Kenneth J. Simcic, M.D., FACP, FACE
Euthanasia and Physician-assisted Suicide
Kenneth J. Simcic, M.D., FACP, FACE
“You’ve [senior citizens] got a duty to die and get out of the
way. Let the other society, our kids, build a reasonable life.”
Lamm, former governor of Colorado
Minneapolis Star Tribune, 3/29/84:13A
"You will never get accustomed to killing somebody. We are not trained
to kill. With euthanasia, your nightmare becomes true."
physician and pro-euthanasia activist
A. Important Definitions
suicide: providing a person with the means to end his or her life,
usually by an overdose of an oral prescription medication.
taking a direct and specific action to intentionally end another
person's life, most
commonly by giving a lethal intravenous injection.
can be voluntary (at the patient’s request), or involuntary
(without the knowledge
or consent of the patient)
death: this term includes both physician-assisted suicide
and euthanasia performed
by a physician.
5. It is important to note that a person can refuse
medical treatment at
the end of life without committing assisted suicide or
6. Palliative sedation: giving a dying patient a potentially
lethal dose of a
narcotic or sedative drug with
the intention of relieving pain, shortness
of breath or other discomforts.
This is done with the patient's consent
and shortening the patient's
life is not intended.
B. The Hippocratic Oath (350 B.C.)
will neither give a deadly drug to anyone if asked for it, nor will I
make a suggestion to
C. Social and Cultural Factors Promoting
Doctor-assisted Death in the U.S. in 2006
is no longer respected as the only giver and taker of
2. Moral relativism-the
lack of moral absolutes in American society.
personal autonomy…"my body, my right".
4. Modern medical
technology-sick people live much longer.
have fewer children-there are fewer family members to care for
sick and aging relatives.
6. Divorce is common-many dying people are alone.
7. We have
become a very busy, utilitarian society that no longer has the
time to care for our
elderly and disabled members.
8. The traditional
doctor-patient relationship is in trouble; when sick
patients are admitted
to the hospital, they rarely receive care from their
personal or family doctor.
9. There is now a tremendous emphasis on reducing the cost of healthcare;
end of life care is expensive,
but the pills for assisted suicide cost only
D. Legal Overview: United States
November 1994: in a statewide referendum, Oregon voters legalize
assisted suicide (51%-49%)
but the law is immediately blocked by a
judicial injunction. Shortly
before the vote, the Oregon Medical Society
changed its position on assisted
suicide from “against” to “neutral”.
2. 3/6/96: The 9th Circuit Court of Appeals rules that Washington
ban on assisted suicide
3. 4/4/96: The 2nd Circuit Court of Appeals rules that New
ban on assisted suicide
4. 6/26/97: U.S. Supreme
a. there is no constitutional right to assisted suicide; there is a
constitutional right to palliative
care for the dying.
b. assisting suicide is not the same as removing life support.
c. assisting suicide is not the same as giving dying patients “palliative
with narcotic or sedative drugs.
d. state bans against assisted suicide are constitutional (Washington,
New York) because states have a valid interest in protecting
integrity of the medical profession and in protecting vulnerable
patients: the elderly, disabled and the terminally ill.
e. states are also free to legalize assisted suicide if they so choose
5. 1997: The
Florida State Supreme Court rules that there is no
constitutional right to assisted suicide.
6. 11/4/97: The Oregon "Death with Dignity Act" becomes law.
a. Oregonians vote against repealing the original law: 60%-40%.
b. the law allows an Oregon physician to write a lethal drug prescription
for a patient.
c. the Drug Enforcement Administration (DEA) rules that the Oregon
law violates the federal Controlled Substances Act (federally
controlled substances can only be used for a “legitimate medical
purpose”) but the DEA is overruled by Attorney General Janet Reno
who allows the Oregon law to stand.
d. 3/25/98: Oregon’s
first death resulting from assisted suicide.
e. 11/6/01: new Attorney General John Ashcroft rules that the Oregon
law is a violation of federal law (Controlled Substances Act) and that
the use of federally controlled substances to assist in a suicide is not a
“legitimate medical purpose”.
f. 11/9/01: Federal judge Robert E. Jones blocks Ashcroft’s ruling.
g. 5/26/04: the Ninth Circuit Court overrules Ashcroft by a 2:1 vote and
upholds the Oregon law.
