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Euthanasia in the United States

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This page is about euthanasia. For assisted suicide, see Assisted suicide in the United States.

Euthanasia or mercy killing is illegal in all fifty states in the United States[1] though it is legal in Canada [2], Luxembourg, Netherlands, Belgium[3] , and Colombia[4]  and Switzerland. [5] There is debate on the correct terminology, but the key difference between euthanasia and assisted suicide is that in cases of assisted suicide, the individual receives assistance, but ultimately voluntarily causes their own death. In euthanasia the individual does not directly end their life, but another person acts to cause the individual's death.[6]

In the United States, six states [7] and the jurisdiction of Washington DC [8] have legalized physician-assisted suicide, while in the state of Montana [9]it is permissible under a 2009 Supreme Court verdict.

Terminology

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The term euthanasia comes from the Greek words "eu"-meaning good and "thanatos"-meaning death, which combined means “well-death” or "dying well"[10]. Voluntary [11]euthanasia refers to when the request for death comes from the patient. Passive [12]euthanasia involves withholding nutrition, and active euthanasia refers to when someone other than the patient, like a physician, actively causes the death of the patient with, for example, the lethal injection of drugs. Involuntary Euthanasia[11] does not involve the person's consent, and is considered murder. In non-voluntary Euthanasia [12] consent is non-obtainable, as is the case for comatose patients or children.

All forms of Euthanasia must be clearly distinguished from assisted suicide [5]where one may provide the means including a plan and drugs but the individual actively takes their own life. When a physician intentionally and with the consent of the patient prescribes lethal drugs to be taken by the patient to end their life, it is called physician assisted suicide[13] or physician aid-in dying.

The firm distinction is made that in Euthanasia the physician administers the lethal drug whereas in physician assisted suicide, the patient self-administers the drug prescribed by the physician.

Table 1. Summary of Terminology

Terminology Definition Legality Famous Cases in United States
Voluntary active euthanasia[14]                    A physician or someone else administers medications, such as narcotics, or another intervention to intentionally cause the patient's death at the patient's explicit request with full informed consent Legal in the Netherlands, Luxemburg, Belgium, Columbia, and parts of Canada Jack Kevorkian, a pathologist in 1999 was convicted of second- degree murder for the televised administration of lethal injection by him to Thomas Youk.[15]
Cessation of life-sustaining treatments (Passive Euthanasia)[16]      Withholding life-sustaining treatments, such as a respirator or artificial tube feeding. Legal in the United States and most other developed countries Terri Schiavo, in 1990, at age 26 went into a persistent vegetative state. Her husband moved to remove her feeding tube. After numerous appeals in state and federal courts, her feeding tube was removed on March 8, 2005, and she died on March 31 ,2005.[17]
Non-voluntary Euthanasia [12] Active euthanasia where consent cannot be directly obtained for example in a comatose individual or infant/child. Euthanasia for children is allowed in Belgium and Colombia.[18][19]
Physician-assisted suicide A physician provides medication as a prescription to be used by eligible patients to end their life by self-ingestion or use Oregon, Montana, Washington, Vermont, California, Colorado, the District of Columbia, the Netherlands, Belgium, Luxemburg, Switzerland, Columbia, Canada, and parts of Germany On December 2009, in the case Baxter vs Montana, the state supreme court ruled that “nothing in Montana Supreme Court precedent or Montana statutes indicated that physician aid in dying is against public policy."[20]
"Double effect" of opioids for pain or dyspnea [21] A physician administers medications like narcotics to alleviate pain knowing there may be other unintended consequences to the medications like hastening death.     Legal in the United States and most other developed countries

Early history

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Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome.[22] After the development of ether, physicians began advocating the use of anesthetics to relieve the pain of death.[23]

Eugenics and the Nazi Involuntary Euthanasia Program

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Eugenics [24] is defined as the science of improving the genetic quality of a human population. The first Nazi eugenics policy, the Law for the Prevention of Hereditarily-Diseased Offspring,[25] was passed in July 1933, requiring registration of all patients with psychiatric illness.

As early as 1920,[26] psychiatrist Alfred Hoche and philosopher Karl Binding advocated for legalized euthanasia for those with mental disabilities who in their view possessed only lebensunwertem lebens (‘life unworthy of living’). Aktion T4[27] began with a "trial" case in late 1938 where Hitler authorized his personal physician Karl Brandt to euthanize a disabled boy at the request of his parents.

