Assisted Suicide Law Research Articles

Have Arguments For and Against Medical Aid in Dying Stood the Test of Time?

Have Arguments For and Against Medical Aid in Dying Stood the Test of Time?

Is assisted suicide a substitute for unassisted suicide?

Posner hypothesised that the legalisation of assisted suicide may substitute for unassisted (unregulated) suicide. We test predictions arising from this hypothesis using data from US states that have legalised assisted suicide. Event study regression estimates provide strong evidence that legalisation of assisted suicide is associated with an increase in total suicides, especially for females and older people. There is some evidence that assisted suicide laws are also associated with a smaller increase in unassisted suicide, though the statistical significance is weaker than for total suicides. Results using the synthetic control method (SCM) are generally consistent with the regression estimates. Overall the US experience to date provides little evidence in support of the Posner substitution hypothesis.

Physician adherence to clinical guidelines in euthanasia and assisted suicide in the Netherlands: a qualitative study.

Euthanasia and assisted suicide laws in the Netherlands require physicians meet clinical guidelines when performing the practice to ensure death is peaceful and painless. Despite oversight by the regional review committees over each case, little research exists into the frequency of guideline deviation and the reasons for nonadherence. Cases reported and reviewed between 2012 and 2017 that did not meet due medical care were analysed for thematic content. Semistructured interviews were conducted with 11 Dutch physicians on their experience with the clinical and pharmacological elements of euthanasia and assisted suicide, their interaction and comportment with the recommended guidelines, and reasons why guideline deviation might occur. Reported case reviews and interviews were used to obtain themes and subthemes to understand how and why deviations from clinical guidelines happened. Violations of due medical care were found in 42 (0.07%) of reported cases. The regional review committees found physicians in violation of due medical care mostly for inadequate confirmation of coma-induction and deviations from recommended drug dosages. Physicians reported that they rarely deviated from the guidelines, with the most common reasons being concern for the patient's family, concern over the drug efficacy, mistrust in the provided guidelines, or relying on the poor advice of pharmacists or hospital administrators. Deviations from the guidelines and violations of due medical care are rare, but should nonetheless be monitored and prevented. A few areas for improvement include skills training for physicians, consistency between review committee rulings, and further clarity on dosage recommendations.

‘How Can Anyone Live Like That?’ Exploring the Conscious and Unconscious Implications for Disabled People of any Change in Assisted Suicide Law

This paper explores the issue of assisted suicide in relation to disabled people from a psychosocial perspective. The implications, particularly the unconscious implications, for disabled people and for the psychosocial dynamics around disability if assisted suicide was made lawful in the UK are explored. Assisted suicide is the subject of persistent attempts at legal change and while not, in theory, specific to disabled people, the issue brings some of the psychosocial dynamics around impairment and disability into focus, illuminating the attitudes and emotions with which disabled people must try to live. Psychoanalytic ideas in relation to trauma, loss, mourning and containment are drawn upon with particular reference to the work of Freud, Klein, Bion and more contemporary thinkers such as Garland, Sinason and Rustin. The paper draws on three texts by disabled people in order to explore emotional responses to profound impairment. Attachment theory helps in considering varying narrative styles. Disability studies literature and legal, social and political contextual issues inform the psychosocial perspective applied in the paper.

Progress in the Social Acceptance of Physician Assisted Suicide Laws

This paper gives an overview of several US laws regarding physician assisted suicide as well as Holland. Each law is reviewed in detail and the paper ends with observations between the laws and the effects of legalization in the various states and Holland.

Arts of Dying and the Statecraft of Killing

Those supporting laws permitting assisted suicide (AS) seem to enact a thin morality, one that permits people who desire AS to get it in the terminal stages of an illness, and that provide safeguards both for those who desire AS and do not desire it. This article explores the way in which all AS legislation subtly frames the question of AS such that AS becomes the clearest option; ensconcing AS in law also gives a moral legitimacy to suicide. Thus, the morality of laws permitting AS are not morally thin. I describe how AS laws create a different social imaginary for dying in Western cultures, one that competes with the traditional Christian understanding. Legalized AS is inevitable in Western liberal democracies, and I claim that the Church, which transformed the ancient Greco-Roman culture, will once again have to create alternative structures, creating a new Ars moriendi, in order to challenge the modern statecraft for killing.

