Source BAssisted Suicide and Euthanasia Timeline

ProQuest Staff. "Assisted Suicide and Euthanasia Timeline." Leading Issues Timelines. 2015: n.p. SIRS Issues Researcher. Web.

10 Feb. 2016.

Background: Physicians in ancient Greece and Rome granted the requests of suffering patients to receive poison, but there were a minority who opposed this practice of assisted suicide. In the 4th Century B.C.E, Hippocrates , "Father of Medicine," created what is later known as the "Hippocratic Oath," in which he stated, "I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect." The emergence of Christianity reinforced the views of the Hippocratic Oath. In the 1200s, Thomas Aquinas penned The Sin of Suicide, in which he described suicide as a mortal sin. 1516 Sir Thomas More provides possibly the earliest reference to euthanasia in English Literature in Utopia, in which he writes, "They console the incurably ill by sitting and talking with them and by alleviating whatever pain they can. Should life become unbearable for these incurables the magistrates and priests do not hesitate to prescribe euthanasia....When the sick have been persuaded of this, they end their lives willingly either by starvation or drugs that dissolve their lives without any sensation of death. Still, the Utopians do not do away with anyone without his permission, nor lessen any of their duties to him." 1647 The early American colonies adopt the common law approach toward suicide. Legislators of the Providence Plantations, that would later become Rhode Island, state that, "[s]elf murder is by all agreed to be the most unnatural, and it is by this present Assembly declared, to be that, wherein he that doth it, kills himself out of a premeditated hatred against his own life or other humor...his goods and chattels are the king's custom." 17th-18th Century In a general attack on religious authority during the Enlightenment , authors John Donne, Montesquieu, and English and French philosophers challenge the admonition against suicide. David Hume writes in an essay, "On Suicide," that "Suicide may often be consistent with interest and with our duty to ourselves, no one can question, who allows that age, sickness, or misfortune, may render life a burden, and make it worse even than annihilation." However, there is no significant public interest in euthanasia and suicide during this period. 1828 The earliest American statute outlawing assisting suicide is enacted in New York and many new states and territories follow suit. Between 1857 and 1865, a New York commission led by Dudley Field drafts a criminal code that prohibits "aiding" a suicide and "furnish[ing] another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life." 1848 After performing the first operation with ether anesthesia two years prior, physician John Warren publishes Etherization, With Surgical Remarks, in which he suggests that ether could be used "in mitigating the agonies of death." 1866 Dr. Joseph Bullar reports using chloroform to palliate pain during the deaths of four patients in the British Medical Journal. 1868 It is a crime in most U.S. states to assist a suicide. 1870 Samuel D. Williams, a nonphysician, addresses the Birmingham [England] Speculative Club on the topic of euthanasia and advocates the use of chloroform or other medications to intentionally end a patient's life "at the express wish of the patient." His speech is reprinted as a book in 1872 and favorably reviewed inPopular Science Monthly. 1870s and 1880s Physicians regularly use opium to relieve the pain of the dying but not to hasten death.

1885 The Journal of the American Medical Association criticizes the euthanasia proposal of Samuel D. Williams as an attempt to make "the physician don the robes of an executioner." 1895 New York lawyer Albert Bach endorses euthanasia as a right for patients to end their own lives at the Medico-Legal Congress. 1899 In his Presidential Address to the American Social Science Association, Simeon Baldwin advocates for euthanasia when he criticizes the "pride of many in the medical profession to prolong such lives at any cost of discomfort or pain to the sufferer."

1906 The Ohio legislature considers "An Act Concerning Administration of Drugs etc. to Mortally Injured and Diseased Persons," but the bill is rejected 79 to 23. 1915 Dr. Harry J. Haiselden, a Chicago hospital's chief of staff, decides, with the parent's consent, not to perform life-saving surgery on a deformed baby so as to "let nature complete its bungled job." The decision creates a public debate on euthanasia. 1917 Dr. Haiselden plays himself in the motion picture The Black Stork about an ill-matched couple who produce a defective baby that is allowed to die. The dead child "floats" into heaven. The film is used as propaganda to promote state-sponsored eugenics programs in the United States that begin in the 1920s and last until the 1970s. 1920 Alfred Hoche, M.D., a professor of psychiatry at the University of Freiburg, and Karl Binding, a professor of law from the University of Leipzig, Germany, authorPermitting the Destruction of Unworthy Life, in which they argue that patients should have the right to ask for "death assistance" from physicians. Hoche and Binding also advocate "in the interest of a higher good" the killing of "complete idiots" and the mentally ill whose "existence weighs most heavily on the community." 1935 Retired public health physician C. Killick Millard founds the Voluntary Euthanasia Legislation Society in England. 1936 The British House of Lords debates and rejects a bill to legalize euthanasia 35 to 14. 1937 Nebraska Senator John Comstock introduces the Voluntary Euthanasia Act to the U.S. Senate but it is never voted on. 1938 Reverend Charles Francis Potter founds the Euthanasia Society of America. The society asserts that legalizing elective euthanasia for terminally ill patients is a merciful and Christian act. 1939 Motivated in part by Permitting the Destruction of Unworthy Life, Adolf Hitler establishes "Aktion T4," a Nazi euthanasia program to eliminate "life unworthy of life." The program orders " mercy killing " of sick and disabled newborns and young children, then expands to older children and adults. The program results in the killing of an estimated 70,000 German citizens in killing centers and psychiatric institutions. 1942 Switzerland legalizes euthanasia for the terminally ill. 1946 The Committee of 1776 Physicians for Legalizing Voluntary Euthanasia in New York State is formed. 1950 The World Medical Association votes on a resolution to recommend that all national medical associations condemn euthanasia "under any circumstances." 1952 U.S. and British supporters of euthanasia submit a petition to the Human Rights Commission of the United Nations to recognize "the right of incurable sufferers to euthanasia, or merciful death." The petition is not accepted. 1954

