Access through your institution. Add or change institution. Save Preferences. Privacy Policy Terms of Use. Access your subscriptions. Free access to newly published articles. Purchase access. Gradually this definition is accepted. Elisabeth Kubler-Ross publishes On Death and Dying , opening discussion of the once-taboo subject of death.
In a near-perfect reversal of the survey, a Gallup poll shows 53 percent of Americans are in favor of allowing a hastened death; 34 percent are opposed. Van Dusen, 77, and his wife, Elizabeth, 80, commit suicide. They are leaders of the Christian ecumenical movement and choose to die rather than suffer from disabling conditions. Quinlan case becomes a legal landmark. But she lives on for another eight years. Ten more U.
First international meeting of right-to-die groups takes place in Tokyo. It argues that old people in poor health might justifiably kill themselves. Whose Life Is It Anyway? A film version appears in Two right-to-die organizations split. It comprises 27 groups from 18 nations. It advocates legal change and distributes how to die information. This launches the campaign for assisted dying in America.
His wife Cynthia, not dying, choses to commit suicide with him. Elizabeth Bouvia, a quadriplegic suffering from cerebral palsy, sues a California hospital to let her die of self-starvation while receiving comfort care. She loses, and files an appeal. The Netherlands Supreme Court approves voluntary euthanasia under certain conditions. 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.
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 Americans Against Human Suffering is founded in California, launching a campaign for what would have become the California Death with Dignity Act. A 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. 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.
Supreme Court decides the Cruzan case, its first aid in dying ruling. Patient competence : Euthanasia is only voluntary if the patient is mentally competent, with a lucid understanding of available options and consequences and the ability to express that understanding and their wish to terminate their own life.
Determining or defining competence is not straightforward. Guilt : Patients may feel they are a burden on resources and are psychologically pressured into consenting. They may feel that the financial, emotional, and mental burden on their family is too great. Even if the costs of treatment are provided by the state, there is a risk that hospital personnel may have an economic incentive to encourage euthanasia consent. Mental illness : A person with depression is more likely to ask for assisted suicide, and this can complicate the decision.
Slippery slope : There is a risk that physician-assisted suicide will start with those who are terminally ill and wish to die because of intractable suffering, but then begin to include other individuals. Possible recovery : Very occasionally, a patient recovers, against all the odds. The diagnosis might be wrong.
In , researchers published findings of a survey in which they asked people from 74 countries their opinions on physician- assisted suicide. Overall, 65 percent of respondents voted against physician-assisted suicide.
In 11 of the 74 countries, the vote was mostly for. In 18 states, the majority were for physician-assisted suicide. These 18 did not include Washington or Oregon. In , a Gallup poll indicated that 73 percent of respondents were in favor of euthanasia in the U.
Among weekly churchgoers, Gallup found that 55 percent were in favor of a doctor ending the life of a patient who is terminally ill, compared with 87 percent of those who do not regularly attend church. It is also a political issue. In countries where euthanasia or assisted suicide are legal, they are responsible for a total of between 0.
In Oregon and Washington states, fewer than 1 percent of physicians write prescriptions that will assist suicide each year. A new survey of doctors in the Netherlands - where assisted suicide is legal - reveals around 1 in 3 would help a patient with a mental illness or…. After death, the body enters a long process of decomposition, as its organic elements split into simpler components.
What happens, and why learn about…. The Dutch data on medical practices which shortens life, in the cases of non-competent or of competent but not-consulted patients, are indeed a matter of concern In short, there is no reason to assume The patient, Ms B, was not suffering from any physical illness.
She was a 50 year old woman who had a 20 year history of depression. Her very unhappy personal life, including a violent marriage and the death of one of her sons by suicide and of the other from cancer, had resulted in her abandoning any wish to go on living. Psychiatric treatment had not helped her and she had made at least one attempt at committing suicide. For several years she had made it known to other people - including her sister, friends and her family doctor - that she wished to die, 'but in a humane way which would not confront others involuntarily with her suicide'.
He concluded that she was not suffering from a psychiatric illness or a major depressive episode, but rather that she had an adjustment disorder 'consisting of a depressed mood, without psychotic signs' arising from bereavement. Her condition was in principle treatable but the chance of success was small.
Dr Chabot tried to persuade Ms B to accept some form of therapy but she refused. She asked him instead to assist her suicide. Dr Chabot was of the opinion that Ms B was experiencing intense, long-term psychic suffering with no prospect of improvement. He was also of the opinion that her explicit and clearly expressed request for assistance with suicide was well-considered, and based on understanding of her situation and the consequences of her decision.
