What about Legalized Assisted Suicide?
Smith, Cheryl K., Issues in Law & Medicine
The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night.(1)
The debate on the right to die has recently reached the proportions the abortion debate has held over the last few decades. This is due, in part, to improvements in medical technology and a gradual shift in medicine from paternalism to patient self-determination.
As in the abortion debate, proponents of assisted suicide have begun to focus their efforts on legal reform. In November of 1991, Initiative 119, a ballot measure in Washington state that would have legalized active euthanasia for competent terminally ill patients, narrowly failed, 46% to 54%.(2) In the three months between December 1991 and March 1992, legislators in four states--Michigan,(3) New Hampshire,(4) Maine,(5) and Iowa(6)--introduced legislation to legalize either assisted suicide or physician aid-in-dying for the terminally ill. In addition, the group Californians Against Human Suffering gathered 570,000 signatures placing a physician aid-in-dying measure on the ballot in California.(7)
In the absence of legal reform, assisted suicide for the terminally ill is now occurring outside of the law throughout the United States.(8) Rather than asking physicians to risk their professions and futures and requiring that patients continue to suffer against their will, carefully drafted laws legalizing assisted suicide in narrow cases should be passed.
Suicide is defined as the intentional taking of one's own life.(9) It is not currently illegal under any state statute, although it may arguably be a crime in a few states under common law.(10)
In order to be classified as assisted suicide the death must be considered a suicide, i.e., not withholding or withdrawal of life support;(11) and there must be "affirmative, assertive, proximate, direct conduct such as furnishing a gun, poison, knife, or other instrumentality of usable means by which another could physically and immediately inflict some death producing injury upon himself."(12)
For the purpose of this article, assisted suicide is distinguished from active euthanasia. In the former, a physician simply prescribes drugs for a patient, who then ends his or her own life. In the latter, the physician or some other person performs the act that brings about death, e.g., a lethal injection.
Assisted Suicide Statutes
Despite the fact that suicide is not a crime, assisted suicide generally is. Twenty-seven states have specific statutes making assisting a suicide a crime.(13) Although it is not clear the types of cases for which most of these statutes were intended, at least one was passed for the specific purpose of preventing assistance in the suicide of a terminally ill individual.(14)
In those states that do not specifically criminalize assisted suicide, it may fall under murder or manslaughter statutes.(15) Because most cases are handled on the trial court level and therefore not reported, one can only speculate on the outcome in an individual case of assisted suicide where no specific statute exists.(16)
An exception to this is the state of Michigan. Michigan has no statute criminalizing assisted suicide. In addition, the case of People v. Campbell(17) reinforces the legality of assisted suicide, as do recent judicial actions related to Dr. Kevorkian's assistance in several suicides.(18) In the Campbell case, not involving a terminally ill person, Steven Campbell gave a gun to a suicidal friend and encouraged him to use it. Mr. Campbell was ultimately charged with murder and initially convicted. On appeal, the conviction was overturned. The court reasoned that under the law suicide is not homicide, "hope alone" does not constitute the necessary intent, and the trend is moving away from classifying assisted suicide as a crime, since two-thirds of states do not do so.(19)
Cases Where Assistance in Suicide Was Requested
The majority of cases regarding the right to die are refusal of medical treatment cases and, as such, are distinguished from assisted suicide cases.(20) There are, however, several cases that explicitly discuss assisted suicide and offer some guidance on how courts view this issue.
The most well-known opinion favoring the right to assisted suicide is that of Bouvia v. Superior Court.(21) Elizabeth Bouvia was quadriplegic from cerebral palsy and lived in a state hospital. She was totally dependent on others and required intermittent pain medication. She petitioned the court, seeking removal of a feeding tube being maintained against her will. The California Court of Appeal ultimately ruled that Ms. Bouvia had the right to refuse medical treatment, stating that the decision to live or die belongs to the patient rather than the state.(22)
While the majority distinguished refusing medical treatment from committing suicide, a concurring opinion written by Justice Compton treated the case as one of requesting assisted suicide. Justice Compton wrote:
The right to die is an integral part of our right to control our own destinies so long as the rights of others are not affected. That right should, in my opinion, include the ability to enlist assistance from others, including the medical profession, in making death as painless and quick as possible.(23)
Although characterized as assisted suicide, the facts of the Bouvia case are quite different from those in the recent case of Donaldson v. Van De Kamp.
