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Physician Assisted Suicide (PAS)

Timeline of U.S. and international
developments from the year 1997 to now
:

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The listing below are brief overviews of Physician Assisted Suicide
developments federally, in various states, and other countries.

Detailed activity in California, Oregon and Washington state are described in separate essays

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law books and gavel About PAS:

Physician Assisted Suicide (PAS) is also called Medical Aid in Dying (MAID), Physician Assisted Dying, Physician Assisted Death, Assisted Death, and Aid in Dying.

PAS is often confused with euthanasia (a.k.a. mercy killing):

  • Euthansia involves one person directly causing the death of another person, typically to terminate the latter's unbearable suffering.

  • In assisted suicide, one person -- typically a physician -- supplies medication which a second person can voluntarily take to end their own life. Secobarbital sodium and pentobarbital are the most commonly used.

  • The lethal dose prescribed is typically 9 g of secobarbital capsules or 10 g of pentobarbital liquid, to be consumed at one time. The person typically falls asleep within 10 minutes after taking the drug and remains sleeping until they die -- usually within one to three hours.

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PAS Status in Canada:

This is discussed in a separate section.

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PAS Status in the U.S.

star Within North America (Canada, the United States, and Mexico), Oregon was the first jurisdiction, that passed a law to legalised PAS. The state government passed the Death With Dignity Act (DWDA), which became effective in 1997. By 2018-OCT, the District of Columbia and five other states had passed similar laws or public referendums: California, Colorado, Hawaii, Vermont, and Washington state. The laws typically 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."

Also, in Montana, PAS was legalized by a court ruling.

Gallup has regularly conducted national polls on assisted dying starting in 1948 when public support was found to be only 37%. Support rose steadily, reaching 75% in 1995. It has varied between 64% and 75% between 1995 and 2017. It will probably increase gradually in the future as more states legalize PAS, and as assisted suicide becomes more common.

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PAS developments, year 2000 until now:

As of 2018-OCT, Physician Assisted Suicide (PAS) is available -- or will be available in the near future -- in the District of Columbia and seven states. Past developments include:

  • 2000-JAN-11: California: The state legislature considered a "Death with Dignity Act." Previous law in California allowed adults of sound mind to "execute a declaration governing the withholding or withdrawal of life sustaining treatment." The proposed law would go further by allowing a person under severely restricted circumstances to obtain "medication for the purpose of ending his or her life in a humane and dignified manner." Doctors would have immunity from civil or criminal actions as long as they participated "in good faith compliance with the act." The act was rejected by the Legislature on FEB-03.

  • 2001-NOV-5: USA: Attorney General attempted to override Oregon's law: The federal Attorney General during the George W. Bush administration, John Ashcroft (R), wrote a letter to Asa Hutchinson, chief of the Drug Enforcement Administration. He declared that assisting a terminally ill patient to commit suicide is not a "legitimate medical purpose" for federally controlled drugs. He said that any physicians who use drugs to help patients die face suspension or revocation of their licenses to prescribe controlled medication. A later court injunction blocked Ashcroft's initiative. More details.

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  • star 2002-APR-01: The Netherlands: The Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect. It allows a physician to assist a patient in committing suicide if:
    • the patient's suffering is unbearable with no prospect of improvement;
    • the patient's request for euthanasia is voluntary and persists over time;
    • the patient is not under the influence of others, psychological illness or drugs;
    • the patient is fully aware of his/her condition, prospects, and options;
    • there must be consultation with at least one other independent doctor who needs to confirm the above conditions;
    • the death must be carried out in a medically appropriate fashion by the doctor or patient, and the doctor must be present;
    • the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents. 12

  • 2002-MAY: HawaiI: Physician assisted suicide bill is rejected: The "Death with Dignity Act," HB 2487, was passed by a House committee in late 2002-FEB. It would have allowed:

    "... a terminally ill, competent adult to obtain a prescription for medication to end his or her life in a humane and dignified manner through a self-administered oral lethal dose. [The bill ...] Prohibits mercy killings, lethal injections, and active euthanasia."

