1

“AID IN DYING” =

PHYSICIAN-ASSISTED SUICIDE

Talking Points For the 2014 Legislative Year

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TALKING POINTS:

PHYSICIAN-ASSISTED SUICIDE

“AID IN DYING” IS ASSISTED SUICIDE, AND IS CURRENTLY A FELONY IN NEW

JERSEY:

Physician-assisted suicide advocates argue that they support “aid in dying” rather than assisted

suicide. However, “aid in dying” – which Kathryn L. Tucker, the Director of Legal Affairs for

Compassion & Choices defines as “the practice of a physician prescribing medication that a

mentally competent, terminally-ill patient can ingest to bring about a peaceful death if the dying

process becomes unbearable”1 – is physician-assisted suicide.

• Physician-assisted suicide is defined as “a physician supplying a patient who wants to

commit suicide with the assistance to commit the act, such as by writing a prescription

for a drug which if taken in large amounts is lethal, and providing the patient with lethal

dosage information.”2

• “Aid in dying” and “death with dignity” are merely euphemisms for physician-assisted

suicide. In fact, these terms are not recognized by the medical community and are used

by assisted-suicide advocates to mask what they advocate.

• In Blick v. Connecticut, a Connecticut court held that the state’s manslaughter statute

“does not include any exception from prosecution for physicians who assist another

individual to commit suicide;” further, “the legislature intended the statute to apply to

physicians who assist a suicide, and intended the term ‘suicide’ to include self-killing by

those who are suffering from unbearable terminal illness.” Therefore, prosecutors were

within their authority to prosecute physicians for providing “aid in dying,” a.k.a. assisted

suicide.3

• In a discussion of Blick, a publication of the American Medical Association (AMA)

characterized the plaintiff’s argument that “aid in dying” was not prohibited as “assisted

suicide” as a “novel approach.”4

PHYSICIAN-ASSISTED SUICIDE IS DANGEROUS TO THE DEPRESSED:

Most if not all terminally-ill patients who express a wish to die meet diagnostic criteria for major

depression or other mental conditions.5 Acknowledging the danger of physician-assisted suicide

to depressed patients should be a concern of all citizens.

3

• Depression is frequently underdiagnosed and undertreated, especially for the elderly and

patients with chronic or terminal medical conditions.6

• In one study, treatment for depression resulted in the cessation of suicidal ideation for 90

percent of the patients.7

• Despite these statistics, “safeguards” in Washington and Oregon (which explicitly permit

physician-assisted suicide) are failing to protect patients, as there are no requirements that

patients receive psychological evaluation or treatment prior to receiving lethal drugs.

• The majority of patients requesting physician-assisted suicide in Oregon have not been

referred for counseling. For example, of the 71 patients who died in 2013 after receiving

prescriptions for lethal drugs under Oregon’s Death with Dignity Act, only two patients

were referred for formal psychiatric or psychological evaluation.8

• Studies have revealed that when offered personal support and palliative care, most

patients adapt and continue life in ways they might not have anticipated. Very few of

these individuals ultimately choose suicide.9

• In light of the pervasive failure of our healthcare system to diagnose and treat depression

and provide adequate palliative care, allowing physician-assisted suicide is profoundly

dangerous for individuals who are already ill and vulnerable or “whose autonomy and

well-being are already compromised by poverty, lack of access to good medical care,

advanced age, or membership in a stigmatized social group.”10

PHYSICIAN-ASSISTED SUICIDE IS DANGEROUS TO THE ELDERLY AND

DISABLED:

Many patients who request physician-assisted suicide are coerced by familial pressures and a

desire not to be a “burden” on their families. Acknowledging the danger of physician-assisted

suicide to the elderly and disabled should be a concern of all citizens.

• Physician-assisted suicide is a predicate for elder abuse. The National Center on Elder

Abuse estimates that one to two million Americans aged 65 or older are injured,

exploited, or otherwise abused physically, emotionally, psychologically, or financially

each year by a caregiver or trusted individual they depend upon.11 Too often, the

physicians and family members to whom a terminally-ill patient looks to for support and

protection are the same ones counseling that suicide may be the best option.