In Donaldson v. Van De Kamp,(24) Thomas Donaldson, who suffered brain cancer and was expected to die within five years, petitioned the court to be allowed assistance in his suicide so that he could be cryogenically preserved until a cure was found and, he hoped, his body returned to life.(25)
The court referred to relevant state interests (preserving life, preventing suicide, protecting innocent third parties, and maintaining the ethical standards of the medical profession) that must be balanced against an individual's interest. It also added an unqualified general interest in the preservation of human life. However, the court failed to articulate whether Donaldson's interest in choosing death outweighed the state's interests. Instead it based its conclusion that Donaldson not be allowed assistance in suicide on the state interest in "maintaining the social order through enforcement of the criminal law."(26) The court reasoned that this interest outweighs any interest of Donaldson in ending his life and having a third party assist him in doing so. The court also reasoned that it is difficult to evaluate the assister's motive and potential undue influence.(27) The implication here is that if an assisted suicide law did not exist, there would be little reason to disallow Mr. Donaldson's request despite the court's determination that no constitutional right existed.
In the case of Zant v. Prevatte,(28) a Georgia prison had petitioned the court to be allowed to force-feed inmate Prevatte, who was attempting to starve himself to death, arguing a compelling state interest in preserving his life. Although acknowledging that the state has a duty to keep prisoners safe from harm, the court ruled that the duty does not justify force-feeding of this former death row prisoner. It reasoned that "[a] prisoner does not relinquish his constitutional right to privacy because of his status as a prisoner."(29) In dictum the court observed that the fact that Prevatte was competent and had no dependents weighed in favor of his right to privacy from such intrusions on his person;(30) ergo, the state interest in preserving life was insufficient to justify forced feeding.
Although Zant did not deal with a terminally ill individual requesting assisted suicide, the factors mentioned, i.e., competency and lack of dependents, are relevant to such cases when weighing the right to privacy against state interests in maintaining life.
Despite the fact that Judge Compton's opinion in the Bouvia case was a concurrence and not part of the majority opinion, these cases and others dealing with refusal of treatment indicate that courts are willing to accept that, in some cases, competent patients have a right to choose death and that medical assistance in such cases is not always inappropriate.
Recent Assisted Suicide Cases
Very few assisted suicides come to the attention of authorities; of those that do, few are prosecuted and even fewer result in convictions. Hemlock Society statistics, compiled from newspaper reports, showed only twelve assisted suicides from 1980 through 1991.(31) Half of these cases occurred in 1991. Whether this increase is due to improved reporting or an actual increase in assisted suicide is unclear.
A recently reported assisted suicide case occurred in Auburn, California. Jesse James Quinn, age eighty-seven, was arraigned on January 23, 1992, for helping his wife commit suicide by leaving a gun on her nightstand. The case was resolved by the judge without a guilty or innocent plea; Mr. Quinn agreed to undergo counseling for a year and give up his firearms in return for eventual dismissal of charges.(32)
On July 16, 1991, forty-nine year old Dick Bauer of Cripple Creek, Colorado, got his mother her gun, at her insistence, so that she could end her suffering. Wanda Bauer was in excruciating pain from what was believed to be terminal liver and pancreatic cancer and had been discharged from the hospital with no pain medication or care plan. Wanda, who shot and killed herself, was found on autopsy to have an infected liver, pancreas, and peritoneum. Physicians at the trial testified that she was dying.(33)
Dick Bauer was charged with assisted suicide under the Colorado statute and, after four days of trial, was found not guilty by a jury of his peers. They believed that Mr. Bauer lacked the requisite intent for the crime.
Had a physician-assisted suicide statute been in place at the time of Wanda Bauer's death, she might have had more incentive to undergo the definitive diagnostic test and receive treatment, rather than ending her life and putting her son through this prosecution.