Senator David Matsuura (D, South Hilo), the chairperson of the Senate Health Committee, personally disagreed with the bill, and refused to allow it to be voted upon by his committee. In a surprise move, the Senate overruled Senator Matsuura by voting to pull the bill out of the Health Committee. HB 2487 was debated on 2002-MAY-02, and was defeated the next day by a single vote! More details.

  • 2002-JUN-30: USA: Pro-life group expands mandate: The National Right to Life Committee (NRLC) was organized in 1972 to restrict or eliminate women's access to abortion.  They decided at their Pittsburgh PA convention to expand their mandate to include bans on human embryo stem-cell research, human cloning, and physician-assisted suicide. 1

  • star 2002-SEP-22: Belgium: A federal law legalizing PAS, titled: "Termination of Life on Request and Assisted Suicide Act" became effective.

  • 2004-MAY: Oregon: Federal Attorney General Ashcroft loses court case: U.S. Attorney General John Ashcroft (R) challenged Oregon's assisted suicide law in the Ninth Circuit Court of Appeals. He argued that physicians who prescribed lethal medications were in contravention of the federal Controlled Substances Act. By a vote of 2 to 1, a three judge panel disagreed, ruling that the regulation of medical practice is a state matter and is outside the jurisdiction of the federal government. On 2004-JUL-20, Attorney General John Ashcroft asked that the May decision of its three-judge panel be reviewed by at least 11 judges. His request was denied in August after most of the 25 judges on the court voted against a review.

  • 2004-AUG: Oregon: Results of pain study: Researchers at the Oregon Health & Science University (OHSU) conducted a survey of the level of pain among 1,724 patients in Oregon, as subjectively perceived by family members of the patient, not the patients themselves. Curiously hey found that since assisted suicide became available, pain has apparently increased. Conservative Christian and secular media disagree about the cause. More details.

  • 2004-NOV-09: Oregon: Federal Attorney General again requested appeal of Oregon's assisted suicide law: John Ashcroft (R) asked the U.S. Supreme Court to review the decision by the 9th U.S. Circuit Court of Appeals. The High Court ruled that the federal government cannot regulate medical practice by preventing physicians from prescribing lethal medication to persons who want to commit suicide under Oregon's assisted suicide law.

  • 2005-MAR-30: Vermont: Physician assisted suicide bill proposed: A bill had been introduced into the Vermont legislature during 2004 to legalize physician assisted suicide. It was patterned after the Oregon law which had been in place for over six years. The bill was not acted upon. It was reintroduced in 2005-FEB and had a possibility of being examined by legislative committees during 2005-APR. A Xogby poll conducted in 2004-DEC showed that 78% of 500 randomly selected Vermont adults said that they would support a bill to allow terminally ill patients to get medication from their physicians to hasten death. The bill was opposed by an group of physicians and religious organizations called the Vermont Alliance for Ethical Healthcare. They put forward the slippery slope argument: they are concerned that the bill could lead to abuses, and eventually to mandatory euthanasia. The Alliance's president, Dr. Robert Orr, said: "The biggest concern is the expansion of the criteria and the abuses that have been increasingly evident" ... in the Netherlands, where euthanasia is legal. The bill was promoted by Death With Dignity Vermont. One of its founders is Dick Walters, 79, a retired merchandise manager for retail department store chains, who was troubled during the death of his father. He said: "He asked me to help him, and there was nothing I could do. It frustrated me." He was joined by Dr. Richard Austin, 82 who said: "I've seen some of my friends here die rotten deaths." He didn't want to die a similar death. They were joined by another doctor, Carmer Van Buren, 77 who was initially troubled by the concept of helping a patient die. But he concluded that hastening death for the terminally ill "is not suicide."