Joseph Fletcher publishes Morals and Medicine , predicting the controversy over euthanasia. 1956 Dr. Jack Kevorkian publishes the journal article, "The Fundus Oculi and the Determination of Death," discussing his photography of the eyes of dying patients. His fascination with death earns him the nickname, "Doctor Death." 1957 • Pope Pius XII issues Catholic doctrine supporting the use of drugs to ease pain but condemning euthanasia. • Death of a Man by Lael Tucker Wertenbaker is published, in which the author describes how she helped her husband commit suicide. 1958 Oxford law professor Glanville Williams endorses euthanasia in The Sanctity of Life and the Criminal Law, proposing that competent, terminally ill patients have the option of voluntary euthanasia. 1967 Dr. Walter W. Sackett, a Florida state representative, introduces a right-to-die bill in Florida's legislature that arouses debate but does not pass. 1968 A special faculty committee at Harvard Medical School recommends in the Journal of the American Medical Association that the definition of death be based on "brain death," also termed an "irreversible coma." They report the definition is needed because of advances in medical technology that maintain vital organs in persons without brain activity. 1969 • Chicago Attorney Louis Kutner writes the first living will as a way for patients to refuse life-sustaining treatment even if they are too ill to communicate. • Daniel Callahan founds the Hastings Center to explore bioethical issues. • A bill to legalize euthanasia is introduced into the British Parliament and does not pass. • A voluntary euthanasia bill is introduced in the Idaho legislature but fails. • Elisabeth Kubler-Ross 's On Death and Dying is published and prompts debate on the treatment of the dying. 1972 Senator Frank Church heads " Death with Dignity : An Inquiry into Related Public Issues," a U.S. Senate Special Commission on Aging hearing, in which euthanasia is one of the subjects debated. 1973 • The American Medical Association releases "A Patient's Bill of Rights" that lists 12 rights including the right to refuse treatment to the extent permitted by law. • Dr. Gertruida Postma, a Dutch physician, stands trial for giving her dying mother a lethal injection. The decision stirs up debate over euthanasia in the Netherlands and leads to the founding of the NVVE, a pro-Euthanasia society. 1974 America's first hospice, The Connecticut Hospice, Inc., in Branford, Connecticut, begins providing hospice services in the home and makes plans for a 44-bed institution in two years. 1975 Dr. Henry P. Van Dusen , 77, former president of Union Theological Seminary New York and an ecumenical Protestant leader, and his wife, 80, carry out a suicide pact when they take an overdose of sleeping pills rather than face the prospect of debilitating old age. The Van Dusens were members of the Euthanasia Society. 1976 • The NVVE launches its Members' Aid Service to provide advice to the dying. • Julia and Joseph Quinlan go to court to have the respirator removed from their 22-year-old daughter, who had been in a persistent vegetative state for almost a year. After being denied in a lower court ruling, the New Jersey Supreme Court rules in their favor 7 to 0 as long as her attending physicians and a hospital panel agree that there is "no reasonable possibility" that she could recover. Karen Ann Quinlan is taken off the respirator. The case is a precedent and stirs up public debate on end-of-life issues. In 1985, after almost 10 years in a coma, she passes away from pneumonia. • The California Natural Death Act is passed. It is the nation's first statute that gives legal standing to living wills and protects physicians from liability for honoring them. 1977 New Mexico, Arkansas, Nevada, Idaho, Oregon, North Carolina and Texas enact natural death laws. 1978