Several cases of assisted suicide have been reported in Michigan since 1990. On June 4, 1990, Dr. Jack Kevorkian assisted Janet Adkins, an Alzheimer's patient from Portland, Oregon, to end her life with his suicide machine. Although he was initially charged with murder, the charges against him were eventually dismissed.(34)
In August of 1990, Bertram (Bob) Harper and his stepdaughter flew with his wife, Virginia Harper, from California to Michigan, where he assisted his wife in ending her life with pills and a plastic bag. Mrs. Harper was dying of liver cancer. Mr. Harper was charged with open murder but ultimately found not guilty by a jury.(35)
In October of 1991, Dr. Kevorkian acted again, assisting in the suicides of two women, neither of whom was terminally ill. He was again charged with open murder, with those charges dismissed in July of 1992.(36) In 1992, Kevorkian assisted in the suicides of five more women.(37)
In a case representative of the current, but usually secret, practice of some doctors, Dr. Timothy Quill reported his assistance in the suicide of a terminally ill cancer patient, with whom he had a long-term physician-patient relationship.(38) His patient, Diane, was diagnosed with leukemia and decided to forgo treatment after learning that her chances of survival were only about 25% even with the treatment. Quill described Diane as a confident and independent person who exercised control over her life. Her decision was fully informed--she knew her prognosis, benefits of treatment, and risks of nontreatment. Although he was aware of the use to which she might put a prescription, he was willing to give her that choice, which she ultimately exercised. After an investigation, the prosecutor in Rochester, New York, decided not to charge Dr. Quill, despite the fact that he had admitted having a part in Diane's suicide.(39)
In 1987, Martin James of West Hollywood, California, assisted in the death of Keith Lower. Lower was suffering from AIDS-related complex. James assisted by mixing thirty barbiturates into a glass of grape juice. According to James, Lower had requested assistance with his suicide. James was not charged with any crime because, according to the district attorney's office, they were unable to prove the basic elements of the crime independent of any confession or other statements made by the suspect.(40) Since then and prior to ending his own life at the end stages of AIDS, James admitted to having assisted in the suicides of as many as eight people.(41)
In a similar case, David Lewis of Vancouver, British Columbia, reported that he had assisted eight AIDS patients in suicide. Canadian authorities declined to prosecute Lewis, who eventually took his own life in the company of friends.(42)
Based on informal information provided by supporters of the Hemlock Society and other anecdotal evidence, the reported cases are only a small percentage of actual assisted suicides for terminally ill people.(43)
Further, in a poll of licensed physicians done by the Center for Health Ethics and Policy at the University of Colorado at Denver, 4.2% of the respondents indicated that they had assisted a patient to stockpile a lethal dose of medication, aware that it might be used for suicide.(44)
All these examples show that assisted suicide for persons who are terminally ill is occurring outside of the law and without any requirements for reporting. Additionally, because so few people are prosecuted for this crime, with discretion in the hands of the medical examiner or prosecutor's office, the current statutes are unjust as applied. Also evident is the fact that juries are hesitant to convict in those cases that are brought to trial, causing useless expenditures and tying up the judicial system unnecessarily.(45)
It is worth noting that a number of the reported cases involve individuals who were not terminally ill. As the current law stands, no distinction is made among assisting the suicide of a healthy person, a chronically ill person, or a terminally ill person. Passage of laws allowing physician-assisted suicide for dying, i.e., terminally ill, persons and providing safeguards against abuse would allow such a distinction and provide for penalties against those who act outside of the law.
Arguments in Favor of Assisted Suicide
Proponents of assisted suicide for persons who are terminally ill assert that patient autonomy weighs heavily in favor of its legalization, or decriminalization. Respect for a person's autonomy requires that his or her considered value judgment must be taken seriously, even if that judgment is believed to be mistaken.(46) Of course, the principle of autonomy, by its very nature, requires that the person desiring assisted suicide be both competent and fully informed. This implies voluntariness and disclosure of all pertinent information.
An autonomous decision to end one's life does not imply that anyone has a duty to assist or that such assistance is morally justified. Therefore, we must look to other reasoning to support the proposition that physicians should be allowed to participate.
A number of commentators have argued that the physician-patient relationship is based on trust and that trust would be violated if doctors were allowed to assist in suicide.(47) In fact, the contrary may be true. Patients who feel unable to discuss sensitive issues such as this are less likely to develop a trusting relationship with their physicians; those who can are more likely to open up, allowing the physicians to evaluate the rationality of their wishes.
Open dialogue with physicians will allow detection of treatable depression or other mental disorders; this will decrease suicides that might occur for these reasons. A retrospective study of suicides by older people showed that 46% had vocalized despondency over medical problems prior to their suicides.(48)
In addition, the ability of patients to freely discuss concerns with physicians will bring to light other information to assist in providing options less drastic than assisted suicide. A study of euthanasia in the Netherlands showed that two-thirds of patients who asked their physicians for assurance that they would be assisted in dying when at the end stage of their disease did not need the assistance because other suitable alternatives were given.(49)
The present legal situation regarding assisted suicide prohibits patients and physicians from freely discussing their problems, with patients fearing involuntary commitment and physicians fearing criminal prosecution.(50)
Relief of Suffering
Relief of suffering has always been a major goal of medicine. It is supported by both the ethical principle of beneficence and the Hippocratic Oath. Although even advocates of assisted suicide would agree that suffering and pain should be relieved by methods short of ending the patient's life when possible, at times the methods used may accelerate a patient's death.
The principle of double effect provides, for some, a rationale for bringing on a patient's death while intending pain relief. Double effect entails performance of an act with a good effect intended that also causes an indirect or unintended effect.(51) An example is giving large doses of morphine to control pain, knowing that respiratory action will be decreased so that the patient may die sooner.
Some physicians and ethicists have argued that while intending a patient's death is immoral, not intending that death but letting the patient die is not. This argument is specious, however. The result of both courses is the same and, intended or not, is foreseeable. Knowing that the outcome in both cases will be death, how can one be moral and the other not? Furthermore, in some cases, removing life support (letting die) may cause the patient more intense suffering, while giving a lethal injection (killing) totally eliminates the suffering. The outcome (death) is the same.
