Legalization Of Assisted Suicide Research Articles

Long-term development of assisted suicide in Switzerland: analysis of a 20-year experience (1999–2018)

The legalisation of assisted suicide is one of the most debated topics in the field of medical ethics worldwide. In countries in which assisted suicide is not legal, public discussions about its approval also encompass considerations of the long-term consequences that such legalisation would bring, for example, how many people will use this option, from what conditions would they be suffering, would there be differences between male and female assisted suicide and which developments and trends could be expected if there were to be a marked increase of cases of assisted suicide over time? In order to answer these questions, we present the development of assisted suicide in Switzerland over a 20-year period (1999-2018; 8738 cases) using data from the Swiss Federal Statistical Office. During the observation period, the number of assisted suicides rose significantly: when four 5-year periods (1999-2003, 2004-2008, 2009-2013, 2014-2018) were analysed, the number of assisted suicide cases doubled over each period compared with the preceding one (Χ = 206.7, 270.4 and 897.4; p <0.001). The percentage of assisted suicides among all deaths rose from 0.2% (1999-2003; n = 582) to 1.5% (2014-2018: n = 4820). The majority of people who chose assisted suicide were elderly, with increasing age over time (median age in 1999-2003: 74.5 years vs 2014-2018: 80 years), and with a predominance of women (57.2% vs 42.8%). The most common underlying condition for assisted suicide was cancer (n= 3580, 41.0% of all assisted suicides). Over time, assisted suicide increased similarly for all underlying conditions; however, the proportion in each disease group remained unchanged. It is a matter of one's viewpoint whether the rise of assisted suicide cases should be considered alarming or not. These figures reflect an interesting social development but still do not appear to represent a mass phenomenon.

Ethical and Legal Aspects of the Dispute Over the Legalization of Assisted Suicide in Italy in 2017-2022

The main purpose of the study undertaken in this paper is a synthetic presentation of the major stages of the dispute over the legalization of assisted suicide in Italy as well as an analysis of selected ethical and legal aspects related to this issue. Assisted suicide is medical and administrative aid provided to a person who has decided to take their own life. It differs from direct euthanasia in the fact that the final act of taking one’s own life, involving deliberate administration of the necessary substances is performed entirely by the patient themself without interference of any third parties. In 2017, the institution of the living will was introduced in Italy, which allows to make a declaration of intent for potential future loss of consciousness and ability to make decisions regarding one’s treatment and saving one’s life. In 2019, the Constitutional Court obliged the parliament to draft a law regulating the termination of life on request. In March 2022, the relevant provisions were voted in the Chamber of Deputies. They were then forwarded to the Senate. Ultimately, this bill was not passed, due to the collapse of the government in July 2022 and the dissolution of the parliament. The conducted analyses showed that the Italian ethical and legal dispute regarding the legalization of assisted suicide is an important element of the contemporary global debate, concerning, among others, medical ethics, value and quality of human life, conscience clause, ethical aspects of suffering and death.

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.

Suicide and Assisted Suicide in Criminal Law and Canon Law

The paper deals with the issue of suicide and assisted suicide, especially its ethical, criminal law and canon law evaluation. In the first chapter, the author explains what needs to be perceived under these terms and how they differ from euthanasia, offers current statistics on suicides in the Slovak Republic and discusses basic types of suicides, evaluates the issue of the right to life from an ethical point of view and criticizes the concept of the “right to death”. He concludes that the possible legalization of assisted suicide and euthanasia would have widespread negative consequences. The second chapter of the paper is based on the constitutional guarantees of the right to life, which is also supported by the international obligations of the Slovak Republic in this area. Subsequently, it offers a criminal analysis of suicide and assisted suicide in the Slovak legal system. In the last, third chapter, the author finally discusses the issue from the perspective of the doctrine, law and practice of the Catholic Church.

Associations of end-of-life preferences and trust in institutions with public support for assisted suicide: evidence from nationally representative survey data of older adults in Switzerland.

