Frequently Asked Questions

Euthanasia and Assisted Suicide
by
Rita L. Marker and Kathi Hamlon

One of the most important public policy debates today surrounds the issues of euthanasia and assisted suicide. The outcome of that debate will profoundly affect family relationships, interaction between doctors and patients, and concepts of basic ethical behavior. With so much at stake, more is needed than a duel of one-liners, slogans and sound bites.

The following answers to frequently asked questions are designed as starting points for considering the issues. For more detailed information see the documented, in-depth material available at this web site.

1. Where are euthanasia and assisted suicide permitted?

In 1995 Australia’s Northern Territory was the first jurisdiction to pass a euthanasia bill.[1]  It went into effect in 1996 but was overturned by the Australian Parliament in 1997.

As of early 2015, euthanasia and/or assisted suicide were permitted in Oregon,[2] Washington,[3] Vermont,[4] The Netherlands,[5] Belgium,[6] Luxembourg[7] and Colombia.[8]

Although euthanasia and assisted suicide are illegal in Switzerland, assisted suicide is penalized only if it is carried out “from selfish motives.”[9]

De facto legalization exists in Montana.[10]

On February 6, 2015, the Canadian Supreme Court ruled that both assisted suicide and euthanasia are legal but suspended implementation of the decision for one year.[11]

2. What is the difference between euthanasia and assisted suicide?

One way to distinguish them is to look at the last act – the act without which death would not occur.

Using this distinction, if a third party performs the last act that intentionally causes a patient’s death, euthanasia has occurred. For example, giving a patient a lethal injection or putting a plastic bag over her head to suffocate her would be considered euthanasia.

On the other hand, if the person who dies performs the last act, assisted suicide has taken place. Thus it would be assisted suicide if a person intentionally swallows an overdose of drugs that has been provided by a doctor for the purpose of causing death. It would also be assisted suicide if a patient pushes a switch to trigger a fatal injection after the doctor has inserted an intravenous needle bearing a lethal drug into the patient’s vein.

3. Doesn’t modern technology keep people alive who would have died in the past?

Modern medicine has definitely lengthened life spans. A century ago, high blood pressure, pneumonia, appendicitis, and diabetes likely meant death, often accompanied by excruciating pain. Women had shorter life expectancies than men since many died in childbirth. Antibiotics, immunizations, modern surgery and many of today’s routine therapies or medications were unknown then.

4. Should people be forced to stay alive?

No. Many people think that euthanasia or assisted suicide is needed so patients won’t be forced to remain alive by being “hooked up” to machines. But the law already permits patients or their surrogates to withhold or withdraw unwanted medical treatment even if that increases the likelihood that the patient will die. Thus, no one needs to be hooked up to machines against their will.

Neither the law nor medical ethics requires that “everything be done” to keep a person alive. Insistence, against the patient’s wishes, that death be postponed by every means available is contrary to law and practice. It is also cruel and inhumane.

There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. That’s when hospice, including in-home hospice care, can be of great help. That is the time when all efforts should be directed to making the patient’s remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to providing emotional and spiritual support for both the patient and the patient’s loved ones.

5. Does the government have the right to make people suffer?

Absolutely not.  Likewise, the government should not have the right to give one group of people (e.g. doctors) the power to directly and intentionally end the lives of another group of people (e.g. their patients).

Activists often claim that laws against euthanasia and assisted suicide are government mandated suffering. But this claim would be similar to saying that laws against selling contaminated food are government mandated starvation.

Laws against euthanasia and assisted suicide are in place to prevent abuse and to protect people from unscrupulous doctors and others. They are not, and never have been, intended to make anyone suffer.

6. But shouldn’t people have the right to commit suicide?

Suicide is not illegal, and, tragically, people can and do intentionally end their own lives. Every 40 seconds a person dies by suicide somewhere in the world.[12]  In the United States alone, there were 41,149 reported suicides in 2013.[13]  At the same time there were 14,196 homicides,[14] making the number of suicides almost three times greater than the number of homicides.

Euthanasia and assisted suicide, however, are not private acts. Rather, they involve at least one person facilitating the death of another. This is a matter of very public concern since it can lead to tremendous abuse, exploitation and erosion of care for the most vulnerable people among us.

Euthanasia and assisted suicide are not about giving rights to the person who dies but, instead, they are about changing public policy, giving doctors the power to prescribe or administer lethal drugs.