He further believed that her rejection of therapy was well-considered. He consulted seven independent experts who all agreed with his assessment of Ms B's situation. None of the doctors consulted by Dr Chabot examined Ms B. She took these drugs in the presence of Dr Chabot, a general practitioner and a friend. Dr Chabot reported her death to the local coroner as death by physician-assisted suicide.
He was prosecuted under Article of the Penal Code. In April the District Court in Assen applied the defence of necessity and found him not guilty of this offence. The Court of Appeals in Leeuwarden upheld the trial court's decision in September The Dutch Supreme Court, however, overturned the rulings of the lower courts.
It concluded that the defence of necessity should have been rejected in this case and accordingly found Dr Chabot guilty as charged. Dr Chabot was convicted under Article , therefore, not because the defence of necessity could not apply in a situation where a patient's suffering was of the kind experienced by Ms B.
Rather it was because he had not ensured that Ms B was actually examined by another doctor before he assisted her suicide. Despite finding Dr Chabot guilty, in view of 'the person of the defendant and the circumstances in which the offence was committed', the Supreme Court declined to impose any punishment.
In February , however, Dr Chabot was reprimanded by a Medical Disciplinary Tribunal which concluded that his behaviour had 'undermined confidence in the medical profession'.
In September the Dutch government revised its prosecutorial guidelines to reflect the holdings of the Supreme Court. If a patient has a psychiatric disorder, the guidelines now require the doctor who receives the request for physician-assisted suicide or active voluntary euthanasia to have the patient examined by at least two other doctors, one of whom must be a psychiatrist. The government also responded to the Supreme Court's ruling by dropping 11 of 15 pending prosecutions in relation to cases where the patient was not in the 'terminal phase' of a somatic illness.
Like many other developments in the Netherlands relating to the regulation of the practice of euthanasia, the Chabot case has been used to found arguments that lead to opposing conclusions. Some commentators view the case as evidence that once the law begins to allow doctors to perform physician-assisted suicide and active voluntary euthanasia, even in strictly and narrowly defined circumstances, the categories of patients who may be legally euthanased will inevitably expand.
Thus, it is claimed, the Chabot case is 'another step down the slippery slope' towards a situation where euthanasia is tolerated and practised in an even more unacceptably wide range of circumstances, including situations where the patient has not requested death. Other commentators acknowledge that the Chabot case raises the real possibility that Dutch courts may in the future 'hold assistance with suicide justifiable in several categories of cases in which the person concerned is not "sick" at all eg the case of very elderly persons who are incapacitated in various ways and simply "tired of life" ' and that '[f]rom there it is only a small additional step to the case in which the person concerned is not suffering at all at the time the request is made but, in anticipation of coming deterioration, wants to be in a position to choose the time of death in advance of becoming incapacitated and dependent'.
Some commentators also describe the Chabot case as a development that tightens the restrictions on the practice of euthanasia in the Netherlands. They argue that the Supreme Court's ruling clarifies the circumstances in which it is not acceptable as well as the circumstances in which it is acceptable for a doctor to help a psychiatric patient commit suicide.
Since the Supreme Court ruling in the Chabot case, the Dutch courts have inspired further controversy in two cases in which doctors ended the lives of severely disabled infants, who were in severe pain and were expected to die within months. In April the District Court in Alkmaar found Doctor Henk Prins formally guilty of the murder in of a baby girl who had been born with a partly formed brain and spina bifida, by giving her a lethal injection after consultation with her parents and other doctors.
The court refused, however, to punish the doctor. In November the Amsterdam Appeals Court affirmed the lower court's decision. A week later, the District Court in Groningen reached an almost identical conclusion in another case where a doctor had been charged with murder for administering a lethal injection to a severely disabled baby. Both cases are on appeal to the Supreme Court of the Netherlands as test cases.
In August , the Royal Dutch Medical Association Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst, KNMG adopted new guidelines for doctors who choose to accede to a patient's request for the hastening of death. Under the new guidelines patients must self-administer drugs whenever possible.
The new guidelines also clarify a doctor's obligation to consult a second doctor before proceeding with euthanasia, emphasising the need for this consultation to take place with an experienced doctor who has no professional family relationship with either the patient or the first doctor.