The legality of euthanasia and assisted suicide (AS) and nature of regulations of these practices remain controversial and the subject of lively debate among experts and the general public. Our study investigates attitudes and behaviours towards AS among older adults in Switzerland where the practice of AS has a relatively long history and remains rather unregulated. We aim to explore how individuals’ preferences regarding their end of life, as well as individuals’ trust in institutions involved in the practice or control of AS are associated with attitudes and behaviours towards AS. We analyse nationally representative data of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2,145). While large majorities supported current legal arrangements around AS in Switzerland (81.7%) and stated that they could consider AS for themselves under certain circumstances (61.0%), only a minority either was a member of a right-to-die organisation already (4.9%) or stated they were likely to become a member of such an organisation (28.2%). Stated preferences for control over the end of life and for maintaining essential capabilities at the end of life showed a positive association with AS-related attitudes and behaviours, whereas preferences for feeling socially and spiritually connected, as well as for not being a burden displayed a negative association with our outcomes. Higher levels of trust in one’s relative were positively associated with both support for the legality of AS and potential use of AS. A positive association was also found between trust in the Swiss legal system and support for the legality of AS. By contrast, trust in religious institutions displayed a negative association with all five AS-related attitudes and behaviours. Similarly, trust in healthcare insurance companies was negatively associated with potential use of AS. Taken together, older adults were generally supportive towards current practices regarding AS. This approval appears to be closely related to individuals’ preferences and, at different extends, to trust in social and public institutions with regard to end-of-life issues, which is relatively high in Switzerland.

Assistierter Suizid und der Geist des Katholizismus

The Christian churches speak out against the legalization of assisted suicide in a variety of documents by using religiously distant and profane arguments that, however, do not stand up to critical scrutiny. This is all the more astounding as the churches have the tradition of Dolorism and thus a body of belief that makes their position on assisted suicide plausible for explicitly religious reasons. It can be surmised that the attempt to veil the actual religious motivation with the help of bad profane arguments is due to the insight that in the secular world it is not promising to use the language of myth.

Inclusive citizenship: refusing the construction of “cognitive foreigners” in neo-liberal times

ABSTRACTIn this article I argue that claims for full inclusion and citizenship for the growing number of people with significant intellectual, cognitive, and psycho-social disabilities are unrealised because of a cognitive ableism embedded in law, policy, and social practice that construes people as “cognitive foreigners”, excluded from belonging on this basis. To explore how to sharpen and better advance full citizenship claims for this group it draws on Hannah Arendt's analysis in The Origins of Totalitarianism of the lethal consequences of denying the “right to have rights” to certain groups made alien. It applies the trajectory she portrays – from rightlessness, to not belonging as a citizen, to having one's right to life itself threatened – as a lens, to examine: contests over disability rights; current struggles over legal recognition of a right to legal capacity and supported decision-making, which it suggests constitutes a basic “right to have rights”; and the legalisation of assisted suicide on the basis of intellectual, cognitive, and psycho-social disability, which comes to “makes sense” in a time of neo-liberal reason and state formation. To disrupt the logic of this trajectory, the article argues for a politics of inclusive citizenship that grows the work of supported decision-making for people with profound intellectual, cognitive, and psycho-social disabilities in actual communities, even as state and other interests contest and deny it legal recognition. Even if the state won't recognise this group's “right to have rights”, proactive communities can.