2/22/05: U.S. Supreme Court agrees to hear the Oregon
(Gonzales v. Oregon, 04-623)
i. 1/17/06: U.S. Supreme Court upholds the Oregon law by a 6-3 vote.
j. as of 1/07, 292 Oregonians have died as a result of assisted suicide
16, 1999: 27, 2000: 27, 2001: 21, 2002: 38, 2003: 42,
37, 2005: 38, 2006: 46).
k. ballot initiatives similar to Oregon’s
have failed in the states of
54%-46%), California (1992: 54%-46%),
Michigan (1998: 70%-30%), and Maine (2000:
7. 1999: A Michigan
court sentences Jack Kevorkian to 10-25 years in
prison for the (videotaped)
lethal injection of ThomasYouk, a 52 year
old man with Lou
Gehrig's disease. Kevorkian assisted in the deaths of
130 people prior
to his imprisonment (he was acquitted on 3 previous
by Michigan courts).
8. 2001: Alaska
State Supreme Court rules that there is no
to assisted suicide.
9. 5/02: Hawaii state legislature votes
against legalization by a 14-11
10. 2/04: Wyoming
state senate votes 19-8 against legalizing assisted
11. 2006: Legislative bills similar to Oregon's law
fail to pass in Vermont
(HB 168) and California
12. 3/07: Another legislative bill (H.44) fails to
pass in Vermont by an
82-63 vote (the 6th
failed attempt in Vermont since 1995).
13. As of 4/05: 38
states had statutes prohibiting assisted suicide and 6
states prohibit it
by common law. Only 5 states other than Oregon
not have laws criminalizing
assisted suicide: North Carolina, Utah,
Wyoming, Ohio and Virginia
After 8 years in prison, Jack Kevorkian is granted an early
release at age 79 for "good behavior".
Another legislative bill fails to pass in California (the 8th failed
attempt in California since 1995).
passage of the Oregon Death with Dignity Act in 1994, more than
80 legislative efforts to legalize assisted suicide have failed
E. The Oregon Death with
1. The patient
must be older than 17.
2. The patient
must be mentally competent and able to take the lethal
3. The patient
must also be terminally ill with life expectancy < 6 months.
4. The request
for suicide must be communicated both orally and in writing.
5. A second
physician must confirm the diagnosis & prognosis and that the
patient is competent
and not depressed.
consultation is only required if the patient’s competency is
questioned by either
physician; it is not otherwise required, even if
depression is suspected.
7. The patient
must self-administer the lethal dose with no assistance from
8. The state has no authorization to investigate unreported
cases or cases
9. The law contains no penalties for non-reporting
10. 1999: the assisted suicide of Kate Cheney raises concerns
supposed "protective guidelines"
in the Oregon law (see reference 30).
F. Oregon Update
1. Oregon 2006: 46 assisted suicide deaths reported; total of 292 since
2. Most common
reasons given by patients for wanting to end their lives
a. losing autonomy (96%).
b. decreased ability to participate
in enjoyable activities (96%).
c. loss of dignity (76%)
3. Previous data from 1998-2004: most
common reasons given by
Oregon patients wanting
to end their lives (from reference 28):
a. losing autonomy (>80%).
b. decreased ability to participate
in enjoyable activities (>80%).
c. losing control of bodily functions
d. fear of being a burden to
family, friends, or caregivers (36%).
e. fear of inadequate pain control (22%).
(Note that “pain” itself
was not one of the top 5 reasons; in fact,
uncontrolled pain has not been clearly documented in any of the assisted
deaths in Oregon.)
4. Most common medical conditions of Oregon patients dying by assisted
b. amyotrophic lateral sclerosis.
5. Lethal medications most commonly used
a. drinking 10 grams of liquid pentobarbital or…
b. swallowing the powder from 10 grams of secobarbital capsules
dissolved in water or applesauce.
6. Less than
5% of Oregon patients dying by assisted suicide have been
consultation was obtained in 31% of cases who died in 1998
but in 5% or less of
those who died in 2003, 2004, 2005 and 2006 (2
of 46 patients in 2006).
published in 2004 reported that the prevalence of family-
reported moderate to
severe pain or distress for people dying in Oregon
increased from 31% in
1996-1997 to 48% (after legalization) in 2000-
9. 10/06: The Oregon Health Department announces that
it will use the
term "assisted death" in
place of "assisted suicide" in official reports.