The new guidelines also affirm that a doctor is under no obligation to perform euthanasia, but state that a doctor who is opposed on principle to euthanasia should make his or her views known as soon as possible to a patient who raises the subject, and should help the patient find another doctor who is willing to assist.
These new guidelines have not yet been incorporated by the Dutch Parliament into the official reporting procedure, that confirms a doctor's compliance with the 'rules of careful practice' and underpins the prosecutorial policy discussed above. The Dutch Parliament may consider doing so later this year, however, when it considers the results of more Remmelink-type research that is currently being undertaken to assess the operation of this reporting procedure.
The proposal recommends that euthanasia should not be punishable by law unless it is proved that a doctor has not adhered to specified criteria; rather than the current situation, where euthanasia technically remains illegal unless it is shown that a doctor has adhered to specified criteria. Media statements made around the same time by the Dutch Minister for Justice indicated her support for this kind of change to the law.
The Dutch Parliament expressed concern at her statements, on the basis that they inappropriately preempted the Parliament's forthcoming assessment of the findings of the empirical research that is currently being done on the euthanasia reporting procedure. In the United States of America, the laws in forty-four states, the District of Columbia and two territories prohibit or condemn assisted suicide, including physician-assisted suicide.
In recent years there have been a number of unsuccessful attempts to introduce state legislative reform to allow a doctor to comply with a patient's request for intervention to hasten the patient's death.
These attempts have included Initiative in the state of Washington, which proposed the legalisation of both physician-assisted suicide and active voluntary euthanasia, for competent patients who were expected to die within six months. Concern at these developments prompted the establishment of State task forces to examine whether the law in this area should be reformed.
To date, the only jurisdiction in the United States of America that has passed legislation expressly permitting a doctor to intervene to hasten a patient's death is the state of Oregon.
The Oregon legislation was passed in November and permits physician-assisted suicide. This legislation is discussed in more detail below. Attempts continue in other States to enact legislative reform similar to the new Oregon law. US courts have also recently begun to address the issue of physician-assisted suicide. Two important cases examining the constitutional validity of statutes prohibiting physician-assisted suicide - Compassion in Dying v.
State of Washington and Quill v. Vacco et al - were decided by federal Courts of Appeal earlier this year. Both cases are discussed further below. The question posed by Ballot Measure 16 was: 'Shall law allow terminally ill adult patients voluntary informed choice to obtain physician's prescription for drugs to end life? The Oregon Death With Dignity Act authorises a specific kind of physician-assisted suicide: it allows a patient to obtain a physician's prescription for drugs to end the patient's life.
Unlike the Northern Territory's Rights of the Terminally Ill Act , however, the Oregon legislation does not also permit a doctor to carry out active voluntary euthanasia. Under the Oregon Death With Dignity Act , only the patient may administer the medication to end his or her life; the legislation does not authorise 'a physician or any other person to end a patient's life by lethal injection, mercy killing or active euthanasia'.
Health care providers who assist a patient to die by prescribing lethal drugs in 'good faith compliance' with the Oregon legislation are immune from civil and criminal liability and from professional disciplinary action. The following conditions all must be satisfied before a patient can be lawfully assisted to die:. This legislation does not impose any duty upon a doctor to participate in the provision of medication to end a patient's life. If a doctor is unable or unwilling to so participate, however, and the patient transfers his or her care to another doctor, the legislation specifies that the first doctor must comply with the patient's request to transfer a copy of relevant medical records to the new doctor.
The Oregon Death With Dignity Act has not yet come into operation as its operation has been suspended by injunction pending the results of a challenge to its constitutional validity. This legal challenge was initiated in November by a group of doctors, patients and operators of residential care facilities.
In August the Oregon Federal District Court held that the legislation was unconstitutional and therefore invalid. The District Court stated that the Fourteenth Amendment was violated because the legislation withheld from terminally ill persons the same legal protections from suicide that apply to other citizens of Oregon.
The court concluded that this withholding was not rationally related to any legitimate state interest and therefore was not justified. The legislation was said to lack sufficient safeguards to ensure that the means to commit suicide was only provided in response to a voluntary request by a competent, terminally ill patient.
The result of that appeal may be influenced by the outcome in the two federal Court of Appeal cases discussed immediately below. The question of whether a statutory prohibition on physician-assisted suicide violates an individual patient's rights under the United States Constitution was considered for the first time by a federal Court of Appeals in the recent case Compassion in Dying v State of Washington.
The case involved a challenge to the constitutional validity of a provision of a Washington statute that made it a crime to aid another person to attempt suicide.