4

• Facing deteriorating health and increasing age, the elderly are at a greater risk of suicide

than any other age group.12 Physician-assisted suicide greatly increases the risk of elder

abuse and suicide among the elderly by creating yet another path of abuse against older

individuals. Abuse of the elderly is often subtle and extremely difficult to detect.

• There have been documented accounts of individuals committing suicide under pressure

and/or duress from family members, friends, and/or suicide advocates present at the

ingestion of lethal drugs.13

• Legalized physician-assisted suicide hides abuse of the elderly and disabled. It provides

complete liability protection for doctors and promotes secrecy. For example, in Oregon

physicians providing physician-assisted suicide are self-reporting, death certificates are

required to report a “natural” death (as opposed to a suicide), and there are no

requirements that witnesses be present at the time of death. This permits absolutely no

transparency and makes patient choice and protections simple illusions.

• The State’s interest in protecting the vulnerable, elderly, and disabled individuals is

compelling. Physician-assisted suicide poses profound dangers that outweigh any alleged

benefits the practice may have in isolated cases.

• The New York State Task Force on Life and the Law explains that “any effort to carve

out exceptions to the prohibitions on assisted suicide or euthanasia would seriously

undermine the state’s interest in preventing suicide in the vast majority of cases…. The

state’s interest in protecting these patients outweighs any burden on individual autonomy

that prohibitions on assisted suicide and euthanasia might entail.”14

PHYSICIAN-ASSISTED SUICIDE PRESENTS ADDITIONAL DANGERS:

The New York State Task Force on Life and the Law found it “naïve and unsupportable” to

assume that any “safeguards” that are erected will be unaffected by the broader social and

medical context in which they will operate.15

• Allowing physicians or other individuals to assist in the suicide of another encourages

health insurance companies and other health care payers to provide coverage for suicide

assistance, but not for treatment of disease or palliative care. This poses a significant

threat to vulnerable persons who may not have adequate access to medical care. A lack

of options may effectively pressure patients into assisted suicide.

5

• For example, in 2008, patient Barbara Wagner was denied coverage under her Oregon

state health plan for medication that would treat her cancer and extend her life; instead,

the state health plan offered to pay for the cost-effective option of ending her life by

physician-assisted suicide.16

• Most patients who request physician-assisted suicide do not have longstanding

relationships with the physicians who provide the lethal drugs. It is not uncommon for

physicians in states allowing physician-assisted suicide to prescribe lethal drugs for

patients whom they have known as little as one week or less.17

• The United States Supreme Court has acknowledged the legitimate government interests

in 1) preserving life; 2) preventing suicide; 3) avoiding the involvement of third parties

and the use of arbitrary, unfair, or undue influence; 4) protecting family members and

loved ones; 5) protecting the integrity of the medical profession; and 6) avoiding future

movement toward euthanasia and other abuses.18

• The New York State Task Force on Life and the Law unanimously concluded that the

dangers of legalized physician-assisted suicide far outweigh any possible benefits.19

REFUSAL/WITHDRAWAL OF LIFE-SUSTAINING TREATMENT IS DIFFERENT THAN

PROACTIVELY KILLING A PATIENT:

There is a medically- and court-recognized difference between the withdrawal of life-sustaining

treatment, which serves only to allow natural death, and the use of lethal drugs or other means to

prematurely cause death.

• The American Medical Association opposes physician-assisted suicide, but finds that it is

ethically acceptable to withdraw or withhold life-sustaining treatment at the request of a

patient who possesses decision-making capacity.20

• The New York State Task Force on Life and the Law distinguished between assisted

suicide and the withdrawal or refusal of life-sustaining treatment, concluding that the

State’s interest in protecting patients and criminalizing physician-assisted suicide

outweighed any claims of individual autonomy.21 In contrast, the Task Force found that

the “constitutional balancing of individual and state interests yields an entirely different

result for decisions to forgo life-sustaining treatment . . . [state] interests are best served

by permitting the refusal of treatment in accord with appropriate guidelines, and []

individual decision making about treatment will ultimately promote the public good.”22