儒家視角下的死亡的尊嚴

LANGUAGE NOTE | Document text in Chinese; abstract also in English.在當代的醫療實踐中，各種新的醫療技術在臨終階段的應用引發了關於如何維護死亡的尊嚴的激烈爭論。爭論的焦點集中在對什麼是人的尊嚴和什麼是死亡的尊嚴的概念的不同理解上。人的尊嚴概念在當代西方的倫理學中尚沒有得到清晰的闡釋，死亡的尊嚴概念更是存在混亂。儒家倫理學則可以在這種討論中為問題的解決提供新的思路。本文試圖重建儒家的人的尊嚴和死亡的尊嚴的基本含義，並對死亡的尊嚴與人的生物學生命的關係，死亡的尊嚴與人的痛苦的關係，死亡的尊嚴同人的自主性的關係，以及死亡的尊嚴同社會公平正義之間的關係做出分析說明。儒家關於人的尊嚴的觀點有助於化解西方死亡倫理研究中出現的概念混亂和理論矛盾。What does a death have dignity? In modern healthcare, the wide use of new technology has generated confusion around how to define and protect human dignity, especially in the case of death and dying. Those who advocate the legalization of assisted suicide often appeal to the right to “die with dignity” and the right to individual autonomy. The problem is that it is very difficult to justify one particular understanding of human dignity in the contemporary pluralistic world through a rational formulation without defining dignity.In this paper, the authors attempt to respond to the current debate on euthanasia and assisted suicide from a Confucian perspective. The paper first defines the Confucian concept of human dignity and shows how the concept could be used in the case of dignity in death and dying. The authors argue that in Confucianism, there are two kinds of dignity: One is intrinsic dignity, which is endowed by Heaven on everyone, and the other is extrinsic dignity, which arises from the cultivation of virtues. This extrinsic dignity is also called “personal dignity.” Unlike the individual-oriented human dignity model, Confucian ethics argue for a family-oriented model of human dignity. That is to say, the Confucian ideal of human dignity is not satisfied by a concept of human dignity that is centered on individual rights and freedom of choice; instead, it focuses on relations in a concrete community in which a person’s human dignity is actualized through morals and virtues. In the case of euthanasia and assisted suicide, therefore, the decision should not be solely based on freedom of choice, but on what kinds of values and obligations the person has. In addition, the paper shows that the Confucian view of human dignity does not support the idea of prolonging life through technological means without restraints.DOWNLOAD HISTORY | This article has been downloaded 1292 times in Digital Commons before migrating into this platform.

“I DON’T KNOW HOW I WANT TO GO BUT I DO KNOW THAT I WANT TO BE THE ONE WHO DECIDES” – THE RIGHT TO DIE – THE HIGH COURT OF SOUTH AFRICA RULES IN Robert James Stransham-Ford and Minister of Justice and Correctional Services; The Minister of Health Professi

The present case concerns the legality of assisted suicide and active euthanasia in South Africa. This particular issue has been a major point of contention, having been debated in South Africa and elsewhere for many years and is generally accepted to be unlawful. In November 1998, the South African Law Commission submitted a report to the then Minister of Health on this issue, entitled “Euthanasia and the Artificial Preservation of Life”. At the time of its submission, the country was facing a number of imposing crises, including the HIV/AIDS epidemic. As a consequence of this, this report did not receive the necessary attention of either the Minister of Health or the legislature at the time. Sixteen years have since passed and in the interim South Africa became a democracy (in 1994). A Constitution was promulgated that inter alia guarantees fundamental human rights to all persons. However, the status quo on euthanasia and assisted suicide has remained unchanged in South Africa.The advances made in medical science have resulted in patients living longer. For some, the advances in medical technology are welcomed in that they can prolong a meaningful life. For others, however, the prolonging of a poor quality of life is viewed as a burden rather than a benefit.On an international level the importance placed on the autonomy of the mentally-sound patient’s right to refuse any medical treatment that will unnecessarily prolong the agony of such patient, and also, for such a patient to receive assistance in ending his or her life at a point where his or her suffering has become so unbearable, has received more attention (at present there are 11 countries or States which recognise the right to assisted suicide and active euthanasia). In South Africa, doctors are placed in a situation where they might wish to act in the best interest of the patient under their care, but at the same time there is no clarity as to their legal position and there is uncertainty as to the scope and content of the legal obligation to provide medical care. The basis for this uncertainty will be referred to within this case note. The potential of being exposed to civil claims and criminal prosecution should they decide to withhold life support to the patient or to provide drugs which may shorten the suffering of the patient, notwithstanding the fact that they are acting in accordance with the wishes of the patient, is real. Cases are dealt with on an ad hoc basis and with no national policy.With the dawning of the constitutional era, a consideration and decision on the right of an individual to assisted suicide in light of the principles of the Bill of Rights contained in the Constitution of South Africa is long overdue. For this reason, the present case is of great significance. The matter concerned an urgent application requiring an immediate decision regarding the Applicant’s request that a medical practitioner, registered in terms of the Health Professions Act 56 of 1974, terminate or enable the Applicant to terminate his life by the administration or provision of a lethal agent which would enable him to end his life. The application was opposed by the Minister of Justice and Correctional Services, the Minister of Health, the Health Professional Council of South Africa and the National Director of Public Prosecutions.

