If 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
Terri Schiavo, a woman who has been
kept alive artificially for the past 13 years even though she is in a
"persistent vegetative state" (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.
Terri 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.
The Fight Over Terri
Who should decide Terri'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.
Less 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 the HPR.
Critics 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.
A Lively Debate
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."
Over 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.
Looking Ahead
The right-to-die debate and the passions it evokes on both sides are
part of a larger national divide over social issues that will play a
prominent role in this November's elections. Consistently siding with
right-to-die opponents has helped President Bush consolidate support
among religious conservative voters in the Republican base. "The
president is committed to creating a culture of life at all stages. That
means at all stages of life, many different conditions," White House
Press Secretary Scott McClellan said at a recent press conference. On
the other side, liberal groups like the Death with Dignity National
Center, which has fought to defend the Oregon law, are seeking to
mobilize voters against what Executive Director Scott Swenson
characterizes as "the government's desire to impose one set of values on
all individuals." Swenson told the HPR that "our political action fund
will work to support candidates that support death with dignity reform
and patient choice."
And so the debate rages on, brought into the public view by high-profile
cases like Schiavo's. It may not get as much attention as higher-profile
social issues like abortion and gay marriage, but it is no less relevant
or contentious. When does life end? Who gets to decide? Why are so many
pro-lifers for the death penalty but against a person from having the
right to live as long as they desire? The answers to
these questions are being contemplated in courts, state capitols, and
living rooms across America, with the outcome still far from certain.
Frequently Asked
Questions
About Physician-Assisted Suicide and
Voluntary Euthanasia
from the Euthanasia Research &
Guidance Organization (ERGO)
Question:
When and where did the modern voluntary euthanasia movement start?
Answer: 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.
Question: When did the movement start to become
bigger and more vocal?
Answer: 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.
Question: How many people support voluntary
euthanasia for the terminally ill?
Answer: 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).
Question: How many physicians support assisted
dying?
Answer: 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 adamantly opposed.
Question: What do the terms used in this FAQ mean?
Answer: '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 ill patient.
Question: Where does the main opposition to
voluntary euthanasia come from?
Answer: The hierarchy of the Roman Catholic Church.
The Church of Jesus Christ of Latter Day Saints (Mormons). Also churches
on the religious right.
Question: Which churches officially support the principle
of assisted dying for the terminally ill?
Answer: The 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.
Question: 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'?
Answer: 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
www.FinalExit.org.
Question: Is the book banned in any country?
Answer: Final 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.
Question: Where has assisted dying been made lawful
in the world recently?
Answer: 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 death rate.
Question: What about the Netherlands, which is
famous for its liberal attitudes? And the Belgians?
Answer: 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
www.assistedsuicide.org
Question: What is the legal position in other
countries?
Answer: 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.
Question: How much assisted dying goes on now in
America?
Answer: 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.
Question: Are suicide and attempted suicide crimes?
Answer: 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.
Question: How can I help to support choice in dying?
Answer: 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.
Why I Believe In
Voluntary Euthanasia and Assisted Suicide
An Essay by Derek Humphry
The 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.
I 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
their papers.*
Let 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.
Word Origins and Eeuphemisms
The 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
factor.)
Total loss of quality of life due to protracted, incurable medical
conditions.
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.
What are the ethical parameters for voluntary euthanasia and
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 laws.
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.
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.
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.
Not Always Noticed
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).
Also, 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 of death.
Police, paramedics, medical examiners, and coroners put a low priority
on investigation of suicide, particularly when evidence comes before
them that the person was dying anyway.
Need For Both Methods
Some 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:
Physician-assisted 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.
Some 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.
As 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
arguments are.
Some Arguments Against
Having considered the logic in favor of euthanasia, a person should also
contemplate the arguments against it:
First, 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.
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.
There 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.
Religious Feelings
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.
Another 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.
Not 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.
Euthanasia 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.
A 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.
Those 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.
The 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.
In 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 exit.
Comfort of Knowledge
What 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.
For 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 position.
"So what are you going to do now?" I asked him.
"Oh, I'm not ready to go yet," he replied. "I've got the means, so I can
hold on a bit longer."
Now 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
life's span.
Thanks 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.
Copyright 2000
Derek Humphry. All rights reserved.