G. The Netherlands (Holland)
not technically legalized until 1/1/02, doctor-assisted death has
been permitted in the
Netherlands since 1973 when a Dutch physician
was given only a suspended
sentence for assisting in the death of her
terminally ill mother.
2. In 1984, the Dutch Royal Society of Medicine issued "rules of careful
conduct" for euthanasia
(“safeguards”): consult another physician, keep
written records, etc.
3. 1991, the
Remmilink Report (prepared from a confidential survey of
11,800 doctor-assisted deaths occured in Holland in
1990 (9% of total deaths);
50% of these were involuntary (without the
consent of the patient or
family); 60% of assisted deaths were not
Doctor-assisted Death in the Netherlands, 1990 (table obtained from www.euthanasia.com on 12/1/03)
Morphine Overdoses Intended to Terminate Life
Total deaths (1991)
deaths as percent of total deaths
(1.) Medische Beslissingen Roknd Het Levenseinde: Rapport
van de Commissie Onderzoek Medische Praktijk inzake Euthanasie (Medical Decisions About the End of Life: Report of the Committee
to Investigate the Medical Practice Concerning Euthanasia) The Hague, 1991; (2.) 1993 World Almanac
and Book of Facts, New York, 1992.
4. 1991: a
Dutch psychiatrist gives a lethal dose to a depressed 50 year old
woman with no other medical
problems who was “suffering
unbearably”. She had recently gone through a bitter divorce and the
deaths of her only 2
children. She received no treatment for her
depression prior to her assisted
5. 1992: a
3 day old infant with spina bifida and limb abnormalities is given
a lethal injection
by a Dutch gynecologist.
6. 1995: at
least 1 in 5 cases of assisted death in Holland occur without the
almost 2/3 of cases of assisted death are not reported.
7. 1998: the suicide
of 86 year old Edward Brongersma is assisted
because he is “tired
of life” (but otherwise in good health).
8. 4/1/02: The Netherlands formally legalizes assisted suicide and
euthanasia after allowing
these practices since 1973.
a. law requirements: pt. persistently requests euthanasia; hopeless pain
or "suffering"; another physician is consulted; a written report is made
a regional committee
b. “physical” suffering is not required and neither is psychiatric
c. the patient’s disease need not be terminal
d. patients as young as 12 are eligible; those ages 12-16 need parental
9. 2/27/03: the Dutch TV program “Reporter” reveals that thousands of
life-shortening acts are not being
reported by physicians because the
reporting requirements are
“too time consuming” (requiring extensive
paperwork and a second opinion).
10. While there are only 3 hospices in Holland, Great Britain has more
11. In 2005, 1933 cases of euthanasia and/or assisted suicide
in Holland (47 more than the previous
12. 2006: In the New England Journal of Medicine, two Dutch
announce that euthanasia of newborn
babies is a regular occurence in the
a. the authors announce that 22
cases were reported to district attorneys'
from 1997-2004 and none of the responsible physicians were
of the babies were euthanized by the authors)
b. all of the euthanized newborns
reportedly had severe spina bifida and
consent was obtained in all cases
c. the authors estimate that up
to 20 newborns are euthanized every year
in the Netherlands
but only 3 cases per year are reported
d. they propose that their "Groningen
protocol" be followed for newborn
13. No Dutch physician has ever served a prison term for assisting
H. Doctor-assisted Death in Other Countries
1. For a short
time in 1996-1997, assisted suicide and euthanasia were
legalized in Australia's
Northern Territory (7 doctor-assisted deaths
occurred before the law was
(5/02) has also legalized assisted suicide and euthanasia, and
assisted suicide is legal
in Switzerland. In 2007; it was estimated
that approx. 350 assisted suicides were occuring in Switzerland every
year. Swiss physicians are not permitted to participate in assisted suicide
(it is left to designated "groups" like Dignitas) and assisted suicide
cannot be performed in Swiss hospitals.
3. 12/03: Belgian
Federal Health Ministry announces that 203 deaths
by euthanasia were reported in the first year of legalization.
4. 2004: Lawmakers
in Belgium declare that the “right to euthanasia”
exist in all hospitals
including Catholic hospitals that have previously
refused to allow it due
to religious objections. (Critics comment that in
Belgium, patients have
a "duty to die" and doctors have a "duty to kill".)