Ageism and elective death

Summary Opting to die in hopeless medical circumstances is gaining acceptance, as is evident in the legalization of assisted suicide in some jurisdictions. I maintain that choosing to die in hopeless medical circumstances can be a rational option not only when continuing to live results in great suffering but especially when doing so diminishes the individual as a person. We are self-reflective entities and our intellectual and emotional consciousness is the essence of our personhood. Significant diminishment of our ability to think coherently and feel effectually by physical maladies, by accompanying continuous suffering, and by the effects of medication intended to relieve our pain, erodes our personhood. It is rational to choose to die as oneself rather than survive as a lessened entity. In support of my contention, I offer a criterion for rationally choosing to die. I also maintain that the issue of whether choosing to die is rational precedes questions about its morality, whether the questions are about violation of ethical or religious codes or practical ones about the effects of choosing to die on family and friends. If choosing to die is irrational, then the moral question does not even arise, for there can be no possibility of an act being both irrational and moral. My position and arguments have prompted two major negative responses. One response is basically dismissal by bioethicists who consider my contention about the rationality of choosing to die too abstract and irrelevant to the practical business of dealing with individuals considering the option to end their blighted lives. Against this, I maintain that bioethicists require a common abstract basis on which to ground their assessments and decisions and that the alternative is a dangerously chaotic situation where advice given to those considering elective death varies from professional to professional and support of families and friends diverges depending on the professional involved. The other negative response is the charge by bioethicists and others that my position is ageist in nature and that my claims encourage diminished concern about the elderly on the part of the medical profession and families. The gist of the charge is that leniency shown regarding elective death in advanced age is a step onto a “slippery slope” to facile acceptance of death among the elderly and hence reduced care and concern about them. My answer is to stress the highly selective nature of my criterion for rationally choosing to die and to point out that ageist implications are due to critics’ generalizations rather than to anything inherent in my position or criterion.

In Debating the Right to Die, a Shift in Tone Among Physicians.

In Debating the Right to Die, a Shift in Tone Among Physicians.

The Mystery of Life in the Laboratory of Democracy: Personal Autonomy in State Law

Recent controversies, such as enactment of an individual mandate to purchase health insurance and the legalization of assisted suicide in Washington and Montana, have renewed the war over personal autonomy. Debates about the value and limits of personal autonomy also play major roles in the controversies over abortion, same-sex intimacy, and same-sex marriage. On one side of the autonomy war, advocates of unfettered individual freedom assert that by her un-coerced and autonomous choice the individual person determines the value of human goods such as life, health, and marriage.On the other side, proponents of strong government restrictions on personal choice hold that personal autonomy conflicts with personal responsibility. This view is used to support strong government restrictions not only on assisted suicide and marriage, but also on the consumption of drugs, cigarettes, and alcohol; and recently on economic activities, such as the decision whether to purchase health insurance.This article attempts to carve a path between the two sides in this autonomy war. It begins by bringing into dialogue with each other four of the most influential legal philosophers of our day, Joseph Raz, Ronald Dworkin, John Finnis, and Robert George. Each of these four makes bold and instructive claims about the value and limits of personal autonomy. The article then examines several different areas of state law where one might expect a principle of autonomy to be implicated, and articulates six important lessons that one can glean from state law about the relationship between personal autonomy and other human goods.

OVERLOOKING THE CRIMINALLY COMPASSIONATE: WHAT ARE THE IMPLICATIONS OF PROSECUTORIAL POLICY ON ENCOURAGING OR ASSISTING SUICIDE?

The decision of the House of Lords in the case of Purdy compelled the Director of Public Prosecutions (DPP) to promulgate guidance as to the exercise of prosecutorial discretion with respect to those suspected of an offence under the Suicide Act 1961. Consequently, the Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide now sets out determining factors for potential culpability in encouraging or assisting suicide. This paper discusses the implications of the Policy, particularly with respect to the role of compassion as a key determining factor which effectively decriminalises acts of assisting or encouraging suicide in the majority of cases, despite such acts remaining technically criminal. Following the DPP's assertion that the location of the actual suicide is irrelevant to the prosecutorial decision, this article considers whether some elements of the Policy might belie this assertion. The apparently heightened risk of prosecution now faced by doctors and other healthcare professionals and workers is also considered. Finally, in light of the apparent prosecutorial endorsement of compassionate assisted suicide, this article questions whether we might now expect the imminent legalisation of assisted suicide.

