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“Underground Euthanasia” and the Harm Minimization Debate

Published online by Cambridge University Press:  01 January 2021

Extract

I have a hairstylist whose lover was very sick. I’d been seeing this stylist for ten years and we’re good friends. [His lover was] becoming an invalid, not able to get out of bed. He said “I hate to ask you this but would you mind writing a prescription to help us out?” [So] I wrote a prescription to a patient who I had never seen, and I sent it to him in the mail and I heard the next time I went in to get my hair cut that it was the most beautiful experience that my stylist had ever had. It was Valentine’s Day and they had a lovely meal with champagne. And they held each other and then, you know, his partner took his pills and was released.

(Joseph, physician)

Type
Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2004

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References

Meier, D.E., Emmons, C.A., Wallenstein, S., et al., “A National Survey of Physician-Assisted Suicide and Euthanasia in the United States,” N. Engl. J. Med. 338 (1998): 11931201.CrossRefGoogle Scholar
Emanuel, E.J., Fairclough, D., Clarridge, B., et al., “Attitudes and Practices of U.S. Oncologists Regarding Euthanasia and Physician-Assisted Suicide,” Annals of Internal Medicine 133 (2000): 527–32.CrossRefGoogle Scholar
Kohlwes, R.J., Koepsell, T.D., Rhodes, L.A., and Pearlman, R.A., “Physicians’ Responses to Patients’ Requests for Physician-Assisted Suicide,” Archives of Internal Medicine 161 (2001): 657–63.CrossRefGoogle Scholar
Douglas, C.D., Kerridge, I.H., Rainbird, K.J., et al., “The Intention to Hasten Death: A Survey of Attitudes and Practices of Surgeons in Australia,” Medical Journal of Australia 175 (2001): 511–15.CrossRefGoogle Scholar
Kuhse, H., Singer, P., Baume, P., et al., “End-of-Life Decisions in Australian Medical Practice,” Medical Journal of Australia 166 (1997): 191–96.CrossRefGoogle Scholar
Magnusson, R.S., Angels of Death: Exploring the Euthanasia Underground (New Haven, Connecticut & London: Yale University Press, 2002).Google Scholar
Magnusson, , supra note 6, at 130–38.Google Scholar
Emanuel, E.J., Daniels, E.R., Fairclough, D.L., et al., “The Practice of Euthanasia and Physician-Assisted Suicide in the United States: Adherence to Proposed Safeguards and Effects on Physicians” JAMA 280 (1998): 507–13.CrossRefGoogle Scholar
Groenewoud, J.H., van der Heide, A., Onwuteaka-Philipsen, B.D., et al., “Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands,” N. Engl. J. Med. 342 (2000): 551–56.CrossRefGoogle Scholar
Hillyard, D., and Dombrink, J., Dying Right: The Death With Dignity Movement (New York: Routledge, 2001): at 186.Google Scholar
Magnusson, , supra note 6, at 9, 168, 208–09.Google Scholar
Kuhse, , supra note 5, at 193.Google Scholar
Emanuel, , supra note 8, at 511.Google Scholar
See, e.g., Miles, S.H., “Physicians and Their Patients’ Suicides,” JAMA 217 (1994): 1786–88; Pollard, B.J., “Can Euthanasia Be Safely Legalized?,” Palliative Medicine, 15 (2001): 61–65; Quill, T., Cassel, C.K., and Meier, D.E., “Care of the Hopelessly Ill: Proposed Clinical Criteria for Physician-Assisted Suicide,” N. Engl. J. Med. 327 (1992): 1380–84; Amarasekara, K., “Euthanasia and the Quality of Legislative Safeguards,” Monash University Law Review 23 (1997): 1–42.CrossRefGoogle Scholar