7.    Shouldn’t there be softer terms to describe doctor-prescribed suicide and doctor-administered euthanasia?

No.

While changes in laws have transformed euthanasia and/or assisted suicide from crimes into “medical treatments” in some jurisdictions, the reality has not changed – patients are dying from lethal doses of drugs that are prescribed or administered by doctors.  Ending one’s own life is suicide.  Ending the life of another person is homicide.

Euthanasia and assisted suicide activists often use euphemisms like “deliverance,” “death with dignity,” “aid-in-dying” and “gentle landing.”  If a change in public policy has to be promoted with euphemisms, doesn’t this make it clear that the use of accurate, descriptive language makes the chilling reality too obvious?

8.  Isn’t euthanasia or assisted suicide only available to people who are dying and in great pain? 

No.   There is not a requirement in any place where euthanasia and/or assisted suicide are legal that the patient be in pain in order to qualify for death.

For example, in Oregon, the official reports indicate that the reason more than 90% of those who die from doctor prescribed suicide do so because they are concerned about loss of autonomy and loss of ability to engage in activities making life enjoyable.  Pain concerns are one of the least cited reasons for assisted-suicide requests.[15]

In The Netherlands, mentally ill patients are given lethal injections.  In Belgium, an elderly couple announced plans to be euthanized even though neither had a terminal illness.  Instead, they feared loneliness if one died from natural causes.

9. Wouldn’t euthanasia and assisted suicide only be at a patient’s request?

No. As one of their major goals, euthanasia proponents seek to have euthanasia and assisted suicide considered “medical treatments.” If one accepts the notion that those practices are good medical treatments, then it would not only be inappropriate, but discriminatory, to deny such good treatments to a patients solely because they are too young or mentally incapacitated to request it.

In Oregon, patients who are mentally incapacitated have been deemed capable of requesting doctor-prescribed suicide.  For example, it has been noted that “a psychological disorder – senility, for example – does not necessarily disqualify a person” from requesting and receiving the lethal prescription.

In United States jurisdictions where doctor-prescribed suicide is considered a medical treatment, the law states that patients cannot be coerced into requesting death.  However, they do not prohibit anyone from advising, suggesting or encouraging a patient to request the lethal dose.

In fact, the supreme court of one state has ruled that a law that bans advising or encouraging another’s suicide violates free speech rights.[16]

10. Could euthanasia or assisted suicide be used as a means of health care cost containment?

Yes.

“Choice” is an appealing word, but inequity in health care is a harsh reality.

In states that permit doctor-prescribed suicide, doctors are to inform patients about all treatment options. But discussing all options does not mean that the patient will have the ability to access those options.

Patients may find that their insurance will not cover the “feasible alternatives” their doctors informed them about but, instead, will pay for doctor-prescribed suicide.

That has already happened in Oregon where the Oregon Health Plan (OHP) notified patients that medications prescribed to extend their lives or improve their comfort level would not be covered, but that the OHP would pay for a lethal drug prescription.[17]

Referring to payment for assisted suicide, the Oregon Department of Human Services explains, “Individual insurers determine whether the procedure is covered under their policies, just as they do any other medical procedure.”[18]

If doctor-prescribed suicide becomes just another “end-of-life option,” and a cheap option at that, the standard of care and provision of health care changes.  There is less and less focus on extending life and eliminating pain, and more and more focus on the “efficient and inexpensive treatment option” of death.

The last to receive health care could be the first to receive doctor-prescribed suicide.

11. Don’t the years of experience in Oregon prove that those who oppose doctor-prescribed suicide are being alarmists when they warn about abuses and problems?

No.

Those who promote doctor-prescribed suicide point to Oregon’s experience with assisted suicide under that state’s “Death with Dignity Law.”  They claim that years of official reports from that state prove that abuses and problems do not occur.  However, when a British House of Lords committee traveled to Oregon seeking information about Oregon’s law, they found that claims about the Oregon experience are problematic, at best.

