Physician Assisted Suicide

1. Physician Assisted Suicide Jody Blanke, Professor Computer Information Systems and Law Mercer University, Atlanta

2. Ancient Rome • “It’s good to be King” (or Emperor) • Convicted criminals forfeited real and personal property to the Emperor • Suicide became a crime

3. English Common Law • Still good to be King • Suicide also a crime, but punished by forfeiture of personal property only • Early American colonies adopted this rule, but over time, abolished forfeiture penalties • By Civil War, suicide is not a crime

4. United States Today • 35 states have statutes specifically banning assisted suicide • Another 9 criminalize it by common law • But competent adults have a right to refuse medical treatment

5. Karen Anne Quinlan • 1975 – Karen Anne Quinlan mixed drugs and alcohol and became comatose • Family sought court order to “pull the plug” • Order granted, but family convinced to wean her from respirator • She remained comatose for over 10 years, until her death in 1986

6. Living Wills • In aftermath of Quinlan case, every state enacted some sort of living will • Most states also have some type of durable power of attorney

7. Nancy Cruzan • 1983 – Nancy Cruzan was in a car accident and became comatose • Court refused to let parents “pull the plug” absent “clear and convincing proof” that that was what Nancy would have wanted • Supreme Court – state has sufficient interest to adopt this higher standard

8. Nancy Cruzan (cont.) • Justice O’Connor – “safeguarding incompetents’ liberty interests is entrusted to the ‘laboratory’ of the states” • Epilogue – a “good friend” came forward with “clear and convincing” evidence that Nancy would not have wanted to live this way – she died in 1990

9. Dr. Kevorkian • Assisted in many suicides in the 1990s • Some states enacted legislation in response e.g., Georgia • Finally, successfully prosecuted for murder – on the fourth try • Paroled in 2007 after serving 8 years of a 10-25 year sentence

10. Oregon’s Death with Dignity Act • Ballot initiative passed in 1994 • Challenged in court • Becomes effective in 1997 • Legal (societal) experiment • “Oregon, the Suicide State”?

11. Oregon’s Death with Dignity Act

12. Oregon’s Death with Dignity Act

13. Oregon’s Death with Dignity Act

14. Supreme Court Cases • Washington v. Glucksberg, and Quill v. Vacco (1997) • Challenged bans on assisted suicide in Washington and New York states • “Fundamental liberty interest” and “equal protection” challenges denied • Court referred to Oregon and the “’laboratory’ of the states”

15. Terry Schiavo • 1990 – Terry Schiavo became comatose as a result of eating disorders • 1998 – husband sought order to remove feeding tube • 2005 – Schiavo died after feeding tube was removed - after 14 appeals, numerous motions and hearings, 5 federal suits, state legislation, federal legislation, and 4 denials of certiorari by the U.S. Supreme Court

16. Other States • Death with Dignity Act • Washington passed it in 2008 • Vermont passed it in 2013 • Montana • First Judicial Court ruled that a terminally ill patient has a right to die under the Montana Constitution (2008) • Montana Supreme Court held that physician assisted suicide is not banned by state law, but did not address the issue of whether there is a constitutionally protected right to die (2009)

17. The Netherlands • Decriminalized physician assisted suicide in 1993 • Legalized it in 2002 • “Intolerable suffering”

18. The Netherlands The law allows medical review board to suspend prosecution of doctors who performed euthanasia when each of the following conditions is fulfilled: • the patient's suffering is unbearable with no prospect of improvement • the patient's request for euthanasia must be voluntary and persist over time (the request can not be granted when under the influence of others, psychological illness or drugs) • the patient must be fully aware of his/her condition, prospects and options • there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above • the death must be carried out in a medically appropriate fashion by the doctor or patient, in which case the doctor must be present • the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)