1

AID IN DYING =
PHYSICIAN-ASSISTED SUICIDE


Talking Points
For the 2014 Legislative Year














2
TALKING POINTS:
PHYSICIAN-ASSISTED SUICIDE


AID IN DYING IS ASSISTED SUICIDE, AND IS CURRENTLY A FELONY IN NEW
JERSEY:

Physician-assisted suicide advocates argue that they support aid in dying rather than assisted
suicide. However, aid in dying which Kathryn L. Tucker, the Director of Legal Affairs for
Compassion & Choices defines as the practice of a physician prescribing medication that a
mentally competent, terminally-ill patient can ingest to bring about a peaceful death if the dying
process becomes unbearable
1
is physician-assisted suicide.

Physician-assisted suicide is defined as a physician supplying a patient who wants to
commit suicide with the assistance to commit the act, such as by writing a prescription
for a drug which if taken in large amounts is lethal, and providing the patient with lethal
dosage information.
2


Aid in dying and death with dignity are merely euphemisms for physician-assisted
suicide. In fact, these terms are not recognized by the medical community and are used
by assisted-suicide advocates to mask what they advocate.

In Blick v. Connecticut, a Connecticut court held that the states manslaughter statute
does not include any exception from prosecution for physicians who assist another
individual to commit suicide; further, the legislature intended the statute to apply to
physicians who assist a suicide, and intended the term suicide to include self-killing by
those who are suffering from unbearable terminal illness. Therefore, prosecutors were
within their authority to prosecute physicians for providing aid in dying, a.k.a. assisted
suicide.
3


In a discussion of Blick, a publication of the American Medical Association (AMA)
characterized the plaintiffs argument that aid in dying was not prohibited as assisted
suicide as a novel approach.
4


PHYSICIAN-ASSISTED SUICIDE IS DANGEROUS TO THE DEPRESSED:

Most if not all terminally-ill patients who express a wish to die meet diagnostic criteria for major
depression or other mental conditions.
5
Acknowledging the danger of physician-assisted suicide
to depressed patients should be a concern of all citizens.

3
Depression is frequently underdiagnosed and undertreated, especially for the elderly and
patients with chronic or terminal medical conditions.
6


In one study, treatment for depression resulted in the cessation of suicidal ideation for 90
percent of the patients.
7


Despite these statistics, safeguards in Washington and Oregon (which explicitly permit
physician-assisted suicide) are failing to protect patients, as there are no requirements that
patients receive psychological evaluation or treatment prior to receiving lethal drugs.

The majority of patients requesting physician-assisted suicide in Oregon have not been
referred for counseling. For example, of the 71 patients who died in 2013 after receiving
prescriptions for lethal drugs under Oregons Death with Dignity Act, only two patients
were referred for formal psychiatric or psychological evaluation.
8


Studies have revealed that when offered personal support and palliative care, most
patients adapt and continue life in ways they might not have anticipated. Very few of
these individuals ultimately choose suicide.
9


In light of the pervasive failure of our healthcare system to diagnose and treat depression
and provide adequate palliative care, allowing physician-assisted suicide is profoundly
dangerous for individuals who are already ill and vulnerable or whose autonomy and
well-being are already compromised by poverty, lack of access to good medical care,
advanced age, or membership in a stigmatized social group.
10



PHYSICIAN-ASSISTED SUICIDE IS DANGEROUS TO THE ELDERLY AND
DISABLED:

Many patients who request physician-assisted suicide are coerced by familial pressures and a
desire not to be a burden on their families. Acknowledging the danger of physician-assisted
suicide to the elderly and disabled should be a concern of all citizens.

Physician-assisted suicide is a predicate for elder abuse. The National Center on Elder
Abuse estimates that one to two million Americans aged 65 or older are injured,
exploited, or otherwise abused physically, emotionally, psychologically, or financially
each year by a caregiver or trusted individual they depend upon.
11
Too often, the
physicians and family members to whom a terminally-ill patient looks to for support and
protection are the same ones counseling that suicide may be the best option.