R(Purdy) v DPP and the Case for Wilful Blindness

This article critiques the recent House of Lords decision, R(Purdy) v DPP, and explores the wider debate over the legalization of assisted suicide, with particular focus on assistance in ‘suicide-tourism’. It proceeds in roughly two parts. In the first part, I seek to make the case that it was not legally necessary for the Lords to order that the Director of Public Prosecutions (DPP) clarify his long-standing policy of not prosecuting those who compassionately assist loved ones to travel abroad to die. On the purely legal merits of the case, the Lords’ hands were not ‘tied’, so to speak, and I will attempt to show that a closer analysis of the argumentation leading to the decision will expose its errors in this respect. This conclusion will then open up the normative question of whether clarification of the DPP’s policy is a progressive development. I suggest that in light of the special practical and ethical considerations at stake, the DPP’s previous practice of turning a blind eye to instances of assisted suicide bearing out certain features-whilst not clarifying his policy to this effect-was the most satisfactory one, and that the Lords’ decision was hence a retrograde step.

The (Contingent) Value of Autonomy and the Reflexivity of (Some) Basic Goods

Many of the legal and policy issues about which people today get most exercised turn on a little-understood relationship between two fundamental principles. On one hand is the principle of autonomy, which, for reasons explored in this article, is often employed in defence of greater freedom and less government intervention in matters of morals and self-harmful conduct. On the other hand is respect for basic goods, those ends and purposes that constitute ultimate, underived, and intelligible reasons for rational action, and which include knowledge, human life, and community, among others. Basic goods provide reasons for human purposing and action (as opposed to desires, emotions, and other sub-rational motivations for action), and are valuable in and of themselves. Thus states act rationally, though not always fully reasonably, when they prohibit injury to basic goods, even by coercive laws and policies.Renewed debates in the United Kingdom and the United States over decriminalisation of physician assisted suicide have in recent months brought into sharper focus foundational disagreements about the relationship between autonomy and basic goods, such as human life. Careful attention to this relationship might enable productive discussion of this and other issues, such as the nature of marriage, the justness of abortion, and controversial uses of tax revenues. This paper attempts to reconcile respect for autonomy with respect for basic human goods.This article begins by reviewing the efforts of two legal philosophers, Joseph Raz and Robert George, to reconcile the value of autonomy with the intrinsic value of other human goods. Raz and George provide reason to believe that understanding, at least, is possible. The article next considers some bold claims about the value of autonomous choice by two scholars who favour legalization of assisted suicide, Andy Olree and Ronald Dworkin. Though Olree’s and Dworkin’s treatments of autonomy and basic goods both fail to account for the full value of many basic goods, such as human life, their arguments suggest a reason why the argument over assisted suicide has become intractable. The article concludes by fashioning a framework for thinking about contested legal issues in a productive manner.

Editorial: A time to live, a time to die? An exploration of the arguments surrounding the legalisation of assisted suicide

Editorial: A time to live, a time to die? An exploration of the arguments surrounding the legalisation of assisted suicide

Broadcasting death and the legality of assisted suicide: are they the antithesis to palliative care?

Perhaps one of the most famous published or performed meditations upon man’s mortality is ‘to be or not to be – that is the question’. Shakespeare’s Prince Hamlet is, depending on your interpretation of the text, contemplating a suicide that will end ‘the heartache and the thousand natural shocks that flesh is heir to’. Via the theatrical contrivance of the soliloquy, his contemplations are conveyed to the audience and through the dramatic device of this internal monologue we gain a deep insight into, and share confidence with, a complex personal perspective and the pain of the character.

Should assisted suicide be performed by physicians only? Results of a survey among physicians in six European countries and Australia

French and German abstracts see p. 8 Background: Whereas there is broad agreement that euthanasia should be performed by physicians only, this is contested for (physician-) assisted suicide. Methods: We conducted a survey to investigate whether European and Australian physicians see morally relevant differences between assisted suicide and euthanasia, and whether, after a possible legalization of assisted suicide, they believe it should be performed by physicians only. Results: 10 139 questionnaires were studied. 76% of the physicians in Belgium, 66% in the Netherlands, 62% in Australia, 48% in Denmark, 44% in Switzerland, and 10% in Sweden thought that assisted suicide should be performed by physicians only. 16% of the physicians in Italy, 30% in Australia, 32% in the Netherlands, 37% in Belgium, 40% in Denmark, 47% in Switzerland, and 51% in Sweden regarded assisted suicide to be morally different from euthanasia. Multinomial logistic regression analysis confirmed the predominant role of the factor country for these opinions. Conclusions: Country-specific views on the question of whether assisted suicide, after a possible legalization, should be performed by physicians only, are highly diverse, even within Western European countries. These differences should be taken into account when searching for common grounds for regulating assisted dying in westernized countries or even within Europe.