• Doris Portwood authors Commonsense Suicide: The Final Right, in which she argues that elderly people in poor health may justifiably kill themselves. • Jean's Way is published in England by Derek Humphry describing how he helped his terminally ill wife die. 1979 Artist Jo Roman , dying of cancer, commits a long-planned suicide after a goodbye party with family and friends. Roman was an outspoken proponent of "self termination" as a "rational and artistic option." 1980 • Pope John Paul II issues Declaration in Euthanasia opposing mercy killing but endorsing the use of medicine to ease pain and the right to refuse extraordinary means for sustaining life. • British author Derek Humphry founds The Hemlock Society in Santa Monica, California, established to support the right of the terminally ill to "self-deliverance." The group advocates for voluntary euthanasia and assisted suicide. • The World Federation of Right to Die Societies is formed in Oxford, England, comprised of 27 groups from 18 nations. 1981 • AIDS is clinically identified, generating interest in euthanasia and assisted suicide. • The Hemlock Society publishes Let Me Die Before I Wake , North America's first how-to suicide book providing active voluntary euthanasia information for the terminally ill. 1983 • Darkness at Noon writer Arthur Koestler and his wife Cynthia, both members of Exit, the Society for the Right to Die with Dignity, commit suicide in London, England. Arthur was terminally ill with leukemia and Parkinson's disease but his wife was healthy. • Elizabeth Bouvia, a 26-year old quadriplegic suffering from cerebral palsy, sues Riverside General Hospital in California to stop force feedings and allow her to die of self-starvation. She loses the case and files an appeal.

1984 • The Dutch Supreme Court rules that physicians may perform voluntary euthanasia for those who are chronically ill for reasons of "irresistible compulsion or necessity." • Advance care directives, or living wills, are recognized in 22 states and the District of Columbia. 1985 • Former ABC news correspondent Betty Rollin releases Last Wish, her story of helping her terminally-ill mother die. The book becomes a bestseller. • Roswell Gilbert, 76, shoots and kills his debilitated wife who begged to die. He is sentenced in Florida to 25 years without parole. He is granted clemency five years later. 1986 • Elizabeth Bouvia is granted the right to refuse force feeding by an appeals court. She instead decides to live and continue the feedings. • Robert Risley, a Los Angeles lawyer whose wife died of cancer, founds Americans Against Human Suffering in California. 1988 • Journal of the American Medical Association prints " It's Over, Debbie," an anonymous essay from a gynecology resident doctor who describes giving a lethal injection to a 20-year-old woman dying of ovarian cancer. The article stirs debate and prompts an investigation of the identity of the doctor who is never found. • The Unitarian Universalist Association of Congregations is the first religious group to pass a national resolution in favor of euthanasia for the terminally ill. • Dr. Jack Kevorkian's article, "The Last Fearsome Taboo: Medical Aspects of Planned Death," is published in Medicine and Law, in which he outlines his proposed system of planned deaths and medical experimentation on patients. 1989 Dr. Jack Kevorkian builds a "suicide machine" at his Royal Oak, Michigan, apartment using $30 worth of scrap parts from garage sales and hardware stores. 1990 • The parents of Nancy Cruzan, who is in a persistent vegetative state as a result of a 1983 car accident, request to withdraw her feeding tube. State hospital officials and then the Missouri Supreme Court refuse the request. In June 1990, The U.S. Supreme Court hears the case and rules in Cruzan v. Director, Missouri Dept. of Health that individuals

have the right to refuse medical treatment. However, since there is no evidence of Cruzan's wishes, her parents' request is denied. Their lawyer counters with new evidence of her wishes and a county probate judge orders that Nancy's feeding tube be removed. Nancy Cruzan passes away in December. • The Washington Initiative is filed as the first state voter referendum on the issue of voluntary euthanasia and physician-assisted suicide. • Dr. Jack Kevorkian assists in the death of Janet Adkins , a 54-year-old woman with Alzheimer's disease, using his suicide machine in an old Volkswagen van at a local park in Detroit, Michigan. District Court Judge Gerald McNally dismisses murder charges against Kevorkian in the death of Adkins. • Congress passes the Patient Self-Determination Act (PSDA) as an amendment to the Budget Reconciliation Act of 1990. The PSDA requires Medicare and Medicaid providers to give patients information about their right to participate in health care decisions, the right to refuse treatment and the right to a living will. The act becomes effective one year later. 1991 • Dr. Timothy Quill describes in the New England Journal of Medicine how he provided barbiturates to "Diane," a leukemia patient, in order to end her life. • Derek Humphry, the executive director of the Hemlock Society, publishes Final Exit, a how-to book on self-deliverance. The book is a national bestseller. • Washington state voters reject Ballot Initiative 119, which would have legalized physician-aid-in-dying. • Dr. Jack Kevorkian assists in the deaths of Marjorie Wantz, a 58-year-old woman with pelvic pain, and Sherry Miller, a 43-year-old woman debilitated with multiple sclerosis. The deaths take place at a rented state park cabin near Lake Orion, Michigan. Wantz dies with lethal drugs from the suicide machine, then Miller dies from carbon monoxide poisoning through a face mask. The Michigan Board of Medicine suspends Dr. Kevorkian's license to practice medicine. 1992 • California voters defeat Proposition 161, the California Death with Dignity Act, which would have allowed physicians to actively administer or prescribe medications to hasten death for terminally-ill patients. • Dr. Jack Kevorkian continues to aid suicides using carbon monoxide. Oakland County Circuit Court Judge David Breck dismisses charges against Kevorkian in the deaths of Sherry Miller and Marjorie Wantz. 1993 • A California judge suspends Dr. Jack Kevorkian's medical license after a request from that state's medical board. • Dr. Jack Kevorkian assists in the death of his 17th patient with the assisted suicide of Thomas Hyde, a 30-year old man with Lou Gehrig's disease. After charges are filed, he continues to aid suicides. He is jailed three times and fasts each time in protest. In December, Kevorkian ends his fast and leaves jail an Oakland County Circuit Court judge reduces his bond to $100 in exchange for his vow not to assist in any more suicides until state courts resolve the legality of his practice. 1994 • A fifth Circuit Court judge dismisses charges against Dr. Jack Kevorkian. • All states and the District of Columbia recognize some type of advance directive procedure. • Oregon voters approve Measure 16, the Oregon Death with Dignity Act , which permits terminally-ill patients to obtain a physician's prescription for medication to end life. U.S. District Court Judge Hogan issues a temporary restraining order against Oregon's Measure 16, following that with an injunction barring the state from putting the law into effect. • District Court Judge Barbara Rothstein overturns Washington state's anti-suicide law in Compassion v. Washington, stating it violates the 14th Amendment. • A Detroit jury acquits Dr. Jack Kevorkian of charges he violated the state's assisted suicide ban in the death of Thomas Hyde. May: The Michigan Court of Appeals strikes down the state's ban on assisted suicide on the grounds it was enacted unlawfully. Dec: The Michigan Supreme Court upholds the constitutionality of Michigan's previous ban on assisted suicide and rules assisted suicide is illegal under common law. Cases against Dr. Jack Kevorkian are reinstated. 1995 June: Dr. Jack Kevorkian opens a suicide clinic that he calls a "mercy clinic" in an office in Springfield Township, Michigan. Erika Garcellano, a 60-year-old Kansas City, Missouri, woman with Lou Gehrig's disease, is the first client. A few days later, the building's owner evicts Kevorkian.

