Physician Assisted Suicide (PAS)
Court activity; legislative
attempts; physician survey
U.S. Supreme Court decision - 1997:
The Supreme Court rendered its decision on the
New York and Washington
cases, on 1997-JUN-26. They found that the average American has no constitutional right
to a physician assisted suicide. The vote was 9 to 0, an unusual, unanimous decision.
Thus, the New York and Washington laws which ban such suicides are constitutional.
On the other hand, the court implied that there is no constitutional bar that would
prevent a state from passing a law permitting physician assisted suicide. Oregon
has done exactly this. So, the battle must be fought on a state by state basis. Chief
Justice Rehnquist wrote:
"Throughout the nation, Americans are engaged in an earnest and profound debate
about the morality, legality and practicality of physician-assisted suicide. Our holding
permits this debate to continue, as it should in an democratic society"
This is a disadvantage to the "pro-life" camp who are working to make certain
that freedom to choose assisted suicide remains unavailable to all Americans. The ruling
means that they will have to prevent all 50 states from passing permissive laws. If
even one state passes such a law, then at least wealthy patients will be able to relocate
to that state, satisfy the resident requirements, and obtain help in dying.
The Supreme Court decision was very narrow in scope. It only ruled on whether the
public had a general right to assisted suicide. The case was originally brought by six
terminally ill individuals in intractable pain who wanted access to assisted suicide. But
by the time that the court heard legal arguments, all six had died. Thus, the court was
unable to rule on whether terminally ill individuals should have a right to assisted
suicide. Instead, they made a decision on whether citizens generally had that right.
Many of the justices indicated that certain groups within society might have a
constitutional right to access to suicide (e.g., individuals who are terminally ill and in
intractable pain). If a case were brought by such a person, then the court might find in
their favor. The trick will be to find a person who can survive a terminal illness long
enough for their case to wander through the judicial system and reach the Supreme Court.
If even one of the original six patients had been able to survive, the court's decision
might have been very different. They might have ruled that people generally had no legal
right to obtain assistance in dying, but that terminally ill patients in pain did have.
Some justices discussed the dual effect theory. This is a situation in which a
physician prescribes an adequate level of morphine or other drugs to control pain, even
while knowing that it will shorten the patient's life. They found that this was acceptable
behavior. Some of the justices expressed concern about any laws which permitted assisted
suicide; they were worried that such laws might be abused, and that they might be the
first of a series of laws which might generate a "slippery slope" towards a
society that has wide-open assisted suicide, without effective controls.
Pain Relief Promotion Act:
The main purpose of this bill is to block access to physician assisted
suicide in the state of Oregon. Although the title of the bill implies that it
is intended to promote pain relief," it would probably have the opposite effect.
Many doctors would likely be concerned about a DEA agent reviewing
prescriptions. They would feel pressured to under-prescribe pain medication,
leaving their patients in agony, to avoid prosecutions.
||1996-JUL: Bill passes House subcommittee: A bill was passed by the
Constitution Subcommittee of the
Judiciary Committee of the House of Representatives. Called the "Pain
Relief Promotion Act," the bill is actually aimed to prevent
individuals from obtaining help in suicide from their doctors. If it becomes
law, it would prevent the use of federally regulated drugs in
physician-assisted suicide. It would prevent the U.S. Attorney General from
making exceptions -- for example in the case of Oregon which has a state law permitting
such suicides. The bill also supports the "use of federally
controlled substances for the alleviation of pain, even if the risk of death
increases in the process." It would establish a research program
into the management of pain at the Department of Health and Human
Ben Mitchell, professor of bioethics and contemporary culture at Trinity
Evangelical Divinity School in Deerfield, IL commented that physician
assisted suicide "is a barbaric answer to pain...When you think
about it, it just makes sense. There's not a single drug approved by the
Food and Drug Administration for use in killing a human being. Drugs are
designed to treat illness, not kill patients. The bill introduces a little
bit of sanity into the culture of death. This will not stop the euthanasia
and assisted-suicide movement in this country, but it will slow it down a
bit." Pro-choice individuals and groups who support an person's right to
choose assisted suicide believe that forcing a person to remain alive when
their continued life has become unbearable, is itself barbaric.