A Brief History of Oregon's
Death With Dignity Law
The Death with Dignity Act was originally passed in 1994 through the
Oregon initiative process. The law was immediately challenged in court
and prevented from going into effect. As the court cases proceeded, the
Oregon Legislature decided the public did not know what it was doing
when it voted and decided to put the issue back on the ballot in 1997.
The Death with Dignity Center won every court challenge and on October
27, 1997, the U.S. Supreme Court denied a hearing to opponents of the
law, allowing the law to go into effect just one week before the 1997
election.
In November 1997, the voters of Oregon overwhelmingly voted to support
the law, by a 60%-40% margin. Support for the law has continued to
increase since its implementation in 1997.
The law has been threatened by opponents at the federal level but the
Death with Dignity National Center continues to work to defend and
promote the law and encourage improvements to end-of-life care for all
dying individuals.
A Twentieth Century
Chronology of Voluntary Euthanasia and Physician-Assisted Suicide 1906 -
2003
Compiled by Derek Humphry
updated March 9 2003
1906 First euthanasia bill drafted in Ohio. It does not
succeed.
1935 World's first euthanasia society is founded in London,
England.
1938 The Euthanasia Society of America is founded by the
Rev. Charles Potter in New York.
1954 Joseph Fletcher publishes Morals and Medicine, predicting
the coming controversy over the right to die.
1957 Pope Pius XII issues Catholic doctrine distinguishing
ordinary from extraordinary means for sustaining life.
1958 Oxford law professor Glanville Williams publishes The
Sanctity of Life and the Criminal Law, proposing that voluntary
euthanasia be allowed for competent, terminally ill patients.
1958 Lael Wertenbaker publishes Death of a Man describing
how she helped her husband commit suicide. It is the first book of its
genre.
1967 The first living will is written by attorney Louis
Kutner and his arguments for it appear in the Indiana Law Journal.
1967 A right-to-die bill is introduced by Dr. Walter W. Sackett
in Florida's legislature. It arouses extensive debate but is
unsuccessful.
1968 Doctors at Harvard Medical School propose redefining
death to include brain death as well as heart-lung death. Gradually this
definition is accepted.
1969 Voluntary euthanasia bill introduced in the Idaho
legislation. It fails.
1969 Elisabeth Kubler-Ross publishes On Death and Dying,
opening discussion of the once-taboo subject of death.
1970 The Euthanasia Society (US) finishes distributing
60,000 living wills.
1973 American Hospital Association creates Patient Bill of
Rights, which includes informed consent and the right to refuse
treatment.
1973 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 country (NVVE).
1974 The Euthanasia Society in New York renamed the Society
for the Right to Die. The first hospice American hospice opens in New
Haven, Conn.
1975 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."
1975 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.
1976 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.
1976 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.
1976 Ten more U.S. states pass natural death laws.
1976 First international meeting of right-to-die groups.
Six are represented in Tokyo.
1978 Doris Portwood publishes landmark book Commonsense
Suicide: The Final Right. It argues that old people in poor health might
justifiably kill themselves.
1978 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.
1979 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 York Times.
1979 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 Education Council.
1980 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.
1980 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.
1980 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.
1980 World Federation of Right to Die Societies is formed in
Oxford, England. It comprises 27 groups from 18 nations.
1981 Hemlock publishes how-to suicide guide, Let Me Die
Before I Wake, the first such book on open sale
1983 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.
1983 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.
1984 Advance care directives become recognized in 22 states
and the District of Columbia.
1984 The Netherlands Supreme Court approves voluntary
euthanasia under certain conditions.
1985 Karen Ann Quinlan dies.
1985 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.
1986 Roswell Gilbert, 76, sentenced in Florida to 25 years
without parole for shooting his terminally ill wife. Granted clemency
five years later.
1986 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.
1986 Americans Against Human Suffering is founded in California,
launching a campaign for what will become the 1992 California Death with
Dignity Act.
1987 The California State Bar Conference passes Resolution
#3-4-87 to become the first public body to approve of physician aid in
dying.
1988 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 article.
1988 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.
1990 Washington Initiative (119) is filed, the first state
voter referendum on the issue of voluntary euthanasia and
physician-assisted suicide.
1990 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.