Even if one accepts the contention that there is a moral difference between these cases, an argument can be made that providing a prescription of pain or sleeping medication to the patient, knowing that he or she might use it to end his or her life, is more like letting die than killing. It is a good act with a good intent--the physician does not desire the death of the patient, but relief of pain or sleeplessness. The physician does not cause the death; the patient does.
Suffering of patients may also be relieved, albeit to a lesser extent, simply by providing the patient with such a prescription. The Hemlock Society hears of numerous cases where patients have stockpiled drugs with the ultimate goal of ending their lives when suffering becomes unbearable, only to die naturally. They report that just having a choice frees them and allows them to raise their threshold of tolerable suffering.
Rebuttal of Arguments against Assisted Suicide
Daniel Callahan argues that the right to self-determination does not extend to assisted suicide because it has historically excluded the right to voluntarily enslave oneself to another. In doing so, he invokes John Stuart Mill's classic work On Liberty, in which Mill states, "The principle of freedom cannot require that he should be free not to be free. It is not freedom to be allowed to alienate his freedom."(52)
Assisted suicide does not authorize another to kill, only to provide the means. This is not enslaving oneself to another; it is simply asking another's assistance in exercising an act of free will. It is clearly not transferring one's right to kill oneself to another. In addition, slavery and euthanasia differ in that "the slave lives in a state of unfreedom;...the dead are neither free nor unfree."(53) What is given up by the choice of suicide is a few more days or weeks of suffering.(54)
Callahan's contention that we have never been allowed the freedom to enslave ourselves fails in other medical contexts as well, for example, surrogate pregnancies or health care powers of attorney. A health care power of attorney or proxy statute allows an individual to give an agent the authority to make decisions regarding life or death once that individual becomes incapable of making decisions,(55) as do some living will statutes.(56)
Opponents of the option of assisted suicide for the terminally ill have argued that physicians and others should not "play God." However, viewing nature and God as one (i.e., dying naturally) fails to take into account other modern medical practices that affect the length of life. If medical professionals are allowed to--and some have argued that they must--continue biological life at all costs beyond what was previously considered the end of life, aren't they playing God?
We ask physicians to play God on a daily basis as they make difficult decisions regarding extending life, treating deadly diseases with poisonous chemicals, and bringing trauma victims back to life.
Although a number of organized religions are opposed to suicide in any event, many religious people consider God as a loving entity who would accept a compassionate reason for cutting life short for a person who has perhaps only a few more days of intolerable pain or suffering. The Unitarian Church, for example, has specifically endorsed the right of individuals to choose to end their lives when terminal.(57)
Another argument against legalizing assisted suicide is what is known as the "slippery slope" or "wedge" argument. This argument states that if we allow assisted suicide for one type of person, then it will lead to assisted suicide for others. Those espousing this position view our society as incapable of drawing the line at a specific kind of conduct. They claim that once we allow voluntary assisted suicide for the terminally ill we will eventually move the line to encompass involuntary euthanasia and to allow killing of persons who are poor, disabled, or otherwise at risk.(58) This ignores the fact that we draw lines and make distinctions regularly. If the argument were true, then legal abortion should by now have led to legal infanticide.
Richard Doerflinger has argued that once assisted suicide for the terminally ill becomes commonplace, other medical treatment for the ill will lose its legal claim to public support, with the result of involuntary euthanasia.(59) This argument fails upon closer examination. Despite the fact that abortion is legal, public payment for childbirth has not gone by the wayside; this extremely cynical view of our society simply does not hold true because we continue to value life.
Another variation on the slippery slope argument claims that people will feel manipulated or pressured to commit suicide. Two common examples are older persons, who will feel compelled to get out of the way or not deplete family resources, and teenagers, who will follow the example of their elders.
As to older persons, legalized assisted suicide would allow physicians to discuss the issue and determine their patients' position prior to the onset of terminal illness. In addition, other caring professionals, such as social workers or nurses, could be involved to assure that truly informed consent is obtained. Finally, we must deal with other risk factors for older persons concomitant with legalizing assisted suicide, e.g., assuring that their decisions are truly informed and rational.
The belief that teenagers may not be able to distinguish between suicide for reasons of suffering due to terminal illness and for other reasons is simply not justified by reality. The suicides of young persons are generally "relatively spontaneous act[s], with little premeditation"(60) and differ fundamentally from those of older persons.(61) The majority of teenagers are as capable as adults of reasoning and differentiating.
A study reported in 1988 showed no association between the suicide rate and approval of suicide for terminal illness, in general.(62) While we must be vigilant and maintain the line at voluntary euthanasia for the terminally ill, these data show that the risk of going down the slippery slope is not as severe as some believe.