    Nancy Dubler, a professor of bioethics at the Montefiore Medical Center in New York said that without a law: "people of a certain education and class and profession will have access to it when others will not. [Oregon] ... has demonstrated that it's socially and morally responsible, socially and morally possible to have a physician-assisted suicide program." However, she has reservations. She added: "I fear if you take a program like Oregon's to a place like California or New York you may get less admirable results." 2

  • 2005-MAR-31: Florida: Terri Schiavo died: During 1990, when she was 26 years-of-age, the supply of oxygen to her brain was interrupted temporarily. She was left in a vegetative state. Her husband advocated removal of her feeding tube in 1998. After years of battling in the Florida Legislature and Courts, the tube was removed. She died 13 days later. An autopsy later revealed that, contrary to her parents' beliefs, she "was in a persistent vegetative state. ... she had massive and irreversible brain damage and was blind." 7

  • 2005-OCT-05: Oregon: U.S. Supreme Court hears arguments on Oregon's law: Oral arguments were heard by the U.S. Supreme Court in its first assisted suicide case since 1997 -- Gonzales v. Oregon. In 2001, U.S. Attorney General John Ashcroft issued a directive stating that: "Assisting suicide is not a 'legitimate medical purpose'....and that prescribing, dispensing, or administering federally controlled substances to assist suicide violates the federal Controlled Substances Act." To date, various courts have repeatedly ruled that the federal act does not restrict the behavior of physicians. 3

    The Family Research Council, an evangelical Christian advocacy group, filed an Amicus Curia brief in favor of preventing Oregon doctors from engaging in physician assisted suicide. 4

  • 2006-JAN-17: U.S.: Supreme Court upholds Oregon's law: In the case Gonzales v. Oregon, the U.S. Supreme Court ruled by a 6 to 3 vote that in 2001 John Ashcroft had incorrectly interpreted the Controlled Substances Act of 1970 -- a law originally intended to fight illegal drugs. Justice Anthony Kennedy issued the ruling for the majority. He wrote, in part:

    "It is difficult to defend the attorney general's declaration that the statue impliedly criminalizes physicians-assisted suicide."

    As expected, the conservative strict constructionist judges on the Court -- Justice Antonin Scalia, Justice Clarence Thomas, and Chief Justice John Roberts -- all dissented.

Reuters News Agency stated:

"White House spokesman Scott McClellan said the Justice Department was reviewing the ruling. Both sides predicted the decision likely will lead to more states adopting assisted suicide laws." 5

  • 2008: Oregon: The Oregon Department of Human Services collected data associated with the state's PAS law between 1998 and 2007. The New England Journal of Medicine reported that in Oregon:

    "... physicians wrote a total of 541 prescriptions for lethal doses of medication (almost always secobarbital or pentobarbital), and 341 people died as a result of taking the medications. Thirteen patients who had received prescriptions were alive at the end of 2007, and the rest of those who received prescriptions ultimately died of their underlying disease. The group of patients who died after ingesting a lethal dose of medication had a median age of 69 years, almost all were white and relatively well-educated, and the group consisted of slightly more men than women. About 86% were enrolled in hospice programs, and 81.5% had terminal cancers." 9

  • star 2008-FEB-19: Luxembourg: The Parliament of Luxembourg passed a law that covered living wills and which legalized physician-assisted suicide and euthanasia.

At the time, PAS was available in four locations around the world:

    • Belgium, the Netherlands, and Switzerland in Europe, and
    • The state of Oregon in the U.S. 9

The law in Luxembourg became effective on 2009-MAR-16, making it the fifth location with legal PAS.

The practice is technically illegal elsewhere in the world, but is frequently performed as an underground practice in secret, both by medical professionals, and relatives of the person seeking an end to her or his life.

  • star 2008-NOV: Washington State: Voters passed a plebiscite that legalized PAS. The vote was 58% to 42%. The Washington Death with Dignity Act was patterned after Oregon's 1997 law. The law in Washington became effective in 2009-MAR-04. PAS is illegal elsewhere in North America (i.e. the remaining 48 states in the U.S., the District of Columbia, Canada, and Mexico).

  • star 2009-DEC: Montana: The state Supreme Court decision in Baxter v. Montana ruled in a 5 to 2 vote that existing state laws allow for terminally ill residents to request lethal medication from a physician. Later attempts by pro-life groups in the state Legislature to overturn the decision failed.

  • star 2013: Vermont: VT Statutes 5281 to 5293 in Chapter 113 "Patient Choice at End of Life" contain the PAS law in Vermont for state residents 18 years of age or older. It was passed by the state Legislature and became effective on 2013-MAY-20. Minor amendments were made during 2015-MAY.