4
Facing deteriorating health and increasing age, the elderly are at a greater risk of suicide
than any other age group.
12
Physician-assisted suicide greatly increases the risk of elder
abuse and suicide among the elderly by creating yet another path of abuse against older
individuals. Abuse of the elderly is often subtle and extremely difficult to detect.

There have been documented accounts of individuals committing suicide under pressure
and/or duress from family members, friends, and/or suicide advocates present at the
ingestion of lethal drugs.
13


Legalized physician-assisted suicide hides abuse of the elderly and disabled. It provides
complete liability protection for doctors and promotes secrecy. For example, in Oregon
physicians providing physician-assisted suicide are self-reporting, death certificates are
required to report a natural death (as opposed to a suicide), and there are no
requirements that witnesses be present at the time of death. This permits absolutely no
transparency and makes patient choice and protections simple illusions.

The States interest in protecting the vulnerable, elderly, and disabled individuals is
compelling. Physician-assisted suicide poses profound dangers that outweigh any alleged
benefits the practice may have in isolated cases.

The New York State Task Force on Life and the Law explains that any effort to carve
out exceptions to the prohibitions on assisted suicide or euthanasia would seriously
undermine the states interest in preventing suicide in the vast majority of cases. The
states interest in protecting these patients outweighs any burden on individual autonomy
that prohibitions on assisted suicide and euthanasia might entail.
14




PHYSICIAN-ASSISTED SUICIDE PRESENTS ADDITIONAL DANGERS:

The New York State Task Force on Life and the Law found it nave and unsupportable to
assume that any safeguards that are erected will be unaffected by the broader social and
medical context in which they will operate.
15


Allowing physicians or other individuals to assist in the suicide of another encourages
health insurance companies and other health care payers to provide coverage for suicide
assistance, but not for treatment of disease or palliative care. This poses a significant
threat to vulnerable persons who may not have adequate access to medical care. A lack
of options may effectively pressure patients into assisted suicide.

5
For example, in 2008, patient Barbara Wagner was denied coverage under her Oregon
state health plan for medication that would treat her cancer and extend her life; instead,
the state health plan offered to pay for the cost-effective option of ending her life by
physician-assisted suicide.
16


Most patients who request physician-assisted suicide do not have longstanding
relationships with the physicians who provide the lethal drugs. It is not uncommon for
physicians in states allowing physician-assisted suicide to prescribe lethal drugs for
patients whom they have known as little as one week or less.
17


The United States Supreme Court has acknowledged the legitimate government interests
in 1) preserving life; 2) preventing suicide; 3) avoiding the involvement of third parties
and the use of arbitrary, unfair, or undue influence; 4) protecting family members and
loved ones; 5) protecting the integrity of the medical profession; and 6) avoiding future
movement toward euthanasia and other abuses.
18


The New York State Task Force on Life and the Law unanimously concluded that the
dangers of legalized physician-assisted suicide far outweigh any possible benefits.
19



REFUSAL/WITHDRAWAL OF LIFE-SUSTAINING TREATMENT IS DIFFERENT THAN
PROACTIVELY KILLING A PATIENT:

There is a medically- and court-recognized difference between the withdrawal of life-sustaining
treatment, which serves only to allow natural death, and the use of lethal drugs or other means to
prematurely cause death.

The American Medical Association opposes physician-assisted suicide, but finds that it is
ethically acceptable to withdraw or withhold life-sustaining treatment at the request of a
patient who possesses decision-making capacity.
20


The New York State Task Force on Life and the Law distinguished between assisted
suicide and the withdrawal or refusal of life-sustaining treatment, concluding that the
States interest in protecting patients and criminalizing physician-assisted suicide
outweighed any claims of individual autonomy.
21
In contrast, the Task Force found that
the constitutional balancing of individual and state interests yields an entirely different
result for decisions to forgo life-sustaining treatment . . . [state] interests are best served
by permitting the refusal of treatment in accord with appropriate guidelines, and []
individual decision making about treatment will ultimately promote the public good.
22


