Euthanasia in the United States

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Involuntary Euthanasia is currently illegal in all 50 states of the United States. [1] Assisted suicide is legal in 10 jurisdictions in the US: Washington, D.C. [2] and the states of California, Colorado, Oregon, Vermont, New Mexico, Maine, [3] New Jersey, [4] Hawaii, and Washington. [5] The status of assisted suicide is disputed in Montana, though currently authorized per the Montana Supreme Court's ruling in Baxter v. Montana that "nothing in Montana Supreme Court precedent or Montana statutes [indicates] that physician aid in dying is against public policy." [6]

Contents

Early history

Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pain of death. In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient's life. Over the next 35 years, debates about euthanasia raged in the United States which resulted in an Ohio bill to legalize euthanasia in 1906, a bill that was ultimately defeated. [7]

Euthanasia advocacy in the U.S. peaked again during the 1930s and diminished significantly during and after World War II. Euthanasia efforts were revived during the 1960s and 1970s, under the right-to-die rubric, physician assisted death in liberal bioethics, and through advance directives and do not resuscitate orders.

Several major court cases advanced the legal rights of patients, or their guardians, to withdraw medical support with the expected outcome of death. These include the Karen Ann Quinlan case (1976), Brophy and Nancy Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg (1997) and the Terri Schiavo case. The numerous legislative rulings and legal precedents that were brought about in the wake of the Quinlan case had their ethical foundation in the famous 1983 report completed by the President's Commission for the Study of Ethical Problems in Medicine, under the title "Deciding to Forgo Life-Sustaining Treatment." [8] The Commission sustained in its findings that it was morally acceptable to give up a life-supporting therapy and that withholding or withdrawing such a therapy is the same thing from an ethical stand-point, while artificial feeding and other life-supporting therapy are of the same importance for the patients and doctors. Before this report, to withdraw a medical therapy was regarded as much more serious decision than not to start a therapy at all, while artificial feeding was viewed as a special treatment. By 1990, barely a decade and a half after the New Jersey Supreme Court’s historic decision, patients were well aware that they could decline any form of medical therapy if they simply choose to do that either directly or by expressing their wish via appointed representative.

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 suicide in both Iowa and Ohio in 1906. The driving force behind this movement was social activist Anna S. Hall. [9] Canadian historian Ian Dowbiggin's 2003 book, A Merciful End, revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

Legislation and political movements

California

In the 1983 case of Barber v. Superior Court, two physicians had honored a family's request to withdraw both respirator and intravenous feeding and hydration tubes from a comatose patient. The physicians were charged with murder, despite the fact that they were doing what the family wanted. The court held that all charges should be dropped because the treatments had all been ineffective and burdensome. Withdrawal of treatment, even if life-ending, is morally and legally permitted and is considered passive euthanasia. Competent patients or their surrogates can decide to withdraw treatments, usually after the treatments are found ineffective, painful, or burdensome. [10]

The California End of Life Option Act from 2016 provides a procedure for assisted suicide of a terminally ill adult. After meeting several requirements, a physician may prescribe the terminally ill adult an "aid-in-dying drug". [11]

Maine

From 1 January 2020, Maine becomes the 8th US state to legalize assisted dying. In June 2019, the Maine Legislature by a very close vote passed a bill to legalize assisted dying. The Governor of Maine signed the bill into law within the same month. [12]

New Jersey

In the United States legal and ethical debates about euthanasia became more prominent in the Karen Ann Quinlan case who went into a coma after allegedly mixing tranquilizers with alcohol, surviving biologically for 9 years in a "persistent vegetative state" even after the New Jersey Supreme Court approval to remove her from a respirator. This case caused a widespread public concern about "lives not worth living", and the possibility of at least voluntary euthanasia if it could be ascertained that the patient would not have wanted to live in this condition. [13] In April 2019, New Jersey became the 7th US state to allow assisted dying after the Governor of New Jersey signed the bill into law and went into effect since August 1, 2019. [4]

Texas

In 1999, the state of Texas passed the Advance Directives Act. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support measures, such as mechanical respiration, from terminally ill patients when such treatment is considered to be both futile and inappropriate. This is sometimes referred to as "passive euthanasia".

