1. Introduction 5. End-of-Life Medical Care
2. Definitions and Language 6. Health Care Implications
3. Moral Questions 7. Special Groups (Disabled and Elderly)
4. Law and Public Policy 8. Euthanasia Timeline

1. Introduction
The twin issues of euthanasia and physician-assisted suicide have sparked intense debate over the years, from Jack Kevorkian, to the Terry Schiavo battle, and to the recent Supreme Court ruling on Oregon's Death With Dignity Act.

Proponents of euthanasia and physician-assisted suicide believe that it is the compassionate choice. They feel that terminally ill people should have the right to end their pain and suffering with a quick, dignified death.

Opponents of euthanasia and physician-assisted suicide worry about a "slippery slope" from euthanasia to murder. They value life at all stages and fear that legalizing euthanasia will unfairly target the poor and disabled.

Doctors, lawyers, philosophers, and religious leaders have been debating the euthanasia issue for over two millennia. The topics below are arranged to give readers an overview of the modern debate.

2. Definitions and Language
"Euthanasia is the deliberate killing of a person for the benefit of that person.

In most cases euthanasia is carried out because the person who dies asks for it, but there are cases called euthanasia where a person can't make such a request.

A person who undergoes euthanasia is usually terminally ill, but there are other situations in which some people want euthanasia...

Euthanasia has many definitions. The Pro-Life Alliance defines it as: 'Any action or omission intended to end the life of a patient on the grounds that his or her life is not worth living.' The Voluntary Euthanasia Society looks to the word's Greek origins - 'eu' and 'thanatos', which together mean 'a good death' - and say a modern definition is: 'A good death brought about by a doctor providing drugs or an injection to bring a peaceful end to the dying process.' Three classes of euthanasia can be identified - passive euthanasia, physician-assisted suicide and active euthanasia - although not all groups would acknowledge them as valid terms."

-- BBC
"Euthanasia Special Report," www.bbc.co.uk
July 1, 1999
PRO: "As a matter of common sense, killing yourself is a lot harder than having someone do it for you. Assuming this bit of common sense is correct, there is reason to suppose that people, on average, are less susceptible to being pressured into killing themselves than they are into letting someone kill them...

A second consequence of the common sense point concerns the acts of suicide and submission to euthanasia that would in fact occur as a result of legalization. One natural way to understand the thought that killing yourself is harder than having someone do it for you is that killing yourself requires firmer resolve. The element of passivity involved in your letting another perform the unpleasant task of putting you out of your misery means that your will is not as active as it would be if you performed the task yourself, and thus weakness or irresolution in the will is less likely to cause failure, less likely to cause an interruption in the lethal action.

Conversely, then, a completed act of suicide warrants more confidence in its having issued from a will that was strong or resolute than does a completed act of submission to euthanasia. Accordingly, though any act by which a person deliberately hastens his or her death raises concerns about its voluntariness, there is less reason to worry, other things being equal, about the voluntariness of suicide than about the voluntariness of submitting to euthanasia..."

-- John Deigh, PhD
Professor of Philosophy and Law,
University of Texas at Austin
"Physician-Assisted Suicide and Voluntary Euthanasia: Some Relevant Differences"
Journal of Criminal Law and Criminology
CON: "In the recent bioethics literature some have endorsed physician-assisted suicide but not euthanasia. Are they sufficiently different that the moral arguments for one often do not apply to the other? A paradigm case of physician-assisted suicide is a patient's ending his or her life with a lethal dose of a medication requested of and provided by a physician for that purpose. A paradigm case of voluntary active euthanasia is a physician's administering the lethal dose, often because the patient is unable to do so. The only difference that need exist between the two is the person who actually administers the lethal dose - the physician or the patient. In each, the physician plays an active and necessary causal role.

In physician-assisted suicide the patient acts last ... whereas in euthanasia the physician acts last by performing the physical equivalent of pushing the button. In both cases, however, the choice rests fully with the patient. In both the patient acts last in the sense of retaining the right to change his or her mind until the point at which the lethal process becomes irreversible.

How could there be a substantial moral difference between the two based only on this small difference in the part played by the physician in the causal process resulting in death?"

