Hospice & Palliative Medicine Resources Opposing Physician-Assisted Suicide
All downloadable resources on this page in one zipped file.
In 2015, a physician-assisted suicide (PAS) bill was introduced in the Colorado legislature. Hospice Analytics participated in an ad hoc coalition known as Coloradans Against Physician-Assisted Suicide (CAPAS) that successfully defeated this bill in nine days. We were surprised to find few resources across the hospice and palliative medicine community opposing PAS, and ultimately decided to share the resources we identified and created. Resources will be frequently updated, so keep checking back or inquire if you don't see what you need. To share resources, contact Jennifer Ballentine, firstname.lastname@example.org.
Special thanks to Ira Byock, MD, for his personal assistance, guidance, and writings in this area.
Statutes, Reports, and Data from States Where PAS Is Legal
Physician-assisted suicide is currently legal by ballot initiative in Oregon and Washington and by legislation in Vermont and now California. (At this writing, the California law has not yet taken effect, however.) In these states, statutory and regulatory structures are in place to govern the practice and data is collected on utilization. It is also legal in Montana by decision of the state Supreme Court. A district court decision in New Mexico which would legalize the practice is under appeal in that state.
- Oregon statute; Oregon Health Authority information and reports
- Washington act; Washington state Department of Health information and reports
- Vermont statute; Vermont Patient Choices information and reports
- California statute: California End-of-Life Options Act
- Comparison table of the four acts in terms of eligibility, process, safeguards, reporting, immunities, and other features.
In 2015, legislation to legalize physician-assisted suicide has been introduced in 22 states. All but one of the bills failed to advance beyond committee hearings or votes on one chamber. As the new 2016 legislative sessions get underway or return from holiday recesses, only five states have active bills in process: Massachusetts and New York (held over from previous sessions), Colorado (new versions of previous bill introduced in both chambers), Nebraska and Arizona (new legislation).
In addition, several lawsuits launched to legalize PAS through the courts have also failed, two in California and one in New Mexico. The New Mexico ruling of August 11, 2015 reverses a lower court decision which had technically legalized PAS in Bernallilo County. The case will likely be appealed to the New Mexico Supreme Court, but for now, the practice is again illegal in the state. The lawsuit filed in New York was dismissed by the state Supreme Court; an appeal is underway.
Organizations and Advocacy Groups Opposing PAS
- Californians Against Assisted Suicide
- Committee Against Physician-Assisted Suicide (Massachusetts)
- Disability Rights Education and Defense Fund
- Maryland Against Physician-Assisted Suicide
- Montanans Against Assisted Suicide
- New Jersey Alliance Against Doctor-Prescribed Suicide
- Not Dead Yet
- Patients' Rights Action Fund
- Patients' Rights Council
- Second Thoughts
- The Compassionate Choice
- True Dignity Vermont
Position Statements from Various National Healthcare Associations and Organizations
- Alzheimers Association, 1998: Neutral/lean oppose: emphasizes rights of individuals to refuse life-sustaining treatment; encourages support through natural death.
- American Academy of Family Physicians (AAFP), 2013: Neutral; recognizes that requests may happen; Work to relieve suffering; Continue care even in face of requests.
- American Academy of Medical Ethics (AAME), 2014: Strongly opposes; considers the practice dangerous to patients, providers, and society.
- American Association of Hospice and Palliative Medicine (AAHPM), 2007: Neutral/lean oppose: Recognizes that in rare cases suffering can exceed our ability to relieve it, which may generate requests for PAD; Recommends seeking all sources of relief of suffering before considering requests; provides rubric for evaluating requests; Recommends withholding/withdrawing LST, VSED, total sedation as alternatives; For physicians in states where legal, proceed with extreme caution; Studied neutrality as an organization.
- American Association of Professional Chaplains (APC), 2014: No explicit mention except in example: being able to articulate ethical pros/cons and relevant state laws if subject raised by patient.
- American College of Medical Quality (ACMQ), 2010: Opposes; recommends physicians be allowed to “disengage” with this aspect of pt’s care if pt in legal jurisdiction insists despite aggressive efforts to relieve suffering, while continuing to provide other care.
- American College of Physicians—American Society of Internal Medicine (ACP-ASIM), 2001: Opposes; references OR results, in particular reasons for requesting. Questions whether it is physician’s role to assist patients in controlling manner, place of death.
- American Medical Association (AMA), 1990s: Unequivocally opposes PAS as “fundamentally incompatible with physician’s role”; statement on EOL care urges best efforts to relieve suffering, nonabandonment, upholding dignity, honoring patient preferences and goals, attending to bereaved.