Somerville, M., Death Talk: The Case Against Euthanasia and Physician-Assisted Suicide (Montreal & Kingston: McGill-Queen’s University Press, 2001): at 54. In fairness to Somerville, she adds that “I am assuming here that hidden euthanasia involves only those who want to be killed and who would be eligible for euthanasia if it were legalized.” I would argue that the evidence does not bear out this assumption. See Magnusson, , supra note 6, at 200–44.Google Scholar
Magnusson, , supra note 6, at 174–99.Google Scholar
Cf. Callahan, D. and White, M., “The Legalization of Physician-Assisted Suicide: Creating a Regulatory Potemkin Village,” University of Richmond Law Review 30 (1996): 183, at 8–9.Google Scholar
Lewins, F., “The Development of Bioethics and the Issue of Euthanasia: Regulating, De-regulating or Re-regulating,” Journal of Sociology 34, no. 2 (1998): 123–34, at 132.CrossRefGoogle Scholar
Magnusson, , supra note 6, at 145–47.Google Scholar
See Billings, J.A. and Block, S.D., “Slow Euthanasia,” Journal of Palliative Care 12 (1996): 2130; Loewy, E.H., “Terminal Sedation, Self-Starvation, and Orchestrating the End of Life,” Archives of Internal Medicine 161 (2001): 329–32.CrossRefGoogle Scholar
Examples include Cohn, F. and Lynn, J., “Vulnerable People: Practical Rejoinders to Claims in Favor of Assisted Suicide,” in Foley, K. and Hendin, H., eds., The Case Against Assisted Suicide (Baltimore: The Johns Hopkins University Press, 2002): 238–60, at 251–55; Amarasekara, K., “Euthanasia and the Quality of Legislative Safeguards,” Monash University Law Review 23 (1997): 1–42.Google Scholar
New York State Task Force on Life & the Law, When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context (New York: The New York State Task Force on Life & the Law, 1994): at 120 (emphasis added).Google Scholar
Id., at 120.Google Scholar
Pollard, B., “Can Euthanasia Be Safely Legalized?” Palliative Medicine 15 (2001): 6165, at 62.CrossRefGoogle Scholar
Callahan, D., “When Self-Determination Runs Amok” Hastings Center Report 22 (1992): 5255, at 53. See also Callahan, D., “Reason, Self-Determination and Physician-Assisted Suicide” in Foley, K. and Hendin, H., eds., The Case Against Assisted Suicide (Baltimore: The Johns Hopkins University Press, 2002): 52–68, at 60.CrossRefGoogle Scholar
Callahan, D., “Regulating Physician-Assisted Death,” N. Engl. J. Med. 331 (1994): 1656.Google Scholar
Byock, , for example, claims that “with the skillful application of psychosocial and spiritual support, dying often becomes an extremely important, valuable and, not rarely, a privileged time in life.” Byock, I., “The Hospice Clinician’s Response to Euthanasia/Physician Assisted Suicide,” The Hospice Journal 9 (1994): 18, at 6. See also Magnusson, R.S., “Challenges and Dilemmas in the ‘Aging and Euthanasia’ Policy Cocktail,” in Weisstub, D. H., Thomasma, D. C., Gauthier, S., and Tomossy, G., eds., Aging: Decisions at the End of Life (Dordrecht: Kluwer Academic Publishers, 2001): at 113–14, 121–22.CrossRefGoogle Scholar
Foley, K. and Hendin, H., “The Oregon Experiment,” in Foley, K. and Hendin, H., eds., The Case Against Assisted Suicide (Baltimore: The Johns Hopkins University Press, 2002): 144–74, at 150.Google Scholar
Id. at 148.Google Scholar
See id. at 151, 160–61, 164, respectively.Google Scholar
See Cook, D.J., Guyatt, G., Jaeschke, R., Reeve, J. Spanier, A. et al., “Determinants in Canadian Health Care Workers of the Decision to Withdraw Life Support from the Critically Ill,” Journal of the American Medical Association 273 (1995): 703–08.CrossRefGoogle Scholar