Death with Dignity Laws and the Medical Examiner

Currently, three states (Oregon, Washington, and Vermont) have “death with dignity,” physician-assisted suicide laws. Twenty-five other states considered death with dignity (DWD) legislation in 2015. Americans and American physicians have mixed opinions about these laws. Oregon, Washington, and Vermont have similar DWD laws that establish criteria and define roles and responsibilities of the physician, patient, and pharmacist. States require record-keeping and statistical reports administered by public health agencies. Yearly summary reports in Oregon and Washington show that physician assisted suicide (PAS) is uncommon. In Oregon in 2014, 105 PAS deaths were documented, of approximately 34 000 total deaths. The majority of PAS deaths involve patients with terminal cancer or neurodegenerative disease. The laws require that the cause of death be attributed to and certified as the underlying natural disease, making the manner of death natural. The attending physician may sign the death certificate. Because the cause and manner of death are legally mandated, the physician assisted suicide laws have little impact on medical examiner offices.

Defending the indefensible? Psychiatry, assisted suicide and human freedom

The siege guns of the forces for change to euthanasia and assisted suicide laws have been pounding for decades, but the longstanding proscription on these practices has held out in all but a few jurisdictions. A few psychiatrists have enlisted with the challengers, but many remain on the battlements, defending the impermissibility of active assistance in dying. Given the long history of the separation of church and state and the significant secularisation of society; the recognition by the law of both acts and omissions as legal causes; lenient sentences for mercy killers; critiques of the “psychiatriatisation” of different aspects of life; and the consistency of public opinion, this recalcitrant stand bespeaks undercurrents and positions that are often by rationalised or camouflaged, and which call for exploration. In this paper, I examine connections between psychiatry and conceptualisations of harm, suffering and natural death; medicalisation, psychiatrisation and medical paternalism; decision-making capacity, rationality and diagnosis; recent legal developments; social pluralism; and religious intuitionism. I conclude that psychiatrists and the psychiatry profession, concerned as they are with enlarging the province of human freedom, should begin a more transparent rapprochement with those they would repel.

Cancer Patients Have Much to Gain From Psychiatric Treatment

Cancer Patients Have Much to Gain From Psychiatric Treatment

Physician assisted suicide

WHILE I WAS ON A CLERKSHIP IN THE INTENSIVE CARE UNIT (ICU), A FRIEND drew my attention to a chapter in Robert Zussman’s book, Intensive Care. In this chapter, an intern on an ICU rotation reports a bizarre dream in which he finds penguins in a basement. In order to save one of these penguins, who can only survive in a cold environment, he puts it in a blender with some ice and turns the blender on. For me, the enduring lesson of my time in the ICU was that bad things can sometimes happen to people in the hospital. Sometimes a treatment can be worse than the disease itself. Sometimes our efforts seem only to prolong a patient’s suffering. Many medical students have had a similar ICU experience at some point in their training; from this, it requires no great leap of reasoning to reconsider the role of the physician in addressing pain and suffering. Should unwilling patients be allowed to forgo life-sustaining therapy? Most systems of law concede this right. But this raises a more difficult question: Should physicians assist certain patients—perhaps those who meet some predefined criteria for measuring distress—in ending their own lives? Within the medical profession and among ethicists there are strong opinions, but there is no widely agreed-upon answer. Perhaps mirroring or perhaps causing this conflicted thinking, lawmakers in our country are similarly divided. In 1997, the US Supreme Court ruled that the Constitution neither explicitly permits nor prohibits physician-assisted suicide. Since then, the states have been free to consider on their own the question of legalizing the practice of assisted suicide. Measures to legalize physician-assisted suicide have been proposed and defeated in eight state legislatures—bringing the number of states outlawing its practice to 38. Oregon, which held a popular referendum on this issue in 1994, became the only state to legalize assisted suicide by implementing its Death With Dignity Act in 1997. In this issue of MSJAMA Juan Carlos Batlle clarifies terminology in recounting the legal and historical differences among assisted suicide, euthanasia, and the withdrawal of life support. Joanne Lynn and Karl Lorenz examine some of the ethical problems that physicians might face in responding to a patient’s request for assisted suicide and draw attention to the failure of the US health care system to provide reliable supportive and palliative care for the dying. Larry Palmer sizes up the legal struggle between the US attorney general and the state of Oregon over that state’s assisted suicide law. All of these authors challenge us to think about this issue, which yields no easy answers.