5. 10/05: The
Canadian Parliament begins debate on a bill that would
legalize euthanasia (Bill
C-407). The bill did not pass.
6. 5/06: An assisted dying legislative bill fails
to pass in Great Britain.
7. 6/06: the British Medical Association (BMA) votes
reverse its year-old
neutral position on euthanasia and assisted suicide
and go back to a policy
of strong opposition to any assisted-dying
8. 11/06: England's Royal College of Obstetricians and
calls for open debate on legalization
of euthanasia for "seriously
disabled" newborn babies.
9. 6/07: Ludwig Minelli, who runs the Dignitas
assisted suicide clinic in
Zurich, Switzerland announces
that he wants Swiss law to change,
allowing him to extend
his clinic's services to the non-terminally ill. He
would like all people, including
the mentally ill and depressed, to be
given the "marvelous
opportunity" to end their lives at his clinic.
10. 7/07: retired Swiss psychiatrist Peter Baumann is sentenced
to one year
in prison for assisting the
suicides of 3 depressed patients. He may be
the only person besides Kevorkian
to serve a prison sentence for
violating assisted suicide
I. Providing Better Options for Suffering
1. It is important
to remember that, first and foremost, doctor-assisted
death is about suffering human beings. We must offer these patients
a. ethical hospice services should be readily available to all dying
b. more doctors should be trained as palliative care ("comfort care")
c. comfort care must also include treatment of other discomforts such as
of breath, constipation, diarrhea, anxiety and
d. all doctors should be better trained in the treatment of pain and
e. in dying patients with incurable diseases: as curative treatments like
chemotherapy are withdrawn, palliative care measures should be
f. remember: we may withdraw treatment but we never “withdraw
need more training, time, and compensation for care of the
dying. All medical schools and residency programs should include
palliative care as part of their
training. All hospitals should have palliative
care/pain mgmt. programs. Pain
is now considered the “5th vital sign”.
who care for sick or elderly relatives need more support.
Better funding for home care: currently, 75% of long-term care money
goes to nursing homes.
4. Responding to requests for doctor-assisted death: "PPD"
a. Pain control (Palliative care) b.
Pastoral care services
c. Treat Depression
J. Medical, Nursing and Disability
Organizations Opposed to Doctor-
(This list was last updated in May 2006)
American Medical Association
American College of Physicians/American Society of Internal Medicine
American Psychiatric Association
American Geriatrics Society
American Osteopathic Association
American Academy of Neurology
National Spinal Cord Injury Association
American Academy of Physical Medicine
of Pain Management
American Academy of Pain Medicine
National Hospice and Palliative Care Organization
Society of Critical Care Medicine
Christian Medical and Dental Association (13,000 members)
American College of Legal Medicine
League of United Latin American Citizens (LULAC)-California
World Medical Association
Royal College of Physicians
Royal College of General Practitioners
Association of Palliative Care Medicine (Great Britain)
Australian Medical Association
Canadian Medical Association
American Nurses Association
Royal College of Nursing
American Association of Critical Care Nurses
Hospice Nurses Association
American Society of Pain Management Nurses
Oncology Nurses Society
American Nursing Leaders
*3. National Disability
Not Dead Yet (formed by disability activists in 1996 when Jack
Kevorkian was acquitted
after assisting in the suicides of 2 women with
National Council on
Independent Living (NCIL)
National Council on Disability (NCD)
American Disabled for Attendant Programs Today (ADAPT)
Justice for All
The Association for
Persons with Severe Handicaps (TASH)
Disability Rights Education and Defense Fund (DREDF)
Association of Programs for Rural Independent Living (APRIL)
American Association of People with Disabilities (AAPD)
National Spinal Cord Injury Association
Society for Disability Studies
(at least 5 of these organizations filed amicus curiae
briefs in support
of the federal government’s position in Oregon vs Gonzales)
British Council of Disabled People
World Institute on Disability
World Association of Persons with Disabilities (WAPD)
*4. Local Disability Groups
Vermont Coalition for Disability Rights (represents 26 Vermont
5. Quotes from Diane
Coleman, J.D. (founder of Not Dead Yet)
a. “Isn’t assisted suicide about individual autonomy and rights, they
ask? No, we say, it’s about discrimination and a profit-driven health
b. “An individual’s right to refuse treatment is one thing, but
immunity for your doctor, caregiver or someone else to kill you is not
a right, it’s a threat.”
