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Assisted suicide

    Assisted suicide is the process by which an individual who may otherwise be incapable is provided with the means (drugs or equipment) to commit suicide In some cases the terms aid in dying or death with dignity are preferredFor example Oregon law draws a distinction between "suicide" and "aid in dying" for criminal purposes ORS 127880 §314 These terms are often used to draw a distinction from suicide; in some legal jurisdictions "suicide" (whether assisted or not) remains illegal while "aid in dying" is permitted citation
    The term euthanasia refers to an act that ends a life in a painless manner performed by someone other than the patient This may include witholding common treatments resulting in death removal of the patient from life support or the use of lethal substances or forces to end the life of the patient

    Legality

    Aid in dying is legal in several jurisdictions including Belgium the Netherlands Switzerland and American states of Oregon (via the Oregon Death with Dignity Act) Washington (by Washington 1000]) and Montana (through a trial court ruling) The Montana ruling was made on December 6, 2008 The Attorney General of the state of Montana is seeking an appeal from the Montana Supreme Court as no ruling has yet been made The province of Quebec has recently acquitted a man charged with assisted suicide which opens the door to its legalization CBCca story As of 2009 Switzerland is the only nation that permits assisted suicide for the mentally ill* A suicide right for the mentally ill? A Swiss case opens a new debate
    Under the Oregon Death with Dignity Act policy in Oregon patients of sound mind can request a prescription for a lethal dose of medication Two doctors must confirm a diagnosis of terminal illness with no more than six months to live Two witnesses one non-doctor unrelated to the patient must confirm the patient's request and the patient must make a second request after 15 days The 2008 Washington law is closely modeled on the Oregon law which was passed in 1994

    History in the United States and Legal Cases

    Assisted suicide dates all the way back to ancient Greece and Rome when many people preferred to die by their own will than to live in pain During these times people would usually consult with a doctor to hear the course of their ailment and then decide whether to end their own life This became controversial when the use of the Hippocratic Oath was introduced The belief of Christianity that every life was a gift from God also added to the controversy In the 1600s Francis Bacon stated that he thought part of a physician’s duty was to alleviate pain even if that means death The use of anesthetics and morphine to end a patient’s life was introduced by Samuel Williams in 1870 while addressing the Birmingham Speculative Club His speech became very popular and was often quoted and reviewed Lawyers and social scientists joined the discussion of physician-assisted suicide in the 1890s Many lawyers supported it by saying that patients deserved the right to choose to live or die Many physicians were against assisting suicide because they thought it would bring the medical profession a bad name and discredit themEmanuel Ezekiel J. "The History of Euthanasia Debates in the United States and Britain" Annals of Internal Medicine Volume 121 Issue 1015 November 1994 793-802 1 Mar 2009

    An Act Concerning Administration of Drugs etc to Mortally Injured and Diseased Persons

    This bill was introduced in Ohio in 1906 by State Representative Hunt to legalize euthanasia It was inspired by the campaigning of wealthy Anna Hill whose mother was suffering from cancer Despite Hill’s efforts this bill was rejected by the Ohio legislature by a vote of 79 to 23Emanuel Ezekiel J. "The History of Euthanasia Debates in the United States and Britain" Annals of Internal Medicine Volume 121 Issue 1015 November 1994 793-802 1 Mar 2009

    Dr. Kevorkian

    Aid in dying in the United States was brought to public attention in the 1990s with the highly publicized case of Dr. Jack Kevorkian Dr. Kevorkian assisted over 40 people in committing suicide in MichiganAngell M. "The Supreme Court and Physician-Assisted Suicide — The Ultimate Right" The New England Journal of Medicine Volume 336:50-532 Jan 1997 1-4 1 Mar 2009 His first public assisted suicide was Janet Adkins an elderly female diagnosed with Alzheimer’s disease in 1989 He was charged with murder but charges were dropped on December 13, 1990 because there were no Michigan laws outlawing suicide or the medical assistance of it so he was not in violation of a law"People v. Kevorkian; Hobbins v. Attorney General" Ascension Health 2007 Ascension Health 7 Apr 2009 < http://wwwascensionhealthorg/ethics/public/cases/case19asp> Yet he later crossed the line from assisting the patient to actively killing the patient himself when he videotaped himself giving a man a lethal injection and aired the tape on 60 Minutes He was found guilty of second-degree murder and served eight years of a 10-25 year sentence He was released in 2007"Kevorkian Case: Kevorkian sentenced to 10 to 25 years" CNN 31 Dec 2007 1. 7 Apr 2009 http://editioncnncom/2007/US/law/12/17/courtarchivekevorkian8/indexhtml