Assisted suicide laws create discriminatory double standard for who gets suicide prevention and who gets suicide assistance: Not Dead Yet Responds to Autonomy, Inc.

Not Dead Yet is a national disability rights organization formed in 1996 to articulate and organize the disability rights opposition to legalization of assisted suicide. In the first half of 2009, Not Dead Yet and four other national disability organizations joined in an amicus brief filed in Baxter v. State of Montana, an assisted suicide case on appeal to the state Supreme Court. Autonomy, Inc., another disability organization, filed an amicus brief in favor of a constitutional right to assisted suicide. The author reviews the lower court opinion and the key arguments in these amicus briefs from the perspective of Not Dead Yet. The Montana District Court concluded that the privacy and dignity provisions of the Montana Constitution establish a constitutional right to physician assisted suicide for terminally ill people, and that potential abuses of that right could be regulated by state statute. The author addresses the question, “What does disability have to do with it?” The author uses a combination of clinical research, legal analysis and the Oregon Reports on assisted suicide to examine the claim that abuses can be prevented by restricting assisted suicide to competent people who are terminally ill and choose it voluntarily. Autonomy, Inc.'s arguments explicitly depend on the medical profession's ability to reliably predict terminal status, and the capacity of society and the law to implement a double standard of suicide prevention and suicide assistance based on terminal status. Not Dead Yet's central argument is that such a double standard based on health status constitutes unlawful discrimination under the Americans With Disabilities Act. The author highlights data from the Oregon Reports demonstrating that lethal prescriptions were issued to people who were not terminally ill under the law's definition, and examines various problems of implementation and enforcement under the Oregon and Washington assisted suicide statutes. Particular attention is given to the problems associated with the role of physicians as gatekeepers under the statutes, providing examples of physicians pressuring people to forego life-sustaining treatment and involuntarily withholding life-sustaining treatment.

The Influence of Death Attitudes and Knowledge of End of Life Options on Attitudes toward Physician-Assisted Suicide

End of life decisions, such as physician-assisted suicide (PAS), have continued to be controversial as health care policy, moral, and individual health care issues. This study considers knowledge of end of life options and death attitudes as predictors of attitudes toward PAS. Data were gathered from approximately 300 adults through a mailing sent to a household research panel. Validated measures of attitudes toward PAS, knowledge about that state's assisted suicide laws, demographics, and attitudes toward death as measured through the Death Attitude Profile-Revised (DAP-R) were collected and analyzed. The data indicate that attitudes toward PAS are a function of knowledge of end of life options as well as death attitudinal factors.