They found that safeguards in the law are disregarded and no one has been disciplined.[19]  In addition, the state does not have the legal authority or the resources to investigate any suspected problems.[20]  There is no assessment of patients after the prescription is written since the state’s job is only to make sure that all the steps happened up to the point the prescription was written.[21]  One official said that after writing the prescription, the physician may not keep track of that patient since “the law itself only provides for writing the prescription, not what happens afterwards.”[22]

It is the prescribing physician who fills out the information for official reports, including whether there were any problems, abuses, etc. at the time the drugs were taken.  But, even the state’s official reports indicate that the prescribing physician is very rarely present when the lethal drugs are taken so the reported information is likely “second hand.”[23]

As early as the first official report, the state acknowledged that it has no way of knowing if the information included in the annual reports is accurate or complete but that it is assumed that the reporting doctors are being their usual careful accurate selves.[24]

Therefore, any claim that, in Oregon, doctor-prescribed suicide is problem free is extremely questionable.

12. Doesn’t doctor-prescribed suicide make certain that patients can take a pill and slip peacefully away, surrounded by their loved ones?

No.  It is inaccurate to state that the patient takes “a pill.”  In fact, a massive dose of drugs must be consumed.

According to Oregon’s 2015 official report, deaths under the Death with Dignity Act occurred after 60% of patients took Secobarbital (Seconal) and 39% took Pentobarbital (Nembutal).[25]  Both are barbiturates (sedatives).  The usual therapeutic dosage for each is 100 to 200 mg.  (Pentobarbital has become extremely difficult to obtain since manufacturers are refusing to supply it because it is used for lethal injections in capital punishment.[26])

However, the usual doctor-prescribed suicide dose for each is 9000 to 10,000 mg.  That is 90 to 100 times the usual therapeutic dose![27]

Advocates describe deaths under the Oregon law as peacefully slipping away.  If it were not for occasional news reports and inadvertent disclosures, assisted-suicide in Oregon would seem problem free. However, there are troubling accounts.  For example:

After Patrick Matheny received his lethal dose of drugs from the Oregon Health Sciences University via Federal Express, he delayed taking them for four months. On the day of his death, he experienced difficulty. His brother-in-law, Joe Hayes, said he had to “help” Matheny die. According to Hayes, “It doesn’t go smoothly for everyone. For Pat, it was a huge problem. It would not have worked without help.”[28]

Another assisted suicide that went awry was disclosed by attorney Cynthia Barrett, an assisted suicide supporter during a class at Portland Community College titled, “Physician Assisted Suicide: Counseling Patients/Clients.” According to Barrett, “The man was at home. There was no doctor there,” she said.”After he took it [the drug overdose], he began to have some physical symptoms. The symptoms were hard for his wife to handle. Well, she [the wife] called 911. The guy ended up being taken by 911 to a local Portland hospital. Revived. In the middle of it. And taken to a local nursing facility. I don’t know if he went back home. He died shortly – some period of time after that time.”[29]

Similar reports have come from The Netherlands:

Although euthanasia and assisted suicide remained technically illegal in The Netherlands until 2001, for many years the Royal Dutch Association of Pharmacy had provided prescribing guidelines to prevent problems and to increase the efficiency of euthanasia and assisted suicide. Yet there are still a number of complications and problems reported with such deaths.[30]

Even Dutch euthanasia activists acknowledge these difficulties, stating in their own euthanasia society publication that, in one out of five cases of euthanasia or medically-assisted suicide, there are problems or complications. [31]

13. Since euthanasia and assisted suicide take place anyway, isn’t it better to legalize them so they’ll be practiced under careful guidelines and doctors will have to report these activities? 

That sounds good, but it doesn’t work.  It assumes that those who are currently breaking the law would adhere to guidelines.

But it is helpful to apply that argument to other situations.

For example, we know that employees sometimes embezzle from their companies.  Would we favor a law that permits them to do so under certain guidelines?

In fact, those who are breaking the law now would likely ignore guidelines, and those who are abiding by the law now would begin to carry out the previously prohibited activity.

14. Isn’t euthanasia or assisted suicide sometimes the only way to relieve excruciating pain?

Quite the contrary. Euthanasia and assisted suicide activists exploit the natural fear people have of suffering and dying by claiming that, without euthanasia or assisted suicide, people will be forced to endure unbearable pain.

However, virtually all pain can be eliminated or – in those rare cases where it can’t be totally eliminated – it can be reduced significantly if proper treatment is provided.

It is a national and international scandal that so many people do not get adequate pain control because physicians are not properly trained in pain control. But giving doctors the power to end their patients’ lives is not the answer to that scandal. The solution is to mandate better education of health care professionals on these crucial issues, to expand access to health care, and to inform patients about their rights as consumers.