Sept: Dr. Jack Kevorkian stands trial for the 1991 assisted suicides of Sherry Miller and Majorie Wantz. He arrives at the Oakland County Courthouse in Pontiac, Michigan, in homemade stocks with ball and chain. Oct: A small group of Michigan doctors announce their support of Dr. Jack Kevorkian and plan to draw up a set of guiding principles for the "merciful, dignified, medically-assisted termination of life." • Australia's Northern Territory approves a bill to legalize euthanasia. The law is overturned by the Australian Parliament two years later. • U.S. District Judge Hogan rules that Oregon's Death with Dignity Act is unconstitutional. The ruling is appealed. 1996 • The Ninth Circuit Court of Appeals strikes down a Washington state law banning assisted suicide. The ruling states that "a liberty interest exists in the choice of how and when one dies, and that the provision of the Washington statute banning assisted suicide, as applied to competent, terminally ill adults who wish to hasten their deaths by obtaining medication prescribed by their doctors, violates the Due Process Clause." • The Second Circuit Court of Appeals reverses a ban on assisted suicide, ruling that "The New York statutes criminalizing assisted suicide violate the Equal Protection Clause because, to the extent that they prohibit a physician from prescribing medications to be self-administered by a mentally competent, terminally ill person in the final stages of his terminal illness, they are not rationally related to any legitimate state interest." • The U.S. Supreme Court announces that it will review the Washington and New York cases sponsored by Compassion in Dying, known as Washington v. Glucksberg and Vacco v. Quill. March: A jury acquits Dr. Jack Kevorkian in the deaths of Merian Frederick and Dr. Ali Khalili. April: Dr. Jack Kevorkian stands trial in his hometown of Pontiac, Michigan, for the assisted suicides of Sherry Miller and Marjorie Wantz. He starts the trial wearing a colonial costume--tights, a white powdered wig, and big buckle shoes--to state he is being tried under centuries-old common law. In May, the jury acquits him. 1997 • The Florida Supreme Court upholds a 129-year old ban on physician-assisted suicide by a vote of 5-to-1. • The U.S. Supreme Court reverses the decisions of the Ninth and Second Circuit Court of Appeals in Washington v. Glucksberg and Vacco v. Quill , upholding state statutes against assisted suicide. • Oregon voters reject Measure 51 that would have repealed the Oregon Death with Dignity Act. 1998 • The Oregon Health Services Commission decides that state funds under the Oregon Health Plan may be used to pay for physician-assisted suicide. Fifteen people choose to end their lives during the first year that the Oregon Death with Dignity Act is implemented. March 14: Dr. Jack Kevorkian assists in his 100th suicide involving a 66-year-old man with lung cancer. Sept: Michigan's second law outlawing physician-assisted suicide goes into effect. Nov.: Michigan voters reject a proposal to legalize physician-assisted suicide. Nov.: Dr. Jack Kevorkian is a guest on 60 Minutes , where he shows a videotape of himself administering a lethal injection to Thomas Youk, a 52-year old man with Lou Gehrig's disease. During the broadcast, Kevorkian says that the act is not assisted suicide but euthanasia. The same month he is charged with the first-degree murder. 1999 • Dr. Jack Kevorkian acts as his own lawyer as he stands trial for murder. On April 13, he is convicted of second-degree murder in the death of Thomas Youk and faces a sentence of 10-25 years in prison. In 2001, judges reject his appeal.

