Do We Have The Right To Die?

Good Life, Good DeathTerri Schiavo 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.

 Table of Contents 
1. The Political Fight Over Terri Schiavo
2. A Lively Debate on Physician-Assisted Suicide
3. FAQs About Physician-Assisted Suicide
4. Why I Believe In Physician-Assisted Suicide
5. Word Origins and Euphemisms
6. The Ethical Parameters for Physician-Assisted Suicide
7. Suicide is Not Always Noticed
8. The Need For Both Methods
9. Some Arguments Against Physician-Assisted Suicide
10. The Comfort of Physician-Assisted Suicide Knowledge
11. The History of Oregon's Death With Dignity Law
12. A 20th Century Chronology of Physician-Assisted Suicide (1906--2003)
13. Physician-Assisted Suicide Links
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 1. The Political Fight Over Terri Schiavo 

Jeb BushWho 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 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.

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 2. A Lively Debate on the Physician-Assisted Suicide 

The Scales of JusticeThe 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.

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 3. FAQs About Physician-Assisted Suicide
Source:  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 or

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

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.

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 4. Why I Believe In Physician Assisted Suicide
by Derek Humphry  

Derek HumphryThe 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.

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 5. Word Origins and Euphemisms 

Good DeathThe 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:

a. 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.)

b. Total loss of quality of life due to protracted, incurable medical conditions.

c. 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.

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 6. The Ethical Parameters for Physician-Assisted Suicide 

a. 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.

b. The person has clearly made a considered and informed decision. An individual has the ability nowadays to indicate this with a "Living Will" (which applies only to disconnection of life supports) and can also, in today's more open and tolerant climate about such actions, discuss the option of a hastened death with health professionals, family, lawyers, etc. But they may not demand it.

c. The euthanasia has not been carried out at the first knowledge of a life-threatening illness, and reasonable medical help has been sought to try to cure or at least slow down the disease. The pro-choice movement does not believe in giving up on life the minute a person is informed of a terminal illness, a common misconception spread by our critics. Life is precious, you only pass this way once, and is worth a fight. It is when the fight is clearly hopeless and the agony - physical and mental - is unbearable that a final exit is an option.

d. The treating physician has been informed, asked to be involved, and the response taken into account. What the physician's response will be depends on the circumstances, of course, but we advise people that as rational suicide is not a crime, there is nothing a doctor can do about it. But it is best to inform the doctor and listen to the response. For example, the patient might be mistaken - perhaps the diagnosis has been misheard or misunderstood. In the last century, patients raising this subject were usually met with a discreet silence, or meaningless remarks, but in this century's more accepting climate of personal freedoms most physicians will discuss potential end of life actions, however cautiously.

e. The person has made a Will disposing of worldly possessions and money. This shows evidence of a tidy mind, an orderly life, and forethought -- all something which is paramount to an acceptance of rational suicide.

f. 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.

g. 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.

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 7. 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.

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.

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 8. The Need For Both Methods 

Doctor DeathSome 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:

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 9. Some Arguments Against Physician-Assisted Suicide

Having considered the logic in favor of euthanasia, a person should also contemplate the arguments against it:

Doctora. 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.

c. 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.

d. 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 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.

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 10. The Comfort of Physician-Assisted Suicide Knowledge 

Final Exit book cover. 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.

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 11. 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 physician-assisted suicide with certain restrictions. Passage of this initiative made Oregon the first U.S. state and one of the first jurisdictions in the world to permit some terminally ill patients to determine the time of their own death.

The measure was approved in the November 8, 1994, general election. 627,980 votes (51.3%) were cast in favor, 596,018 votes (48.7%) against. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. Measure 51, referred in the wake of Washington v. Glucksberg by the state legislature in November 1997, sought to repeal the Death with Dignity Act, but was rejected by 60% of voters. The act was challenged by the George W. Bush administration, but was upheld by the Supreme Court of the United States in Gonzales v. Oregon in 2006.

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 evaluation.

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%).

An 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."

The Death with Dignity Act was the basis of the Washington Death with Dignity Act in 2008. In 2011 the documentary film How to Die in Oregon was released. It won the Grand Jury prize for documentary film at the 27th Sundance Film Festival.

According to Dignity in Dying, Lord Falconer's Assisted Dying Bill, first tabled in the House of Lords in June 2014, "draws on the experience" of the Death with Dignity Act.

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 12. A 20th Century Chronology of Physician-Assisted Suicide (1906--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 flaunts 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

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 13. Physician-Assisted Suicide Links 
Blue dot The World Federation of Right to Die Societies -
Blue dot Death With Dignity Official Site -
Blue dot Final Exit Official Site -
Blue dot Compassion and Choices Official Site -
Blue dot Profile of Compassion and Choices -
Blue dot Profile of Final Exit Network -
Blue dot How to Make Difficult Life-Prolonging Healthcare Decisions -
Blue dot End of Life Options -
Blue dot Euthanasia Pro and Con -
Blue dot Physician-Assisted Suicide Fast Facts -
Blue dot Google Scholar Search Results for "Physician Assisted Suicide" -
Blue dot Google News Stories on Physician Assisted Suicide -
Blue dot All Sides of the Issue to Euthanasia and Physician Assisted Suicide (PAS) -
Blue dot The Shadow Side of Assisted Suicide -
Blue dot Right To Die -
Blue dot Assisted Suicide -
Blue dot Category:Euthanasia -
Blue dot Oregon's Physician-Assisted Suicide Law -
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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." - Friedrich Nietzsche

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