In 2002, the Patients Rights Council published an important book, Power over Pain: How to Get the Pain Control You Need, which is an incredibly valuable tool for people to use in obtaining pain relief.[32]

Everyone – whether a person with a life-threatening illness or a chronic condition – has the right to pain relief. With modern advances in pain control, no patient should ever be in excruciating pain.  Unfortunately, many doctors have never had a course in pain management so they’re unaware of what to do.

If a patient who is under a doctor’s care is in excruciating pain, there’s definitely a need to find a different doctor. But that doctor should be one who will control the pain, not one who will prescribe or administer lethal drugs.

There are board certified specialists in pain management who can not only help alleviate physical pain but who are also skilled in providing necessary support to deal with emotional suffering and depression that often accompany physical pain.

15. Isn’t opposition to euthanasia and assisted suicide just an attempt to impose religious beliefs on others? 

No.  Euthanasia and assisted suicide activists have attempted for a long time to make it seem that anyone opposed to their agenda is trying to impose his or her religion on others. But that’s not the case.

Nonetheless, stereotyping has been, and will continue to be, part and parcel of campaigns to promote doctor-prescribed suicide and doctor-administered euthanasia. Its purpose is to marginalize those who work to protect vulnerable patients.

People on both sides of the euthanasia and assisted suicide controversies claim membership in religious denominations. There are also individuals on both sides who claim no religious affiliation at all. But it’s even more important to realize that these are not religious issues, nor should this be a religious debate.

The debate over euthanasia and assisted suicide is about public policy and the law.

The fact that the religious convictions of some people parallel what has been long-standing public policy does not disqualify them from taking a stand on an issue.

For example, there are laws that prohibit sales clerks from stealing company profits. Although these laws coincide with religious beliefs, it would be absurd to suggest that such laws should be eliminated. And it would be equally ridiculous to say that a person who has religious opposition to it shouldn’t be able to support laws against stealing.

Similarly, the fact that the religious convictions of some euthanasia and assisted-suicide opponents parallel what has been long-standing public policy does not disqualify them from taking a stand on the issues.

16. Where does the main support for euthanasia and assisted suicide come from?

The most visible and vocal proponents of euthanasia and assisted suicide are organizations made up of committed activists who seek to change the laws. But, they are only able to pursue their agenda because of funding from a handful of extremely generous sources.

Far from reflecting any grassroots desire, the push for legalization of euthanasia and assisted suicide is a “top down” creation where the few seek to change the laws that affect everyone.[33]

17. Since suicide isn’t against the law, why should it be illegal to help someone commit suicide?

Neither suicide nor attempted suicide is criminalized anywhere in the United States or in many other countries. This is not because of any “right” to suicide. When penalties against attempted suicide were removed, legal scholars made it clear that this was not done for the purpose of permitting suicide. Instead it was intended to prevent suicide. Penalties were removed so people could seek help in dealing with the problems they’re facing without risk of being prosecuted if it were discovered that they had attempted suicide.

[1]   “Rights of the Terminally Ill Act,” Northern Territory of Australia (1996).  See additional information on Australia.

[2]   Oregon’s “Death with Dignity Act” (ORS 127.800-897) passed in November 1994 and went into effect in 1997. See additional information on Assisted Suicide in Oregon.

[3]   Washington approved the Washington “Death with Dignity Act” on Nov. 4, 2008. See additional information on Washington.

[4]   Vermont ‘s law permitting doctor-prescribed suicide went into effect on May 20, 2013.  See additional information on Vermont.

[5]   Although both euthanasia and assisted suicide had been widely practiced in the Netherlands for many years, they remained technically illegal until passage of a bill for the “Review of cases of termination of life on request and assistance with suicide” was approved in April 2001. See additional information on Holland.

[6]   Belgium’s law was passed on May 16, 2002.  See additional information on Belgium.

[7]   See additional information on Luxembourg.

[8]   In 1997, Colombia’s Supreme Court ruled that penalties for mercy killing should be removed but the decision was not to go into effect until guidelines were approved by the Colombian Congress. (Republic of Colombia Constitutional Court, Sentence # c-239/97, Ref. Expedient # D-1490, May 20, 1997.)
The guidelines were not approved until 18 years later, in April 2015.  (Sabrina Martin, “At last Colombia approves euthanasia guidelines.” PanAm Post, April 23, 2015 and Simeon Tegal, “Colombia just legalized euthanasia,” Global Post, April 29, 2015.) See additional information on Colombia.