6
In Vacco v. Quill, the United States Supreme Court affirmed the distinction between
assisting suicide and the withdrawal of life-sustaining treatment, stating it is a
distinction widely recognized and endorsed in the medical profession and in our legal
traditions and that it is important, logical, and rational.
23



PHYSICIAN-ASSISTED SUICIDE IS NOT NECESSARY TO TREAT PAIN:

Patients who request physician-assisted suicide overwhelmingly cite their reasons for doing so as
a fear of a perceived (not necessarily actual) loss of autonomy, loss of dignity, and decreasing
ability to participate in activities that make life enjoyable. Very few patients are in pain or even
fear pain in the end of life. For those patients that are in pain, that pain can be controlled or
alleviated completely.

Most experts in pain management believe that 95 to 98 percent of pain can be relieved in
terminally-ill patients.
24


The pain of the remaining patients can always be alleviated through sedation.
25


Even the euthanasia advocacy organization Compassion & Choices has advocated that
patients must be adequately informed that sedation is an option at the end of life.
26


Even when physician-assisted suicide is requested by patients in pain, in most cases the
patient will withdraw the request after pain management, depression, and other concerns
are addressed.
27



IF PHYSICIAN-ASSISTED SUICIDE IS AVAILABLE TO ENSURE AUTONOMY,
THEN IT CANNOT BE CONTAINED AND MUST BE AVAILABLE TO ALL PEOPLE:

Patients who request physician-assisted suicide overwhelmingly cite their reasons for doing so as
a fear of a perceived (not necessarily actual) loss of autonomy, loss of dignity, and decreasing
ability to participate in activities that make life enjoyable.
28
Yet if these reasons are adequate to
support legalizing physician-assisted suicide, then physician-assisted suicide must be legal for all
people, endangering the most vulnerable in our culture.

None of these reasons are unique to terminally-ill patients, and they leave room for other
individuals to also claim a need, or a right, to physician-assisted suicide. For example,
these very reasons can be cited by a person left paralyzed after an accident or illness.

7
It will be difficult, if not impossible, to limit physician-assisted suicide to competent,
terminally-ill patients. Individuals who are not competent, who are not terminally-ill
(but potentially in more pain than a terminally-ill patient), or who cannot self-administer
lethal drugs will also seek the option of physician-assisted suicide, and no principled
basis will exist to deny them this right.

An Oregon Deputy Attorney General has stated that the Americans with Disabilities Act
(ADA) would likely require the state to offer reasonable accommodation to enable the
disabled to avail themselves of the Death with Dignity Act.
29


Once physician-assisted suicide is accepted as an answer to suffering, loss of autonomy,
dependence on others, or the decreased ability to participate in enjoyable activities in life,
there is nothing to prevent those life-value judgments from pervading American culture
and imposing those same quality-of-life judgments on the disabled and elderly
involuntarily, and at any stage of life.


THE MEDICAL COMMUNITY DOES NOT SUPPORT PHYSICIAN-ASSISTED SUICIDE:

The American Medical Association (AMA), whose lead is generally followed by other medical
associations, does not support physician-assisted suicide. It states that allowing physicians to
participate in assisted suicide would cause more harm than good. Physician-assisted suicide is
fundamentally incompatible with the physicians role as healer, would be difficult or impossible
to control, and would pose serious societal risks.
30


The AMA further states that [i]nstead of participating in assisted suicide, physicians
must aggressively respond to the needs of patients at the end of life. Patients should not
be abandoned once it is determined that cure is impossible. Multidisciplinary
interventions should be sought including specialty consultation, hospice care, pastoral
support, family counseling, and other modalities. Patients near the end of life must
continue to receive emotional support, comfort care, adequate pain control, respect for
patient autonomy, and good communication.
31


While discussing a challenge to Connecticuts law prohibiting assisted-suicide, a
publication of the AMA characterized the plaintiffs argument that aid in dying was not
prohibited as assisted suicide as a novel approach.
32



THE OREGON EXPERIENCE DEMONSTRATES THE DANGERS OF PHYSICIAN-
ASSISTED SUICIDE:

8
Assisted suicide advocates claim that the experience in Oregonwhere physician-assisted
suicide was legalized in 1997supports their claims that the practice poses no dangers. But the
experience in Oregon instead demonstrates serious flaws and dangers in the provision of legal
physician-assisted suicide.