The parties who initiated the action - four doctors, three terminally ill patients and a Washington non-profit organisation called Compassion in Dying - contended that this statutory provision was invalid to the extent that it prohibited doctors from prescribing life-ending medication for use by terminally ill, competent adults who wish to hasten their own deaths.
They claimed the statutory provision was invalid on two bases:. These matters, involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment. At the heart of liberty is the right to define one's own concept of existence of meaning, of the universe, and of the mystery of human life.
Beliefs about these matters could not define the attributes of personhood were they formed under compulsion of the State. The majority judges reached this conclusion via a two stage process of legal analysis. First, they identified a liberty interest in choosing the time and manner of one's own death. They also described this interest as a "constitutionally recognised 'right to die'".
They deduced the existence of this liberty interest after examining historical attitudes towards suicide, current societal attitudes towards physician-assisted suicide and the manner of death, and previous Supreme Court decisions addressing the scope of the liberty interest under the Due Process Clause. The majority judges believed that two of these Supreme Court decisions in particular were 'fully persuasive' as to the existence of a due process liberty interest in controlling the time and manner of one's own death.
In one of these cases, the case Planned Parenthood v. Casey the Supreme Court reaffirmed a woman's liberty interest in deciding whether or not to have an abortion, on the basis that such a decision was central to her personal dignity and autonomy. The majority judges in the instant case concluded that a terminally ill person's decision concerning how and when to die is at least as central to personal dignity and autonomy as the abortion decision.
It considered that 'no decision is more painful, delicate, personal, important, or final than the decision how and when one's life shall end'. The other Supreme Court case on which the majority relied was the case Cruzan v. Director, Missouri Department of Health. The Supreme Court in Cruzan held by a majority of that this restriction did not violate patients' rights under the due process clause. In reaching this conclusion, however, four of the five majority judges averted to the existence of a competent person's constitutionally protected right to refuse any kind of unwanted medical treatment.
The majority of the federal Court of Appeals in Compassion in Dying v. State of Washington stated that it was 'clear that Cruzan stands for the proposition that there is a due process liberty interest in rejecting unwanted medical treatment, including the provision of food and water by artificial means'.
As the Supreme Court in Cruzan had also recognised that refusal of treatment such as artificial feeding and hydration would inevitably lead to death, the Court of Appeals went on to conclude that Cruzan 'necessarily recognises a liberty interest in hastening one's own death'. Having identified a due process liberty interest in choosing the time and manner of one's own death, the majority acknowledged that this did not mean an individual has 'a concomitant right to exercise that interest in all circumstances or to do so free from state regulation'.
The majority assessed the validity of the restriction by weighing the liberty interest of the individual against six countervailing and legitimate state interests. We would be less than candid In the first case - volitional death - the physician is aiding or assisting a patient who wishes to exercise a liberty interest, and in the other - involuntary death - another person acting on his own behalf, or, in some instances society's, is determining that an individual's life should no longer continue.
We consider it less important who administers the medication than who determines whether the terminally ill person's life shall end. The majority concluded that all these state interests were at their weakest, and the liberty interest in choosing the time and manner and one's death was at its strongest, in the case of competent terminally ill individuals.
The majority conceded that the state has a particularly strong interest in protecting individuals who are making life and death decisions from undue influence and other forms of abuse. It concluded that the state therefore has a wide power to regulate the exercise by a terminally ill person of the liberty interest in choosing the time and manner of one's death, but that this power does not allow the state to ban its exercise completely. The Washington statute prohibiting physician-assisted suicide did effectively prevent terminally ill people from choosing the time and manner of their own deaths, because most terminally ill people could not hasten their own deaths without the assistance of a physician.
The Washington statute therefore imposed an unacceptable constraint on the liberty interest of terminally ill, competent adults who wished to hasten their deaths using medication prescribed by their physicians. To the extent that the statue imposed such a constraint, it violated the Due Process Clause and therefore was unconstitutional.
Having reached this conclusion, the majority considered it unnecessary to examine the argument that the Washington statute also violated the Equal Protection Clause. The majority stated, however, that it did not agree with the reasoning of the District Court of Oregon in Lee v. The three dissenting judges concluded that the Washington statute violated neither the Due Process Clause nor the Equal Protection Clause. In relation to the former, they denied that the statute infringed a liberty interest in choosing to commit suicide.
