In November 1998, Michigan voters rejected Proposal B, a citizen initiative that would have legalized physician-assisted suicide (PAS). Although polls had long indicated overwhelming support for PAS, support for Proposal B declined before the election. We analyzed exit-poll data to characterize opponents, supporters, and cross-over voters. We then compared our results with those from earlier research that examined attitudinal and socio-demographic influences. We found that many presumptive PAS supporters did not vote for Proposal B. These data may call into question prospects for similar initiatives.

Medicalized Death and the Right to Die Movement Prior to the 20th Century, most Americans died at home, surrounded by family, friends, and neighbors. Religion, not medicine, governed the death bed for there was little physicians could do for the dying. Eventually, however, advances in medicine and technology would lead to dramatic changes in the timing and location of death: patients not only began living longer, they were also dying longer, and unlike their predecessors, were more likely to die alone, in institutions, and among strangers. Modern medicine, in its zeal to conquer death, had become obsessed with its curative function and ability to extend the lives of the dying. To many in the medical community, death represented failure and was something to be avoided at all costs, and like many other social problems in the United States, had become medicalized.

The legalization of physician-assisted suicide (PAS) remains a hotly debated issue throughout the United States, and continues to capture the attention of government officials at both the state and federal levels. While the practice is currently legal in Oregon, some federal lawmakers and officials from the U.S. Department of Justice have attempted to outlaw that state's practice through legislation (e.g., the Pain Relief Promotion Act of 1999), or through a strained interpretation of the federal Controlled Substances Act. And while several citizen groups throughout the United States have attempted but failed to legalize PAS through popular initiative, several state lawmakers have succeeded in specifically outlawing the practice. Yet even though physician-assisted suicide (PAS) remains unlawful in every state except Oregon, there is ample evidence that American physicians throughout the United States have participated in PAS by providing their terminally ill patients with lethal prescriptions.

A recurring theme in the debate over adequate pain management is the extent to which physicians’ fear of criminal investigation and prosecution has set up barriers to appropriate dispensing of pain relief to patients. While there have been several studies looking at the regulatory environment and its effect on physicians’ prescribing practices and the treatment of pain, there has been scant research on the probability of investigation or prosecution of physicians who aggressively prescribe opioids for pain management.

To understand whether physicians’ fear of investigation or prosecution is based on a realistic assessment of risk, the authors surveyed chief prosecutors in four states (Maryland, Connecticut, Oregon, and Washington), all of which have varying degrees of focus, prosecutorial culture, and regulatory attitudes toward this issue.

The experience of having to suffer debilitating pain is far too common in the United States, and many patients continue to be inadequately treated by their doctors. Although many physicians freely admit that their pain management practices may have been somewhat lacking, many more express concern that the prescribing of heightened levels of opioid analgesics may result in closer regulatory scrutiny, criminal investigation, or even criminal prosecution.

Although several researchers have examined the regulatory environment and the threat of sanction or harm it poses to physicians and patients, few have examined the likelihood of investigation or prosecution stemming from the aggressive use of opioids in physician-directed pain management. Accordingly, in an effort to assess whether the fear of prosecution is realistic and, if so, what factors contribute to its likelihood, we surveyed chief prosecutors in four states about their knowledge, opinions, and attitudes concerning opioids and the prosecution of physicians stemming from the treatment of patients who were either terminally ill or suffering from chronic noncancer pain.