[9]  Swiss law states, “Whoever, from selfish motives, induces another to commit suicide or assists him therein shall be punished, if the suicide was successful or attempted, by confinement in a penitentiary for not more than five years or by imprisonment.” [Article 115 of the Penal Code] [emphasis added].  See additional information on Switzerland.

[10]   On December 31, 2009, the Montana Supreme Court declared that, if charged with prescribing drugs to end a patient’s life, physicians could use the patient’s consent as a defense to a charge of assisted suicide.  The decision established de facto legalization.  See additional information on Montana.

[11]   See additional information on Canada.

[12]   World Health Organization, 2014 .

[13]   American Foundation for Suicide Prevention, citing the Centers for Disease Control and Prevention (CDC).

[14]   Federal Bureau of Investigation (FBI), “Crime Statistics for 2013″.

[15]   Oregon Public Health Division, “Oregon’s Death with Dignity Act – 2014,” Feb. 2, 2015, p. 5.

[16]   Stephan Montemayor, “Trial begins for group accused of assisting Apple Valley woman’s suicide,” Star Tribune, May 3, 2015. Refers to State v. Melchert-Dinkel, 844 N.W. 2d 13 (Minn 2014).

[17] KATU Television, “Letter noting assisted suicide raises questions” (interview about one such case and the response of the Oregon Health Plan).

[18] Oregon Dept. of Human Services, “FAQs about the Death with Dignity Act.”

[19] The testimony was published in: House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, “Assisted Dying for the Terminally Ill Bill [HL]” Volume II: Evidence. Apr. 4, 2005.  (Hereafter referred to as HL) Testimony of Dr. Katrina Hedberg, Pg. 257, Q. 555.

Available at: http://www.publications.parliament.uk/pa/ld200405/ldselect/ldasdy/86/86ii.pdf.

[20]  Hedberg, HL, p. 266, Q. 615.

[21]  Hedberg, HL, p. 259, Q. 566. (Emphasis added.)

[22]  Hedberg, HL, p. 259, Q. 567. (Emphasis added.)

[23]  Oregon Public Health Division, “Oregon’s Death with Dignity Act – 2014.”  See pg. 5.

[24]  Oregon Health Division, CD Summary, “A Year of Dignified Death,”  See pg. 2.

[25]  Oregon Public Health Division, “Oregon’s Death with Dignity Act – 2014.”  See pg. 5.

[26]  Nigel Jaquiss, “Penalized By The Death Penalty,” Willamette Week, May 21, 2014.

[27]  Jennifer Fass and Andrea Fass, “Physician-assisted Suicide: Ongoing Challenges for Pharmacists, “ Am. J. Health Syst Pharm. 2011:68(9): 846-849.

[28] Erin Barnett, “Dilemma of Assisted Suicide: When?” Oregonian, January 17, 1999 and Erin Barnett, “Man with ALS makes up his mind to die,” Oregonian, March 11, 1999.

[29] Catherine Hamilton, “The Oregon Report: What’s Hiding behind the Numbers?” Brainstorm, March 2000. Hamilton was present at the class which she audiotaped. The revelations made at the class were also discussed on Portland’s KXL Radio and in the Oregonian. [David Reinhard, “The pills don’t kill: The case, First of two parts, Oregonian, March 23, 2000 and David Reinhard, “The pills don’t kill: The case, Second of two parts,” Oregonian, March 26, 2000.

[30] Johanna H. Groenewoud, et al., “Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands,” 342 New England Journal of Medicine (February 24, 2000), pp. 553-555.

[31] Beatrijs Trip, “Summary of Interview with former professor of pharmacology and hospital doctor, Dr. Jan Glerum,” from “Relevant,” Volume 26, Number 3, July 2000, posted on World Federation of Right to Die Societies web site . Dr. Glerum is described in the summary as a pharmacist and hospital doctor who “was often involved with euthanasia and in the attempts of people to kill themselves.”

[32]  To obtain a copy of Power over Pain, contact the Patients Rights Council.

[33]  For a discussion of funding for assisted suicide, see:  R. Marker, “Dying for the Cause: foundation funding for the ‘right-to-die’ movement,” Philanthropy, (January/February 2001), pp. 26-29.