Caplan, A. L., Snyder, L., and Faber-Langendoen, K., for the University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel, “The Role of Guidelines in the Practice of Physician-Assisted Suicide,” Annals of Internal Medicine 132 (2000): 476–81, at 478–79.CrossRefGoogle Scholar
Callahan, , supra note 26, at 1656.Google Scholar
Hillyard and Dombrink note that all physician reports were in full compliance with the law in 1998. See Hillyard, and Dombrink, , supra note 10, at 186. In 1999 Sullivan and colleagues reported full compliance “as best we could determine”: Sullivan, A.D., Hedberg, K., and Fleming, D.W., “Legalized Physician-Assisted Suicide in Oregon — The Second Year,” N. Engl. J. Med. 342 (2000): 598604, at 603. One physician was reported in 2000. Id. at 605–07.Google Scholar
Jochemsen surveys evidence of non-compliance with the criteria required to be established for the purposes of the necessity defense, prior to the introduction of the Termination of Life on Request and Assisted Suicide (Review Procedures) Act: Jochemsen, H., “Why Euthanasia Should Not Be Legalized,” in Weisstub, D.H., Thomasma, D.C., Gauthier, S. and Tomossy, G., eds., Aging: Decisions at the End of Life (Dordrecht: Kluwer Academic Publishers, 2001): 6790, at 71–78. Similarly, see Hendin, H., “The Dutch Experience,” in Foley, K. and Hendin, H., eds., The Case Against Assisted Suicide (Baltimore: The Johns Hopkins University Press, 2002): 97–121, at 103ff; Keown, J., Euthanasia, Ethics and Public Policy: An Argument Against Legalization (Cambridge: Cambridge University Press, 2002): at 103–24. Although initially acknowledged in case law, guidance as to the scope of the necessity defense was also found in the statutory notification procedure that applied to euthanasia deaths under burial legislation. That procedure included some fifty criteria which acted as guidelines for the public prosecutor when assessing doctors’ reports. See, further, Griffiths, J., Bood, A., and Weyers, H., Euthanasia & the Law in the Netherlands (Amsterdam: Amsterdam University Press, 1998): 114–16.CrossRefGoogle Scholar
van der Wal, G., van der Maas, P.J., Bosma, J.M., Onwuteaka-Philipsen, B.D., Willems, D.L., et al., “Evaluation of the Notification Procedure for Physician-Assisted Death in the Netherlands,” N. Engl. J. Med. 335 (1996): 1706–11.CrossRefGoogle Scholar
Onwuteaka-Philipsen, B.D., van der Wal, G., Kostense, P.J., and van der Maas, P.J., “Consultants in Cases of Intended Euthanasia or Assisted Suicide in the Netherlands,” Medical Journal of Australia 170 (1999): 360363 (confirming that the consultant saw the patient in 88 percent of cases).CrossRefGoogle Scholar
Hendin, H., “Euthanasia Consultants or Facilitators?” Medical Journal of Australia 170 (1999): 351–52.CrossRefGoogle Scholar
Cohen-Almagor, R., “An Outsider’s View of Dutch Euthanasia Policy and Practice,” Issues in Law & Medicine 17 (2001): 3568, at 66.Google Scholar
Jochemsen, , supra note 35, at 77.Google Scholar
See van der Maas, P.J., van der Wal, G., Haverkate, I., de Graaff, C.L.M., Kester, J.G.C., Onwuteaka-Philipsen, B.D., et al., “Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995,” N. Engl. J. Med. 335 (1996): 16991705; van der Maas, P.J., van Delden, J. J.M., Pijnenborg, L., “Euthanasia and Other Medical Decisions Concerning the End of Life,” The Lancet 338 (1991): 669–74.CrossRefGoogle Scholar
Kuhse, H., Singer, P., Baume, P. et al. , supra note 5.Google Scholar
Griffiths, J., “Human Rights and Euthanasia,” MBPSL Newsletter, no. 5 (2001): at 2, available at <http://www.rug.nl/law/research/programmes/mbpsl/researchprogram/newsletters/> (accessed July 22, 2004).Google Scholar
