Euthanasia in the United States
Encyclopedia
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
, and Montana
. 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.
, 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.
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
.
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."
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
.
. 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." However, some have lived past the age of 19 with TD.
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 2009, Maine voters defeated a referendum to legalize physician-assisted suicide. The proposal was defeated by a 51%-49% margin.
A 2002 Gallup survey showed that 72% of Americans supported 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 to support euthanasia more than those who did. The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were 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.
) 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.
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
is illegal in all states of the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
. Physician aid-in-dying (PAD), or assisted suicide
Assisted suicide
Assisted suicide is the common term for actions by which an individual helps another person voluntarily bring about his or her own death. "Assistance" may mean providing one with the means to end one's own life, but may extend to other actions. It differs to euthanasia where another person ends...
, is legal in the states of Washington, Oregon
Oregon
Oregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern...
, and Montana
Montana
Montana is a state in the Western United States. The western third of Montana contains numerous mountain ranges. Smaller, "island ranges" are found in the central third of the state, for a total of 77 named ranges of the Rocky Mountains. This geographical fact is reflected in the state's name,...
. 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
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
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
Oregon Ballot Measure 16 (1994)
Measure 16 of 1994 established the U.S. state of Oregon's Death with Dignity Act , which legalizes physician-assisted dying with certain restrictions. Passage of this initiative made Oregon the first U.S...
) in 1994, the state of Michigan included Proposal B in their ballot in 1998, and Washington's Initiative 1000 passed in 2008.
Early history
In a 2004 article in the Bulletin of the History of MedicineBulletin of the History of Medicine
The Bulletin of the History of Medicine is an academic journal founded in 1939. It is the official publication of the American Association for the History of Medicine. It is also the official publication of the Johns Hopkins Institute of the History of Medicine...
, Brown University historian Jacob M. Appel
Jacob M. Appel
Jacob M. Appel is an American author, bioethicist and social critic. He is best known for his short stories, his work as a playwright, and his writing in the fields of reproductive ethics, organ donation, neuroethics and euthanasia....
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
Clarence Darrow
Clarence Seward Darrow was an American lawyer and leading member of the American Civil Liberties Union, best known for defending teenage thrill killers Leopold and Loeb in their trial for murdering 14-year-old Robert "Bobby" Franks and defending John T...
and Jack London
Jack London
John Griffith "Jack" London was an American author, journalist, and social activist. He was a pioneer in the then-burgeoning world of commercial magazine fiction and was one of the first fiction writers to obtain worldwide celebrity and a large fortune from his fiction alone...
, played in advocating for the legalization of euthanasia.
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
Do not resuscitate
In medicine, a "do not resuscitate" or "DNR" is a legal order written either in the hospital or on a legal form to respect the wishes of a patient to not undergo CPR or advanced cardiac life support if their heart were to stop or they were to stop breathing...
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
Karen Ann Quinlan
Karen Ann Quinlan was an important figure in the history of the right to die controversy in the United States....
(1976), Brophy and Nancy Cruzan
Nancy Cruzan
Nancy Beth Cruzan was a figure in the right-to-die movement. After an automobile accident left her in a persistent vegetative state, her family petitioned in courts for three years, as far as the U.S. Supreme Court , to have her feeding tube removed...
cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg
Washington v. Glucksberg
Washington v. Glucksberg, 521 U.S. 702 , was a case in which the Supreme Court of the United States unanimously held that a right to assistance in committing suicide was not protected by the Due Process Clause.-Facts:Dr...
(1997) and the Terri Schiavo case
Terri Schiavo case
The Terri Schiavo case was a legal battle in the United States between the legal guardians and the parents of Teresa Marie "Terri" Schiavo that lasted from 1998 to 2005...
.
Montana
On December 5, 2008, state District Court judge Dorothy McCarter ruled in favor of a terminally ill BillingsBillings, Montana
Billings is the largest city in the U.S. state of Montana, and is the principal city of the Billings Metropolitan Area, the largest metropolitan area in over...
resident who had filed a lawsuit with the assistance of Compassion & Choices
Compassion & Choices
Compassion & Choices is a nonprofit organization in the United States working to improve patients' rights and choices at the end of life...
, 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
Montana Supreme Court
The Montana Supreme Court is the highest court of the Montana state court system in the U.S. state of Montana. It is established and its powers defined by Article VII of the 1972 Montana Constitution...
delivered its verdict in the case of Baxter v. Montana
Baxter v. Montana
Baxter v. Montana, was a Montana Supreme Court case, argued on September 2, 2009, and decided on December 31, 2009, that addressed the question of whether the state's constitution guaranteed terminally ill patients a right to lethal prescription medication from their physicians.-Background of the...