Opinion split on assisted suicide laws

Opinion split on assisted suicide laws

Assisted suicide: a matter of life and death

On Feb 19, 2009, Debbie Purdy from Bradford, UK, lost her case to clarify the assisted suicide law in the Court of Appeal. In 1995, Purdy was diagnosed with primary-progressive multiple sclerosis at the age of 32 and can no longer walk. She is considering ending her life at Dignitas, a Swiss assistedsuicide clinic where she could take a lethal dose of barbiturates prescribed by its doctors, when her illness takes over and makes her life unbearable. Purdy wants to know how her husband, Omar Puente, could help her make necessary arrangements without being prosecuted, but the Director of Public Prosecutions (DPP) refused to specify such circumstances. She brought the DPP to the courts, arguing that this refusal breached her human rights, such as the freedom from torture and from inhumane and degrading treatment, as well as her individual right to privacy as specifi ed in Articles 3 and 8 of the European Convention on Human Rights. Her case, however, was ruled against by both the High Court and the Court of Appeal. The Purdy litigation is yet another high-profi le case on issues of assisted suicide since Dianne Pretty, a patient with amyotrophic lateral sclerosis, brought similar charges in 2001 against the DPP in the High Court, the Court of Appeal, the House of Lords, and the European Court of Human Rights and lost all of them. “What these cases are telling us is that the state of the law is highly unsatisfactory”, says Sarah Wooton, chief executive of the UK organisation Dignity in Dying. “How can people plan their actions if they don’t know how the DPP makes decisions regarding prosecution?” However, Peter Saunders, director of Care Not Killing, another UK organisation, disagrees. “The law is actually very clear”, he says. “It’s not illegal to commit suicide, but assisting someone to do it is illegal.” Under section 2 of the 1961 Suicide Act “a person who aids, abets, counsels or procures the suicide of another, or attempt by another to commit suicide shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years”. The same section also says, however, that “no proceeding shall be instituted for the off ence under this section except by or with the consent of the Director of Public Prosecutions”. In other words, the DPP has the discretion to decide whether such off ences would be prosecuted.

Assisted suicide debated in the United States

When the US Supreme Court upheld Oregon's controversial assisted suicide law in January, it rekindled other states' efforts to pass similar legislation. With a 6–3 decision, the court ruled that the US attorney general can't punish doctors who abide by Oregon's law, which specifies under what

Historical and Contemporary Issues in End-of-Life Decisions: Implications for Social Work

End-of-life circumstances have changed dramatically in recent years. In the past century life expectancy has increased by 62 percent and people are living longer with chronic illness. This article discusses evolving health practices and polices in end-of-life decisions. Treatments to prolong life and provide comfort, and interventions that hasten death, are discussed. Recent assisted suicide and euthanasia laws are analyzed and compared. Implications for social work and social work practitioners are addressed.

Improving our care at life's end: making a difference.

Although there are few human experiences as profound and universal as the end of life, we are only beginning to create a health care system that will allow people to die as they wish, with dignity and with as little pain as possible. The challenges to creating that system are attitudinal, financial, clinical, and emotional. Despite increasing public discussion about end-of-life care, many people are uncomfortable thinking about their own deaths or the deaths of those they love. Talking openly about this is even harder. Beyond emotional barriers lie practical ones. Doctors, nurses, and social workers are not trained well in managing pain and addressing the patient's and family's emotional and spiritual needs. Long-time habits of thoughts and action are difficult to change--doctors are focused on curing rather than caring. Hospitals and nursing homes need additional staff and frequently face cutbacks and staff turnover. In addition, care may not be coordinated around patient needs; rather, planning may focus on what Medicare and other insurance policies cover. Financial coverage may be unavailable to support home and community-based care, but is usually available for hospital care. Furthermore, factors unrelated to end-of-life care can influence the provision of these services. For example, my state, New Jersey, has a high number of hospital beds compared with other states, and pressure is exerted to fill them. Therefore, the majority of New Jerseyans die in hospitals, even though surveys show most people would prefer to die in their homes. New data also suggest that the relatively high number of hospital beds has an effect on use of intensive care. A 2002 report of Last Acts, funded by the Robert Wood Johnson Foundation, indicated that New Jersey had one of the highest rates of elderly individuals who spent seven or more days in intensive care during the last six months of their lives (Last Acts, 2002). Although community-based hospice care is more appropriate in most cases and is less costly, the need to fill hospital beds may drive this trend. Other states face unique issues that drive the provision and quality of care. Interest in improving end-of-life care grew during the 1990s in response to legal challenges to assisted suicide laws and a recognition that new strategies were needed to improve the care of people near the end of life. First, the publicized attempts by Dr. Jack Kevorkian to assist in the suicides of seriously ill individuals called attention to the health care system's failure to effectively address pain and suffering. Second, individuals with life-threatening illnesses and their physicians sued their state leaders (in New York State and Washington State) to establish a constitutional right to physician-assisted suicide. In a leading 1997 decision, Vacco v. Quill, the U.S. Supreme Court declined to find a legal right to assisted suicide, but suggested that individuals may have a right to better end-of-life care and pain care (Vacco v. Quill, 1997). Finally, a national hospital project funded by the Robert Wood Johnson Foundation attempted to improve end-of-life decision making and reduce the frequency of artificially supported, painful, and prolonged dying processes. Although the study's interventions, including the use of a skilled nurse to obtain patient wishes, enhance understanding of patient outcomes, and promote palliative care, failed to improve end-of-life care, the study marked a turning point in bringing new attention, professional training, service programs, and research to improve the care of the dying population (SUPPORT Principal Investigators, 1995). Despite the many challenges presented by our health care system, many caring professionals are making a difference through palliative care, an approach to life-threatening illness that emphasizes patient comfort throughout the course of the illness. The most prominent type of palliative care is hospice, which seeks to keep patients comfortable during the final stages of their illness and focus on quality of life. …