• Twenty-seven people choose physician-assisted suicide in the second year it is legal in Oregon. 2000 • Maine voters narrowly reject an initiative to approve the legalization of euthanasia. Nov.: The Dutch Parliament votes to legalize euthanasia for seriously ill patients. The law goes into effect the next year. 2001 • Diane Pretty, a British woman in the advanced stages of motor neuron disease, seeks permission for her husband to end her life but she is denied by the London High Court, the House of Lords, and the European Court of Human Rights. She dies in a hospice a few weeks later. • Attorney General John Ashcroft declares that physician-assisted suicide violates the Controlled Substances Act of 1970 and threatens to revoke the medical licenses of physicians who participate.

2002 • Belgium passes a similar law to the Netherlands, allowing both voluntary euthanasia and physician-assisted suicide. • Thirty-eight people in Oregon end their lives with help from their doctors. 2003 The New York Times reports on " suicide tourists " who travel to Switzerland to end their lives legally. 2004 The Ninth Circuit Court of Appeals rules against Attorney General John Ashcroft's assertion that Oregon's Death with Dignity Act violates the Controlled Substances Act. 2005 A Florida Circuit Court judge rules that the feeding tube be removed from Terri Schiavo, a woman who collapsed in her home at the age of 26 and has been living for 15 years in a persistent vegetative state. Her husband's petition to have her feeding tube removed in 1998 precipitated a seven-year legal battle with her parents. The case garners national attention and protest from religious and political leaders, including Florida Governor Jeb Bush and President George W. Bush, who signs a bill to keep Schiavo alive. The Supreme Court is asked to intervene but refuses six times. In the end, Terri Schiavo's tube is removed and she dies 13 days later on March 31. 2006 • The U.S. Supreme Court rules 6-3 in Gonzales v. Oregon that the Controlled Substances Act does not authorize the attorney general to ban the use of controlled substances for physician-assisted suicide in Oregon. Dec.: Jack Kevorkian is granted parole in six months if he promises to not conduct any more assisted suicides. 2007 June 1: Jack Kevorkian is released from prison. 2008 June 11: A multiple sclerosis sufferer who wants her husband to help her end her life wins a landmark ruling in the United Kingdom. Two judges grant her permission "to bring a High Court challenge forcing the Director of Public Prosecutions to clarify under what circumstances people can be prosecuted for helping a loved one to die." June 28: A healthy 79-year-old German woman kills herself with the aid of another because she did not want to live in a nursing home. Nov.: Washington voters approve a proposition to allow physicians to prescribe lethal doses of medication to terminally ill people who want to end their lives. Washington is the second state, after Oregon, to legalize assisted suicide . 2009 May 23: A woman with pancreatic cancer becomes the first person in Washington to die under the assisted-suicide law. Sept. 23: Great Britain clarifies its laws on assisted suicide and outlines ways a person who helps another person die will escape punishment.

2010

Jan. 2: Montana becomes the third U.S. state to legalize physician-assisted suicide . June 26: Germany’s highest court rules “it is not a criminal offense to cut off life-sustaining treatment for a patient who so desires.” The verdict is expected to lead to significant changes in the practice of assisted suicide in Germany.

2011

March 8: India's Supreme Court issues guidelines on the use of euthanasia. May 15: Voters in Zurich reject an attempt to ban assisted suicide and euthanasia. June 3: Dr. Jack Kevorkian dies in a Michigan hospital at the age of 83.

2012

Feb. 7: The Georgia Supreme Court rules that a law aimed at limiting and controlling assisted suicide is unconstitutional.

2013May 20: The state of Vermont legalizes doctor-assisted suicide.

June 10: Quebec announces it is poised to legalize euthanasia. In June 2014, Quebec joins the Netherlands, Belgium and Luxembourg "as one of the few jurisdictions in the world to allow physicians to administer lethal injections to suffering patients."

July 31: An appeals court in London upholds a law against euthanasia.

2014

Jan. 14: A ruling in New Mexico "clears the way for competent, terminally ill patients to seek their doctors' help in getting prescription medication if they want to end their lives on their own terms."

Feb. 14: Belgium passes new right-to-die legislation that allows euthanasia for terminally ill children of any age.

Nov. 1: After moving from California to Oregon to take advantage of Oregon's Death with Dignity Law, Brittany Maynard ends her life with drugs prescribed by her doctor.

Source CEuthanasia’s Slippery Slope

By Charles Lane

Lane, Charles. "Euthanasia's Slippery Slope." Washington Post. 20 Aug. 2015: A.15. SIRS Issues Researcher. Web. 10 Feb.

2016.

If you were a psychiatrist and a chronically depressed patient told you he wanted to die, what would you do?

In Belgium, you might prescribe this vulnerable, desperate person a fatal dose of sodium thiopental.