Dr. and Ms. Hamilton Reply

Back to table of contents Previous article Next article Letters to the EditorFull AccessDr. and Ms. Hamilton ReplyN. GREGORY HAMILTON M.D.CATHERINE A. HAMILTON M.A.,N. GREGORY HAMILTON M.D.Search for more papers by this authorCATHERINE A. HAMILTON M.A.Search for more papers by this author,Published Online:1 Jun 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We thank Dr. Ganzini for her comments and agree with her observation that psychiatrists’ ethical views affect their clinical understanding and decisions concerning patients who request that a doctor give them a prescription for a lethal overdose. In fact, that was the point of our recent article (reference 2 in her letter): the legalization of assisted suicide has created competing paradigms—in some ways, mutually exclusive paradigms—of responding to suicide requests in Oregon.Dr. Ganzini also writes that she was the psychiatrist who determined that Ms. Cheney, an 85-year-old patient with growing dementia, did not meet the competency requirements of the Oregon assisted-suicide law, apparently due to dementia. Yet she also attempted to justify a second opinion, which also indicated that Ms. Cheney was suffering from dementia but cleared the ailing woman for a lethal overdose anyway, an overdose that she eventually received. Why Dr. Ganzini comes down in her letter on the side of someone else’s opinion favoring assisted suicide remains unclear. Neither can her dilemmas be impartially considered with only the information she herself is willing to present as a basis for discussion. Dr. Ganzini’s comments themselves illustrate a serious problem with the Oregon assisted-suicide law. Virtually everything known about such cases comes from those who have participated in the process of giving patients overdoses and need to justify their behavior (1 , 2) . That is why, once again, we call for open and impartial review of anonymous assisted-suicide cases in Oregon, something that has not happened previously. We are grateful to the patient described in our recent clinical case conference for giving us permission to review his extensive medical records and to publish our findings in the medical literature.Portland, Ore.

Dr. and Ms. Hamilton Reply

Back to table of contents Previous article Next article Letters to the EditorFull AccessDr. and Ms. Hamilton ReplyN. GREGORY HAMILTON M.D.CATHERINE A. HAMILTON M.A.,N. GREGORY HAMILTON M.D.Search for more papers by this authorCATHERINE A. HAMILTON M.A.Search for more papers by this author,Published Online:1 Jun 2006AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleTo the Editor: We thank Dr. Ganzini for her comments and agree with her observation that psychiatrists’ ethical views affect their clinical understanding and decisions concerning patients who request that a doctor give them a prescription for a lethal overdose. In fact, that was the point of our recent article (reference 2 in her letter): the legalization of assisted suicide has created competing paradigms—in some ways, mutually exclusive paradigms—of responding to suicide requests in Oregon.Dr. Ganzini also writes that she was the psychiatrist who determined that Ms. Cheney, an 85-year-old patient with growing dementia, did not meet the competency requirements of the Oregon assisted-suicide law, apparently due to dementia. Yet she also attempted to justify a second opinion, which also indicated that Ms. Cheney was suffering from dementia but cleared the ailing woman for a lethal overdose anyway, an overdose that she eventually received. Why Dr. Ganzini comes down in her letter on the side of someone else’s opinion favoring assisted suicide remains unclear. Neither can her dilemmas be impartially considered with only the information she herself is willing to present as a basis for discussion. Dr. Ganzini’s comments themselves illustrate a serious problem with the Oregon assisted-suicide law. Virtually everything known about such cases comes from those who have participated in the process of giving patients overdoses and need to justify their behavior (1 , 2) . That is why, once again, we call for open and impartial review of anonymous assisted-suicide cases in Oregon, something that has not happened previously. We are grateful to the patient described in our recent clinical case conference for giving us permission to review his extensive medical records and to publish our findings in the medical literature.Portland, Ore.