One dissenting judge categorically denied that there was any such interest. Another dissenting judge doubted that there was any such interest, but did not finally decide the question. The third dissenting judge accepted that there was a liberty interest in choosing to commit suicide, but characterised it as an interest of much less strength than the liberty interest in 'choosing the time and manner of one's own death' relied upon by the majority judges.
The dissenting judges discussed four state interests:. The dissenting judges concluded that any liberty interest in committing suicide, possessed by a competent, terminally ill adult, was legitimately restricted by the Washington statute. This was because the Washington statute rationally advanced the four legitimate and strong state interests identified above. Vacco et al.
That case also examined the constitutional validity of a statutory prohibition on physician-assisted suicide. The provisions under scrutiny in this second case were the parts of the New York Penal Law that criminalised assisted suicide. The provisions were alleged to be unconstitutional to the extent that they prohibited doctors from prescribing lethal medication to be self-administered by a mentally competent, terminally ill adult in the final stages of terminal illness.
The legal challenge was initiated by three doctors and three terminally ill patients. The arguments advanced by the litigants in Quill v. Vacco et al were similar to those before the court in Compassion in Dying v. State of Washington. The New York statutory provisions were alleged to be unconstitutional on the basis that they violated both the Due Process Clause and the Equal Protection Clause of the Fourteenth Amendment.
The majority of the Second Circuit Court of Appeals refused to accept that the New York statutory provisions violated any fundamental liberty interest under the Due Process Clause - specifically, the asserted right of competent, terminally ill persons to assisted suicide in the final stages of their illness.
They felt unable to conclude that this right to assisted suicide could be read into the Constitution, on the basis that the Supreme Court of the United States had not yet identified this new right and had also advised restraint in identifying new fundamental rights. The two majority judges did accept, however, that the New York statutory provisions violated the Equal Protection Clause. They stated that these provisions clearly did not treat similarly situated citizens alike.
This was because the law in New York allowed patients in the final stages of terminal illness who were attached to life-support systems to hasten their deaths by directing the removal of that life support, but did not allow patients who were in a similar situation - except for the previous attachment of life-support systems - to hasten their death by self-administration of prescribed drugs. The majority saw no valid difference, for the purposes of Equal Protection analysis, between the so-called 'passive' assistance in dying permitted by the law and the so-called 'active' assistance forbidden by the statutory provisions under scrutiny.
The majority further held that this unequal treatment was not rationally related to any legitimate state interest. This conclusion also rested on the fact that New York law allowed patients to hasten their deaths by ordering the withdrawal of life-sustaining treatment. The majority argued that if the state considered a patient's choice to hasten death in that context to be consistent with the interests of the state, it must also be consistent with those state interests to allow a patient to choose to hasten death by taking lawfully prescribed medication.
These judges therefore concluded that the New York prohibition on assisted suicide violated the Equal Protection Clause to the extent that it applied to mentally competent, terminally-ill patients in the final stages of terminal illness who wished to self-administer lethal drugs.
The third judge in this case agreed that the New York statutory provisions should be struck down. His reasoning, however, differed from that of the majority. He concluded that the constitutional validity of the statutory prohibition in question was 'highly suspect' - both under the Due Process Clause and the Equal Protection Clause - but not clearly invalid under either clause.
The constitutional validity of the prohibition depended largely on the strength of the state interests involved, but the New York legislature had not provided current and clear statements explaining which state interests the law aimed to protect. Accordingly, this judge was prepared to strike down these particular statutory prohibitions as unconstitutional - but took no position on the constitutional validity of similar provisions which might be enacted in the future and accompanied by clear explanations of the aims of the legislators.
An appeal against this decision of the Second Circuit Court of Appeals is expected. Should this case or Compassion in Dying v. State of Washington reach the Supreme Court, it remains to be seen how the highest court in the United States of America would assess the arguments raised in these cases in relation to the Due Process Clause and Equal Amendment Clause.
Both physician-assisted suicide and active voluntary euthanasia are prohibited by the criminal law in the United Kingdom. Active voluntary euthanasia comprises murder. Murder is a common law offence in the United Kingdom and carries a mandatory life sentence. A murder charge can be reduced to manslaughter if the defendant can invoke any one of three exceptions contained in the Homicide Act UK : provocation, diminished responsibility and suicide pacts.
None of these exceptions are likely to apply in a situation where a doctor has killed a patient at the patient's request. The first attempt took place in The Bill was promoted by the Voluntary Euthanasia Legalisation Society, which had been founded a year earlier.
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