Ward, B.J., and Tate, P.A., “Attitudes Among NHS Doctors to Requests for Euthanasia,” British Medical Journal 308 (1994): 1332–34. Thirty-eight respondents (9 percent) responded affirmatively to the question: “Have you ever taken active steps to bring about the death of a patient who asked you to do so?”.CrossRefGoogle Scholar
Keown, J., Euthanasia, Ethics and Public Policy: An Argument Against Legalization (Cambridge: Cambridge University Press, 2002): at 61.CrossRefGoogle Scholar
Id. at 62.Google Scholar
Meier, , supra note 1; Douglas, , supra note 4, respectively.Google Scholar
Keown, , supra note 45, at 61.Google Scholar
Chochinov, H.J., Tataryn, D., Clinch, J.J., and Dudgeon, D., “Will to Live in the Terminally Ill,” The Lancet 354 (1999): 816–19; see also Emanuel, E.J., Fairclough, D.L., Emanuel, L.L., “Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and their Caregivers,” JAMA 284 (2000): 2460–68.CrossRefGoogle Scholar
Pollard, B.J., “Can Euthanasia Be Safely Legalized?” Palliative Medicine 15 (2001): 6165 at 63.CrossRefGoogle Scholar
Downey, M., “Care for Dying ‘Needs Millions More Dollars,’” Sydney Morning Herald, March 26, 1997, at 6. Later, following pressure from churches and the Australian Medical Association, a further cut was avoided: Brough, J. and Alcorn, G., “Howard Guarantees Palliative Care Funds,” Sydney Morning Herald, March 27, 1997, at 6.Google Scholar
Dworkin, R., “Assisted Suicide: The Philosophers’ Brief,” The New York Review of Books, March 27, 1997: 4147.Google Scholar
Ganzini, L., Nelson, H.D., Schmidt, T.A., Kraemer, D.F., Delorit, M.A., and Lee, M.A., “Physicians’ Experiences with the Oregon Death with Dignity Act,” N. Engl. J. Med. 342 (2000): 557–63.CrossRefGoogle Scholar
Ganzini, L., Nelson, H.D., Lee, M.A., Kraemer, D.F., Schmidt, T.A., and Delorit, M.A., “Oregon Physicians’ Attitudes About and Experiences With End-of-Life Care Since Passage of the Oregon Death with Dignity Act,” JAMA 285 (2001): 2363–69.CrossRefGoogle Scholar
Ganzini, L., Harvath, T.A., Jackson, A., Goy, E.R., Miller, L.L., and Delorit, M.A., “Experiences of Oregon Nurses and Social Workers with Hospice Patients Who Requested Assistance with Suicide,” N. Engl. J. Med 347 (2002): 582–88.CrossRefGoogle Scholar
Ganzini, , supra note 53, at 562.Google Scholar
Ganzini, , supra note 55.Google Scholar
Veldink, J.H., Wokke, J.H.J., van der Wal, G., de Jong, V., van den Berg, L.H., “Euthanasia and Physician-Assisted Suicide Among Patients with Amyotrophic Lateral Sclerosis in the Netherlands,” N. Engl. J. Med, 346 (2002): 1638–44 (reporting on a Dutch study which found that, between 1994 and 1999, 20 percent of 203 patients with ALS died by euthanasia or assisted suicide); Bindels, P.J.E., Krol, A.,van Ameijden, E., Mulder-Folkerts, D.K.F., van den Hoek, J. A. R., et al., “Euthanasia and Physician-Assisted Suicide in Homosexual Men with AIDS,” The Lancet 347 (1996): 499–505 (reporting on a Dutch study in which 22 percent of men with AIDS died through assisted suicide or euthanasia, 12 times the national euthanasia rate of 2.1 percent).CrossRefGoogle Scholar
See Battin, M., Ethical Issues in Suicide (New Jersey: Prentice Hall, 1995): at 201, 225.Google Scholar
Emanuel, , supra note 49.Google Scholar
New York State Task Force on Life & the Law, supra note 22 (Executive Summary). See also id. at 120ff.Google Scholar
Nielsen, T.O., “Guidelines for Legalized Euthanasia in Canada: A Proposal,” in Somerville, M., ed., Death Talk: The Case Against Euthanasia and Physician-Assisted Suicide (Montreal & Kingston: McGill-Queen’s University Press, 2001): 144–53, at 145.Google Scholar