In fall of 1939, Euthanasie Programme was underway, under the direction of Dr. Karl Brandt and Philip Bouhler. The headquarters of the operation were at Tiergartenstrasse 4, Berlin and the code name for the program was derived from that address—T-4.There were about 200,000 victims in Germany and Austria from 1939 to 1945,[28] with another additional 100,000 in the Eastern European countries.

Euthanasia in the United States

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History

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New York, in 1828 passed a statute explicitly outlawing assisted suicide.[29] Later, In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient's life.[30] Over the next 35 years, debates about euthanasia raged in the United States, resulting in an Ohio bill to legalize euthanasia in 1906, a bill that was ultimately defeated.[31]

Euthanasia advocacy in the U.S. peaked again during the 1930's and diminished significantly during and after World War II when the Nazi abuse of involuntary euthanasia turned people’s perception against it. [32] Euthanasia efforts resurged in the 1960’s and 1970’s when California legalized a patient's right to refuse life-prolonging treatment. The state legislature passed the Natural Death Act[33], allowing for living wills.

Active Euthanasia in the United States

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In 1980, Derek Humphrey formed the Hemlock Society [34] in Los Angeles, a grassroots organization that promoted the cause of active euthanasia. Hemlock was merged with End of Life Choices in 2003, which changed its name to Compassion and Choices [35].

In 1988 there was controversy over an article published in the Journal of American Medicine [36] entitled “It’s over Debbie”. The article described how a gynecology resident had injected a lethal dose of morphine to a terminal ovarian cancer patient.

Jack Kevorkian

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Jack Kevorkian

Jack Kevorkian, an American pathologist,[37] was involved in the first assisted suicide of a Hemlock society member on June 4, 1990. He went on to create euthanasia devices called the Thanatron and Mercitron that patients could use to end their lives.

The Thanatron[38] had three canisters mounted on a metal frame. Each bottle had a syringe that contained a medication. One contained saline, another contained a sleep-inducing barbiturate called sodium thiopental and the third had a lethal mixture of potassium chloride, which immediately stopped the heart, and a paralytic, pancuronium bromide[37].

The Mercitron[39] device  employed a gas mask fed by a canister of carbon monoxide which was used by the patient to commit suicide.

On March 26, 1999, Jack Kevorkian[40] was charged with second-degree murder for a videotaped administration of a lethal injection to Thomas Youk, who was suffering from Lou-Gehrig’s disease and had given consent to the injection. Kevorkian served eight years in prison and was released on parole in 2007. He died on June 3, 2011 from thrombosis and complications of liver cancer.[37]

Timothy Quill

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Timothy Quill, a physician in Rochester described in an article in the New England Journal of Medicine his rationale and role in the death of a forty five year old woman Diane with leukemia who had requested a humane death.[41] No charges or indictments were brought forth against Dr. Quill and he continues to be an advocate for physician assisted suicide.

Lawrence Egbert

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An anaesthesiologist from Maryland, Egbert became the face of the Euthanasia movement after Kevorkian’s conviction. He was a member of the Final Exit Network [42], an offshoot of the Hemlock society. He claimed to have assisted in hundreds of suicides using asphyxiation by helium. He was stripped of his license in 2014 for his role in six suicides in Maryland.[43]

Recent Non-physician Euthanasia

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Recent convictions include one of a man in the state of Washington who shot his wife, who had terminal brain cancer. Her mental state had declined, so she was not be eligible for Washington’s Death with Dignity law. He got a two year sentence. [44]

U.S. public opinion on euthanasia

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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. In a recent Gallup poll[45] in May 2018, 73% of U.S. adults agree with physician assisted death by painless means in patients with terminal illness and suffering. This consistent with the 69% to 70% Gallup polling has recorded since 2013.The party line breakdown is 81% of Democrats and Democratic-leaning independents as well as 67% of Republicans and Republican leaners support euthanasia. The gender gap in this poll was about 65 % women in favor of euthanasia versus 72% men.

Opinion by religious affiliation

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In the 2018 Gallup poll [45]41% of people in the United States who were weekly church goers supported euthanasia as compared to 78% of seldom or never churchgoers who were in favor of euthanasia with about 58% of those who attended church less regularly being in support of the practice. In a 2013 Pew [46]research poll white Protestants (61%) and about half of white Catholics (55%) approve of laws that allow physician-assisted suicide, as did two-thirds of religiously unaffiliated adults. Black Protestants, white evangelical Protestants and Hispanic Catholics disapproved of laws that allow doctor-assisted suicide by a 2-1 margin.