Between October 2007 and December 2011, 100 people went to a clinic in Belgium's Dutch-speaking region with depression, or schizophrenia, or, in several cases, Asperger's syndrome, seeking euthanasia. The doctors, satisfied that 48 of the patients were in earnest, and that their conditions were "untreatable" and "unbearable," offered them lethal injection; 35 went through with it.

These facts come not from a police report but an article by one of the clinic's psychiatrists, Lieve Thienpont, in the British journal BMJ Open. All was perfectly legal under Belgium's 2002 euthanasia statute, which applies not only to terminal physical illness, still the vast majority of cases, but also to an apparently growing minority of psychological ones. Official figures show nine cases of euthanasia due to "neuropsychiatric" disorders in the two-year period 2004-2005; in 2012-2013, the number had risen to 120, or 4 percent of the total.

Next door in the Netherlands, which decriminalized euthanasia in 2002, right-to-die activists opened a clinic in March 2012 to "help" people turned down for lethal injections by their regular physicians. In the next 12 months, the clinic approved euthanasia for six psychiatric patients, plus 11 people whose only recorded complaint was being "tired of living," according to a report in the Aug. 10 issue of JAMA Internal Medicine.

If you find this sinister, I agree. Bioethicists Barron H. Lerner and Arthur L. Caplan, who reviewed the data from the Low Countries in JAMA Internal Medicine, observe that the reports "seem to validate concerns about where these practices might lead."

That's putting it mildly. Thienpont acknowledges that "the concept of 'unbearable suffering' has not yet been defined adequately" and that "there are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium."

Yet she and her colleagues continue to put the mentally ill to death, insisting that they are respecting their wishes -- though, as she writes, "further studies are recommended."

Thienpont's co-author Wim Distelmans, a leading advocate of euthanasia, has ended the life of a 44-year-old who was anguished, but not terminally ill, due to a botched sex-change operation. Distelmans also put to death identical 45-year-old deaf twins who said they lost the will to live upon learning they would eventually go blind.

Frank van den Bleeken, imprisoned for 30 years for rape and murder, sought euthanasia from Distelmans, citing his incurable violent impulses and the misery of life behind bars. Belgian officials and Distelmans initially agreed; a lethal

injection the murderer might have gotten as punishment in the United States would be supplied as therapy in anti-death penalty Europe.

In January, however, Distelmans backed out just before the scheduled procedure -- there was still hope for van den Bleeken to get treatment at a facility in the Netherlands, he said.

Distelmans faced little accountability either way. The body empowered to scrutinize his actions, after the fact, was Belgium's Euthanasia Control and Evaluation Commission -- of which he is co-chairman. It has reviewed thousands of cases since 2002 but referred exactly none to law enforcement.

The "very worrisome" trends in Europe "should give us pause" about where the "assisted dying" movement might lead in this country, Lerner and Caplan write.

To be sure, by authorizing doctors to administer lethal drugs, in terminal and non-terminal cases, the Benelux countries go far beyond laws in Oregon and four other states, which permit physicians to prescribe, not administer, a fatal dose -- and only in cases of terminal physical illness.

Those limitations, and their effectiveness since Oregon adopted its law in 1997, help explain why 24 states, and the District, are considering assisted-suicide legislation, which 68 percent of the public supports in some form, according to a Gallup poll.

What's noteworthy about euthanasia in Europe, though, has been its tendency to expand, once the taboo against physician-aided death was breached in favor of more malleable concepts such as "patient autonomy."

"What is presented at first as a right is going to become a kind of obligation," Belgian law professor Etienne Montero has warned.

In 2013, euthanasia accounted for one of every 28 deaths in the Netherlands, three times the rate of 2002. In the Dutch-speaking part of Belgium, one of every 22 deaths was due to euthanasia in 2013, a 142 percent increase since 2007. Belgium has legalized euthanasia for children under 12, though only for terminal physical illness; no child has yet been put to death.

The United States, like Europe, is aging, with all that implies for the spread of Alzheimer's and other cognitive disorders. If pressure rises for more doctor-assisted death, Lerner and Caplan insist, "physicians must remain primarily healers."

"Part of the problem with the slippery slope," they write, "is that you never know when you are on it."

Source DAssisted-Suicide Laws' Contagious Effect

Kheriaty, Aaron. "Assisted-Suicide Laws' Contagious Effect." Washington Post. 22 Nov. 2015: A.27. SIRS Issues

Researcher. Web. 10 Feb. 2016.

By Aaron Kheriaty

The debate over doctor-assisted suicide is often framed as an issue of personal autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who - assuming they are of sound mind - are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences.

