Physician-assisted suicide is defined as suicide committed with the aid of another person, sometimes a doctor.[1] It applies outside of the medical context as well, assisting a suicidal individual achieve their own death by providing a weapon or other means. "Assisted suicide" has been used to describe medical aid in dying in the United States for terminally ill, mentally capable adults who self-administer medication to shorten their own dying process. The term is often used interchangeably with physician-assisted suicide (PAS), "physician-assisted dying", "physician-assisted death", "aid in dying", "death with dignity", "right to die", "compassionate death", "compassionate dying", "end-of-life choice", and "medical assistance at the end of life".
Physician-assisted suicide is often confused with euthanasia (sometimes called "mercy killing"). In cases of euthanasia the physician administers the means of death, usually a lethal drug. In physician-assisted suicide (PAS) the patient self-administers the means of death.[3]
Physician assisted death or "aid in dying" is legal in six states, Oregon, Washington, Vermont, California, Montana, Colorado and Washington DC. The Oregon, Washington, Vermont, Colorado, California and Washington DC laws expressly state that, "actions taken in accordance with [the Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law." This distinguishes the legal act of medical aid in dying from the act of suicide.
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History
Early movements
The first significant drive to legalize assisted suicide in the United States arose in the early years of the twentieth century. In a 2004 article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted death in both Iowa and Ohio in 1906. In Ohio, the legislation was inspired by the campaign of heiress Anna S. Hall, whose mother had died a painful death from cancer. Despite Hall's efforts, the bill was rejected by the Ohio legislature by a vote of 79 to 23.
Glucksberg v. Washington
Dr. Harold Glucksberg, along with four other physicians, three terminally ill patients, and Compassion and Dying, brought a case against the state of Washington for banning assisted suicide. The case was filed in District Court in 1994.
Following a series of appeals, the U.S. Supreme Court decided in 1997 in a unanimous decision to uphold Washington's ban. They cited the Due Process Clause and argued that assisted suicide isn't guaranteed as a fundamental liberty protected by due process. The case allowed individual states to decide independently on the medical aid-in-dying issue. It set the stage for legislative efforts on the state level.
Dr. Kevorkian
Assisted suicide 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 Michigan. His first public assisted suicide was in 1990, of Janet Adkins, a 54-year-old woman diagnosed with early-onset 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.
Years later, Kevorkian crossed the line from assisting the patient to actively killing the patient himself. Kevorkian 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, and died on June 3, 2011.
Brittany Maynard
In 2014, the death of Brittany Maynard, an advocate for the legalization of aid in dying, from brain cancer led to renewed debate in the United States over assisted suicide, and was cited as being responsible for bills in several states on the topic. Her home state of California, which she left to reside in Oregon to access its Death With Dignity Act, became the fifth state to authorize aid in dying, in 2015.
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California
In 1992, the group Californians against Human Suffering proposed Proposition 161 to allow patients with less than six 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 failed to pass with 46 percent of the vote.
Subsequent efforts were tried to pass assisted death legalization through the California State Legislature in 1999, 2005 and 2006, all of which failed. The California legislature passed a bill legalizing the practice in September 2015, and the bill was signed into law by Governor Jerry Brown on October 5, 2015, making California the fifth state to authorize medical aid in dying and the second to do so through the legislature. The Act began implementation on June 9, 2016. The law went into effect in June 2016.
District of Columbia
In January 2015, D.C. Council member Mary M. Cheh introduced her Death with Dignity Act of 2015.
On October 5, 2016, the D.C. Committee on Health and Human Services voted 3-2 for the Death with Dignity Act of 2015.
On November 1, 2016 the D.C. Council voted to advance the Death with Dignity Act with an 11-2 vote. Now, it needs to go through another vote in the council and the Mayor's office.
After Mayor Bowser's signature on 23rd December, 2016 and after the mandatory 30 day Congress review, the law went into full effect on February 18, 2017.
Montana
Aid in dying is legal in Montana through a state supreme court decision. In Baxter v. Montana the Montana Supreme Court ruled in a 5-2 decision that state law allows for terminally ill Montanans to request lethal medication from a physician under existing statutes. The Attorney General of the state of Montana sought an appeal from the Montana Supreme Court, but the court, by a decision of five to two, affirmed the lower court's ruling on the state law. The Court did, however, limit the scope of the decision by not determining if the state's constitution protected the right.
Oregon
Oregon voters first approved the Death with Dignity Act (DWDA) by general election in November 1994 by a margin of 51% to 49%. Ballot Measure 16, a citizen initiative sponsored by Oregon Right to Die Political Action Committee, 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.
The law went into effect in October 1997 after an injunction delayed implementation. In November 1997, Measure 51 was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%.
Challenges
Lee v. State of Oregon
In December 1994, doctors and patients argued that the DWDA violated the U.S. Constitution's first and fourteenth amendments in Lee v. Oregon. U.S. District Court Judge Michael Hogan placed a temporary injunction, that he later made permanent, on the Act.
In February 1997, the Ninth Circuit Court of Appeals ruled to dismiss the challenge to the Death with Dignity Act.
Measure 51, Oregon Repeal of Death with Dignity
In 1997, Measure 51 was placed on the November ballot. It failed and 60% of Oregon voters, more than the original 1994 vote, expressed their support for the Death with Dignity Act.