-- Dan Brock, PhD
Frances Glessner Lee Professor of Medical Ethics and Director of the Division of Medical Ethics, Harvard Medical School
"Voluntary Active Euthanasia"
The Hastings Center Report
3. Moral Questions
PRO: "In debates with those bioethicists and physicians who believe that euthanasia is both deeply compassionate and also a logical way to cut health care costs, I am invariably scorned when I mention 'the slippery slope.' When the states legalize the deliberate ending of certain lives -- I try to tell them -- it will eventually broaden the categories of those who can be put to death with impunity.

I am told that this is nonsense in our age of highly advanced medical ethics. And American advocates of euthanasia often point to the Netherlands as a model -- a place where euthanasia is quasi-legal for patients who request it...

Yet the Sep. 1991 official government Remmelink Report on euthanasia in the Netherlands revealed that at least 1,040 people die every year from involuntary euthanasia. Their physicians were so consumed with compassion that they decided not to disturb the patients by asking their opinion on the matter."

-- Nat Hentoff
Columnist, The Village Voice
"The Slippery Slope of Euthanasia"
Washington Post
Oct. 3, 1992
CON: "This [slippery slope] argument is singularly implausible if one who makes it means that there is a logical connection between the killings in question such that one who endorses the first cannot without inconsistency refuse to endorse the last. The fact that in one case a person is killed in his own interest because he requests it, whereas in the other a person is killed in the interest of others without (or contrary to) his consent, is surely a morally relevant difference. Since this is so, the question 'How can we draw the line?' should not perplex one for long. No one thinks that making killing in self-defense an exception to criminal homicide starts one on a slippery slope which logically must end in the abolition of the crime of murder; no one should think the same about legalizing voluntary euthanasia...

In the Netherlands we have a living laboratory in which the euthanasia experiment in being conducted, and it is claimed that active non-voluntary and involuntary euthanasia are openly practiced there, exactly as predicted by the slippery slope argument. But the claim of the open and common practice of involuntary euthanasia has been often repeated but has never been substantiated, and indeed has been repeatedly challenged."

-- Derek Humphry
Founder and Former Executive Director, Hemlock Society
"The Case for Assisted Suicide and Active Voluntary Euthanasia"
Dec. 13, 2006
PRO: "The primary opposition to the idea that terminally ill, mentally competent people should be able to choose to hasten death with medical assistance often comes from religious sources, primarily the Catholic hierarchy and, more recently, the right-to-life movement."

-- Compassion and Choices
"Frequently Asked Questions," www.compassionandchoices.org
May 11, 2007
CON: "Many proponents of legalization maintain that opposition to legalization is fundamentally religious in nature and that secular objections are only a cloak for underlying moral convictions concerning the sanctity of life...

It is worth noting that such nonreligious organizations as the American Medical Association, the American Geriatrics Society, the American Hospital Association, and the National Hospice and Palliative Care Organization are strongly opposed to legalization for reasons that are obviously medical and social."

-- Kathleen Foley, MD and
Herbert Hendin, MD
The Case Against Assisted Suicide: For the Right to End-of-Life Care
4. Law and Public Policy
PRO: "While some people refer to the liberty interest implicated in right-to-die cases as a liberty interest in committing suicide, we do not describe it that way. We use the broader and more accurate terms, 'the right to die,' 'determining the time and manner of one's death,' and 'hastening one's death' for an important reason. The liberty interest we examine encompasses a whole range of acts that are generally not considered to constitute 'suicide.' Included within the liberty interest we examine, is for example, the act of refusing or terminating unwanted medical treatment...

Casey and Cruzan provide persuasive evidence that the Constitution encompasses a due process liberty interest in controlling the time and manner of one's death -- that there is, in short, a constitutionally recognized 'right to die.'"

-- Compassion in Dying v. Washington (280 KB)
United States 9th Circuit Court of Appeals
Mar. 6, 1996
CON: "This Court has...recognized, at least implicitly, the distinction between letting a patient die and making that patient die.

In Cruzan v. Director, Mo. Dept. of Health (1990), we concluded that '[t]he principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions,' and we assumed the existence of such a right for purposes of that case. But our assumption of a right to refuse treatment was grounded not, as the Court of Appeals supposed, on the proposition that patients have a general and abstract 'right to hasten death,' but on well established, traditional rights to bodily integrity and freedom from unwanted touching. In fact, we observed that 'the majority of States in this country have laws imposing criminal penalties on one who assists another to commit suicide."