In 1998, 24 reported patients received prescriptions for lethal drugs under the law, with
16 resulting deaths. In 2013, 122 reported patients received prescriptions for lethal drugs,
with 71 reported deaths.
33


The prevailing reasons for requesting physician-assisted suicide continue to be concerns
about loss of autonomy (93%), decreasing ability to participate in activities that make life
enjoyable (88.7%), and loss of dignity (73.2%).
34
Yet these reasons for seeking
physician-assisted suicide are not unique to the terminally-ill and leave room for anyone
with a chronic disease or condition to claim a need for physician-assisted suicide as well.

Physicians providing physician-assisted suicide are self-reporting, death certificates are
required to report natural death (as opposed to a suicide), and there are no requirements
that witnesses be present at the time of deathleaving patients completely vulnerable to
coercion at the end of life.

Studies touting the safety of the Death with Dignity Act are based upon Oregons
annual reports, which are lacking necessary information.

Oregon collects information about the time and circumstances of patients deaths only
when the physician or another health care provider is present at the time of death. Yet in
2013, health care providers were present in only 11 of the 71 deaths
35
meaning that
information about approximately 75 percent of the patients is unknown. This creates
unacceptable gaps in Oregons data.

The majority of reported patients requesting physician-assisted suicide in Oregon are not
referred for psychological or psychiatric counseling. In 2013, only 2 out of 71 patients
was referred for formal psychiatric or psychological counseling.
36
This statistic defies
studies demonstrating that the majority of patients requesting physician-assisted suicide
are battling with depression and will change their mind when treated.

Patients are being pushed into the assisted-suicide option. In 2008, patient Barbara
Wagner was denied coverage under her Oregon state health plan for medication that
would treat her cancer and extend her life; instead, the state health plan offered to pay for
the cost-effective option of ending her life by physician-assisted suicide.
37


9
Proper palliative care is languishing in Oregon. In 2004, Oregon nurses reported that the
inadequacy of meeting patients needs had increased up to 50 percent and that [m]ost
of the small hospitals in the state do not have pain consultation teams at all.
38


Physician-shopping is not uncommon in Oregon, with some physicians prescribing
drugs for patients they have known for less than a week.
39


While the Death with Dignity Act requires two witnesses at the time of request for
physician-assisted suicide, one of those witnesses can be a relative who stands to inherit
from the patient, and the second witness can simply be a friend of the relative. There is
no safety in the witness requirement.

THE WASHINGTON EXPERIENCE DEMONSTRATES THE DANGERS OF PHYSICIAN-
ASSISTED SUICIDE:

Assisted suicide advocates claim that the experience in Washingtonwhere physician-assisted
suicide was legalized in 2008supports their claims that the practice poses no dangers. But the
experience in Washington instead demonstrates serious flaws and dangers in the provision of
legal physician-assisted suicide.

In 2009, 65 reported patients received prescriptions for lethal drugs under the law, with
63 reported deaths. In 2012, 121 reported patients received prescriptions for lethal drugs,
with 83 reported deaths from ingesting the drugs.
40


The prevailing reasons for requesting physician-assisted suicide were concerns about loss
of autonomy (94%), less ability to engage in activities that make life enjoyable (90%),
and loss of dignity (84%).
41
Yet these reasons for seeking physician-assisted suicide are
not unique to the terminally-ill and leave room for anyone with a chronic disease or
condition to claim a need for physician-assisted suicide as well.