What if it turns out that the individuals who make this choice in fact are influencing the actions of those who follow? Ironically, on the same day that Gov. Jerry Brown (D) signed the bill to legalize physician-assisted suicide in California last month, an important study was published by British scholars David Jones and David Paton demonstrating that legalizing assisted suicide in other states has led to a rise in overall suicide rates - assisted and unassisted - in those states. The study's key findings show that, after controlling for demographic and socioeconomic factors and other state-specific issues, physician-assisted suicide is associated with a 6.3 percent increase in total suicide rates. These effects are greater for individuals older than 65 (for whom the associated increase was 14.5 percent). The results should not surprise anyone familiar with the literature on the social contagion effects of suicidal behavior. You don't discourage suicide by assisting suicide.

Consider what social scientists call the Werther effect - the fact that publicized cases of suicide can produce clusters of copycat cases, often disproportionately affecting young people, who frequently use the same method as the original case. The name comes from Goethe's 18th-century novel "The Sorrows of Young Werther," in which the protagonist, thwarted in his romantic pursuits, takes his own life with a pistol. After the publication of this immensely popular book, authorities in Germany noted a rash of suicides among young men using the same means. This finding has been replicated many times since in rigorous epidemiological studies, including research demonstrating this effect following cases of doctor-assisted suicide.

Because this phenomenon is well validated, the U.S. Centers for Disease Control and Prevention, the World Health Organization and the U.S. surgeon general have published strict journalistic guidelines for reporting on suicides to minimize this effect. It is demoralizing to note that these guidelines were widely ignored in the reporting of recent instances of assisted suicide, with the subject's decision to end his or her life frequently presented in the media as inspiring and even heroic.

A related phenomenon influences suicide trends in the opposite direction, however; the so-called Papageno effect suggests that coverage of people with suicidal ideation who do not attempt suicide but instead find strategies that help them to cope with adversity is associated with decreased suicide rates. The name comes from a lovesick character in Mozart's opera "The Magic Flute," whose planned suicide is averted by three child spirits who remind him of alternatives to death.

The case of Valentina Maureira, a 14-year-old Chilean girl who made a YouTube video begging her government for assisted suicide, illustrates the Werther and Papageno effects. Maureira admitted that the idea to end her life began after she heard about the case of Brittany Maynard, a 29-year-old woman with terminal brain cancer who campaigned prominently for the right to assisted suicide before ending her life last year. But Maureira changed her mind after meeting another young person also suffering from the same disease, cystic fibrosis, who conveyed a message of hope

and encouraged her to persevere in the face of adversity. With our laws, we can encourage vulnerable individuals in one of these two directions: the path of Werther or the path of Papageno.

Aside from publicized cases, there is evidence that suicidal behavior tends to spread person to person through social networks, up to three "degrees of separation" away. So my decision to take my own life would affect not just my friends' risk of doing the same, but even my friends' friends' friends. No person is an island.

Finally, it is widely acknowledged that the law is a teacher: Laws shape the ethos of a culture by affecting cultural attitudes toward certain behaviors and influencing moral norms. Laws permitting physician-assisted suicide send a message that, under especially difficult circumstances, some lives are not worth living - and that suicide is a reasonable or appropriate way out. This is a message that will be heard not just by those with a terminal illness but also by anyone tempted to think he or she cannot go on any longer.

Debates about physician-assisted suicide raise broad questions about our societal attitudes toward suicide. Recent research findings on suicide rates press the question: What sort of society do we want to become? Suicide is already a public health crisis. Do we want to legalize a practice that will worsen this crisis?

The writer is an associate professor of psychiatry and director of the medical ethics program at the University of California at Irvine School of Medicine. This piece is adapted from a longer commentary that appeared in the Southern Medical Journal in October.

Source EAid-in-Dying Advocacy Group Girds for Battles After California Victory

Galewitz, Phil. "Aid-in-Dying Advocacy Group Girds for Battles After California Victory." Kaiser Health News. 19 Nov. 2015:

n/a. SIRS Issues Researcher. Web. 10 Feb. 2016.