In 2005, a six-month-old infant, Sun Hudson, with a uniformly fatal disease thanatophoric dysplasia, was the first patient in which "a United States court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child's parent". [14]

Massachusetts

Currently, euthanasia is illegal in Massachusetts. According to Ch. 201D §12 Massachusetts states that "Nothing in this chapter shall be construed to constitute, condone, authorize, or approve suicide or mercy killing or to permit any affirmative or deliberate act to end one's own life other than to permit the natural process of dying". [15] Even though euthanasia as well as physician assisted suicide is not legal in Massachusetts, the Supreme Court ruled in 1997 to not allow euthanasia or physician assisted suicide, but to give the freedom to the patient to refuse life supporting medical care by making these two laws different from one another. So now although there is no euthanasia in Massachusetts, one is allowed to refuse artificial life support measures. [15]

Oregon

Oregon voters passed the Death with Dignity Act in 1997.

Unsuccessful initiatives

Attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and legislation bills within the United States in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, and Michigan included Proposal B in their ballot in 1998.

U.S. public opinion

In the U.S., there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States.

Opinions of the general public

Since 1947, Gallup polling has regularly asked thousands of American citizens: “When a person has a disease that cannot be cured, do you think doctors should be allowed to end the patient’s life by some painless means if the patient and his family request it?” [16] to gauge public opinion on euthanasia. The question leaves unclear the diagnosis, age, or background of the patient and the legality of the situation. However, the question does clarify that the euthanasia is, in this case, voluntary. Support for euthanasia has increased from 37% in 1947 to a peak of 75% in 2005; however, support fell back to 64% in 2012. Gallup also uses a different phrasing to capture opinions of physician-assisted suicide instead of euthanasia by using terms like "severe pain, suicide, legalization." However, in these scenarios, support falls by roughly 10-15% showing that support for euthanasia is higher than support for physician-assisted suicide among the general population. This is an interesting discrepancy as there are no states in which voluntary euthanasia is legal, but at least 5 in which physician-assisted suicide is legal.

Physicians' opinions

A recent review studied surveys, interviews, and death certificates from 1947-2016 to gain insight into physician opinions on both physician-assisted suicide and euthanasia. [17] In the U.S., less than 20% of physicians reported any patients asking for assistance with euthanasia or physician-assisted suicide; 5% or fewer reported agreeing to assist patients with euthanasia or physician-assisted suicide requests. In Oregon and Washington state, where physician-assisted suicide is legal, less than 1% of physicians prescribe medications for physician-assisted death each year. In other countries, these percentages were much higher - for example, 60% of Dutch physicians have prescribed medication for physician-assisted suicide; in the Netherlands and Belgium, over half of doctors reported patient requests for aid in dying. The study found a large percentage of these requests to be associated with cancer and to be for patients who were "older, white, and well-educated". [17]

Opinions among physicians are harder to elucidate and have much smaller sample sizes than for the general public, and therefore may not be as accurate. [17] Physicians surveyed were less likely to support either physician-assisted suicide or euthanasia than the public. Unlike the public opinion, physicians were more comfortable with physician-assisted suicide than euthanasia. In other countries where both are legal, namely Belgium and the Netherlands, physicians are much more supportive with a roughly 85% support rate. [17]

Opinions by religious affiliation

In various studies from the 1990s, previously surveyed religious groups reported that religiosity (i.e., self-evaluation and frequency of worship service attendance) correlated to opinions on euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed to euthanasia than to those who had a lower level of religiosity. [18] However, this study represents decades old data that is not confirmed by newer sources.

In more recent studies, a gap is exposed in the meaning of the word "religion" and how it relates to individual views on euthanasia. [19] Evidently, there are vast differences between religious observers between and within religious sects. The deep differences among different religions, especially those religions not prevalent in the Western world, have been ill-accounted for in the vast majority of studies attempting to link euthanasia and religious views. [19] Future research needs to better elucidate which religious views they correlate to views on euthanasia, with less emphasis on which religion/sect a person "belongs" to, as this may lead to clearer correlation between which beliefs are more or less likely to influence opinions on euthanasia.