K. The Best Arguments against Doctor-assisted
*1. Look at what's happened
in Holland where doctor-assisted death has
been permitted since 1973. This is the only hard "data" on the long-term
consequences of legalization.
a. assisted suicide leads to euthanasia
b. euthanasia for the terminally ill leads to euthanasia for the chronically ill
c. euthanasia for physical suffering leads to euthanasia for psychological
d. voluntary euthanasia leads to involuntary euthanasia (what about
for these patients?)
e. euthanasia for adults leads to euthanasia for adolescents, children &
is no better example of the "slippery slope")
f. the Dutch have a socialized medical system where everyone is insured;
incentives encouraging assisted death would be far
in the U.S. where not everyone has health insurance (see
*2. You can't legalize
assisted suicide without eventually legalizing
a. what about those patients who are too sick to ask for or swallow a
dose?; to deny them assisted suicide would be
b. a "back-up" treatment is needed for failed cases of assisted suicide
of cases); what should emergency personnel do if called to
scene of a failed assisted suicide? If there are problems with
punishment by lethal injection, there will be more problems
assited suicide and euthanasia
c. quote from Dutch physician
P.V. Admiraal: "In spite of these
every doctor who decides to assist in suicide must be aware
something can go wrong with the result being a failure of the
For this reason one should always be prepared to proceed to
euthanasia..." (ref. 32)
death is the ultimate form of "cost-containment". Derek
the former Hemlock Society (now renamed “Compassion
has claimed that “economic necessity” is the ultimate force
the assisted suicide movement: “the hastened demise of people
only a short time to live would free resources for others.”
*4. What about "choice"
for doctors, nurses, and pharmacists who are
morally opposed? Any involvement makes them morally complicit: a.)
nurses assisting at bedside;
b.) pharmacists filling a lethal prescription; c.)
morally opposed physicians
who are forced to refer patients to a willing
must remain healers and not killers; don't corrupt the medical
6. Patients already have the "right to die" naturally: they can refuse any
medical treatment. Legalizing doctor-assisted death will give doctors
"right to kill".
7. We now have
better treatments for pain and depression than ever
death puts vulnerable groups of people at risk; the "right
to die" can become the
"duty to die" for the elderly, disabled, poor, and
the mentally ill.
9. We can already
offer "palliative sedation" to dying patients with severe
pain or discomfort. The
principle of "double effect” makes this an ethical
10. It is discriminatory
to describe some suicidal wishes as “rational”
indications for assisted
suicide when they occur in terminal or disabled
patients, but other suicidal
wishes as “irrational” and worthy of life-
saving interventions when
they occur in healthier patients.
11. Physician involvement
in capital punishment is considered unethical by all
of organized medicine’s
governing bodies. Physician involvement in
assisted death is unethical
for the same reasons. It is interesting that
assisted suicide is legal
in Switzerland but it is illegal for physicians to be
present when it is performed.
12. The disability community
is almost universal in its opposition to
legalization of any form
of doctor-assisted death.
L. Answering Popular Arguments in Favor
of Doctor-assisted Death
1. Doctors already give lethal doses of pain medication to some dying
When this occurs, it is done with the intention of easing the pain, not
killing the patient. According
to the "principle of double effect", this is
competely ethical and is
not the same as assisted suicide or euthanasia.
on life support such as kidney dialysis or a respirator have
the “right to die”
by stopping the life support treatments, so others
not on life support should have assisted suicide available.
Patients are removed from life support to respect their wishes and
a natural death when
the time has come. Patients don’t always die when
treatment is withdrawn
(Karen Quinlan lived many more years). This is
a totally different situation
from assisted suicide and euthanasia where
death is always intended
and death is always the result.
3. You may not agree with it, but dying patients deserve this "choice".
Legalizing this choice for some people puts others at serious risk. This
why the disabled community
feels threatened and is up in arms. The
Supreme Court has ruled
that states have a compelling interest to limit
this choice in order to protect “vulnerable”
groups of people such as the
elderly, the disabled, and
the terminally ill. Involuntary euthanasia gives a
patient no choice. And what about the “choice” of morally opposed
doctors, nurses, and pharmacists
who may be forced into complicity if
they are required to refer
or transfer the patient to a willing colleague?