Prohibition against Killing by Doctors
Some invoke the Hippocratic Oath in arguing that physicians should not assist in suicides of persons who are terminally ill.(63) Although the oath undoubtedly reflects many of the underlying values in medicine, it is rarely studied in medical school and sworn to by only 6% of medical students.(64) Modified versions of the oath are offered in 42% of the schools.(65)
Moreover, the Hippocratic Oath contains an internal inconsistency that may make it impossible to adhere to in cases of intractable pain. The oath requires physicians to relieve pain, as well as giving no deadly medicine. In such cases, both courses, relieving pain and not giving a deadly drug, may not be possible.
In addition, as technology has progressed and values changed, other parts of the oath have been violated. These include not charging a fee for teaching others the art of medicine and the edict not to participate in abortions. So while of historical value in medicine, the Hippocratic Oath should be relied upon as a guide, rather than strictly construed according to its meaning at the time it was written. After all, Hippocrates had no inkling of the state of the medical art in the twentieth century.
Another reason to allow physicians to participate in assisted suicide is that they have unique knowledge of drugs and the ability to prescribe them. Lacking this expertise and access to drugs, a nonphysician may have great difficulty in committing suicide in an efficient, painless, and dignified manner and could end up in a worse position than he or she was originally in. Physicians, dentists, and veterinarians, interestingly, now account disproportionately among successful suicides,(66) yet no one would argue that they are somehow more entitled to a painless and dignified death.
Finally, some fear that once they "taste blood," physicians will be unable to stop killing.(67) In fact, a study by the Dutch showed the opposite to be true. The Remmelink Report indicated that many physicians who had practiced euthanasia would be hesitant to do so again.(68) This study probably reflects the fact that physicians, like most people, still find death distasteful and prefer to help people to continue living as long as there is still hope.
Better Medical Care Will Alleviate Need
Although no one would dispute that medical care could be improved in this country, even that will not totally alleviate the need or demand for assisted suicide in the cases of some terminally ill patients. While pain control is inadequately practiced, particularly for oncology patients, even with improvement the pain of some patients will not be adequately controlled. An estimated 5% to 20% of terminal cancer patients have been shown to experience uncontrollable pain,(69) and this blanket proscription of assisted suicide will not protect them.
Even if all pain could be controlled, terminally ill patients have other valid reasons for asking to have their dying process shortened. Unbearable suffering in the form of constant nausea, incontinence, diarrhea, intense itching, and other side effects of drugs and illness are demeaning and more than some can take. Failure to legalize the option of assisted suicide in such cases ignores that some people want not only the option of better medical care, but an exit from their misery.
Undoubtedly, a number of patients may request assisted suicide because they are depressed about their illness or the financial impact it is having on them or their families. The current practice of oncologists is to undermedicate or not treat depressed patients because of the perception that they are dying anyway.(70) While appropriate treatment will help depressed patients find a reason to continue living, it provides no help for terminal patients who are not clinically depressed and only limited help for those who are depressed but rationally considering suicide.
Scope of Legalized Assisted Suicide
Laws permitting assisted suicide must be limited to a narrow class of people and contain appropriate safeguards to prevent the potential abuses previously discussed. At a minimum, performance of assisted suicide must meet criteria established by the Dutch. The patient must be informed regarding his or her condition, prognosis, and treatment; the request must be persistent and voluntary, without outside pressure; consultation with at least one other physician must be obtained; and all of these must be documented.(71) In addition, the patient must be terminally ill and mentally competent, and there must not be any reasonable alternatives available. In order to assure that the patient is mentally competent and capable of giving informed consent, a psychiatric or psychological consultation must be made available, when necessary.
Besides documenting that these criteria are met, reporting requirements are essential to protecting against abuse and involuntariness.(72) Failure to abide by the law should result in prosecution.
Much criticism has been made of the situation in the Netherlands, and allegations of abuse are often cited. However, assisted suicide is not legal there, and physicians still face possible prosecution. With a specific law, reporting requirements, and penalties for failure to obey these requirements, the possibility of abuse will be substantially reduced, if not eliminated.
Dealing with Related Issues
While assisted suicide for persons who are terminally ill should be legalized, attention must be given to other needs of persons who are older, disabled, and poor. In a study of suicides of persons age fifty and over in New York, common stressors associated with late-life suicide were identified. These are financial problems; family discord; burdens and stress of illness; the impact of substance abuse; perceived, real, or threatened loss of a valued role, status, or significant other; isolation or other lack of support; and others.(73)
People who are disabled and poor face many of these same stresses and are also at risk for suicide. There are, however, a number of steps we can take to minimize this risk. First, access to health care should become a number one priority in this country. This includes increasing crisis intervention services, improved pain control, and equal provision of health care unrelated to economic status. Physicians must be trained not only to take care of the illness or disability, but to recognize other related factors such as depression or isolation and refer to appropriate agencies.