-- Vacco v. Quill (40 KB)
United States Supreme Court






PRO: "Cases like Schiavo's touch on basic constitutional rights, such as the right to live and the right to due process, and consequently there could very well be a legitimate role for the federal government to play. There's a precedent -- as a result of the highly publicized deaths of infants with disabilities in the 1980s, the federal government enacted 'Baby Doe Legislation,' which would withhold federal funds from hospitals that withhold lifesaving treatment from newborns based on the expectation of disability. The medical community has to have restrictions on what it may do to people with disabilities -- we've already seen what some members of that community are willing to do when no restrictions are in place."

-- Not Dead Yet
Research Analyst Stephen Drake
"End of Life Planning:
Q & A with Disabilities Advocate"
Reno Gazette-Journal
Nov. 22, 2003
CON: "We'll all die. But in an age of increased longevity and medical advances, death can be suspended, sometimes indefinitely, and no longer slips in according to its own immutable timetable.

So, for both patients and their loved ones, real decisions are demanded: When do we stop doing all that we can do? When do we withhold which therapies and allow nature to take its course? When are we, through our own indecision and fears of mortality, allowing wondrous medical methods to perversely prolong the dying rather than the living?

These intensely personal and socially expensive decisions should not be left to governments, judges or legislators better attuned to highway funding."

-- Los Angeles Times
Editorial: "Planning for Worse Than Taxes"
Mar. 22, 2005
5. End-of-Life Medical Care
PRO: "Once a patient has the means to take their own life, there can be decreased incentive to care for the patient's symptoms and needs. The case of Michael Freeland is an example. Michael had been given a lethal prescription and when his doctors were planning for his discharge to his home from the hospital, one physician wrote that while he probably needed attendant care at home, providing additional care may be a 'moot point' because he had 'life-ending medication'. His assisted suicide doctor did nothing to care for his pain and palliative care needs. This seriously ill patient was receiving poor advice and medical care because he had lethal drugs."

-- Physicians for Compassionate Care
"Top 10 FAQs," www.pccef.org
Aug. 14, 2006
CON: "Assisting death in no way precludes giving the best palliative care possible but rather integrates compassionate care and respect for the patient's autonomy and ultimately makes death with dignity a real option...

The evidence for the emotional impact of assisted dying on physicians shows that euthanasia and assisted suicide are a far cry from being 'easier options for the caregiver' than palliative care, as some critics of Dutch practice have suggested. We wish to take a strong stand against the separation and opposition between euthanasia and assisted suicide, on the one hand, and palliative care, on the other, that such critics have implied. There is no 'either-or' with respect to these options."

-- Gerrit Kimsma. MD and
Evert van Leeuwen, PhD
"Assisted Death in the Netherlands: Physician at the Bedside
When Help Is Requested"
Physician-Assisted Dying: The Case for Palliative Care & Patient Choice
PRO: "A doctor's commitment to acting for patients' good creates a clear obligation to help a patient avoid an agonizing, protracted death. Allowing a patient to suffer when the suffering could be ended is an obvious violation of the duty of beneficence...

Sometimes, because of special features of the need, or because of the special relationship, or because of the uniqueness of the knowledge involved, a physician may have a professional obligation to assist in a suicide or perform euthanasia."

-- Rosamond Rhodes, PhD
Professor of Medical Education and Director of Bioethics Education,
Mount Sinai School of Medicine
"Physicians, Assisted Suicide,
and the Right to Live or Die"
Physician Assisted Suicide:
Expanding the Debate
CON: "Medicine surely owes patients assistance in their dying process -- to relieve their pain, discomfort, and distress. This is simply part of what it means to seek to relieve suffering, always an essential part of caring for the living, including when they are in the process of their dying. But medicine has never, under anyone's interpretation, been charged with producing or achieving death itself. Physicians cannot be serving their art or helping their patients -- whether regarded as human beings or as persons -- by making them disappear."