A systematic review from 2017 summarizes the of religious beliefs about major end-of-life issues in the five major world religions. [47] In the United States, physicians with a Roman Catholic affiliation were three times more likely to object to withdrawal of life support, compared to Protestants and Jews, or no religious affiliation. In Belgium, there was a high rate of opposition to euthanasia among orthodox Jews as opposed to non-orthodox Jews.

Opinion by race and gender on Euthanasia in the United States

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Earlier 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. [48]African Americans were almost 3 times more likely to oppose euthanasia than white Americans.  In Oregon in a 2013 study 66% of African Americans supported euthanasia as opposed to 82% of Whites.[49]

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. African American men are 3.61 times more likely to oppose euthanasia rthan white American men.[50]

Feminism and Euthanasia

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In "Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia [51]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.

Prominent feminist and writer Charlotte Perkins Gilman [52], who had terminal breast cancer took her own life in 1938 and was an early champion of euthanasia. Sandra Bem [53], a prominent psychologist and feminist had progressive Alzheimer’s disease and took her life in 2014 in her home.

Experiences with Euthanasia in the World

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Netherlands

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Netherlands in April 2002 became the first country to legalize euthanasia and reported 6585 assisted deaths in 2017, increasing by 8% from 6091 reported assisted deaths in 2016.[54] Recent controversy has ensued over the rise in assisted deaths and the investigation into the death of a woman with severe dementia.[55]

Belgium

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Belgium passed a law in 2002 legalizing euthanasia, becoming the second country in the world to do so. Belgium is the first country in the world that authorized euthanasia at all ages legalizing in February 2014.[18] In 2003, there were 235 euthanasia cases, representing 0.2 percent of nationwide deaths, and in 2013, there were 1,807 cases[56], which was 1.7 percent of deaths.[57]

Switzerland

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Swiss law only allows for providing the means to commit suicide, and reasons for doing so must not be based on self-gain or self-interest.[58]

The Swiss have been tolerant of organizations like Dignitas and Exit which provide assisted dying services for a fee. This has given rise to concerns about death tourism. Recently the Australian scientist David Goodall, [59] a member of Exit international, made headlines when he went to Switzerland for a voluntary death. In 2017, 734 people ended their lives using Exit’s services compared to 723 the year before.

Colombia

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Colombia is the only Latin-American country where euthanasia has been legal since 1997. On March 9, 2018, Colombia passed a resolution permitting euthanasia for children. [19]