    Washington Initiative 119

    In 1991 the state chapter of the Hemlock Society introduced Initiative 119 as an amendment to Washington’s 1979 Natural Death Act The ballot question asked if terminally ill adults should be allowed to receive physician aid-in-dying This initiative was very controversial Supporters of the initiative advertised cancer patient’s statements of wanting a dignified death Opponents invoked fear in the public by saying the initiative would allow doctors to kill patients The initiative failed only receiving 46 percent of the voteAnnas George J.. "Death by Prescription" The New England Journal of Medicine Volume 331 Number 1803 Nov 1994 1240-1243 7 Apr 2009

    California's Proposition 161

    In 1992 the group Californians against Human Suffering proposed Proposition 161 to allow patients with less than 6 months to live the right to receive assistance from physicians in dying This proposition offered more safeguards against abuse by physicians than Washington’s Initiative 119 such as special protections for patients in nursing facilities This measure also did not pass with only 46 percent of the voteAnnas George J.. "Death by Prescription" The New England Journal of Medicine Volume 331 Number 1803 Nov 1994 1240-1243 7 Apr 2009

    Oregon's Ballot Measure 16

    The Hemlock Society introduced Ballot Measure 16 in Oregon in 1994 It asked if terminally ill patients with less than 6 months to live should be able to receive a prescription for lethal drugs and included many provisions to protect against misuse such as two oral requests and a written request from the patient The patient must also be referred to counseling if a mental illness is suspected This ballot measure passed by a narrow margin with 513 percent of the vote This was seen as a victory for supporters of assisted suicide The passage of this measure became very controversial Many feared that people would flock to Oregon to take advantage of this law"Ballot Measures" Death with Dignity National Center 2008 1. 7 Apr 2009

    Oregon's Ballot Measure 51

    In 1997 the Oregon Legislative Assembly sent Measure 51 to the ballot This measure would have repealed Ballot Measure 16, but was defeated by 60 percent of the vote This bill was introduced because of the controversy surrounding the passage of Ballot Measure 16 and the slow implementation of it"Ballot Measures" Death with Dignity National Center 2008 1. 7 Apr 2009

    Gonzales v. Oregon

    Gonzales v. Oregon was brought to the United States Supreme Court in 2006 The Supreme Court ruled that the United States Attorney General could not enforce the Controlled Substances Act against physicians prescribing drugs to assist terminally ill patients in committing suicide because it would be in conflict with the law established by Oregon’s Ballot Measure 16"Gonzales v. Oregon" Death with Dignity National Center 2008 1. 7 Apr 2009 The Controlled Substances Act would have allowed the Attorney General to control or stop the distribution of fatal drugs to terminally ill patients"The Controlled Substances Act" US Drug Enforcement Administration 2008 US Drug Enforcement Administration 7 Apr 2009 < http://wwwusdojgov/dea/pubs/abuse/1-csahtm>

    New York Cases

    In 1994 a suit was filed in New York claiming that the anti-assisted suicide statue was a violation of equal protection and liberty guarantees of the Fourteenth Amendment This claim was rejected by the District Court on the basis that there is no right to assisted suicide given by the US Constitution In 1996 the US Court of Appeals overturned this ruling with the reasoning that the criminalization of assisted suicide violates the Equal Protection Cause This ruling led to the overturn of laws in Washington as well and affected states such as Alaska Arizona California Hawaii Idaho Montana Nevada Oregon Connecticut and Vermont This case was appealed to the US Supreme CourtMarker Rita L. "Assisted Suicide: The Continuing Debate" International Task Force (2009) 1- 18 1 Mar 2009