Morally-opposed Catholic hospitals in Belgium now have
4. You can't force your religion on the rest of society (the “Religion vs.
Modernism” argument). Religious arguments are not necessary to
effectively argue against assisted
suicide. None of the arguments in the
preceding section are based
on religious principles. Numerous
organizations that support
legalized abortion (such as the AMA) oppose
doctor-assisted death. The disabled community is heavily in
opposition to assisted death and none of their arguments are
5. We need legalization for those
few hard cases of uncontrollable
pain; safeguards/guidelines will
prevent abuses. We already have
palliative sedation for hard
cases. Abortion was originally intended for
“hard cases’ of
unwanted pregnancy (rape, incest, life of the mother).
There are now at least 1.3 million abortions/year performed in the U.S.
"Safeguards/guidelines" have not limited abortion in the U.S.
deaths and euthanasia in the
Quote from Wesley J. Smith, author of Forced Exit: Euthanasia,
Assisted Suicide, and the
New Duty to Die: “Adopting killing as an
acceptable answer to human suffering eventually changes popular
outlooks...once killing is redefined as medical treatment, it becomes
transformed from ‘bad’ to ‘good’. Thus, the guidelines
intended to ‘protect against abuse’ eventually are viewed not as
protections but instead as hurdles separating sick and dying patients
the beneficence of death. In such
an intellectual and cultural milieu,
it becomes easy to justify ignoring or violating ‘guidelines’
Responding to Other Popular Arguments in Favor of Doctor-Assisted Death
must people suffer if they are going to anyway within a short period of time?"
Response: Like living, the reality of dying is that it will often involve a component of suffering. But there is no reason
for this suffering to be excessive or inappropriate. With the technology that we now have available for the control of pain
and other discomforts, pain that cannot be completely relieved can at least be made tolerable.
If a dying patient is suffering, the solution to this problem should be better medical care, not killing the patient. Modern
palliative care involves a holistic approach that addresses the physical, psychological, and spiritual dimensions of a patient's
"Palliative sedation" (see below) is a valid option for those rare patients whose
pain cannot be relieved by conventional doses or analgesic and sedative drugs. A short period of palliative sedation prior
to death is a much more dignified option than doctor-assisted death.
The idea that there is compassion in killing is a truly radical notion that goes against
the Hippocratic tradition that has guided medicine for more than 2,000 years. The original meaning of the word "compassion"
is "to suffer with", and this is what we are called to do as family members and healthcare workers. We are called to share
in the patient's suffering and provide as much comfort and support as possible. This includes providing the best palliative
care that medicine has to offer. Doctor-assisted death is much closer to abandonment than it is to true compassion.
suicide should be made legal for those few hard cases where pain cannot be controlled. Safeguards will prevent
Response: The "few" hard cases argument was used to legalize abortion. There are now 1.3 million abortions yearly in the U.S. As for safeguards, they have not worked for abortion
in the U.S. and they have not worked in the Netherlands for euthanasia. Cases where pain cannot be controlled are indeed very few. Palliative
sedation is a valid and ethical option for these patients (see below). In Oregon, "safeguards" in the law apparently
failed to protect Kate Cheney (see reference 30).
already give lethal doses of pain medications to some dying patients; why not just legalize the practice for all dying patients?"
Response: Intention is everything. This is why there are different degrees of murder and manslaughter. If a physician's intention
is to relieve a patient's pain, and the patient or the patient's family* is properly informed and in agreement, then it is
ethical to give a potentially lethal dose of pain medication and accept the risks. However, if the intention is to bring about
death, then the act is not ethical. Traditionally, this is called the "principle of double effect". It was recently supported
by the Supreme Court. In those rare cases where pain cannot be controlled, the principle of
double effect allows for "palliative sedation".
Palliative sedation consists of giving very large and potentially fatal doses of narcotic
pain medications such as morphine in order to induce a coma-like state of sedation.
In these cases, death sometimes results if breathing stops from over-sedation. As long as the physician's intention
is to relieve pain, the risk of hastening death is acceptable and ethical if the patient (or the patient's family) agrees
to take the risk. Organized medicine has accepted this practice as ethical for a very long time. The principle of double effect
is invoked almost every time that cancer chemotherapy or emergency surgery is performed since sometimes patients do not survive
Some proponents of doctor-assisted death call palliative sedation "undignified"--a death
without dignity. They feel that death by assisted suicide or euthanasia is somehow more dignified. This has certainly not
been the case with many of the assisted suicides performed by Jack Kevorkian where bodies have been left in cars next to hospitals
a patient is unconscious or otherwise unable to make his/her decisions, these decisions are usually made by the patient's
patients deserve to have this choice. You may not agree with doctor-assisted death but you can't force your morality on society."