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• In Vacco v. Quill, the United States Supreme Court affirmed the distinction between

assisting suicide and the withdrawal of life-sustaining treatment, stating it is a

“distinction widely recognized and endorsed in the medical profession and in our legal

traditions” and that it is important, logical, and rational.23

PHYSICIAN-ASSISTED SUICIDE IS NOT NECESSARY TO “TREAT PAIN”:

Patients who request physician-assisted suicide overwhelmingly cite their reasons for doing so as

a fear of a perceived (not necessarily actual) loss of autonomy, loss of dignity, and decreasing

ability to participate in activities that make life enjoyable. Very few patients are in pain or even

fear pain in the end of life. For those patients that are in pain, that pain can be controlled or

alleviated completely.

• Most experts in pain management believe that 95 to 98 percent of pain can be relieved in

terminally-ill patients.24

• The pain of the remaining patients can always be alleviated through sedation.25

• Even the euthanasia advocacy organization Compassion & Choices has advocated that

patients must be adequately informed that sedation is an option at the end of life.26

• Even when physician-assisted suicide is requested by patients in pain, in most cases the

patient will withdraw the request after pain management, depression, and other concerns

are addressed.27

IF PHYSICIAN-ASSISTED SUICIDE IS AVAILABLE TO ENSURE “AUTONOMY,”

THEN IT CANNOT BE CONTAINED AND MUST BE AVAILABLE TO ALL PEOPLE:

Patients who request physician-assisted suicide overwhelmingly cite their reasons for doing so as

a fear of a perceived (not necessarily actual) loss of autonomy, loss of dignity, and decreasing

ability to participate in activities that make life enjoyable.28 Yet if these reasons are adequate to

support legalizing physician-assisted suicide, then physician-assisted suicide must be legal for all

people, endangering the most vulnerable in our culture.

• None of these reasons are unique to terminally-ill patients, and they leave room for other

individuals to also claim a need, or a “right,” to physician-assisted suicide. For example,

these very reasons can be cited by a person left paralyzed after an accident or illness.

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• It will be difficult, if not impossible, to limit physician-assisted suicide to “competent,

terminally-ill patients.” Individuals who are not competent, who are not terminally-ill

(but potentially in more pain than a terminally-ill patient), or who cannot self-administer

lethal drugs will also seek the option of physician-assisted suicide, and no principled

basis will exist to deny them this “right.”

• An Oregon Deputy Attorney General has stated that the Americans with Disabilities Act

(ADA) would likely require the state to offer “reasonable accommodation” to “enable the

disabled to avail themselves” of the Death with Dignity Act.29

• Once physician-assisted suicide is accepted as an answer to suffering, loss of autonomy,

dependence on others, or the decreased ability to participate in enjoyable activities in life,

there is nothing to prevent those life-value judgments from pervading American culture

and imposing those same quality-of-life judgments on the disabled and elderly

involuntarily, and at any stage of life.

THE MEDICAL COMMUNITY DOES NOT SUPPORT PHYSICIAN-ASSISTED SUICIDE:

The American Medical Association (AMA), whose lead is generally followed by other medical

associations, does not support physician-assisted suicide. It states that “allowing physicians to

participate in assisted suicide would cause more harm than good. Physician-assisted suicide is

fundamentally incompatible with the physician’s role as healer, would be difficult or impossible

to control, and would pose serious societal risks.”30

• The AMA further states that “[i]nstead of participating in assisted suicide, physicians

must aggressively respond to the needs of patients at the end of life. Patients should not

be abandoned once it is determined that cure is impossible. Multidisciplinary

interventions should be sought including specialty consultation, hospice care, pastoral

support, family counseling, and other modalities. Patients near the end of life must

continue to receive emotional support, comfort care, adequate pain control, respect for

patient autonomy, and good communication.”31

• While discussing a challenge to Connecticut’s law prohibiting assisted-suicide, a

publication of the AMA characterized the plaintiff’s argument that “aid in dying” was not

prohibited as “assisted suicide” as a “novel approach.”32

THE OREGON EXPERIENCE DEMONSTRATES THE DANGERS OF PHYSICIAN-

ASSISTED SUICIDE:

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Assisted suicide advocates claim that the experience in Oregon—where physician-assisted

suicide was legalized in 1997—supports their claims that the practice poses no dangers. But the

experience in Oregon instead demonstrates serious flaws and dangers in the provision of legal

physician-assisted suicide.

