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Definitions of Terms
• Euthanasia literally means "an easy death." It involves actions that are intended to relieve suffering by causing the death of the suffering person.
• Active euthanasia means to perform actions that directly cause the death of another person.
• Passive euthanasia is a somewhat ambiguous term, and some question whether there even is such a thing as passive euthanasia. It is typically thought of as withholding or withdrawing life-sustaining treatment, such as a ventilator or feeding tube, and thereby hastening death by technically natural causes.
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• Assisted suicide is any act by which an individual provides another person with the means to kill himself.
• Physician-assisted suicide (also called physician-assisted dying, doctor-assisted suicide, and medically assisted suicide) is assisted suicide wherein a physician provides the means—typically, lethal medication. Some consider physician-assisted suicide to lie somewhere between active and passive euthanasia, while others consider it equivalent to active euthanasia.
• Assisted dying is a term used predominantly in the U.K. and U.S. to indicate medically assisted suicide for the terminally ill.1
Where Is Euthanasia Legal & When Was It Legalized?
-Oregon (Death with Dignity Act) 1997
-Washington (Death with Dignity Act) 2009
-Montana (Baxter v. Montana) 2013
-Vermont (Patient Choice and Control at End of Life Act) 2014
-New Mexico, Bernalillo County only (Morris v. Brandenberg) 2014
-California (End of Life Option Act) 2016
Notes: In 1997, the U.S. Supreme Court ruled in Washington v. Glucksberg that a state law prohibiting assisted suicide did not offend the Due Process Clause of the Fourteenth Amendment to the Constitution. The Court having thus declined to overturn all state laws prohibiting assisted suicide, activists have since then operated on a state-by-state basis to get physician-assisted suicide legalized via legislation or state court rulings.
As of this writing, Oregon, Washington, Vermont, and California have passed laws permitting physician-assisted suicide for the terminally ill. Montana allows it through a court ruling, while in New Mexico, a court ruling currently allows it in Bernalillo County only, but a statewide ruling is pending with the New Mexico Court of Appeals/Supreme Court.2
Notes: Switzerland is the only country where lethal drugs or other forms of assisted suicide do not have to be administered by a physician and the patient does not have to be a resident of Switzerland. Assisted suicide is illegal in Switzerland if someone is assisting out of selfish motives, though it is doubtful how such motivation could be definitively established.
Also, there are some countries, like Germany, where the laws concerning assisted suicide are not clear.
How Many People Have Died from Physician-Assisted Suicide?
-United States (Oregon & Washington)
As of 2015, according to the Oregon Health Authority's annual report (required by state law), a total of 1,545 people have received lethal prescriptions under the Death with Dignity Act since its passage in 1997. Of those, 991 have died from ingesting the medicine.
Notably, the number of prescriptions given out has increased each year. Between 1998 and 2013, the number increased by an average of 12.1 percent annually, but between 2014 and 2015, the rate of increase spiked to 24.4 percent. A total of 218 individuals received prescriptions in 2015, of whom 125 died from ingesting the medication and 50 died from other causes. The status of the remaining 43 patients is unknown. Seven additional patients died that year from ingesting lethal medication obtained prior to 2015.3
The figures for Washington State are similar. Its most recent report records that lethal medication was given to 213 people in 2015. Of these, 166 died after ingesting the medication, while 24 died from other causes. Twelve others are known to have died, but the cause is unknown, and the state has no information on the remaining 11 individuals.4
-The Netherlands & Belgium
The number of euthanasia and assisted suicide deaths in Holland increased by 75 percent in five years, from 3,136 such deaths in 2010 to 5,516 in 2015. The 2015 total comprised 3.9 percent of all deaths in the country that year; prior to 2010, euthanasia accounted for 2.8 percent of all deaths.5
The most recent statistics from Belgium report that, in 2013, there were 1,816 euthanasia or assisted suicide deaths, accounting for 4.6 percent of all deaths in the country that year. The total represented a 26.8 percent increase over the 1,432 such deaths in 2012, which in turn saw a marked increase from the 2011 total of 1,133.6
Who Gets Physician-Assisted Suicide?