Sixty-three percent of patients listed a fear of being a burden on family, friends, and
caregivers as a reason for requesting assisted suicide, raising the concern that patients
were pushed into suicide.
42


A psychiatric or psychological evaluation is not required in Washington. Out of 103
patients who died after receiving prescriptions for lethal drugs,
43
only 3 received
psychiatric/psychological referrals, and no information is available regarding whether
they were treated for any mental complications. This number is under-representative of
the number of patients dealing with depression or other mental conditions.
44


10
Nearly half of the patients reported to have died had a relationship with their physician
of less than a week to 24 weeks.
45


Because the Department of Health will not disclose any information that identifies
patients, physicians, pharmacists, witnesses, or other participants in activities covered
by the Death with Dignity Act, there is no mechanism by which these participants can be
held accountable. Further, this provides cover for witnesses and participants from
organizations like Compassion & Choices who travel into a state specifically to provide
suicide to vulnerable patients.


THE NETHERLANDS EXPERIENCE DEMONSTRATES THE DANGERS OF
PHYSICIAN-ASSISTED SUICIDE:

Physician-assisted suicide and euthanasia have been legal in the Netherlands for years. Yet
instead of strengthening autonomy at the end of life, the legalization of physician-assisted suicide
and euthanasia has proven to degrade and dehumanize the lives of patients, resulting in
physicians routinely performing euthanasia without the consent of their patients. The experience
in the Netherlands proves that physician-assisted suicide cannot be contained and will ultimately
lead to euthanasia.

Once assisted suicide was allowed in the Netherlands, involuntary euthanasia followed.
As the New York State Task Force on Life and the Law concluded, [A]ssisted suicide
and euthanasia are closely linked; as experience in the Netherlands has shown, once
assisted suicide is embraced, euthanasia will seem only a neater and simpler option to
doctors and their patients.
46


A report commissioned by the Dutch government demonstrated that more than half of
euthanasia and assisted-suicide-related deaths were involuntary in the year studied.
47


At least half of Dutch physicians actively suggest euthanasia to their patients.
48


Studies in 1997 and 2005 revealed that eight (8) percent of infants who died in the
Netherlands were euthanized by doctors.
49


Studies show that hospice-style palliative care is stunted in the Netherlands: there are
very few hospice facilities, very little in the way of organized hospice activity, and few
specialists in palliative care.
50



11
THE BELGIAN EXPERIENCE DEMONSTRATES THE DANGERS OF PHYSICIAN-
ASSISTED SUICIDE:

Physician-assisted suicide and euthanasia are also legal in Belgium. In 2014, Belgium became
the first country to enact a law permitting terminally-ill minors of any age to request euthanasia.

A recent study published in the Canadian Medical Association Journal
51
demonstrated
that where physician-assisted suicide (and in Belgium, euthanasia) is allowed, abuse will
inevitably follow.

Out of 1,265 nurses questioned, 120 of them (almost 10 percent) reported that their last
patient was involuntarily euthanized.

Only four (4) percent of nurses involved in involuntary euthanasia reported that the
patient had ever expressed his or her wishes about euthanasia.

Most of the patients euthanized without consent were over 80 years old, reaffirming the
fact that assisted suicide and euthanasia quickly lead to elder abuse.

The researchers acknowledged that nurses are likely reluctant to report illegal acts (here,
euthanizing a patient without physician involvement). Thus, it is possible that the
number of nurses killing their patients without physician involvement is much higher
than revealed by the study.

The researchers concluded that [i]t seems the current law and a control system do not
prevent nurses from administering life-ending drugs. In other words, the safeguards
purported by suicide advocates simply do not work.


STATE OF THE STATES:

37 states criminalize assisted suicide: AK, AR, AZ, CA, CO, CT, DE, FL, GA, HI, ID,
IL, IN, IA, KS, KY, LA, ME, MD, MI, MN, MS, MO, NE, NH, NJ, NY, ND, OK, PA,
RI, SC, SD, TN, TX, VA, and WI

5 states (arguably) prohibit assisted suicide under common law of crimes or judicial
interpretation of homicide statutes: AL, MA, NC, OH, and WV

3 states and the District of Columbia have left the legal status of assisted suicide
undetermined: DC, NV, UT, and WY

12
3 states permit assisted suicide: OR, VT, and WA

1 state recognizes a statutory consent defense for those aiding a suicide: MT

1 state law banning assisted suicide is in litigation following an unfavorable court
decision: NM.