• In 1998, 24 reported patients received prescriptions for lethal drugs under the law, with

16 resulting deaths. In 2013, 122 reported patients received prescriptions for lethal drugs,

with 71 reported deaths.33

• The prevailing reasons for requesting physician-assisted suicide continue to be concerns

about loss of autonomy (93%), decreasing ability to participate in activities that make life

enjoyable (88.7%), and loss of dignity (73.2%).34 Yet these reasons for seeking

physician-assisted suicide are not unique to the terminally-ill and leave room for anyone

with a chronic disease or condition to claim a need for physician-assisted suicide as well.

• Physicians providing physician-assisted suicide are self-reporting, death certificates are

required to report “natural” death (as opposed to a suicide), and there are no requirements

that witnesses be present at the time of death—leaving patients completely vulnerable to

coercion at the end of life.

• Studies touting the “safety” of the Death with Dignity Act are based upon Oregon’s

annual reports, which are lacking necessary information.

• Oregon collects information about the time and circumstances of patients’ deaths only

when the physician or another health care provider is present at the time of death. Yet in

2013, health care providers were present in only 11 of the 71 deaths35—meaning that

information about approximately 75 percent of the patients is unknown. This creates

unacceptable gaps in Oregon’s data.

• The majority of reported patients requesting physician-assisted suicide in Oregon are not

referred for psychological or psychiatric counseling. In 2013, only 2 out of 71 patients

was referred for formal psychiatric or psychological counseling.36 This statistic defies

studies demonstrating that the majority of patients requesting physician-assisted suicide

are battling with depression and will change their mind when treated.

• Patients are being pushed into the assisted-suicide “option.” In 2008, patient Barbara

Wagner was denied coverage under her Oregon state health plan for medication that

would treat her cancer and extend her life; instead, the state health plan offered to pay for

the cost-effective option of ending her life by physician-assisted suicide.37

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• Proper palliative care is languishing in Oregon. In 2004, Oregon nurses reported that the

inadequacy of meeting patients’ needs had increased “up to 50 percent” and that “[m]ost

of the small hospitals in the state do not have pain consultation teams at all.”38

• “Physician-shopping” is not uncommon in Oregon, with some physicians prescribing

drugs for patients they have known for less than a week.39

• While the Death with Dignity Act requires two witnesses at the time of request for

physician-assisted suicide, one of those witnesses can be a relative who stands to inherit

from the patient, and the second witness can simply be a friend of the relative. There is

no safety in the witness requirement.

THE WASHINGTON EXPERIENCE DEMONSTRATES THE DANGERS OF PHYSICIAN-

ASSISTED SUICIDE:

Assisted suicide advocates claim that the experience in Washington—where physician-assisted

suicide was legalized in 2008—supports their claims that the practice poses no dangers. But the

experience in Washington instead demonstrates serious flaws and dangers in the provision of

legal physician-assisted suicide.

• In 2009, 65 reported patients received prescriptions for lethal drugs under the law, with

63 reported deaths. In 2012, 121 reported patients received prescriptions for lethal drugs,

with 83 reported deaths from ingesting the drugs.40

• The prevailing reasons for requesting physician-assisted suicide were concerns about loss

of autonomy (94%), less ability to engage in activities that make life enjoyable (90%),

and loss of dignity (84%).41 Yet these reasons for seeking physician-assisted suicide are

not unique to the terminally-ill and leave room for anyone with a chronic disease or

condition to claim a need for physician-assisted suicide as well.

