A Brief History of Physician-Assisted Suicide in the US

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Also known as assisted dying or medical aid in dying, assisted suicide has become an ethical question in the United States. This practice historically was not within the domain of standard medicine in the United States but has occurred both above and below the board as a way to end patient suffering. 

Physician-assisted dying (PAD) occurs when the patient requests a prescription for a lethal dose of medication, according to the American Academy of Hospice and Palliative Medicine. The patient takes the medicine, typically through ingestion, with the intention of ending the patient's life. 

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Eight states in the United States, plus Washington, D.C., currently legalized some form of physician-assisted suicide. Known as Death with Dignity laws, these protections give patients control over their lives and deaths in extreme circumstances. 

However, it wasn’t always this way. In this guide, we’ll step back through time to explore a brief history of physician-assisted suicide in the U.S. 

The Beginnings of Death With Dignity Legislation

Right to Die laws in the U.S. have come a long way since their earliest days. Initially met with horror and shock, these laws fought a hard fight to gain attention and traction within Congress at both a state and federal level. In fact, the first euthanasia (ending life without suffering) bill in the United States dates back over 100 years to 1906 in Ohio

Though this first bill didn’t succeed, the Euthanasia Society of America was founded in 1938 by Rev. Charles Potter in New York. By 1947, a reported 37 percent of people favored physician-assisted dying. These early days in the history of physician-assisted suicide began a conversation that would continue through the 20th century about the right to die. 

Earliest accounts of physician-assisted suicide

The first accounts of assisted suicide showed up in 1958 with Lael Wertenbaker’s book, Death of a Man. Wertenbaker shared her husband’s battle with terminal cancer and how she ultimately helped him commit suicide to ease his suffering. Though not physician-assisted, Wertenbaker’s book achieved its goal of encouraging the public to rethink end-of-life care. 

Dr. Kevorkian's well-known cases of physician-assisted suicide in the United States put the practice on the map. This doctor earned the nickname "Dr. Death" after helping over 40 people commit suicide in Michigan during the 1990s. 

To complete these assisted suicides, Dr. Kevorkian created a device known as the Thanatron, Greek for “Instrument of Death.” Though it sounds scary, it was simply an automated drip hooked up to an intravenous needle. Similar to lethal injection, patients would trigger an injection that began by putting them to sleep, then stopping their hearts while they were unconscious. 

After filming himself giving a man a lethal injection on tape for the TV program "60 Minutes," Dr. Kevorkian was found guilty of second-degree murder. He served eight years of a 10- to 25-year death sentence. These cases made public awareness around physician-assisted suicide grow. 

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Criticisms and Praise of Death With Dignity Legislation

With the rise in advance care planning, Death with Dignity legislation still happens today. Much of the conversation revolves around the morality and legality of physician-assisted suicide and whether doctors can partake in activities that intentionally “harm” patients, even with permission. 

Though most people have strong feelings one way or the other, the issue never looks black and white. Many valid points exist both for and against PAD. 

Criticism Against Death with Dignity Legislation

To begin, let’s discuss some of the most prominent criticism against this type of legislation. While many criticize this option based on religious and cultural beliefs, we’ll only look at non-religious reasoning:

  • Improved access to care: One of the main reasons many medical professionals oppose PAD involves improved access to hospice and palliative care. More people have more options when it comes to managing their end-of-life care. 
  • Patient autonomy: There are also limits to patient’s autonomy when it comes to the state legislature. By challenging the value of human life, there is a question of autonomy. 
  • Where to draw the line: Physician-assisted suicide could lead to euthanasia for those not able to consent, like those with mental illness, handicaps, etc. 
  • Hippocratic Oath: How can doctors assist patients with ending their lives when they’ve taken an oath to do no harm?

Praise for Death with Dignity legislation

Many people also point to a lot of reasons for Death with Dignity Legislation. Most of this comes down to the definition of what it means to die a “good death.”

  • Personal choice: The biggest argument for this legislation states that the right to die should involve a personal choice. 
  • Limit suffering: When patients suffer, PAD offers a form of kindness and compassion. 
  • Definition of harm: In relation to the Hippocratic Oath, advocates argue the definition of “harm none” should adjust. Couldn’t doctors also limit harm by ending the patient’s life without pain?
  • Alternative care: PAD isn't the only form of palliative care. Instead, it offers an option for those who seek it out among the many other care options. 

Where Physician-Assisted Suicide Stands Today

Today, physician-assisted suicide is legal in 8 states as well as Washington, D.C.:

  • California 
  • Colorado
  • District of Columbia
  • Hawaii
  • Maine
  • New Jersey
  • Oregon
  • Vermont
  • Washington

Each state’s legislation affects the type of intervention physicians can take to aid their patients through end-of-life measures. The existing laws for the most part follow Oregon, the first state to approve a Death with Dignity Act in 1994. 

Under Oregon’s laws, many safeguards stay in place to protect patients and physicians. First, two physicians must confirm the patients' residency, diagnosis, prognosis, mental competence, and whether they make the request voluntarily. Then, two waiting periods must occur — the first between the initial requests and the second before receiving and filling the prescription. 

Once the patient receives the prescription, the patient must decide if and when to use it. A reported one-third of qualified terminally ill people never actually use the prescription. However, having it available gives much-needed peace of mind to many. 

Today, more people than ever support Death with Dignity legislation. Propelled by the Death Positive movement, campaigns in New York, Mas

How to Support Death with Dignity Legislation

Have you become a supporter of Death with Dignity Legislation? You can tap into a lot of ways to get involved. Currently, 70 percent of Americans support some type of Death with Dignity or right-to-die legislation. Despite this support, the majority of states still have no legislation protecting physician-assisted suicide. 

To stay informed, learn more about your state’s statutes around Death with Dignity using this navigation tool. Learn more about campaigns and news around death positivity in your state for other ways to get involved on a local scale. Last but not least, talk to your friends and family about your own end-of-life wishes and create a free account to store and share your decisions.  

A Century of Progress: Death with Dignity 

Though many conversations continue around the ethics and morality of physician-assisted suicide, it remains a powerful point of legislation in many states. For those facing terminal illnesses and lowered quality of life, many view Death with Dignity laws as a way to give patients back control over their lives and their bodies. 

This legislation was hard-earned, with physicians and patients becoming the leading activists. Though most states still have a long way to go, it’s easy to see just how far access to end-of-life care has come in the United States. Someday, patients in all 50 states may have complete access to a full spectrum of care and compassion when it matters most. 


Sources:
  1. Beschizza, Rob. “The Thanatron, Jack Kevorkian's Death Machine.” Wired. 1 May 2007. Wired.com
  2. “Chronology of Assisted Dying in the US.” Death in Dignity. DeathinDignity.com
  3. “Death with Dignity Acts.” Death with Dignity. DeathwithDignity.org
  4. “For Advocates.” Death With Dignity. DeathwithDignity.org
  5. “Statement on Physician-Assisted Dying.” American Academy of Hospice and Palliative Medicine. AAHPM.org.

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