The bill is clearly unconstitutional. The U.S. Supreme Court decision of
1997 implied that states can pass laws which permit physician assisted
suicide, and that individuals have a right to take advantage of these laws
if they wish. The Federal Government can hardly pass a law to prevent such access.
||1999-OCT: Bill passes the House: The Pain Relief Promotion Act was passed
by the House, by a vote of 271 to 156. Lori Hougens, spokesperson for
National Right to Life was pleased. She said: "Congress has
just sent a very strong bipartisan message that the appropriate role
of a doctor is to be helping his patient, not to be pushing them off a
bridge...Doctors should not be killing their patients, they should be
helping them." 1
If passed, the law would place physicians in a dreadful situation. The
law stipulates that a doctor can prescribe a narcotic for the relief
of pain, even if it has the undesirable side effect of shortening a
patient's life. But if they misjudge the dose, give the patient too
much medication, and cause that patient's quick death then the
physician may be charged under the act, and end up with a 20 year jail
sentence. Each physician who prescribes a narcotic for pain relief
will worry about a DEA investigator looking over their shoulder,
evaluating the dose and trying to guess the doctor's intent. The trick
would be to prescribe insufficient medication to accelerate the
patient's death too much, and catch the attention of the federal
officials. Physicians are liable to err on the side of their own
safety and prescribe inadequate medication to control the pain. A lot
of patients will be in severe, continuous agony if this bill becomes
On the other hand, the law does recognize that doctors would be able
to prescribe narcotics even if they have the side effect of shortening
a patient's life somewhat. Such dosages are common place throughout
North America. However, they are on legally shaky ground in many
jurisdictions. Passage of the law would legalize this very common
method of pain control. Some physicians currently leave their patients
in agony out of fear of being charged with murder because they
shortened the patient's life by even a small amount. Doctor's will now
be able to prescribe some level of medication, and reduce their
patient's agony, without endangering themselves.
||2000-DEC-15: Bill dies for the year: The US Senate adjourned
for the year without voting on the Act. The bill was dead, but could
revived in 2001. 2
||2001-NOV: "Conquering Pain Act of 2001" introduced: Senator
Ron Wyden (D-OR) introduced a bill, S1024, which has been referred to a
Senate committee. An identical bill, HR2156, was introduced by Rep.
Darlene Hooley (D-OR); it was referred to a House subcommittee. Unlike
the earlier Pain Relief Promotion Act, this bill seems to be a
genuine effort to improve pain management. Introduced by two members of
Congress from Oregon, it did not attack the Oregon physician assisted
suicide law. It was referred to the Committee on Health, Education,
Labor, and Pensions where it died.
Dr. Diane Meier of Mount Sinai School of Medicine in New York, NY led a survey
of 1,902 doctors during the year 2000 on the topic of physician assisted suicide.2,3
They polled doctors who specialized in aging, infectious diseases, cancer and diseases
which affected kidneys, nerves and lungs. These were the areas of medicine where they felt
that requests for assisted suicide might commonly surface. They found that:
||6.4% of those who responded admitted that they had helped at least one patient commit suicide.|
||They speculate that actual number is probably much larger, as many doctors would be
unwilling to disclose criminal acts that they have performed.|
||"...requests for assisted suicide or euthanasia are frequently made to
physicians who practice in specialties in which they are likely to care for dying
patients, and that the decision to honor such a request is not rare in the United States."|
||Among the group that had helped at least one patient to die, 53% said that the
assisted-death of their most recent patient was caused by a lethal injection. The rest
wrote a prescription for pills that would cause death.|
||29% of the doctors agreed to help in a suicide because their patient was in severe pain.
78% did it because their patient was in severe discomfort other than pain.|
||Their patients gave many reasons for wanting to die:
||79% cited discomfort other than pain
||53% cited loss of dignity
||52% cited fear of uncontrollable symptoms.
It would appear that laws which restrict physician assisted suicide to cases involving
terminal illness with intractable pain will only handle the wishes of a minority of those
persons who seek assisted death.
Jeff Johnson, "Pain relief promotion act passes house,"
Family news in focus, at: http://www.family.org/cforum/fnif/news/a0008306.html
John Giglio, "Misnamed 'Pain Relief Promotion Act' Fails as Congress
Adjourns," 2000-DEC-16, American Pain Foundation, at:
"Doctor-assisted Suicide Not Rare in U.S., Study Finds," Reuters News
Article, New England Journal of Medicine, 1998-APR-23.
"S.1024; Title: A bill to amend the Public Health Service
Act to provide for a public response to the public health crisis of pain, and
for other purposes," Thomas, Library of Congress, at:
Copyright © 1997 to 2009 by Ontario Consultants on Religious Tolerance
Last updated 2009-MAR-06
Author: Bruce A Robinson