• Sixty-three percent of patients listed a fear of being a “burden” on family, friends, and

caregivers as a reason for requesting assisted suicide, raising the concern that patients

were pushed into suicide.42

• A psychiatric or psychological evaluation is not required in Washington. Out of 103

patients who died after receiving prescriptions for lethal drugs,43 only 3 received

psychiatric/psychological referrals, and no information is available regarding whether

they were treated for any mental complications. This number is under-representative of

the number of patients dealing with depression or other mental conditions.44

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• Nearly half of the patients reported to have died had a “relationship” with their physician

of less than a week to 24 weeks.45

• Because the Department of Health will not disclose any information that identifies

patients, physicians, pharmacists, witnesses, or “other participants” in activities covered

by the Death with Dignity Act, there is no mechanism by which these participants can be

held accountable. Further, this provides cover for witnesses and participants from

organizations like Compassion & Choices who travel into a state specifically to provide

suicide to vulnerable patients.

THE NETHERLANDS EXPERIENCE DEMONSTRATES THE DANGERS OF

PHYSICIAN-ASSISTED SUICIDE:

Physician-assisted suicide and euthanasia have been legal in the Netherlands for years. Yet

instead of strengthening autonomy at the end of life, the legalization of physician-assisted suicide

and euthanasia has proven to degrade and dehumanize the lives of patients, resulting in

physicians routinely performing euthanasia without the consent of their patients. The experience

in the Netherlands proves that physician-assisted suicide cannot be contained and will ultimately

lead to euthanasia.

• Once assisted suicide was allowed in the Netherlands, involuntary euthanasia followed.

As the New York State Task Force on Life and the Law concluded, “[A]ssisted suicide

and euthanasia are closely linked; as experience in the Netherlands has shown, once

assisted suicide is embraced, euthanasia will seem only a neater and simpler option to

doctors and their patients.”46

• A report commissioned by the Dutch government demonstrated that more than half of

euthanasia and assisted-suicide-related deaths were involuntary in the year studied.47

• At least half of Dutch physicians actively suggest euthanasia to their patients.48

• Studies in 1997 and 2005 revealed that eight (8) percent of infants who died in the

Netherlands were euthanized by doctors.49

• Studies show that hospice-style palliative care is stunted in the Netherlands: there are

very few hospice facilities, very little in the way of organized hospice activity, and few

specialists in palliative care.50

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THE BELGIAN EXPERIENCE DEMONSTRATES THE DANGERS OF PHYSICIAN-

ASSISTED SUICIDE:

Physician-assisted suicide and euthanasia are also legal in Belgium. In 2014, Belgium became

the first country to enact a law permitting terminally-ill minors of any age to request euthanasia.

• A recent study published in the Canadian Medical Association Journal51 demonstrated

that where physician-assisted suicide (and in Belgium, euthanasia) is allowed, abuse will

inevitably follow.

• Out of 1,265 nurses questioned, 120 of them (almost 10 percent) reported that their last

patient was involuntarily euthanized.

• Only four (4) percent of nurses involved in involuntary euthanasia reported that the

patient had ever expressed his or her wishes about euthanasia.

• Most of the patients euthanized without consent were over 80 years old, reaffirming the

fact that assisted suicide and euthanasia quickly lead to elder abuse.

• The researchers acknowledged that nurses are likely reluctant to report illegal acts (here,

euthanizing a patient without physician involvement). Thus, it is possible that the

number of nurses killing their patients without physician involvement is much higher

than revealed by the study.

• The researchers concluded that “[i]t seems the current law… and a control system do not

prevent nurses from administering life-ending drugs.” In other words, the “safeguards”

purported by suicide advocates simply do not work.

STATE OF THE STATES:

• 37 states criminalize assisted suicide: AK, AR, AZ, CA, CO, CT, DE, FL, GA, HI, ID,

IL, IN, IA, KS, KY, LA, ME, MD, MI, MN, MS, MO, NE, NH, NJ, NY, ND, OK, PA,

RI, SC, SD, TN, TX, VA, and WI

• 5 states (arguably) prohibit assisted suicide under common law of crimes or judicial

interpretation of homicide statutes: AL, MA, NC, OH, and WV

• 3 states and the District of Columbia have left the legal status of assisted suicide

undetermined: DC, NV, UT, and WY

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• 3 states permit assisted suicide: OR, VT, and WA

• 1 state recognizes a statutory “consent” defense for those “aiding” a suicide: MT

• 1 state law banning assisted suicide is in litigation following an unfavorable court

decision: NM.