Ethical arguments

Arguments for euthanasia

Arguments for euthanasia are varied and include a diverse array of opinions. Commonly cited reasons for euthanasia include:

Arguments against euthanasia

There are varied arguments for not using euthanasia in a public health care setting as well. Commonly cited reasons for not advocating for euthanasia include:

See also

Related Research Articles

Euthanasia is the practice of intentionally ending life to eliminate pain and suffering.

<span class="mw-page-title-main">Assisted suicide</span> Suicide undertaken with aid from another person

Assisted suicide – sometimes referred to as medical aid in dying – means a procedure in which people take medications to end their own lives with the help of others, usually medical professionals. The term usually refers to physician-assisted suicide (PAS), which is an end of life measure for a person suffering a painful, terminal illness. Once it is determined that the person's situation qualifies under the physician-assisted suicide laws for that location, the physician's assistance is usually limited to writing a prescription for a lethal dose of drugs.

<span class="mw-page-title-main">Life support</span> In medicine

Life support comprises the treatments and techniques performed in an emergency in order to support life after the failure of one or more vital organs. Healthcare providers and emergency medical technicians are generally certified to perform basic and advanced life support procedures; however, basic life support is sometimes provided at the scene of an emergency by family members or bystanders before emergency services arrive. In the case of cardiac injuries, cardiopulmonary resuscitation is initiated by bystanders or family members 25% of the time. Basic life support techniques, such as performing CPR on a victim of cardiac arrest, can double or even triple that patient's chance of survival. Other types of basic life support include relief from choking, staunching of bleeding by direct compression and elevation above the heart, first aid, and the use of an automated external defibrillator.

The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of the right to die is often bestowed with the understanding that a person with a terminal illness, incurable pain, or without the will to continue living should be allowed to end their own life, use assisted suicide, or decline life-prolonging treatment. The question of who, if anyone, may be empowered to make this decision is often the subject of debate.

Measure 16 of 1994 established the U.S. state of Oregon's Death with Dignity Act, which legalizes medical aid in dying with certain restrictions. Passage of this initiative made Oregon the first U.S. state and one of the first jurisdictions in the world to permit some terminally ill patients to determine the time of their own death.

Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia or advanced heart disease than for injury. In popular use, it indicates a disease that will progress until death with near absolute certainty, regardless of treatment. A patient who has such an illness may be referred to as a terminal patient, terminally ill or simply as being terminal. There is no standardized life expectancy for a patient to be considered terminal, although it is generally months or less. Life expectancy for terminal patients is a rough estimate given by the physician based on previous data and does not always reflect true longevity. An illness which is lifelong but not fatal is a chronic condition.

Voluntary euthanasia is the ending of a person's life at their request in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in recent years.

Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide Act" which was passed in 2001 and took effect in 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering, the information provided to the patient, the absence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee.

Vacco v. Quill, 521 U.S. 793 (1997), was a landmark decision of the Supreme Court of the United States regarding the right to die. It ruled 9–0 that a New York ban on physician-assisted suicide was constitutional, and preventing doctors from assisting their patients, even those terminally ill and/or in great pain, was a legitimate state interest that was well within the authority of the state to regulate. In brief, this decision established that, as a matter of law, there was no constitutional guarantee of a "right to die."

<span class="mw-page-title-main">Dignity in Dying</span> UK pro-euthanasia organisation

Dignity in Dying is a United Kingdom nationwide campaigning organisation. It is funded by voluntary contributions from members of the public, and as of December 2010, it claimed to have 25,000 actively subscribing supporters. The organisation declares it is independent of any political, religious or other affiliations, and has the stated primary aim of campaigning for individuals to have greater choice and more control over end-of-life decisions, so as to alleviate any suffering they may be undergoing as they near the end of their life.