1
Kathryn L. Tucker & Christine Salmi, Aid in Dying: Law, Geography and Standard of Care in
Idaho, THE ADVOCATE, August 2010, at 42.
2
MODERN DICTIONARY FOR THE LEGAL PROFESSION (3d ed. 2001).
3
Blick v. Connecticut, 2010 Conn. Super. LEXIS 1412, at *39-40 (Conn. Super. Ct. June 1,
2010).
4
Kevin B. OReilly, Assisted-Suicide Statute Challenged by 2 Connecticut Doctors, AMER. MED.
NEWS ( Oct 19, 2009), available at http://www.ama-
assn.org/amednews/2009/10/19/prsd1019.htm (last visited Mar. 13, 2014).
5
See, e.g., New York State Task Force on Life and the Law, WHEN DEATH IS SOUGHT: ASSISTED
SUICIDE AND EUTHANASIA IN THE MEDICAL CONTEXT x, 13 (1994).
6
Id. at 32 (1994).
7
Id. at 26.
8
Oregons Death with Dignity Act2013 (Jan. 2014), available at
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity
Act/Pages/index.aspx (last visited Mar. 13, 2014).

9
New York State Task Force on Life and the Law, supra, at 178.
10
Washington v. Glucksberg, 521 U.S. 702, 732 (1997) (quoting New York State Task Force on
Life and the Law, supra, at 120).
11
National Center on Elder Abuse, A Response to the Abuse of Vulnerable Adults (Washington,
D.C. 2000).
12
New York State Task Force on Life and the Law, supra, at 30.
13
See, e.g., Herman Hendin, SEDUCED BY DEATH: DOCTORS, PATIENTS, AND ASSISTED SUICIDE
50-56, 61, 128-32, 142 (1998).
14
New York State Task Force on Life and the Law, supra, at 73-74.
15
Id. at 125.
16
See, e.g., Steven Ertelt, Woman Victimized by Oregon Assisted Suicide Law Urges Washington
to Vote No (October 28, 2008), available at http://www.lifenews.com/2008/10/28/bio-2608/ (last
visited Mar. 13, 2014).
17
See Oregons annual Death with Dignity Act reports, available at
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity
Act/Pages/index.aspx (last visited Mar. 13, 2014).
18
Glucksberg, 521 U.S. at 792-93.
19
New York State Task Force on Life and the Law, supra, at ix.
20
See American Medical Association, Code of Medical Ethics, Opinion 2.211 Physician-
Assisted Suicide, available at http://www.ama-assn.org/ama/pub/physician-resources/medical-
ethics/code-medical-ethics/opinion2211.shtml (last visited Mar. 13, 2014); American Medical
Association, Opinion 2.20 Withholding or Withdrawing Life-Sustaining Medical Treatment
13