    US Supreme Court

    The Supreme Court started to hear arguments in 1997 to decide whether states have the right to prohibit assisted suicide The Justices unanimously upheld the right of states to prohibit assisted suicide Advocates of assisted suicide saw this as opening the door for debate on the issue at the state levelMarker Rita L. "Assisted Suicide: The Continuing Debate" International Task Force (2009) 1- 18 1 Mar 2009

    Krischer v. McIver

    This case was brought to the Florida Supreme Court in 1997 by the Florida chapter of the Hemlock Society in an attempt to overturn the state’s anti-assisted suicide law The question was if AIDS patient Charles Hall had the right to end his life with the help of Dr. Charles McIver The Circuit Judge ruled that Hall did have this right and the case was appealed to the Florida Supreme Court This court upheld the constitutionality of Florida’s law against assisted suicideMarker Rita L. "Assisted Suicide: The Continuing Debate" International Task Force (2009) 1- 18 1 Mar 2009

    Sampson and Doe v. State of Alaska

    In 1999 two terminally ill patients Kevin Sampson and Jane Doe sued for an order to exempt their physicians from being charged with manslaughter for assisting them in committing suicide The superior court ruled against them and they appealed to the Alaska Supreme Court This court upheld the previous ruling with the reasoning that the Alaska Constitution’s right to privacy and liberty does not allow terminally ill patients to be assisted by physicians in committing suicideMarker Rita L. "Assisted Suicide: The Continuing Debate" International Task Force (2009) 1-18 1 Mar 2009

    Terri Schiavo

    Terri Schiavo went into cardiac arrest in her home in 1990 This led her to go into a coma and eventually be in a vegetative state for 15 years while her family fought a battle in the courts Her husband Michael Schiavo fought for her feeding tube to be removed and claimed that Terri did not want to live if she could not function Her parents fought for her to be kept alive arguing that she believe in the sanctity of life and still maintained some functions The court ordered her feeding tube to be removed in 2003 but President Bush ordered that it be reinstated until all the facts of the case were heard Her tube was eventually removed permanently in 2005Lynne Diana "The whole Terri Schiavo story" World Net Daily Exclusive 24 Mar 2005 1. 7 Apr 2009 http://wwwworldnetdailycom/news/articleasp?ARTICLE_ID=43463

    Published research

    A study approved by the Dutch Ministry of Health the Dutch Ministry of Justice and the Royal Dutch Medical Association reviewed the efficacy in 111 cases of physician-aided dying (PAD)Groenewoud JH et al. Clinical problems with the performance of euthanasia and physician assisted suicide in the Netherlands NEJM 2000; 342: 551-7 This showed that 32% of cases had complications These included 12% time to death longer than expected (45min – 14 days) 9% with problems administering the required drugs 9% with a physical symptom (eg nausea vomiting myoclonus) and 2% waking from coma In 18% of cases the doctors had to provide euthanasia because of problems or failures with PAD
    The Portland (Oregon) Veterens Affairs Medical Center and the Department of Psychiatry at the Oregon Health and Science University set out to assess the prevalence of depression in 58 patients who had chosen PAD Linda Ganzini Elizabeth R Goy Steven K Dobscha Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey BMJ 2008; 337: 1662 Of 15 patients who went to receive PAD three (20%) had a clinical depression All patients who participated in the study were determined in advance to be mentally competent The authors conclude that the'current practice of the (Oregon) Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug
    In a Dutch study of patients with severe and persistent symptoms requiring sedation the researchers found that only 9% of patients received a palliative care consultation prior to being sedated Judith Rietjens Johannes van Delden Bregje Onwuteaka-Philipsen Hilde Buiting Paul van der Maas and Agnes van der Heide Continuous deep sedation for patients nearing death in the Netherlands: descriptive study
    BMJ Apr 2008; 336: 810 - 813

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