1 Kathryn L. Tucker & Christine Salmi, Aid in Dying: Law, Geography and Standard of Care in

Idaho, THE ADVOCATE, August 2010, at 42. 2 MODERN DICTIONARY FOR THE LEGAL PROFESSION (3d ed. 2001).

3 Blick v. Connecticut, 2010 Conn. Super. LEXIS 1412, at *39-40 (Conn. Super. Ct. June 1,

2010). 4 Kevin B. O’Reilly, Assisted-Suicide Statute Challenged by 2 Connecticut Doctors, AMER. MED.

NEWS ( Oct 19, 2009), available at http://www.ama-

assn.org/amednews/2009/10/19/prsd1019.htm (last visited Mar. 13, 2014). 5 See, e.g., New York State Task Force on Life and the Law, WHEN DEATH IS SOUGHT: ASSISTED

SUICIDE AND EUTHANASIA IN THE MEDICAL CONTEXT x, 13 (1994). 6 Id. at 32 (1994).

7 Id. at 26.

8 Oregon’s Death with Dignity Act—2013 (Jan. 2014), available at

http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity

Act/Pages/index.aspx (last visited Mar. 13, 2014).

9 New York State Task Force on Life and the Law, supra, at 178.

10 Washington v. Glucksberg, 521 U.S. 702, 732 (1997) (quoting New York State Task Force on

Life and the Law, supra, at 120). 11 National Center on Elder Abuse, A Response to the Abuse of Vulnerable Adults (Washington,

D.C. 2000). 12 New York State Task Force on Life and the Law, supra, at 30.

13 See, e.g., Herman Hendin, SEDUCED BY DEATH: DOCTORS, PATIENTS, AND ASSISTED SUICIDE

50-56, 61, 128-32, 142 (1998). 14 New York State Task Force on Life and the Law, supra, at 73-74.

15 Id. at 125.

16 See, e.g., Steven Ertelt, Woman Victimized by Oregon Assisted Suicide Law Urges Washington

to Vote No (October 28, 2008), available at http://www.lifenews.com/2008/10/28/bio-2608/ (last

visited Mar. 13, 2014). 17 See Oregon’s annual Death with Dignity Act reports, available at

http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity

Act/Pages/index.aspx (last visited Mar. 13, 2014). 18 Glucksberg, 521 U.S. at 792-93.

19 New York State Task Force on Life and the Law, supra, at ix.

20 See American Medical Association, Code of Medical Ethics, Opinion 2.211 – Physician-

Assisted Suicide, available at http://www.ama-assn.org/ama/pub/physician-resources/medical-

ethics/code-medical-ethics/opinion2211.shtml (last visited Mar. 13, 2014); American Medical

Association, Opinion 2.20 – Withholding or Withdrawing Life-Sustaining Medical Treatment

13

available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-

medical-ethics/opinion220.shtml (last visited Mar. 13, 2014). 21 New York State Task Force on Life and the Law, supra, at 73.

22 Id. at 74-75.

23 521 U.S. 793, 800-01 (1997). See also id., 521 U.S. at 808 (stating that “the two acts are

different” and referring to the distinction as a “longstanding and rational distinction”). 24 See, e.g., Timothy E. Quill & Christine K. Cassel, Professional Organizations’ Position

Statements on Physician-Assisted Suicide: A Case for Studied Neutrality, ANNALS OF INTERNAL

MED. 2003; 138(3): 208, available at http://www.annals.org/cgi/reprint/138/3/208.pdf (last

visited Mar. 13, 2014). See also Project on Death in America/Open Society Institute, Brief as

Amicus Curiae for Reversal of the Judgments Below at Part II.A.1, Vacco v. Quill, 521 U.S. 793

(1997) (stating that pain can be alleviated in 98 percent of cases); Robert A. Burt,

Constitutionalizing Physician-Assisted Suicide: Will Lightning Strike Thrice?, 35 DUQ. L. REV.