By Phil Galewitz

Fresh off a political triumph in California, the nation's chief advocacy group for physician-assisted suicide laws is mobilizing for many more battles on behalf of terminally ill patients. Since Democratic Gov. Jerry Brown signed California's end-of-life options bill last month, a new chapter is starting for Compassion & Choices, a Denver-based nonprofit that led the campaign for the measure and has pushed for such laws for nearly 19 years. California is the fifth state, and largest by far, to allow physicians to prescribe lethal doses of drugs to patients who want to end their lives in their last stages of terminal illnesses. Aid-in-dying bills were introduced this year in 23 state legislatures, plus in the District of Columbia, up from four last year, according to Compassion & Choices. Despite formidable opposition from the Catholic Church, disabled rights groups and parts of the medical community, the group sees its strength growing. Contributions and grants reached $17.1 million in the 2013-2014 fiscal year, more than double the previous five years' average, its latest IRS filings on Charity Navigator show. A $2 million contribution from billionaire financier George Soros' Open Society Foundations was the third largest from more than 50,000 donors. Compassion & Choices' volunteer force has tripled since mid-2014, numbering about 3,500 now, according to the group. The shift in statehouse sentiment is powered by polls measuring a sizeable boost in public support for doctors helping terminally ill patients die--68 percent favored it in 2015, a 17-point swing in two years, according to Gallup. The polling firm credits the impact of the national spotlight on Brittany Maynard's death one year ago on Nov. 1. A California newlywed with terminal brain cancer, Maynard chose to end her life on her terms in Oregon where the state allowed physicians to prescribe lethal drugs. Compassion & Choices connected with Maynard through a friend, and then worked to publicize her story, assisting in producing two widely-watched video interviews on YouTube and helping line up a People magazine article that put her on the cover shortly before her death at age 29. Maynard spoke movingly about why she chose to control the timing of her death and spare herself and her family the added pain of waiting for a natural death. Her story put a compelling human face on an emotionally sensitive national debate that Compassion & Choices played an influential part in shaping. "Brittany was young and full of life and saw her life horribly interrupted by brain cancer," said Jessica Grennan, national political advocacy director for the group. "She could talk about what her wishes were and do so eloquently ... and that really made everyone question what they wanted at the end of their life." Compassion & Choices is embracing that lesson as its campaign expands. As more states take up the aid-in-dying issue, Grennan said her group will continue using individual stories to educate the public and lawmakers. In late October, Maynard's husband, Dan Diaz, met with Massachusetts' lawmakers and testified at a hearing in Boston. The New Jersey Senate is expected to vote on the issue in the next two months following last year's approval in the state House.

California's law is expected to take effect next year, but opponents hope to get enough signatures for a ballot initiative to overturn it next November. Personal stories will continue to make the difference in getting lawmakers' support, said Barbara Coombs Lee, the group's president. "Individual stories are always what move people because they think, 'Oh, but for the grace of God, go I,'" Coombs Lee said. "We have been so fortunate to have the resources to take the charge Brittany gave us and use it to see new laws passed. ... It has been nothing short of a miracle." In fact, Compassion & Choices campaigned hard to build support for the California law and then persuade legislators and Brown to back a bill. Compassion & Choices collected endorsements from several city councils, including Los Angeles, and submitted sympathetic opinion articles to major newspapers. In addition to generating news coverage, the organization directed funds to California. In 2014 and 2015, it spent $150,000 on online advertising and other types of outreach and $500,000 on focus groups, polling and other efforts to sway lawmakers and public opinion in the state, the group said. Part of what Compassion & Choices has done is reframe the end-of-life debate on different terms. For instance, Catholic leaders have called laws such as California's "assisted suicide" and argue that actively ending life is immoral and could cause some patients to die early for convenience of others. "In a health care system grappling with constantly escalating costs, the elderly and disabled are in great peril now that assisted suicide has become legal," the state's Catholic bishops said in a statement on Oct. 5 after Brown signed the End-of-Life Option Act. In contrast, Compassion & Choices argues that "aid in dying" is the most neutral term to describe measures that some advocates call "death with dignity" and some opponents label "assisted suicide." The group insists assisted suicide does not accurately describe terminally ill, but mentally competent, people who request life-ending medication that must be self-administered. The Associated Press Stylebook, widely used by news media, advises laws such as California's be described as "medically assisted suicide" and allowing "the terminally ill to end their own lives with medical assistance." Coombs Lee has spearheaded lawmaking on behalf of the terminally ill for two decades. A former nurse turned attorney, she helped draft the ballot initiative that Oregon voters adopted to create the nation's first aid-in-dying law in 1994. Since then, Compassion & Choices has helped win similar authorizations through ballot initiatives, legislation and court rulings in Vermont, Montana and Washington, in addition to California. New Mexico's law is suspended while under review by the state's highest court after conflicting decisions in two lower courts in 2014 and 2015. The group Coombs Lee leads formed through a 2003 merger between two forerunners: Compassion in Dying, which Coombs Lee helped found in 1996, and the Hemlock Society, founded in 1980. With a unified front now on lobbying activities, Compassion & Choices counts 71 full-time employees, up from 46 in 2013, and, along with its Denver headquarters, keeps offices in California, Oregon, Montana and New Mexico. Compassion & Choices' volunteers run phone banks, lead rallies and host parties to promote its side of the aid-in-dying debate. Its website invites people with end-of-life issues to share their stories there. Nationally, health professionals are split on measures aiding people who wish to die. Physicians' powerful lobbying group, the American Medical Association, remains opposed while the American Public Health Association, whose wider constituency includes public health policymakers, public health nurses and even restaurant inspectors, favors medically assisted suicide laws. Despite social acceptance of hospice and palliative care for the terminally ill, both have their limits in controlling pain. Coombs Lee said people still have a need and the right to control how they die.

"What keeps me going all these years is knowing the comfort and peace of mind that giving people this option for aid in dying brings to people looking at death in the face," she said. "Whether they fill the prescription or not and whether they ingest the medication or not just having the option gives them a sense of control."

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Title: Aid-in-Dying Advocacy Group Girds for Battles After California VictorySource: Kaiser Health NewsAuthor: Galewitz, PhilPublication Date: Nov 19, 2015Page Number: n/aDatabase: SIRS Issues Researcher 

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