-- Leon Kass, MD, PhD
Addie Clark Harding Professor, Committee on Social Thought and the College, University of Chicago
"'I Will Give No Deadly Drug':
Why Doctors Must Not Kill"
The Case Against Assisted Suicide: For the Right to End-of-Life Care
6. Health Care Implications
PRO: "Legalized euthanasia and assisted suicide would have the potential to save financially strapped government programs, such as Oregon's Medicaid plan, millions by eradicating people whose care is expensive. Perhaps that is why, when Measure 16 [the Oregon 'Death With Dignity' Act] passed, the director of Oregon's Medicaid plan announced that assisted suicide would be considered 'comfort care' and thus paid for by the state's Medicaid plan."

-- Wesley Smith, JD
Anti-Euthanasia Activist
Forced Exit
CON: "Even though the various elements that make up the American healthcare system are becoming more circumspect in ensuring that money is not wasted, the cap that marks a zero-sum healthcare system is largely absent in the United States... Considering the way we finance healthcare in the United States, it would be hard to make a case that there is a financial imperative compelling us to adopt physician-assisted suicide in an effort to save money so that others could benefit..."

-- Merrill Matthews, Jr., PhD
Council for Affordable Health Insurance
"Would Physician-Assisted Suicide Save the Healthcare System Money?"
Physician Assisted Suicide:
Expanding the Debate
PRO: "Health Maintenance Organizations (HMOs) may attempt to reduce health care costs by refusing to pay for expensive or 'unnecessary' procedures. What better way to cut costs than on those people who won't be here much longer anyway?

If this sounds farfetched, consider the following: While discussing the recently passed Oregon right-to-die law, a spokesperson for QualMed Oregon Health Plan confirmed that it would cover lethal medications 'as a prescription' while its 'value option' plan limits hospice care to $1,000...

Just think of all the money that could be saved by HMOs if they spared the expense of treating AIDS patients or the disabled, many of whom could easily be classified as terminally ill..."

-- George Runner
California State Senator
"Valley Perspective; Suicide Is Not a Treatment for Anything;
he 'Right to Die' Plus Managed Care is a Dangerous Combination"
Los Angeles Times
Apr. 4, 1999
CON: "One large managed-care plan currently enrolls approximately 1.7 million adults and has an annual budget of almost $4.5 billion. In 1995, approximately 13,000 of the enrolled adults died, including 3,800 who died of cancer. Over the last six months of life, the mean cost for patients enrolled in this managed-care plan who died of breast cancer was $21,329 (in 1995 dollars), with about $9,500 spent in the last month of life. Assuming that 2.7 percent of the patients who died would have chosen physician-assisted suicide (351 patients), forgoing an average of four weeks of life at an average savings of $9,500, the managed-care plan's expenditures would have been reduced by $3.3 million, or less than 0.08 percent of its total budget. For other managed-care plans that tend to have higher proportions of young, healthy patients with lower death rates, the absolute and relative savings are likely to be even smaller...

Physician-assisted suicide is not likely to save substantial amounts of money in absolute or relative terms, either for particular institutions or for the nation as a whole."

-- Ezekiel Emanuel, MD, PhD
and Margaret Battin, MD
"What Are the Potential Cost Savings From Legalizing Physician-Assisted Suicide?"
New England Journal of Medicine
July 16, 1998
7. Special Groups (Disabled and Elderly)
PRO: "Though often described as compassionate, legalized medical killing is really about a deadly double standard for people with severe disabilities, including both conditions that are labeled terminal and those that are not. Disability opposition to this ultimate form of discrimination has been ignored by most media and courts, but countless people with disabilities have already died before their time...

Legalized medical killing is not a new human right, it's a new professional immunity. It would allow health professionals to decide which of us are 'eligible' for this service, and exempt them from accountability for their decisions. Killing is not just another medical treatment option, and it must not be made any part of routine health care. In these days of cost cutting and managed care, we don't trust the health care system, and neither should you."

-- Not Dead Yet
Disability Rights Organization
"About Us"
May 11, 2007
CON: "We do not believe that the right to assisted suicide is premised on a diminished quality of life for people with disabilities. It is based on respect for the autonomy of terminally ill individuals during their final days... It does not deny people with disabilities suicide prevention services, protection against murder, or protection from other abuses. We further contend that, though we must always be vigilant in preventing abuses, the right will not necessarily be expanded to individuals or situations for which it was not intended...