Second, social services for all of these groups must be improved to decrease social isolation, to provide respite care for families and friends caring for the sick and disabled, and to educate about substance abuse.
Finally, easy access to firearms must be decreased. One study showed that 66% of suicides among older persons were committed with firearms, in comparison to 57% among people under sixty-five.(74) This indicates a desperation that should have been identified by a caregiver along the way.
Although assisted suicide for persons who are terminally ill may seem an extreme solution for an extreme problem, recent polls indicate that a majority of Americans support this option, and a number of physicians are already helping their patients to die. Narrowly drawn laws should allow physicians to help people who are suffering or terminally ill to end their lives when other alternatives fail. Only then will we be acting compassionately while continuing to value individual choice. However, we must continue to evaluate and address other related and even more pressing issues such as depression, provision of health care to all, social isolation of persons who are older or disabled, and handgun control.
(1) Friedrich W. Nietzsche, quoted in Bartlett's Familiar Quotations 1195 (1951).
(2) Janny Scott, Suicide Aid Turns to California, L.A. Times, Nov. 7, 1991, at 3.
(3) H.B. 5415, Mich. 86th Legis., 2d Sess. (1992).
(4) H.B. 1275, N.H. Legis., 1992 Sess. (1992).
(5) Legis. Doc. 2257, Me. 115th Legis., 2d Sess. (1992).
(6) S. File 2066, Iowa 74th Legis., 2d Sess. (1992).
(7) This measure was also defeated at the ballot, 46% to 54%.
(8) See, e.g., Timothy E. Quill, Death and Dignity: A Case of Individualized Decision Making, 324 New Eng. J. Med. 691 (1991) (discussing author's role in a patient's suicide); Doctors Who Help Patients Die; MDs Reveal a Secret Practice: Aiding Suicides, Mercy Killing, Newsday, Sept. 29, 1991, at 4 (reporting that 10% of respondents to poll by Physician's Management Magazine admitted to assisting suicide in some way).
(9) Random House Dictionary, College Ed. 1314 (1969).
(10) See, e.g., State v. Willis, 121 S.E.2d 854 (N.C. 1961).
(11) See, e.g., Or. Rev. Stat. [unkeyable] 127.645(3) (1990); R.I. Gen. Laws [unkeyable] 23-4.11-10(a) (Michie Supp. 1991); Wis. Stat. Ann. [unkeyable] 154.11(1) (West 1989).
(12) Bouvia v. Superior Court, 225 Cal. Rptr. 297 (Cal. Ct. App. 1986).
(13) Alaska Stat. [unkeyable] 11.41.120(a)(2) (1983); Ariz. Rev. Stat. Ann. [unkeyable] 13-1103(A) (1985); Ark. Code Ann. [unkeyable] 41-1504(1) (1987); Cal. Penal Code [unkeyable] (West 1988); Colo. Rev. Stat. [unkeyable] 18-3-104(1)(6) (1986); Conn. Gen Stat. Ann. [unkeyable] 53a-56(a) (West 1985); Del. Code Ann. tit. 11 [unkeyable] 645 (1987); Fla. Stat. Ann. [unkeyable] 782.08 (West 1989); Kan. Stat. Ann. [unkeyable] 21-3406 (1981); Me. Rev. Stat. Ann. tit. 17-A [unkeyable] 201 1983); Minn. Stat. Ann. [unkeyable] 609.215 (West 1987); Miss. Code Ann. [unkeyable] 97-3-49 (1973); Mo. Rev. Stat. [unkeyable] 565.023.1(2) (1986); Mont. Code Ann. [unkeyable] 45-5-105 (1985); N.D. Cent. Code [unkeyable] 12.1-16-04 (Supp. 1991); Neb. Rev. Stat. [unkeyable] 28-307 (1979); N.H. Rev. Stat. Ann. [unkeyable] 630:4 (1986); N.J. Stat. Ann. [unkeyable] 26:11-6 (West 1982); N.M. Stat. Ann. [unkeyable] 30-2-4 (1984); N.Y. Penal Law [unkeyable] 125.15 (McKinney 1987); Okla. Stat. Ann. tit. 21, [unkeyable] 813-818 (West 1983); Or. Rev. Stat.[unkeyable] 163.125(1) (1983); 18 Pa. Cons. Stat. Ann. [unkeyable] 2505(a) (1983); S.D. Codified Laws Ann. [unkeyable] 22-26-37 (1979); Tex. Penal Code Ann. [unkeyable] 22.08 (Vernon 1989); Wash. Rev. Code Ann. [unkeyable] 9A.36.060 (1988); Wis. Stat. Ann. [unkeyable] 940.12 (West 1982). The Michigan legislature has enacted a temporary ban on suicide assistance pending a commission study on physician-assisted suicide. Julia Prodis, Doctor Assists in 2 Suicides; Governor Signs 15-Month Ban, Indianapolis Star, Dec. 16, 1992, at C2.