Response: Issues of life and death cannot be arbitrary matters of "choice". Legalization of doctor-assisted death will have
implications far beyond the individual patient. Although some citizens might feel that they would benefit from legalization,
it would put other citizens at risk for coercion and possible involuntary euthanasia. This would be especially true for "vulnerable"
citizens such as the elderly, the disabled, and the mentally ill-the "right to die" could become the "duty to die". This was
one of the reasons given by the U.S. Supreme Court when they ruled that there was no constitutional right to assisted suicide
in June 1997. The point should also be made that dying patient's considering assisted suicide don't really have a "choice"
unless they have access to quality end-of-life palliative care. Laws can be viewed as restrictions
on personal freedoms for the good of society as a whole. For this reason, 35 states now have statutes that prohibit assisted
The involuntary euthanasia that is occurring in the Netherlands gives patients no choice. It is the ultimate absence
of choice--the ultimate insult to a patient's autonomy.
Many who favor doctor-assisted death also favor forcing doctors who morally object to
it to refer patients to a willing physician. What about the doctor's choice in these situations? Patients have a "duty to die" and doctors have a "duty to kill". Similar issues arise when pharmacists
are forced to find the patient a willing pharmacist if they are unwilling to fill the prescription for the obvious lethal
dose. There is no reason why a patient can't find another doctor or pharmacist on their own if their own provider objects
on moral grounds.
Every American has first amendment rights on this important issue. This includes the
right to attempt to persuade others within the limits of the law. This is the very essence of the American political system.
It is not "forcing one's morality" on America-such phrases “poison the debate” and are inappropriate rhetoric.
And finally, the case of Oregonian Kate Cheney is very troubling (see http://www.findarticles.com/p/articles/mi_qa3798/is_199910/ai_n8870779%20-%2034k). It seems that Cheney's assisted suicide was more the choice of her family rather than her own decision
are making this a religious issue--you can't force your religion on the rest of society."
Response: None of the objections to doctor-assisted death that I have stated thus far are based on religion. The American Medical
Association, the American College of Physicians, and more than 40 other medical organizations oppose doctor-assisted
death. None of these organizations have religious affiliations and most of them support legal abortion. Nearly every
disability rights organization in the United States opposes doctor-assisted death for reasons that have nothing to do
Legislation or public policy that happens to parallel religious teachings is not automatically
made irrelevant. Our laws against stealing, lying, and murder also coincide with certain religious teachings (the Ten Commandants).
It would be absurd to suggest that such laws be eliminated because of this.
I'm not "forcing my opinion" on anyone. Don't poison our debate with such accusations and rhetoric. Just like
you, I'm exercising my right to free speech on this important issue. Please don't insinuate that my position is
radical or extreme. You are the one who is trying to change not only the law, but over 2,000 years of Hippocratic tradition
in the practice of medicine.
"If some suffering patients can die by refusing life-sustaining treatments then why can't
other suffering patients die by requesting life-ending treatment?"
Response: These are totally different situations. Patients are removed from life support equipment to respect their wishes
regarding unwanted medical care and to allow a natural death if and when the time has come. The patient does not ALWAYS die:
Karen Quinlan lived 9 years after her mechanical ventilation was discontinued. Doctor-assisted death is intended to give the
patient no chance at survival. Previous "right to die" legislation (Quinlan, Cruzan) was successful because withdrawing life
support was portrayed as being very DIFFERENT from euthanasia. When we remove a patient from a ventilator we do not also remove
all oxygen from the patient's hospital room. (The only "right to die" is the right to die NATURALLY.)
The U.S. Supreme Court recognized this difference as "a distinction widely recognized
and endorsed in the medical profession and in our legal tradition". The Court also cited 34 prior legal decisions that upheld
polls have repeatedly shown that the majority of the American public and the majority of American doctors are in favor of
legalization. This is America: give the people what they want."