ON THE COVERON THE COVER

WHILE I WAS ON A CLERKSHIP IN THE INTENSIVE CARE UNIT (ICU), A FRIEND drew my attention to a chapter in Robert Zussman’s book, Intensive Care. In this chapter, an intern on an ICU rotation reports a bizarre dream in which he finds penguins in a basement. In order to save one of these penguins, who can only survive in a cold environment, he puts it in a blender with some ice and turns the blender on. For me, the enduring lesson of my time in the ICU was that bad things can sometimes happen to people in the hospital. Sometimes a treatment can be worse than the disease itself. Sometimes our efforts seem only to prolong a patient’s suffering. Many medical students have had a similar ICU experience at some point in their training; from this, it requires no great leap of reasoning to reconsider the role of the physician in addressing pain and suffering. Should unwilling patients be allowed to forgo life-sustaining therapy? Most systems of law concede this right. But this raises a more difficult question: Should physicians assist certain patients—perhaps those who meet some predefined criteria for measuring distress—in ending their own lives? Within the medical profession and among ethicists there are strong opinions, but there is no widely agreed-upon answer. Perhaps mirroring or perhaps causing this conflicted thinking, lawmakers in our country are similarly divided. In 1997, the US Supreme Court ruled that the Constitution neither explicitly permits nor prohibits physician-assisted suicide. Since then, the states have been free to consider on their own the question of legalizing the practice of assisted suicide. Measures to legalize physician-assisted suicide have been proposed and defeated in eight state legislatures—bringing the number of states outlawing its practice to 38. Oregon, which held a popular referendum on this issue in 1994, became the only state to legalize assisted suicide by implementing its Death With Dignity Act in 1997. In this issue of MSJAMA Juan Carlos Batlle clarifies terminology in recounting the legal and historical differences among assisted suicide, euthanasia, and the withdrawal of life support. Joanne Lynn and Karl Lorenz examine some of the ethical problems that physicians might face in responding to a patient’s request for assisted suicide and draw attention to the failure of the US health care system to provide reliable supportive and palliative care for the dying. Larry Palmer sizes up the legal struggle between the US attorney general and the state of Oregon over that state’s assisted suicide law. All of these authors challenge us to think about this issue, which yields no easy answers.

Judge Halts Attempt to Overturn Oregon’s Assisted-Suicide Law

Judge Halts Attempt to Overturn Oregon’s Assisted-Suicide Law

Lethal judgments: assisted suicide and American law

Lethal judgments: assisted suicide and American law