(14) Conn. Gen. Stat. Ann. [unkeyable] 53a-56(a) (West 1985).
(15) See, e.g., State v. Jones, 67 S.E. 160 (S.C. 1910) (finding inciter to suicide guilty of murder when causal connection between incitement and death established); and Commonwealth v. Hicks, 82 S.W. 265 (Ky. 1904) (finding accessory to suicide before the fact guilty of murder as principal in the second degree).
(16) But see, State v. Marti, 290 N.W.2d 570 (Iowa 1980) (upholding conviction for involuntary manslaughter of a person found guilty of preparing and providing a weapon for an intoxicated person who shot himself).
(17) 335 N.W.2d 27 (Mich. Ct. App. 1983).
(18) Tamar Lewin, Judge Clears Doctor of Murdering Woman with a Suicide Machine, N.Y. Times, Dec. 14, 1990, at A1 (reporting that Michigan district court judge threw out murder charges against Dr. Jack Kevorkian because the death of the woman by suicide was caused by her actions and not Dr. Kevorkian's assistance); People v. Kevorkian, No. CR-92-11 5190-FC (Mich. Cir. Ct. July 21, 1992) (dismissing criminal charges for homicide against Dr. Kevorkian after ruling that because suicide is not a crime,someone assisting in suicide should not be charged with a crime). But see People ex rel. Thompson v. Kevorkian, No. 90-390963 AZ (Mich. Cir. Ct. Feb. 5, 1991) (issuing civil injunction against Dr. Kevorkian to cease assisted suicides), appeal filed, No. 138155-L (Mich. Ct. App. May 18, 1992).
(19) Campbell, 335 N.W.2d at 29-30.
(20) See, e.g., Superintendent of Belchertown Schools v. Saikewicz, 370 N.E.2d 417, 426 n.11; McKay v. Bergstedt, 801 P.2d 617, 625-27 (Nev. 1990).
(21) 225 Cal. Rptr. 297, 307-08 (Cal. Ct. App. 1986) (Compton, J., concurring).
(22) Id. at 305.
(23) Id. at 308 (Compton, J., concurring).
(24) 4 Cal. Rptr. 2d 59 (Cal. Ct. App. 1992).
(25) Id. at 60-61.
(26) Id. at 63.
(27) Id. at 64.
(28) 286 S.E.2d 715 (Ga. 1982).
(29) Id. at 716.
(30) Id. at 717.
(31) National Hemlock Soc'y, Cases of Euthanasia, Murder, and Assisted Suicide (1991).
(32) Sacramento Bee, Jan. 24, 1992, at B1.
(33) Personal observations by author at trial of Richard Bauer, Feb. 12, 1992.
(34) See Lewin, supra note 18.
(35) Cecil Angel, "I Knew ... What I Did Was Right"; Jurors Agree Harper Didn't Murder Wife, Det. News & Free Press, May 11, 1991, at 1A.
(36) See People v. Kevorkian, No. CR-92-11 5190-FC (Mich. Cir. Ct. July 21, 1992) (regarding Dr. Kevorkian's assistance in suicides of Sherry Miller and Marjorie Wantz).
(37) See Michigan Doctor at Side of 4th Suicide, N.Y. Times, May 16, 1992, at 6 (reporting on Kevorkian's involvement in the suicide of Susan Williams); Scott Bowles et al., Kevorkian Assists in Suicide No. 5, Det. News & Free Press, Sept. 27, 1992, at 1A (reporting on Kevorkian's involvement in the suicide of Lois Hawes); Jim Irwin, "Dr. Death" Assists in 6th Suicide in Michigan, Indianapolis Star, Nov. 24, 1992, at A4 (reporting on Kevorkian's involvement in the suicide of Catherine A. Andreyev); Julia Prodis, supra note 13 (reporting on Kevorkian's involvement in the suicides of Marguerite Tate and Marcella Lawrence).
(38) See Quill, supra note 8.
(39) Lawrence K. Altman, Jury Declines to Indict Doctor Who Said He Aided in a Suicide, N.Y. Times, July 27, 1991, at 1.
(40) Wash. Times, Apr. 14, 1988, at 1.
(41) Eugene Register-Guard, Jan. 5, 1992, at 1.
(42) Montreal Gazette (Quebec), July 5, 1990, at 1.
(43) The author and other staff of the National Hemlock Society regularly receive telephone calls from individuals who plan to assist in the suicide of terminally ill persons or who have been involved in such assistance.
(44) Center for Health Ethics & Policy, U. Colo. at Denver, Licensed Physician Questionnaire 5 (1988) (attitudinal survey, on file with Center for Health Ethics & Policy).
