Euthanasia in the United States

Euthanasia is illegal in all states of the United States. Physician aid in dying (PAD), or assisted suicide, is legal in the states of Washington, Oregon, Montana, and Vermont. The key difference between euthanasia and PAD is who administers the lethal dose of medication. Euthanasia entails the physician or another third party administering the medication, whereas PAD requires the patient to self-administer the medication and to determine whether and when to do this. Attempts to legalize PAD resulted in ballot initiatives and "legislation bills" within the United States of America in the last 20 years. For example, the state of Washington voters saw Ballot Initiative 119 in 1991, the state of California placed Proposition 161 on the ballot in 1992, Oregon voters passed Measure 16 (Death with Dignity Act) in 1994, the state of Michigan included Proposal B in their ballot in 1998, and Washington's Initiative 1000 passed in 2008. Vermont's state legislature passed a bill making PAD legal in May 2013.

Early history

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

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

Several major court cases advanced the legal rights of patients, or their guardians, to practice at least voluntary passive euthanasia (physician assisted death). These include the Karen Ann Quinlan (1976), Brophy and Nancy Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg (1997) and the Terri Schiavo case.

In a 2004 article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. The driving force behind this movement was social activist Anna S. Hall. Canadian historian Ian Dowbiggen's 2003 book, A Merciful End, revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

Legislation and political movements

California

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

Montana

On December 5, 2008, state District Court judge Dorothy McCarter ruled in favor of a terminally ill Billings resident who had filed a lawsuit with the assistance of Compassion & Choices, a patient rights group. The ruling states that competent, terminally ill patients have the right to self-administer lethal doses of medication as prescribed by a physician. Physicians who prescribe such medications will not face legal punishment. On December 31, 2009, the Montana Supreme Court delivered its verdict in the case of Baxter v. Montana. The court held that there was "nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy."

New Jersey

In the United States legal and ethical debates about euthanasia became more prominent in the case of Karen Ann Quinlan who went into a coma after allegedly mixing tranquilizers with alcohol, surviving biologically for 9 years in a "persistent vegetative state" even after the New Jersey Supreme Court approval to remove her from a respirator. This case cause a widespread public concern about "lives not worth living" and the possibility of at least voluntary euthanasia if it could be ascertained that the patient would not have wanted to live in this condition.

Oregon

Measure 16 in 1994 established the Oregon Death with Dignity Act, which legalizes physician-assisted dying with certain restrictions, making Oregon the first U.S. state and one of the first jurisdictions in the world to officially do so. The measure was approved in the 8 November 1994 general election in a tight race with the final tally showing 627,980 votes (51.3%) in favor, and 596,018 votes (48.7%) against. The law survived an attempted repeal in 1997, which was defeated at the ballot by a 60% vote. In 2005, after several attempts by lawmakers at both the state and federal level to overturn the Oregon law, the Supreme Court of the United States ruled 6-3 to uphold the law after hearing arguments in the case of Gonzales v. Oregon.

Texas

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

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

Washington

In 2008, the electorate of the state of Washington voted in favor of Initiative 1000 which made assisted suicide legal in the state through the Washington Death with Dignity Act.

Vermont

On May 20 2013, Vermont Governor Peter Shumlin signed a legislative bill making PAD legal in Vermont.

Unsuccessful initiatives

Attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and legislation bills within the United States in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, Oregon passed the Death with Dignity Act in 1994, and Michigan included Proposal B in their ballot in 1998. Despite the earlier failure, in November 2008 euthanasia was approved in Washington by Initiative 1000.

The California Compassionate Choices Act was introduced in 2005, patterned after Oregon's Death with Dignity Act. After being defeated in 2006, it was introduced as AB 374 in 2007.

In 2000, Maine voters defeated a referendum to legalize physician-assisted suicide. The proposal was defeated by a 51%-49% margin.

U.S. public opinion on euthanasia

Reflecting the religious and cultural diversity of the United States, there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States. During the past 30 years, public research shows that views on euthanasia tend to correlate with religious affiliation and culture, though not gender.

Opinion by religious affiliation

In one recent study dealing primarily with Christians, Southern Baptists, Pentecostals, and Evangelicals and Catholics tended to be opposed to euthanasia. Moderate Protestants, (e.g., Lutherans and Methodists) showed mixed views concerning end of life decisions in general. Both of these groups showed less support than non-affiliates, but were less opposed to it than conservative Protestants. Respondents that did not affiliate with a religion were found toProtestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were not similar to those of non-affiliates. Within all groups, religiosity (i.e., self-evaluation and frequency of church attendance) also correlated to opinions on euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed to euthanasia than to those who had a lower level of religiosity.

Opinion by race and gender

Recent studies have shown white Americans to be more accepting of euthanasia than black Americans. They are also more likely to have advance directives and to use other end-of-life measures. Black Americans are almost 3 times more likely to oppose euthanasia than white Americans. The main reason for this discrepancy is attributed to the lower levels of trust in the medical establishment. Researchers believe that past history of medical abuses towards minorities (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. Studies have also found that there are significant disparities in the medical treatment and pain management that white Americans and other Americans receive.

Among black Americans, education correlates to support for euthanasia. Black Americans without a four-year degree are twice as likely to oppose euthanasia than those with at least that much education. Level of education, however, does not significantly influence other racial groups in the US. Some researchers suggest that black Americans tend to be more religious, a claim that is difficult to substantiate and define. Only black and white Americans have been studied in extensive detail. Although it has been found that minority groups are less supportive of euthanasia than white Americans, there is still some ambiguity as to what degree this is true.

A recent Gallup Poll found that 84% of males supported euthanasia compared to 64% of females. Some cite the prior studies showing that women have a higher level of religiosity and moral conservatism as an explanation. Within both sexes, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that black American women are 2.37 times more likely to oppose euthanasia than white American women. Black American men are 3.61 times more likely to oppose euthanasia than white American men.

In “Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia” Susan M. Wolf warns of the gender disparities if euthanasia or physician-assisted suicide were legal. Wolf highlights four possible gender effects: higher incidence of women than men dying by physician-assisted suicide; more women seeking physician-assisted suicide or euthanasia for different reasons than men; physicians granting or refusing requests for assisted suicide or euthanasia because of the gender of the patient; gender affecting the broad public debate by envisioning a woman patient when considering the debate.

See also

• Assisted suicide in the United States
• Baxter v. Montana
• Karen Ann Quinlan and Terri Schiavo case - cases of persistent vegetative state
• Principle of double effect
• Terry Wallis

Further reading

• Appel, Jacob M. 2004. "A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906" in Bulletin of the History of Medicine, Volume 78, Number 3, pp. 610–634.
• Emanuel, Ezekiel J. 2004. "The history of euthanasia debates in the United States and Britain" in Death and dying: a reader, edited by T. A. Shannon. Lanham, MD: Rowman & Littlefield Publishers.
• Kamisar, Yale. 1977. Some non-religious views against proposed 'mercy-killing' legislation in Death, dying, and euthanasia, edited by D. J. Horan and D. Mall. Washington: University Publications of America. Original edition, Minnesota Law Review 42:6 (May 1958).
• Magnusson, Roger S. “The sanctity of life and the right to die: social and jurisprudential aspects of the euthanasia debate in Australia and the United States” in Pacific Rim Law & Policy Journal (6:1), January 1997.
• Stone, T. Howard, and Winslade, William J. “Physician-assisted suicide and euthanasia in the United States” in Journal of Legal Medicine (16:481-507), December 1995.