See also

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References

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  1. ^ Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Current oncology (Toronto, Ont.), 18(2), e38-45.
  2. ^ Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Jama, 316(1), 79-90.
  3. ^ Buiting, H., van Delden, J., Onwuteaka-Philpsen, B., Rietjens, J., Rurup, M., van Tol, D., Gevers, J., van der Maas, P., … van der Heide, A. (2009). Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study. BMC medical ethics, 10, 18. doi:10.1186/1472-6939-10-18  
  4. ^ Redacción Salud (19 February 2015). "Los principios para regular la eutanasia"(in sp). ElEspectador.com.CS1 maint:  
  5. ^ a b Hurst SA, Mauron A (February 2003). "Assisted suicide and euthanasia in Switzerland: allowing a role for non-physicians". BMJ. 326 (7383): 271–  
  6. ^ Harris, D (2006). "Assisted dying: the ongoing debate". Postgraduate Medical Journal. 82 (970): 479–482. doi:10.1136/pgmj.2006.047530. ISSN 0032-5473. PMC2585714
  7. ^ State Appeals Court Reinstates California's Right-To-Die Law". The New York Times. 15 June 2018. Retrieved 17 June 2018.
  8. ^ http://www.washingtontimes.com, The Washington Times. "D.C. physician-assisted suicide law goes into effect".  
  9. ^ http://www.washingtontimes.com, The Washington Times. "D.C. physician-assisted suicide law goes into effect".  
  10. ^ Dowbiggin, I. (2007). A concise history of euthanasia: life, death, God, and medicine. Rowman & Littlefield.   
  11. ^ a b Emanuel, E. J. (1994). Euthanasia: Historical, ethical, and empiric perspectives. Archives of Internal Medicine, 154(17), 1890-1901.   
  12. ^ a b c Rachels J (January 1975). "Active and passive euthanasia". N. Engl. J. Med. 292 (2): 78–80. doi:10.1056/NEJM197501092920206. PMID 1109443. Archived from the original on 2010-06-30.
  13. ^ Snyder, L., & Sulmasy, D. P. (2001). Physician-assisted suicide. Annals of Internal Medicine, 135(3), 209-216.   
  14. ^ Brock, D. W. (1992). Voluntary active euthanasia. Hastings Center Rep   
  15. ^ Bostrom, B. A. (2002). In the Michigan Court of Appeals: people vs. Jack Kevorkian. Issues L. & Med., 18, 57.
  16. ^ Sensky, T. (2002). Withdrawal of life sustaining treatment: Patients' autonomy and values conflict with the responsibilities of clinicians. BMJ: British Medical Journal, 325(7357), 175   
  17. ^ Greer, George W., Circuit Judge (February 25, 2005). "In re: The guardianship of Theresa Marie Schiavo, Incapacitated. Michael Schiavo, Petitioner, v. Robert Schindler and Mary Schindler, Respondents, File No. 90-2908-GD-003" (PDF). Florida Sixth Judicial Circuit]. p. 3. Retrieved June 26, 2006   
  18. ^ a b "Belgium child euthanasia plan backed". BBC News. 2013-12-13. Retrieved 2018-11-15.
  19. ^ a b Triviño, Maria Alejandra. "Colombia has regulated euthanasia for children and adolescents - LatinAmerican Post". latinamericanpost.com. Retrieved 2018-11-15.
  20. ^ Johnson, Kirk (2009-12-31). "Montana Ruling Bolsters Doctor-Assisted Suicide". The New York Times. ISSN 0362-4331.
  21. ^ Krakauer, E. L., Penson, R. T., Truog, R. D., King, L. A., Chabner, B. A., & Lynch, T. J. (2000). Sedation for intractable distress of a dying patient: acute palliative care and the principle of double effect. The Oncologist, 5(1), 53-62.
  22. ^ Van Hooff, A. J. (2004). Ancient euthanasia:‘good death’and the doctor in the graeco-Roman world. Social science & medicine, 58(5), 975-985.   
  23. ^ Emanuel, E. J. (1994). The history of euthanasia debates in the United States and Britain. Annals of Internal Medicine, 121(10), 793-802.   
  24. ^ Galton, F. (1985). Essays in eugenics.   
  25. ^ für Volksgesundheitsdienst, R. (1935). Law for the Prevention of Hereditarily Diseased Offspring. Approved translation of the Gesetz sur Verhütung erbkranken Nachwuchses Berlin.
  26. ^ Lesh, J. P. (2012). The Nazis’ Voiceless Victims: a case for cultural genocide. History in the Making, 1(1), 19-28.   
  27. ^ Noack, T., & Fangerau, H. (2007). Eugenics, euthanasia, and aftermath. International Journal of Mental Health, 36(1), 112-124.   
  28. ^ . Cohen Jr, M. M. (2010). Overview of German, Nazi, and Holocaust medicine. American Journal of Medical Genetics Part A, 152(3), 687-707.   
  29. ^ Alesandro, J. A. (1993). Physician-Assisted Suicide and New York Law. Alb. L. Rev., 57, 819. Earle, M. (2017).   
  30. ^ A Short History of Euthanasia-A Brief Look into the Centuries Old Debate over an Individual’s Right to Die.   
  31. ^ . Emanuel, E. J. (1994). The history of euthanasia debates in the United States and Britain. Annals of Internal Medicine, 121(10), 793-802.   