(45) Derek Humphry & Ann Wickett, The Right to Die 225-26 (1986).
(46) Cheryl K. Smith, Informed Consent--A Shift from Paternalism to Self-Determination? Topics in Health Rec. Mgmt., Sept. 1990, at 17.
(47) See, e.g., Robert N. Butler, Physician-Assisted Suicide: The Wrong Way to Go, Geriatrics, July 1990, at 13; David W. Louisell, Euthanasia and Biothanasia: On Dying and Killing, 40 Linacre Q. 234 (1983).
(48) Susan C. Younger et al., Availability of Knowledgeable Informants for a Psychological Autopsy Study of Suicides Committed by Elderly People, 38 J. Am. Geriatrics Soc'y 1169 (1990).
(49) Paul J. Van Der Maas et al., Euthanasia and Other Medical Decisions Concerning the End of Life, 338 Lancet 669 (1991) (reporting on research by Dutch study commission on euthanasia chaired by Prof. J. Remmelink) (hereinafter Remmelink Rep.).
(50) Nan Billings, "Final Exit" Reader Sent to Mental Hospital! Hemlock Q., Apr. 1992, at 1.
(51) Thomas Beauchamp & James Childress, Principles of Biomedical Ethics 127 (3d ed. 1989).
(52) Daniel C. Callahan, Can We Return Death to Disease? Hastings Center Rep., Jan.-Feb. 1989, Supp. at 5.
(53) Franklin G. Miller, Euthanasia Still Open for Debate, 3 J. Clinical Ethics 247 (1992).
(55) See Thomas A. Eaton & Edward J. Larson, Experimenting with the "Right to Die" in the Laboratory of the States, 25 Ga. L. Rev. 1253, 1308-18 (1991).
(56) See, e.g., Haw. Rev. Stat. [unkeyable] 327D-1 to -7 (Supp. 1988); Or. Rev. Stat. [unkeyable] 127.605 to 650 (1990).
(57) Unitarian Universalist Ass'n Gen. Assembly, Resolution: The Right To Die with Dignity (1988), reprinted in The Park Ridge Center, Active Euthanasia, Religion, and the Public Debate 68-69 (1991).
(58) Beauchamp & Childress, supra note 51, at 139-41.
(59) Richard Doerflinger, Assisted Suicide: Pro-Choice or Anti-Life? Hastings Center Rep., Jan.-Feb. 1989, Supp. at 18, 19.
(60) Harry M. Hoberman, The Impact of Sanctioned Assisted Suicide on Adolescents, 4 Issues in Law & Med. 191, 200 (1988).
(61) Susan B. Sorenson, Suicide Among the Elderly: Issues Facing Public Health, 81 AM. J. Pub. Health 1109, 1110 (1991).
(62) David Lester, Societal Approval of Suicide, 62 Psychol. Rep. 958 (1988).
(63) The relevant portion is "I will neither give a deadly drug to anybody, if asked for, nor will I make a suggestion to this effect."
(64) N.Y. Times, May 15, 1990, at B6.
(66) Rodney R. A. Syme, Dr. Jack Kevorkian and Medical Assisted Suicide, 154 Med. J. Austl. 203, 204 (1991).
(67) Doerflinger, supra note 59, Supp. at 19.
(68) Remmelink Rep., supra note 49, at 673.
(69) Ronald Melzack, The Tragedy of Needless Pain, Sci. Am., Feb. 1990, at 27.
(70) Karel, Undertreatment of Pain, Depression Needs to Be Addressed Before Euthanasia Made Legal in U.S., Psychiatric News, Dec. 20, 1991, at 1.
(71) Cheryl K. Smith, Euthanasia in the Netherlands: Medical Record Documentation Requirements, Topics Health Rec. Mgmt., Aug. 1991, at 45.
(72) Reporting should take the form of both medical record documentation, with regular review by a state agency, and a confidential report to the state of each case of aid in dying. See, e.g., Model Aid in Dying Act, 75 Iowa L. Rev. 139, 205-06 (1989).
(73) Yeates Conwell et al., Completed Suicide at Age 50 and Over, 38 J. Am. Geriatrics Soc'y 640 (1990).
(74) Patrick J. Meehand et al., Sucides Among Older United States Residents: Epidemiological Characteristics and Trends, 81 AM. J. Pub. Health 1198, 1198-99 (1991).…
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Publication information: Article title: What about Legalized Assisted Suicide?. Contributors: Smith, Cheryl K. - Author. Journal title: Issues in Law & Medicine. Volume: 8. Issue: 4 Publication date: Spring 1993. Page number: 503+. © 1999 National Legal Center for the Medically Dependent & Disabled, Inc. COPYRIGHT 1993 Gale Group.
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