. 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."
Oregon
Ballot 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. stateU.S. state
A U.S. state is any one of the 50 federated states of the United States of America that share sovereignty with the federal government. Because of this shared sovereignty, an American is a citizen both of the federal entity and of his or her state of domicile. Four states use the official title of...
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
Supreme Court of the United States
The Supreme Court of the United States is the highest court in the United States. It has ultimate appellate jurisdiction over all state and federal courts, and original jurisdiction over a small range of cases...
ruled 6-3 to uphold the law after hearing arguments in the case of Gonzales v. Oregon
Gonzales v. Oregon
Gonzales v. Oregon, 546 U.S. 243 , was a decision by the United States Supreme Court, which ruled that the United States Attorney General could not enforce the federal Controlled Substances Act against physicians who prescribed drugs, in compliance with Oregon state law, for the assisted suicide of...
.
Texas
In 1999, the state of Texas passed the Texas Futile Care LawAdvance Directives Act
The Texas Advance Directives Act , also known as the Texas Futile Care Law, describes certain provisions that are now Chapter 166 of the Texas Health & Safety Code...
. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support
Life support
Life support, in medicine is a broad term that applies to any therapy used to sustain a patient's life while they are critically ill or injured. There are many therapies and techniques that may be used by clinicians to achieve the goal of sustaining life...
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
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
, Sun Hudson, with a uniformly fatal disease thanatophoric dysplasia
Thanatophoric dysplasia
Thanatophoric dysplasia is a severe skeletal disorder characterized by extremely short limbs and folds of extra skin on the arms and legs.-Symptoms:Infants with this condition have disproportionately short arms and legs with extra folds of skin...
, 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." However, some have lived past the age of 19 with TD.
Washington
In 2008, the electorate of the state of Washington voted in favor of Intiative 1000 which made assisted suicide legal in the state through the Washington Death with Dignity Act.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 ActOregon Ballot Measure 16 (1994)
Measure 16 of 1994 established the U.S. state of Oregon's Death with Dignity Act , which legalizes physician-assisted dying with certain restrictions. Passage of this initiative made Oregon the first U.S...
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 2009, 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 opinion research shows that views on euthanasia tend to correlate with religious affiliation and culture, though not gender.A 2002 Gallup survey showed that 72% of Americans supported euthanasia.
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
Lutheranism
Lutheranism is a major branch of Western Christianity that identifies with the theology of Martin Luther, a German reformer. Luther's efforts to reform the theology and practice of the church launched the Protestant Reformation...
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 to support euthanasia more than those who did. The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were 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, though this difference may be explained by other factors. 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 StudyTuskegee Syphilis Study
The Tuskegee syphilis experiment was an infamous clinical study conducted between 1932 and 1972 in Tuskegee, Alabama by the U.S. Public Health Service to study the natural progression of untreated syphilis in poor, rural black men who thought they were receiving free health care from the U.S...
) 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
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
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 StatesAssisted suicide in the United StatesPhysician-assisted suicide in the United States is legal in the states of Oregon, Montana and Washington.The process is set forth in law, including the requirements that the patient must be of sound mind when requesting assisted suicide, as confirmed by a doctor and other witnesses; and the patient...
- Karen Ann QuinlanKaren Ann QuinlanKaren Ann Quinlan was an important figure in the history of the right to die controversy in the United States....
and Terri Schiavo caseTerri Schiavo caseThe Terri Schiavo case was a legal battle in the United States between the legal guardians and the parents of Teresa Marie "Terri" Schiavo that lasted from 1998 to 2005...
- cases of persistent vegetative statePersistent vegetative stateA persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is... - Principle of double effectPrinciple of double effectThe principle of double effect; also known as the rule of double effect; the doctrine of double effect, often abbreviated as DDE or PDE; double-effect reasoning; or simply double effect, is a set of ethical criteria for evaluating the permissibility of acting when one's otherwise legitimate act...
- Terry WallisTerry WallisTerry Wallis is an American man living in the Ozark Mountains of Arkansas who on June 11, 2003 regained awareness after spending almost 20 years in a minimally conscious state....
- Baxter v. MontanaBaxter v. MontanaBaxter v. Montana, was a Montana Supreme Court case, argued on September 2, 2009, and decided on December 31, 2009, that addressed the question of whether the state's constitution guaranteed terminally ill patients a right to lethal prescription medication from their physicians.-Background of the...
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.