  32. ^ Joseph, J. (2005). The 1942 ‘euthanasia’debate in the American Journal of Psychiatry. History of Psychiatry, 16(2), 171-179   
  33. ^ Jonsen, A. R. (1978). Dying right in California—the natural death act.
  34. ^ Humphrey, D., & Clement, M. (2000). Freedom to die: People, politics, and the right-to-die movement. St. Martin's Press.   
  35. ^ Leming, M. R., & Dickinson, G. E. (2010). Understanding dying, death, and bereavement. Cengage Learning.  
  36. ^ Lundberg, G. D. (1988). 'It's over, Debbie'and the euthanasia debate. JAMA, 259(14), 2142-2143.   
  37. ^ a b c Schneider, Keith (June 3, 2011). "Dr. Jack Kevorkian Dies at 83; A Doctor Who Helped End Lives". The New York Times.
  38. ^ Betzold, M. Physician-Assisted Suicide: Kevorkian, Oregon, and the Arguments in Between   
  39. ^ Denzin, N. K. (1992). The suicide machine. Society, 29(5), 7-10.
  40. ^ Johnson, Dirk. "KEVORKIAN FACES A MURDER CHARGE IN DEATH ON VIDEO". Retrieved 2018-11-15.
  41. ^ Quill, T. E. (1991). "Death and Dignity". New England Journal of Medicine. 324 (10): 691–694. doi:10.1056/NEJM199103073241010. PMID 1994255.
  42. ^ "Lawrence Egbert: Assisted Suicide's New Face". Newsweek. 2010-03-14. Retrieved 2018-11-15.
  43. ^ "Doctor Loses License Over Assisted Suicides". Retrieved 2018-11-15.
  44. ^ https://abcnews.go.com/US/washington-man-sentenced-years-prison-killing-terminally-ill/story?id=18386879   
  45. ^ a b Inc., Gallup,. "Americans' Strong Support for Euthanasia Persists". Gallup.com. Retrieved 2018-11-15. {{cite news}}: |last= has generic name (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  46. ^ "Religious Groups' Views on End-of-Life Issues". Pew Research Center's Religion & Public Life Project. 2013-11-21. Retrieved 2018-11-16.
  47. ^ Chakraborty, R., El-Jawahri, A. R., Litzow, M. R., Syrjala, K. L., Parnes, A. D., & Hashmi, S. K. (2017). A systematic review of religious beliefs about major end-of-life issues in the five major world religions. Palliative & supportive care, 15(5), 609-622.  
  48. ^ Werth Jr., James L.; Blevins, Dean; Toussaint, Karine L.; Durham, Martha R. The influence of cultural diversity on end-of-life care and decisions. The American Behavioral Scientist; Oct 2002; 46, 2; pp. 204-219.   
  49. ^ Sandeen, Peggy Jo Ann, "Public Opinion and the Oregon Death with Dignity Act" (2013). Dissertations and Theses. Paper 1015.   
  50. ^ Jennings, Patricia K., Talley, Clarence R.. A Good Death?: White Privilege and Public Opinion. Race, Gender, & Class. New Orleans: Jul 31, 2003. Vol. 10, Iss. 3; p. 42. the public opinion
  51. ^ Wolf, S., & Wolf, S. (1996). Gender, feminism, and death: Physician-assisted suicide and euthanasia (pp. 282-317).   
  52. ^ Knight, D. D. (1999). The Dying of Charlotte Perkins Gilman. American Transcendental Quarterly, 13(2), 137.   
  53. ^ Tulloch, G. (2015). IV. Sandra Bem, Feminism, assisted suicide and euthanasia. Feminism & Psychology, 25(1), 113-117.   
  54. ^ "Number of official cases of euthanasia rise 10% in the Netherlands". 12 April 2017
  55. ^ Boffey, Daniel (2018-07-25). "Doctor in Netherlands 'asked family to hold down euthanasia patient'". the Guardian. Retrieved 2018-11-15.
  56. ^ Chambaere, K., Vander Stichele, R., Mortier, F., Cohen, J., & Deliens, L. (2015). Recent trends in euthanasia and other end-of-life practices in Belgium. New England Journal of Medicine, 372(12), 1179-1181.   
  57. ^ Samuel, Henry (2018-08-07). "Belgium authorised euthanasia of a terminally ill nine and 11-year-old in youngest cases worldwide". The Telegraph. ISSN 0307-1235. Retrieved 2018-11-15.
  58. ^ Fahy, Jo. "Growing number of people sign up for assisted suicide". SWI swissinfo.ch. Retrieved 2018-11-15.
  59. ^ "David Goodall, 104, Scientist Who Fought to Die on His Terms, Ends His Life". Retrieved 2018-11-15.

Further reading

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  • Appel Jacob M (2004). "A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906". Bulletin of the History of Medicine. 78 (3): 610–634. doi:10.1353/bhm.2004.0106. PMID 15356372.
  • 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.
  • Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA. 2016;316(1):79–90. doi:10.1001/jama.2016.8499
  • Lavi, S. J. (2009). The modern art of dying: A history of euthanasia in the United States. Princeton University Press.
  • Dowbiggin, I. (2006). The modern art of dying: a history of euthanasia in the United States. Journal of the History of the Behavioral Sciences, 42(3), 282-284.
  • Emanuel, E. (2017). Euthanasia and physician-assisted suicide: focus on the data. The Medical Journal of Australia, 206(8), 339-340.

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