Oregon v. Ashcroft
U.S. Attorney General John Ashcroft issued a directive in 2001 to prevent the Oregon Death With Dignity Act from being implemented. The state of Oregon successfully sued and proceeded with implementation.
Vermont
In May 2013, the Vermont Legislature passed the Patient Choice and Control at End of Life Act. Governor Peter Shumlin signed it into law. The law is based on, but is less restrictive than, the Oregon model.
Vermont was the first state to pass an aid in dying law through the legislative process. In January 2013 the act was introduced to the Senate, and in May 2013 it was passed by both the house and senate.
Vermont residents 18 years old or older who are mentally capable adults with a terminal illness and a prognosis of 6 months or less to live can make an oral request and obtain medication from a physician. The bill requires a second opinion, written and oral requests, and other provisions.
Washington
In 1991, a ballot question asked if terminally ill adults should be allowed to receive physician aid-in-dying. The initiative failed, receiving 46 percent of the vote.
Washington voters approved the Death with Dignity Act by general election in November 2008 by a margin of 58% to 42% "This measure would permit terminally ill, competent, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity."
Other jurisdictions
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 dying. 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 dying.
Arizona
In Arizona, the city of Bisbee became the first municipality in the country to approve an aid in dying resolution, although the vote is not legally binding.
The resolution states that the city of Bisbee: - Respects the diversity of perspectives of its citizens, - Supports equal protection within the diversity of perspectives on end-of-life decisions, - Recognizes the practice of Aid in Dying as a legitimate individual liberty, - And, while not a legally enforceable document, urges prosecutorial discretion by the Cochise County Attorney in de-prioritizing cases involving prosecution of a person who has supported, been present, or facilitated a loved one to advance the time of his or her imminent death when facing intolerable suffering.
Colorado
Representatives Lois Court and Joann Ginal introduced assisted suicide legislation in 2015 in the Colorado House. The bill was voted down in committee 8-5 .
In April 2016, Julie Selsberg and Jaren Ducker filed an initiative with the secretary of state seeking to authorize medical aid in dying in November 2016 through the ballot process.
On November 8, 2016 Colorado voters passed Proposition 106 making assisted death legal among patients with terminal illness.
Connecticut
Legislation to legalize assisted suicide received a public hearing by Connecticut's state legislature for three consecutive sessions in 2013, 2014, and 2015, but has failed to receive a committee vote.
Florida
Krischer v. McIver was a case 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 this right, and the case was appealed to the Florida Supreme Court. This court upheld the constitutionality of Florida's law against assisted suicide.
Maryland
In early 2015 Maryland lawmakers began debating a "Death With Dignity" bill, though governor Larry Hogan had suggested he would oppose it.
Massachusetts
The Massachusetts Death with Dignity Initiative, a ballot measure to legalize aid in dying, was narrowly defeated in the 2012 general election, with 51% of voters against the proposal.
A poll taken by the Boston Globe and the University of New Hampshire between September 21 and September 27, 2012, found Massachusetts residents supporting Question 2 68%, with 20% opposed. Another public poll by the University of Massachusetts and YouGov American found similar results as late as October 8 with 65% in support and 19% opposed.
New Jersey
A New Jersey Assembly committee voted in favor of assisted suicide legislation, and the full state Assembly plans to vote on Assemblyman John Burzichelli's bill, known as A 2270, the New Jersey Death with Dignity Act, on November 13, 2014, although the bill failed to receive a vote in the Senate. The bill would have required patients suffering from a terminal disease to first verbally request a prescription from their attending physician, followed by a second verbal request at least 15 days later and one request in writing signed by two witnesses. In addition, the attending physician would have to offer the patient a chance to rescind their request. Whether Governor Chris Christie would sign and enact an assisted suicide bill is uncertain.
New Mexico
A New Mexico court legalized the practice in Bernalillo County in January 2014; this decision was overturned on August 11, 2015, which upheld the state's ban on assisted suicide.
New York
In 1994, a suit was filed in New York claiming that the anti-assisted suicide statute 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 U.S. Constitution. In 1996, the U.S. Court of Appeals overturned this ruling with the reasoning that the criminalization of assisted suicide violates the Equal Protection Clause. However, the U.S. Supreme Court unanimously reversed the U.S. Court of Appeals decision in Vacco v. Quill, 521 U.S. 793 (1997).
In February 2015, New York state senators Brad Hoylman and Diane Savino introduced a "Death With Dignity Act" to allow physician-assisted suicide in the state.
Tennessee
Tennessee's legislature has begun debating legalizing assisted suicide.
State power to allow and regulate
States have the power to regulate, allow or prohibit assisted suicide.
In 1997, in the cases of Washington v. Glucksberg and Vacco v. Quill, the U.S. Supreme Court ruled unanimously that there is no Constitutional right to assisted suicide, and that states therefore have the right to prohibit it. Advocates of assisted suicide saw this as opening the door for debate on the issue at the state level.
Gonzales v. Oregon was brought to the United States Supreme Court in 2006. The court ruled that the United States Attorney General could not enforce the federal Controlled Substances Act against physicians who prescribed drugs, in compliance with Oregon state law, for the assisted suicide of the terminally ill.
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