<span class="mw-page-title-main">Legality of euthanasia</span>

The legality of euthanasia varies between countries and territories. Efforts to change government policies on euthanasia of humans in the 20th and 21st centuries have met with limited success in Western countries. Human euthanasia policies have also been developed by a variety of NGOs, most advocacy organisations although medical associations express a range of perspectives, and supporters of palliative care broadly oppose euthanasia.

Child euthanasia is a form of euthanasia that is applied to children who are gravely ill or have significant birth defects. In 2005, the Netherlands became the first country since the end of Nazi Germany to decriminalize euthanasia for infants with hopeless prognosis and intractable pain. Nine years later, Belgium amended its 2002 Euthanasia Act to extend the rights of euthanasia to minors. Like euthanasia, there is world-wide public controversy and ethical debate over the moral, philosophical and religious issues of child euthanasia.

Euthanasia became legal in New Zealand when the End of Life Choice Act 2019 took full effect on 7 November 2021. It is illegal to "aid and abet suicide" under Section 179 of the New Zealand Crimes Act 1961. The clauses of this act make it an offence to "incite, procure or counsel" and "aid and abet" someone else to commit suicide, regardless of whether a suicide attempt is made or not. Section 179 covers both coercion to undertake assisted suicide and true suicide, such as that caused by bullying. This will not change under the End of Life Choices Act 2019, which has provisions on coercion of terminally ill people.

<span class="mw-page-title-main">Assisted suicide in the United States</span> Medically-induced suicide with help from another person

Assisted suicide is suicide with the aid of another person. In the United States, the term "assisted suicide" is typically used to describe what proponents refer to as medical aid in dying, in which terminally ill adults are prescribed and self-administer barbiturates if they feel that they are suffering significantly. The term is often used interchangeably with physician-assisted suicide (PAS), "physician-assisted dying", "physician-assisted death", "assisted death" and "medical aid in dying" (MAiD).

Both Euthanasia and Assisted Suicide are illegal in the United Kingdom and could be prosecuted as murder or manslaughter.

There are many religious views on euthanasia, although many moral theologians are critical of the procedure.

<span class="mw-page-title-main">Euthanasia in Canada</span> Legal history of euthanasia in Canada

Euthanasia in Canada in its legal voluntary form is called Medical Assistance in Dying and it first became legal along with assisted suicide in June 2016 for those whose death was reasonably foreseeable. In March 2021, the law was further amended by Bill C-7 which to include those suffering from a grievous and irremediable condition whose death was not reasonably foreseeable. According to the Fourth Annual Report on MAID, there were 13,241 MAID deaths reported in Canada in 2022.

Terminal dehydration is dehydration to the point of death. Some scholars make a distinction between "terminal dehydration" and "termination by dehydration". Courts in the United States generally do not recognize prisoners as having a right to die by voluntary dehydration, since they view it as suicide.

A surrogate decision maker, also known as a health care proxy or as agents, is an advocate for incompetent patients. If a patient is unable to make decisions for themselves about personal care, a surrogate agent must make decisions for them. If there is a durable power of attorney for health care, the agent appointed by that document is authorized to make health care decisions within the scope of authority granted by the document. If people have court-appointed guardians with authority to make health care decisions, the guardian is the authorized surrogate.

California End of Life Option Act is a law enacted in June 2016 by the California State Legislature which allows terminally ill adult residents in the state of California to access medical aid in dying by self-administering lethal drugs, provided specific circumstances are met. The law was signed in by California governor Jerry Brown in October 2015, making California the fifth state to allow physicians to prescribe drugs to end the life of a terminally ill patient, often referred to as physician-assisted suicide.

References

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  18. 1 2 Gielen, Joris; Van den Branden, Stef; Broeckaert, Bert (2009-11-01). "The operationalisation of religion and world view in surveys of nurses' attitudes toward euthanasia and assisted suicide". Medicine, Health Care and Philosophy. 12 (4): 423–431. doi:10.1007/s11019-009-9217-8. ISSN   1572-8633. PMID   19629746. S2CID   5473633.
  19. "Arguments in favour of and against euthanasia - Euthanasia - GCSE Religious Studies Revision". BBC Bitesize. Retrieved 2021-09-20.

Further reading