Those who oppose a right to assisted suicide predict that a substantial number of people with disabilities would be killed against their will if assisted suicide were legalized. However, there is no evidence that this has happened to people on life-support systems, who have had the right to die at least since the Cruzan decision in 1990. We believe that abuses of assisted suicide, to the extent they are now occurring behind closed doors, are less likely to continue once assisted suicide is legalized and appropriately regulated."

-- Andrew Batavia, JD
Former Associate Professor, Health Law and Policy, Florida International University
"Disability and Physician-Assisted Dying"
Physician-Assisted Dying: The Case for Palliative Care & Patient Choice
PRO: "In an era when resources are increasingly being squeezed while the population ages and health care needs increase, the elderly and the dying compete against other portions of the population for health care services. Given the high and seemingly disproportionate costs of health care for the elderly and those in the final phase of life, these 'users of excessive medical resources' may be the targets of cost-saving efforts...

The calls for legalizing physician-assisted suicide arise in a social system that is inattentive to the complex physical, emotional, and spiritual needs of people as they near the end of life. Additionally, abuse is a real risk, especially among those who are elderly..."

-- Felicia Cohn, PhD and
Joanne Lynn, MD
"Vulnerable People: Practical Rejoinders to Claims in Favor of Assisted Suicide"
The Case Against Assisted Suicide:
For the Right to End-of-Life Care
CON: "The [Oregon assisted suicide] law has not had the dire social consequences that some opponents predicted. There is no evidence that it has been used to coerce elderly, poor, or depressed patients to end their lives, nor has it caused any significant migration of terminally ill people to Oregon.

As compared with Oregonians who died naturally from similar diseases in 2004, those who died by means of physician-assisted suicide tended to be younger (median age, 64 versus 76 years)."

-- Susan Okie, MD
Contributing Editor,
The New England Journal of Medicine
"Physician-Assisted Suicide -
Oregon and Beyond"
New England Journal of Medicine
Apr. 21, 2005
8. Euthanasia Timeline
1938 - On Jan. 16th, 1938 Charles Francis Potter announces the founding of the National Society for the Legalization of Euthanasia (NSLE), which is soon renamed the Euthanasia Society of America (ESA).

1950 - The World Medical Association votes to recommend to all national medical associations that euthanasia be condemned "under any circumstances." In the same year, the American Medical Association issues a statement that the majority of doctors do not believe in euthanasia.

1967 - The first living will is written by attorney Louis Kutner and his arguments for it appear in the Indiana Law Journal.

1972 - The U.S. Senate Special Commission on Aging (SCA) holds the first national hearings on death with dignity, entitled "Death with Dignity: An Inquiry into Related Public Issues."

1973 - The American Medical Association adopts a "Patient's Bill of Rights" which recognizes the right of patients to refuse treatment.

1976 - The New Jersey Supreme Court rules in the 1976 In re Quinlan case that 21-year-old Karen Quinlan can be detached from her respirator.

1980 - Derek Humphry forms the Hemlock Society, a grassroots euthanasia organization, in Los Angeles.

1990 - Jack Kevorkian, MD, assists Janet Adkins, a Hemlock Society member, in committing suicide in Michigan. Adkins death is the first of many suicides in which Dr. Kevorkian assists.

1994 - The Oregon Death With Dignity Act is passed, becoming the first law in American history permitting physician-assisted suicide.

1997 - The Supreme Court rules in Washington v. Glucksberg and Vacco v. Quill that there is not a constitutional right to die.

2005 - The Terri Schiavo case garners national media attention. After a Florida Circuit Judge ruled that Terri Schiavo' feeding tube be removed and the Florida Supreme Court overturned "Terri's Law," a law intended to reinsert the feeding tube, the United States Supreme Court refuses for the sixth time to intervene in the case. Terri Schiavo dies on Mar. 31, 2005, 13 days after her feeding tube is removed.

2006 - The Supreme Court, in a 6-3 opinion in Gonzales v. Oregon, holds that the Controlled Substances Act does not authorize the Attorney General to ban the use of controlled substances for physician-assisted suicide. Oregon's Death With Dignity Law is upheld.