-Oregon & Washington
According to Oregon Health Authority, in 2015 the median age of people who died from physician-assisted suicide in the state was 73. Of those, 93.1 percent were white, and 43.1 percent had at least an undergraduate degree.
As for reasons for requesting assisted suicide, patients cited decreasing ability to participate in activities that made life enjoyable (96.2 percent), loss of autonomy (92.4 percent), and loss of dignity (75.4 percent) as among their main concerns. Slightly less than half of them, 48.1 percent, were worried about being a burden on their family, friends, and caregivers.7
Unlike previous years, more women than men died from physician-assisted suicide in Oregon in 2015, which parallels an overall increase in female suicides in the United States that year.8
The demographics are similar for the state of Washington, where 98 percent of those who died from physician-assisted suicide were white, and 74 percent had at least some college education, although men made up a larger number of cases (53 percent) than women (47 percent). But as in Oregon, the number of people receiving lethal medication has increased steadily every year since assisted suicide was legalized in 2009.9
-Holland & Belgium
The Dutch Euthanasia Commission reports that, between 2010 and 2015, cases of euthanasia for patients with psychiatric disorders jumped dramatically in the country, from just 2 such cases in 2010 to 56 in 2015, including one woman who had been sexually assaulted as a child and was told her post-traumatic stress was untreatable. In the same time span, cases of euthanasia for patients with dementia rose from 25 to 109.10 Most of those seeking assisted suicide for mental health reasons were women.11
Currently, Dutch law permits children as young as 12 years old to request assisted suicide, but a parent or guardian must consent if the patient is under 16 years old.12
In Belgium, there were 67 cases of assisted suicide for psychiatric disorders in 2013.13 This country also allows minors to request assisted suicide, but parental consent is required for those under the age of 18.14 •
Support for so-called aid-in-dying bills has increased in the last twenty years, thanks in large part to how physician-assisted suicide and euthanasia are presented to the public.
In the 1990s, Jack Kevorkian (1928–2011) was the face of the assisted-suicide movement. Before being charged with murder for the 1997 death of Thomas Youk, which was televised on 60 Minutes, Kevorkian had killed 130 people using his "thanatron" or "death machine." His obsession with death, particularly as expressed in his odd artwork and music, and his campaign to do post-mortem experiments, did little to make euthanasia palpable to the public.
British-born Derek Humphry (b. 1930), another activist for assisted dying and founder of the Hemlock Society (now merged with Compassion and Choices), once said that while Dr. Kevorkian brought euthanasia to public attention, he may have "ruined it in the eyes of the medical profession."1
Philip Nitschke (b. 1947) advocates for euthanasia in his native Australia. He founded Exit International and, like Kevorkian, has been a bit overzealous in his pursuit of legalized assisted suicide. Last year, he tore up his medical license after an Australian medical board laid out several conditions he must follow in order to continue practicing as a physician.2 He did not help his public campaign by doing a stage comedy act that received poor reviews.3
Although Kevorkian, Humphrey, and Nitschke brought euthanasia into the public square, it was Brittany Maynard who changed the public perception of assisted dying. Unlike the other three, who were older and male, Maynard was young, vibrant, and female. She sought lethal barbiturates after learning, at age 29, that she had terminal brain cancer. She and her husband and family moved from California to Oregon so she could legally obtain medication to end her life. Because of her campaign, as well as her family's continued work in advocating for aid-in-dying bills, California has since legalized assisted suicide.
Unlike Kevorkian, Humphrey, and Nitschke, Maynard was someone the public could relate to. For better or worse, the fact that she was a beautiful young woman made her case seem all the more tragic, as widely disseminated pictures and videos showed the progression of her disease. Maynard was also articulate and justified her desire to die in a way that seemed rational and evoked sympathy. •
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