Chapter 5.B. Physician-Assisted Suicide

p. 576

Kevorkian ultimately served about 8 years of his sentence, with release on parole on June 1, 2007.  Monica Davey, Kevorkian Freed After Years in Prison for Aiding Suicide, N.Y. Times, June 2, 2007, at A3.

p. 577

Through December 31, 2006, physicians had written 456 prescriptions under Oregon's Death with Dignity Act.  Of the 456 patients, 292 died after ingesting the prescribed medication (64%), about 20 were still alive, and the rest died of their illnesses.  Somewhat more than one-tenth of one percent of deaths in Oregon now result from assisted suicide

For an analysis of the Oregon experience, see Susan Okie, Physician-Assisted Suicide—Oregon and Beyond, 352 N. Engl. J. Med. 1627 (2005).

You can find a copy of the actual reports by the Oregon Health Division at Summary of Oregon's Death with Dignity Act--2006, Eighth Annual Report on Oregon's Death with Dignity Act, Seventh Annual Report on Oregon's Death with Dignity Act, Sixth Annual Report on Oregon's Death with Dignity Act, Fifth Annual Report on Oregon's Death with Dignity Act, Fourth Annual Report on Oregon's Death with Dignity Act, Oregon's Death with Dignity Act: Three years of legalized physician-assisted suicide, Oregon's Death with Dignity Act: The Second Year's Experience, and Oregon's Death with Dignity Act: The First Year's Experience.

p. 578

The U.S. Court of Appeals for the 9th Circuit rejected Attorney General Ashcroft's effort to override Oregon's assisted suicide law, holding that he lacked authority under the Controlled Substances Act to intervene.  Oregon v. Ashcroft, 368 F.3d 1118 (9th Cir. 2004).  In January 2006, the Supreme Court affirmed the 9th Circuit, concluding that the Controlled Substances Act does not give the Attorney General authority to declare "illegitimate a medical standard for care and treatment of patients that is specifically authorized under state law."  Gonzales v. Oregon, 126 S. Ct. 904 (2006).

p. 587

In a survey of Dutch physicians in 2005, three years after the Netherlands legalized assisted suicide and euthanasia, researchers found a significant decrease in the use of assisted suicide and euthanasia, accompanied by greater use of palliative sedation (formerly called terminal sedation).  For example, the euthanasia rate in 2005 was 1.7 percent of all deaths, down from 2.6 percent in 2001 and equal to the rate in 1990.  In addition the rate of life-ending acts without a current explicit request from the patient dropped from 0.7 percent in 2001 to 0.4 percent in 2005.  The researchers observed that the reduction in assisted suicide and euthanasia may have reflected a substitution of palliative sedation for assisted suicide and euthanasia and/or a decline in the likelihood that physicians would attribute patient death to the effects of opioid administration.  As to the latter, it is possible that physicians were less likely in 2005 than in previous years to mistakenly believe that their use of opioids to treat patient suffering had hastened patient deaths.  Agnes van der Heide, et al., End-of-Life Practices in the Netherlands under the Euthanasia Act, 356 New Eng. J. Med. 1957 (2007).

p. 591

In a surprising decision in favor of a patient's liberty rights based on Cruzan and Glucksberg, a panel of the D.C. Circuit found a limited constitutional right of terminally ill persons to receive experimental drugs without FDA approval (i.e., a negative right for the patients and their physicians to use the drugs without FDA interference).  In Abigail Alliance v. Eschenbach, 445 F.3d 470 (D.C. Cir. 2006), the court held that terminally ill patients can use experimental drugs that have passed successfully through Phase I of the FDA's drug approval process, when no alternative treatment options are available.  Six months later, the decision was vacated, and the en banc court ultimately rejected the claim of a constitutional right to receive experimental drugs.  During the litigation, the FDA proposed a new rule to give terminally ill patients greater access to experimental drugs.  For an edited version of the panel decision, see Abigail AllianceFor the en banc decision, see Abigail Alliance (en banc).

For commentary on Abigail Alliance, see the November-December 2006  issue of the Hastings Center Report for articles by Rebecca Dresser and John Robertson and the January 10, 2007 issue of JAMA for an article by Peter Jacobson and Wendy Parmet.


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