1990 Dr. Jack Kevorkian assists in the death of Janet
Adkins, a middle-aged woman with Alzheimer's disease. Kevorkian
subsequently flounts the Michigan legislature's attempts to stop him
from assisting in additional suicides.
1990 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.
1990 Hemlock of Oregon introduces the Death With Dignity Act into
the Oregon legislature, but it fails to get out of committee.
1990 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.
1991 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.
1991 Nationwide Gallup poll finds that 75 percent of
Americans approve of living wills.
1991 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 million.
1991 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.
1991 Washington State voters reject Ballot Initiative 119,
which would have legalized physician-aided suicide and aid in dying. The
vote is 54-46 percent.
1992 Americans for Death with Dignity, formerly Americans Against
Human Suffering, places the California Death with Dignity Act on the
state ballot as Proposition 161.
1992 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.
1992 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 percent.
1993 Advance directive laws are achieved in 48 states, with
passage imminent in the remaining two.
1993 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 assisted suicide.
1993 President Clinton and Hillary Rodham Clinton publicly
support advance directives and sign living wills, acting after the death
of Hugh Rodham, Hillary's father.
1993 Oregon Right to Die, a political action committee, is
founded to write and subsequently to pass the Oregon Death with Dignity
Act.
1994 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.
1994 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.
1994 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.
1994 All states and the District of Columbia now recognize
some type of advance directive procedure.
1994 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."
1994 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.
1994 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.
1994 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 into effect.
1995 Oregon Death with Dignity Legal Defense and Education
Center is founded. Its purpose is to defend Ballot Measure 16 legalizing
physician-assisted suicide.
1995 Washington State's Compassion ruling is overturned by
the Ninth Circuit Court of Appeals, reinstating the anti suicide law.
1995 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.
1995 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.
1995 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.
1995 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 suicide case.
1996 The Northern Territory of Australia passes voluntary
euthanasia law. Nine months later the Federal Parliament quashes it.
1996 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.
1996 A Michigan jury acquits Dr. Kevorkian of violating a
state law banning assisted suicides.
1996 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.)
1996 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.
1997 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 in June.
1997 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.
1997 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.
1997 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."
1997 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.
1997 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.
1997 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.
1998 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.
1998 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.
1998 16 people die by making use of the Oregon Death With
Dignity Act, receiving physician-assisted suicide in its first full year
of implementation.
1998 Measure B on the Michigan ballot to legalize
physician-assisted suicide defeated by 70 - 30%.
1999 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.
1999 26 people die by physician-assisted suicide in the
second full year of the Oregon PAS law.
2000 World Euthanasia Conference, Boston
2000 Citizens' Ballot Initiative in Maine to approve the
lawfulness of Physician-Assisted Suicide was narrowly defeated 51-49
percent.
2001 Kevorkian's appeal decision reached after 2 years 7
months. Judges reject it.
2001 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.
2002 Dutch law allowing voluntary euthanasia and
physician-assisted suicide takes effect on 1 February. For 20 years
previously it had been permitted under guidelines.
2002 Belgium passes similar law to the Dutch, allowing both
voluntary euthanasia and physician-assisted suicide.
2003 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.
SOURCE: Euthanasia
Research & Guidance Organization
Links
The Vegetative State: A Fate Worse Than Death -
http://www.near-death.com/experiences/suicide10.html
The Case for Assisted Suicide and Active Voluntary Euthanasia -
http://www.near-death.com/experiences/suicide08.html
How Society Can Implement Voluntary Euthanasia -
http://www.near-death.com/experiences/suicide09.html
Current News and Archives Concerning Death With Dignity -
http://www.dwd.org/fss/news.asp
The History of Oregon's Physician-Assisted Suicide Law -
http://www.dwd.org/law/briefhistory.asp
Oregon's Physician-Assisted Suicide Law -
http://www.dhs.state.or.us/publichealth/chs/pas/ors.cfm
Euthanasia Research & Guidance Organization's Online Book and Video
Store -
http://www.finalexit.org/store.html
Latest News Stories on Assisted-Suicide and Euthanasia -
http://news.yahoo.com/fc?tmpl=fc&cid=34&in=us&cat=assisted_suicide
Sociology of Death and Dying -
http://www.trinity.edu/~mkearl/death.html
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"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." - Nietzsche |
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