available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-
medical-ethics/opinion220.shtml (last visited Mar. 13, 2014).
21
New York State Task Force on Life and the Law, supra, at 73.
22
Id. at 74-75.
23
521 U.S. 793, 800-01 (1997). See also id., 521 U.S. at 808 (stating that the two acts are
different and referring to the distinction as a longstanding and rational distinction).
24
See, e.g., Timothy E. Quill & Christine K. Cassel, Professional Organizations Position
Statements on Physician-Assisted Suicide: A Case for Studied Neutrality, ANNALS OF INTERNAL
MED. 2003; 138(3): 208, available at http://www.annals.org/cgi/reprint/138/3/208.pdf (last
visited Mar. 13, 2014). See also Project on Death in America/Open Society Institute, Brief as
Amicus Curiae for Reversal of the Judgments Below at Part II.A.1, Vacco v. Quill, 521 U.S. 793
(1997) (stating that pain can be alleviated in 98 percent of cases); Robert A. Burt,
Constitutionalizing Physician-Assisted Suicide: Will Lightning Strike Thrice?, 35 DUQ. L. REV.
159, 166 (1996) (stating that knowledgeable physicians and researchers claim that pain can be
alleviated in 98 percent of cases); Kathleen M. Foley, Transforming the Culture of Dying,
PROJECT ON DEATH IN AMERICA: JANUARY 2001- DECEMBER 2003 REPORT OF ACTIVITIES 11
(Open Society Institute, 2004).
25
American Geriatrics Society, Brief as Amicus Curiae Urging Reversal of the Judgments Below
at Part I.B, Vacco v. Quill, 521 U.S. 793 (1997); Wesley J. Smith, FORCED EXIT: THE SLIPPERY
SLOPE FROM ASSISTED SUICIDE TO LEGALIZED MURDER 207 (1997).
26
In the case Hargett v. Vitas, Compassion & Choices is suing a hospice for failing to inform a
patient of her option to choose palliative sedation. See Compassion & Choices, Hargett v. Vitas
(2010), available at http://www.compassionandchoices.org/page.aspx?pid=474 (last visited Jan.
21, 2010).
27
New York State Task Force on Life and the Law, supra, at 108 n.113.
28
See Oregons annual Death with Dignity Act reports, supra.
29
See Smith, supra, at 136 (citing Correspondence of Deputy Attorney General David Schuman
to state Senator Neil Bryant (Mar. 15, 1999)).
30
American Medical Association, Code of Medical Ethics, Opinion 2.211 Physician-Assisted
Suicide available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-
medical-ethics/opinion2211.shtml (last visited Mar. 14, 2014).
31
Id.
32
OReilly, supra.
33
Oregons Death with Dignity Act2013 (Jan. 2014), available at
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity
Act/Pages/index.aspx (last visited Mar. 13, 2014) (Eight of these deaths were patients who
received prescriptions during 2011 or 2012).
34
Id.
35
Id.
36
Id.
37
See, e.g., Ertelt, supra.
38
See Brief Amicus Curiae of International Task Force et al., filed in Baxter v. Montana,
available at http://www.internationaltaskforce.org/montana.htm (last visited Jan. 25, 2011)
(citing House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill,
Testimony of Sue Davidson of the Oregon Nurses Assn, response to question 1098).
39
See Oregons annual Death with Dignity Act reports, supra.
14

40
Washington State Department of Health 2012 Death with Dignity Act Report Executive
Summary2012 (Feb. 2013), available at
http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct.aspx (last
visited Mar. 13, 2014) (104 patients are known to have died; however, 18 are reported to have
died without ingesting the lethal drugs, and for three who died their ingestion status is unknown.)
41
Id.
42
Id.
43
Id. (Data was not available for one of the participants in 2012 who died.)
44
Id.
45
Id.
46
New York State Task Force on Life and the Law, supra, at 145.
47
See Smith, supra, at 107-09 (citing the Dutch governments Remmelink Report).
48
See id. at 110 (citing Richard Fenigsen, Report of the Dutch Government Committee on
Euthanasia, ISSUES LAW & MED. 7:339 (Nov. 1991); Special Report from the Netherlands,
N.E.J.M. 1699-711 (1996)).
49
See id. at 119 (citing Agnes van der Heide et al., Medical End-of-Life Decisions Made for
Neonates and Infants in the Netherlands, LANCET 350:251-55 (July 26, 1997); Astrid M.
Vrakking et al., Medical End-of-Life Decisions Made for Neonates and Infants in the
Netherlands, 1995-2001, LANCET 365:1284-86 (Apr. 9, 2005)).
50
See id. at 225.
51
Els Inghelbrecht et al., The role of nurses in physician-assisted deaths in Belgium, CAN. MED.
ASSN J. (June 15, 2010).