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
(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 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.
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
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
A Lively Debate on the Physician-Assisted Suicide
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.
FAQs About Physician-Assisted Suicide
Euthanasia Research & Guidance
When and where did the modern voluntary euthanasia
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
When did the movement start to become bigger
and more vocal?
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 terminally ill?
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 adamantly opposed.
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 ill
Where does the main opposition to voluntary
euthanasia come from?
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
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
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
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 recently?
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.
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
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
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.
Why I Believe In Physician Assisted Suicide
|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.
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
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
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 Euphemisms
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,
The Ethical Parameters for Physician-Assisted
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,
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.
Suicide is 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.
medical examiners, and coroners put a low priority
on investigation of suicide, particularly when
evidence comes before them that the person was
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
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 Physician-Assisted Suicide
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.
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.
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,
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
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
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.
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
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.
The 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.
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
Copyright 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 which legalizes
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.
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
Gonzales v. Oregon
Under 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.
The 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 psychological
The law 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."
From 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 act.
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 populations."
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,
Assisted Dying Bill, first tabled in the
House of Lords
in June 2014, "draws on the experience" of the
Death with Dignity Act.
A 20th Century Chronology of Physician-Assisted
First euthanasia bill drafted in Ohio. It does
World's first euthanasia society is founded
in London, England.
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
Pope Pius XII issues Catholic doctrine distinguishing
ordinary from extraordinary means for sustaining
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.
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. It fails.
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 living wills.
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 country (NVVE).
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
Dutch Voluntary Euthanasia Society (NVVE) launches
its Members' Aid Service to give advice to the
dying. Receives 25 requests for aid in the first
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
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
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 York Times.
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.
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
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
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
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
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
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
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 article.
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 million.
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
Americans for Death with Dignity, formerly Americans
Against Human Suffering, places the California
Death with Dignity Act on the state ballot as
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 percent.
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
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
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 into effect.
Oregon Death with Dignity Legal Defense and
Education Center is founded. Its purpose is
to defend Ballot Measure 16 legalizing physician-assisted
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
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 suicide case.
The Northern Territory of Australia passes voluntary
euthanasia law. Nine months later the Federal
Parliament quashes it.
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
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 in June.
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
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'
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 -
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
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
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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