Fitzgerald, J., “Bioethics, Disability and Death: Uncovering Cultural Bias in the Euthanasia Debate,” in Jones, J. and Marks, Basser L.A., eds., Disability, Divers-ability, and Legal Change (The Hague: Martinus Nijhoff, 1999): 267–81, at 272.Google Scholar
Miles, , supra note 14, at 1787 and 1786, respectively. See also New York State Task Force on Life & the Law, supra note 22, at 121–24.Google Scholar
Somerville, , supra note 15, at 24–85.Google Scholar
Callahan, D., “Good Strategies and Bad: Opposing Physician-Assisted Suicide,” Commonweal 126 (December 3, 1999): 7.Google Scholar
Byock, , supra note 27, at 2. Ian Maddocks, an Australian pioneer in palliative care, states that “What I do not want … is to see a brisk new expectation arise in our society that a quick death is a noble one, that for the sake of the family, the health budget or the stress upon carers, it will be best to elect euthanasia. This is because I feel that some of the excellent sharing and exchanges of love that inspire and comfort the rest of us will be lost in accepting that fatal attraction, and our society will be the poorer for it.” Maddocks, I., “Hope in Dying: Palliative Care and a Good Death,” in Morgan, J., ed., An Easeful Death? Perspectives on Death, Dying and Euthanasia (Sydney: Federation Press, 1996): 5770, at 70.Google Scholar
Pollard and Winton argue, for example, that “Killing the failures of medical or social care would be negative, in that it would not contribute to finding solutions to their problems”: Pollard, B. and Winton, R., “Why Doctors and Nurses Must Not Kill Patients,” Medical Journal of Australia 158 (1993): 426–29, at 428.CrossRefGoogle Scholar
den Hartogh, G., “The Slippery Slope Argument,” in Kuhse, H., and Singer, P., eds., A Companion to Bioethics (Oxford: Blackwell Publishers Inc, 1998): 280290, at 289.Google Scholar
Hartogh, den, supra note 69, at 287.Google Scholar
Somerville, , supra note 15, at 54.Google Scholar
Somerville, , supra note 15, at 56.Google Scholar
Magnusson, , supra note 6, at 200–29.Google Scholar
See Hillyard, and Dombrink, , supra note 10.Google Scholar
See Muskin, P.R., “The Request to Die: Role for a Psychodynamic Perspective on Physician-Assisted Suicide,” JAMA 279 (1998): 323–28.CrossRefGoogle Scholar
Hillyard, and Dombrink, , supra note 10, at 167–74.Google Scholar
Hillyard, and Dombrink, quote Dr Greg Hamilton, a Portland psychiatrist, who stated “I suppose in the death camps in various military movements there have been rules and guidelines about how to carry out the procedures at death camps, but that doesn’t make it right”: Hillyard and Dombrink, supra note 10, at 173. See, further, Hamilton, N.G., “Oregon’s Culture of Silence,” in Foley, K. and Hendin, H., eds., The Case Against Assisted Suicide (Baltimore: The Johns Hopkins University Press, 2002): 175–91.Google Scholar
Hillyard, and Dombrink, , supra note 10, at 174.Google Scholar
See Tulsky, J.A. Ciampa, R. Rosen, E.J., for the University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel, “Responding to Legal Requests for Physician-Assisted Suicide. Annals of Internal Medicine 132 (2000): 494–99; Snyder, L. and Caplan, A.L., “Assisted Suicide: Finding Common Ground,” Annals of Internal Medicine 132 (2000): 468–69.CrossRefGoogle Scholar
See, e.g., Asch, D., “The Role of Critical Care Nurses in Euthanasia and Assisted Suicide,” N. Engl. J. Med. 334 (1996): 1374–79.CrossRefGoogle Scholar
Keown, , supra note 45, at 63.Google Scholar