  • star 2016-JUN: California: Efforts to pass a PAS law failed in 1992, 1999, 2005, and 2006. However, the California End of Life Option Act was passed by the state legislature during 2015-SEP, signed into law the next month by Governor Jerry Brown, and came into effect during 2016-JUN.

  • star 2016-OCT: The Netherlands: The federal government announced that it plans to draft a law that would allow assisted suicide for older individuals who:

    "... have a well-considered opinion that their life is complete."

They would be allowed:

"... under strict and careful criteria, ... to finish that life in a manner dignified for them."

During the previous year, PAS accounted for 5,516 deaths in the Netherlands. This was 3.9% of all deaths in the country.

The health and justice ministers said:

"The cabinet is of the opinion that a request for help (in dying) from people who suffer unbearably and have no hope without an underlying medical reason can be a legitimate request."

  • star 2016-NOV: Colorado: A PAS bill was introduced in 2015 but failed in committee. During 2016-APR, Julie Selsberg and Jaren Ducker filed an initiative with the Secretary of State to hold a referendum to legalize PAS. On election day, 2016-NOV-08, the voters passed Proposition 106 to legalize the practice among patients with a terminal illness.

  • star 2017-FEB: District of Columbia: The Death with Dignity Act was introduced by Council member Mary M. Cheh. It was passed by the D.C. Council and signed by Mayore Bowser. After a review by the U.S. Congress, where it was unsuccessfully opposed by Republicans, it went into effect on 2017-FEB-18.

  • star 2018-APR-05: Hawaii: Governor Yutaka Ige (D) signed a MAID law. It was patterened after laws in Oregon and Washington state. He said:

    "It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace."

    The law takes effect on 2019-JAN-01.

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Information sources on Physician Assisted Suicide:

The U.S. public, faith groups, and advocacy groups are severely divided on matters related to physician assisted suicide. Some of the web sites dealing with this topic are:

We recommend that you access multiple sites, in order to to understand all sides to the issue.

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References used:

  1. Jim Rudd, "National Right to Life's Deception," at: http://covenantnews.com/rudd020701.htm
  2. Joh Schwartz & James Estrin, "In Vermont, a Bid to Legalize Physician-Assisted Suicide," Gadsden Times, (Alabama), 2005-MAR-30, at: http://www.gadsdentimes.com/
  3. "U.S. Supreme Court begins hearings in assisted suicide case tomorrow," Life Site News mailing, 2005-OCT-04. See http://www.LifeSiteNews.com
  4. "Amicus Brief Filed in Oregon Assisted Suicide Case: Gonzales v. Oregon," Family Research Council, at: http://www.frc.org/
  5. James Vicini, "Court rules govt. can't stop Oregon suicide law," Reuters News Agency, 2005-JAN-17, at: http://today.reuters.com/
  6. "A Careful Reading of State Reports Indicates Oregon and Washington Laws are Safe and Rarely Used," Death with Dignity National Center, 2010-Spring, at: http://www.deathwithdignity.org/
  7. "Schiavo autopsy shows irreverible brain damage," NBC News, 2005-JUN-15, at: http://www.nbcnews.com/
  8. "Countries with End-of-life help laws and/or regulations," Dignitas, 2016-FEB-22, at: http://www.dignitas.ch/
  9. Robert Steinbrook, "Physician-Assisted Death From Oregon to Washington State," The New England Journal of Medicine, 2008-DEC-11, at: http://www.nejm.org/
  10. "Chapter 113: Patient Choice At End Of Life," Vermont General Assembly, 2013 & 2015, at: http://legislature.vermont.gov/
  11. "Assisted Suicide," Wikipedia, as on 2018-OCT-03, at: https://en.wikipedia.org/
  12. "Euthanasia in the Netherlands, Wikipedia, as on 2015-SEP-15, at: https://en.wikipedia.org/
  13. "Netherlands may extend assisted dying to those who feel 'life is complete'," The Guardian, 2016-OCT-12, at: https://www.theguardian.com/

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Copyright 2000 to 2018 by Ontario Consultants on Religious Tolerance
Last updated 2018-OCT-04

Author: Bruce A Robinson
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