted suicide in the second
full year of the Oregon PAS law.
World Euthanasia Conference, Boston
Citizens' Ballot Initiative in Maine to approve the
lawfulness of Physician-Assisted Suicide was narrowly
defeated 51-49 percent.
Kevorkian's appeal decision reached after 2 years 7
months. Judges reject it.
MS victim Diane Pretty asks UK court to allow her husband
to help her commit suicide. The London High Court, the
House of Lords, and the Court of Human Rights, in Strasbourg,
all say no. She dies in hospice a few weeks later.
Dutch law allowing voluntary euthanasia and physician-assisted
suicide takes effect on 1 February. For 20 years previously
it had been permitted under guidelines.
Belgium passes similar law to the Dutch, allowing both
voluntary euthanasia and physician-assisted suicide.
US Attorney-General Ashcroft asks the 9th Circuit Court
of Appeal to reverse the finding of a lower court judge
that the Oregon Death With Dignity Act l994 does not
contravene federal powers. 129 dying people have used
this law over the last five years to obtain legal physician-assisted
suicide. The losers of this appeal will almost certainly
ask the US Supreme Court to rule.
Euthanasia Research &
Physician-Assisted Suicide Links
"In a certain
state it is indecent to live longer. To go vegetating
in cowardly dependence on physicians and machinations,
after the meaning of life, the right to life,
has been lost, that ought to prompt a profound
contempt in society."
- Friedrich Nietzsche
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