Response: It is very important to specify the exact question that was asked in an opinion poll since the wording of the question
can be very misleading. Because of this, the accuracy of various opinion polls has been questioned. If the public strongly
favors doctor-assisted death, they why did referendums for assisted suicide fail in California, Washington, Michigan and Maine
and only pass by the narrowest of margins (51%:49%) in Oregon in 1994 (these are all fairly liberal states). In California,
there have been 5 attempts to legalize euthanasia and/or assisted suicide by either referendum or legislative bill since 1988.
All 5 attempts have failed.
It should be noted that certain subgroups of Americans are strongly opposed to doctor-assisted
death. These include nursing home patients, the disabled, and some minority groups. The majority of oncology (cancer) physicians
are opposed to euthanasia and so are the majority of hospice workers. These are the health care workers that work most directly
with the dying. If the majority of physicians favor legalization, then why did the physicians of the Oregon Medical Society
vote 121-1 to support the repeal of the Oregon Death With Dignity Act in 1997? (American Medical News, 5/19/97). In November 1997, the people of Oregon voted NOT to repeal this
act by a 60%:40% margin, but no other states have legalized assisted suicide.
ethics" is a dangerous practice. It has given us
slavery and the Nazi Holocaust. If a majority of Americans were ever to support pedophilia,
should we then make it legal?
personally opposed to doctor-assisted death, but I don't want to force my beliefs on other people."
Response: I find your position confusing and morally contradictory. Why do you personally oppose doctor-assisted death? If
you feel that it is evil or immoral, then why don't you feel a responsibility to stand up against it? This same kind of attitude
allowed the Holocaust to happen. How many good German people were personally opposed to the killing, but...? Since when do
Americans tolerate evil and immorality in the name of pluralism? We do not take this approach with other evils such as child
abuse and pedophilia. It is a tradition in America for individuals to fight for what they think is right and fight against what they feel is wrong. You must not feel
very strongly about this important issue.
physician-assisted suicide will probably result in fewer actual cases of it in the U.S. If patients know that they have the option available, they
will be less likely to attempt suicide out of fear when they are in the early stages of an illness."
Response: The logic of this argument seems inherently faulty-that legalizing assisted suicide will actually make it less common.
The data from the Netherlands does not support this contention and neither does the data from Oregon. In the Netherlands, legalization of doctor-assisted death has clearly led to more doctor-assisted death. I know of no situation
in history where legalizing a previously illegal activity actually made it less common.
a woman has a right to an abortion, then a suffering patient has a right to doctor-assisted death."
Response: This argument has actually been used by a circuit court judge.
perfect example of the slippery slope of immorality. The right to life is the most fundamental of the human rights. Like legal
abortion, legalization of doctor-assisted death will lead to its own slippery slope (just as we have seen in the Netherlands). Many medical
organizations that fully support legal abortion are strongly opposed to doctor-assisted death (i.e., the American Medical
The "right" to an abortion is predicated upon the misguided reasoning that
the unborn child is a human life but "not a person". Even if this thinking was accurate, how could it be applied to adults
with terminal illness? It is worth noting that, at the time of Roe vs. Wade in 1973, proponents of abortion scoffed
at the prospect of legal abortion eventually leading to legal euthanasia.
thought: If a mother can kill her innocent, unwanted daughter for the sake of convenience, then why can't a daughter
kill her innocent, unwanted mother for the same reason?
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the Author: Dr. Kenneth J. Simcic was born in Pittsburgh, Pennsylvania. He
attended Duquesne University in Pittsburgh before obtaining his medical degree from Temple University Medical School
in Philadelphia. He then joined the United States Army and completed his internship, residency and fellowship at
Fitzsimons Army Medical Center in Denver, Colorado.
Dr. Simcic's specialty is adult endocrinology. He served for 20 years as an Army physician before taking his current
position at the University of Texas Heatlth Sciences Center/San Antonio. He was a member of the Bioethics Committee
at William Beaumont Army Medical Center in El Paso, Texas, and served as Chairman of the Bioethics Committee
at Brooke Army Medical Center in San Antonio.
Simcic is a Fellow of both the American College of Physicians and the American College of Endocrinology. He has also
been awarded the "A" Proficiency Designator-the Army Medical Department's highest award recognizing professional expertise,
exceptional ability, and outstanding achievement.
Dr. Simcic is the father of 3 daughters and he and
his wife Mary will celebrate their 25th wedding anniversay in June 2007.