159, 166 (1996) (stating that knowledgeable physicians and researchers claim that pain can be

alleviated in 98 percent of cases); Kathleen M. Foley, Transforming the Culture of Dying,

PROJECT ON DEATH IN AMERICA: JANUARY 2001- DECEMBER 2003 REPORT OF ACTIVITIES 11

(Open Society Institute, 2004). 25 American Geriatrics Society, Brief as Amicus Curiae Urging Reversal of the Judgments Below

at Part I.B, Vacco v. Quill, 521 U.S. 793 (1997); Wesley J. Smith, FORCED EXIT: THE SLIPPERY

SLOPE FROM ASSISTED SUICIDE TO LEGALIZED MURDER 207 (1997). 26 In the case Hargett v. Vitas, Compassion & Choices is suing a hospice for failing to inform a

patient of her option to choose palliative sedation. See Compassion & Choices, Hargett v. Vitas

(2010), available at http://www.compassionandchoices.org/page.aspx?pid=474 (last visited Jan.

21, 2010). 27 New York State Task Force on Life and the Law, supra, at 108 n.113.

28 See Oregon’s annual Death with Dignity Act reports, supra.

29 See Smith, supra, at 136 (citing Correspondence of Deputy Attorney General David Schuman

to state Senator Neil Bryant (Mar. 15, 1999)). 30 American Medical Association, Code of Medical Ethics, Opinion 2.211 – Physician-Assisted

Suicide available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-

medical-ethics/opinion2211.shtml (last visited Mar. 14, 2014). 31 Id.

32 O’Reilly, supra.

33 Oregon’s Death with Dignity Act—2013 (Jan. 2014), available at

http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity

Act/Pages/index.aspx (last visited Mar. 13, 2014) (Eight of these deaths were patients who

received prescriptions during 2011 or 2012). 34 Id.

35 Id.

36 Id.

37 See, e.g., Ertelt, supra.

38 See Brief Amicus Curiae of International Task Force et al., filed in Baxter v. Montana,

available at http://www.internationaltaskforce.org/montana.htm (last visited Jan. 25, 2011)

(citing House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill,

Testimony of Sue Davidson of the Oregon Nurses Ass’n, response to question 1098). 39 See Oregon’s annual Death with Dignity Act reports, supra.

14

40 Washington State Department of Health 2012 Death with Dignity Act Report Executive

Summary—2012 (Feb. 2013), available at

http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct.aspx (last

visited Mar. 13, 2014) (104 patients are known to have died; however, 18 are reported to have

died without ingesting the lethal drugs, and for three who died their ingestion status is unknown.) 41 Id.

42 Id.

43 Id. (Data was not available for one of the participants in 2012 who died.)

44 Id.

45 Id.

46 New York State Task Force on Life and the Law, supra, at 145.

47 See Smith, supra, at 107-09 (citing the Dutch government’s Remmelink Report).

48 See id. at 110 (citing Richard Fenigsen, Report of the Dutch Government Committee on

Euthanasia, ISSUES LAW & MED. 7:339 (Nov. 1991); Special Report from the Netherlands,

N.E.J.M. 1699-711 (1996)). 49 See id. at 119 (citing Agnes van der Heide et al., Medical End-of-Life Decisions Made for

Neonates and Infants in the Netherlands, LANCET 350:251-55 (July 26, 1997); Astrid M.

Vrakking et al., Medical End-of-Life Decisions Made for Neonates and Infants in the

Netherlands, 1995-2001, LANCET 365:1284-86 (Apr. 9, 2005)). 50 See id. at 225.

51 Els Inghelbrecht et al., The role of nurses in physician-assisted deaths in Belgium, CAN. MED.

ASS’N J. (June 15, 2010).