- American Medical Directors Association (AMDA), 1997: Unequivocal opposition to any participation in PAS
- American Nurses Association (ANA), 2013: Code of ethics strictly forbids participation in PAS by nurses as strictly prohibited on basis incompatible with professional role; Recognizes that such a policy does not solve the distress of nurses fielding requests, practicing in states where legal, or may be personally in favor; Emphasizes continued education on communication, methods to relieve suffering of all kinds, professional support.
- American Psychological Association (APA), no date, but apparently pre-2008: Neither supports nor opposes but recognizes crucial role of psychologists in assessing suicidal intent and offering counseling to distressed individuals and resolves to prepare profession for dealing with issue.
- American Society of Health-System Pharmacists (ASHP), Neutral/lean oppose: Emphasizes role of trust in provider-patient; provider-health system; provider-care team relationships; Supports rights of pharmacists to decide whether to participate or not; Provides rubric for decision making
- The Arc (for People with Intellectual and Developmental Disabilities), 2013: PAS must be prohibited for persons with intellectual and developmental disabilities due to inherent risk of undue influence
- Hospice and Palliative Nurses Association (HPNA), 2011: Opposes legalization PAS; Affirms nurses as vigilant advocates for humane and ethical care for alleviating suffering and nonabandonment; Supports public policy that advances access and quality of palliative and hospice care
- National Association of Social Workers (NASW), 2005: Neither supports nor opposes; recommends practice “being present” with patients and families requesting PAS in states where legal. Code of Ethics of the National Association of Social Workers. Washington DC: NASW Press, 2010.
- National Hospice and Palliative Care Organization (NHPCO), 2005: Guiding concepts value of life and access to high-quality care; does NOT support legalization of PAS but does affirm commitment to patient comfort and dignity with regard to choice.
- Not Dead Yet, 2015: Talking points and lessons from disability history positing that PAS is a form of "deadly discrimination"
- World Medical Association (WMA), 2005: Opposed; PAS is unethical and "must be condemned by the medical profession."
State Hospice Organization Position Statements & Policies
- Hospice and Palliative Care Association of the Rockies (Colorado & Wyoming)
- Michigan Hospice and Palliative Care Organization
- New Jersey Hospice and Palliative Care Organization
Articles, Talking Points, Editorials, Op-Eds, Other Links
- PAS backgrounder and discussion, by Jennifer Ballentine, Hospice Analytics (1/15; contact us for details).
- "A Doctor-Assisted Disaster for Medicine," William L. Toffler, MD, Wall Street Journal (8/17/15)
- "Why Assisted Suicide Must Not Be Legalized," by Marilyn Golden, Disability Rights Education and Action Fund
- "Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality," Ryan T. Anderson, PhD, The Heritage Foundation.
- "Why I Am Against Physician-Assisted Suicide," Eddie Ytuarte, Peace and Freedom Party, California's Feminist Socialist Political Party, 2007.
- "Physician-Assisted Suicide Is Always Wrong," Ryan T. Anderson, PhD, Newsweek (3/26/15)
- "14 Reasons to Oppose Physician-Assisted Suicide," prepared by the New Jersey Hospice and Palliative Care Organization to defeat proposed bill, 2015.
- ProCon.org: http://euthanasia.procon.org/
- Hospice and Palliative Medicine Talking Points opposing PAS in Colorado (1/15/15)
- Ira Byock, MD, editorial in LA Times, "We should think twice about 'death with dignity'." (1/30/15)
- Ira Byock, MD, editorial in NY Times, "Dying shouldn't be so brutal." (1/31/15)
- Ira Byock, MD, Virginia Senate Testimony. (1/31/13)
- Ira Byock, MD, article in Politico, "Democrats shouldn't endorse suicide," (6/8/2015)
- Rachel Aviv, article in The New Yorker, "The Death Treatment," (6/22/2015), detailing the practices of physician-assisted suicide and euthanasia for depression in Belgium
- A 20-minute televised interview with Jennifer Ballentine (opposing), Barbara Combs Lee (President Compassion & Choices, supporting) and two legislator bill sponsors (supporting). (2/1/15)
- A brief televised interview with Jennifer Ballentine (opposing) regarding PAS and a difficult patient case in Denver (1/17/15)
- Disability Rights Education and Defense Fund, "A Progressive case against an assisted suicide law." (2014)
- Ezekiel Emanuel, MD, editorial in NY Times, "Four myths about doctor-assisted suicide." (10/27/12)
- E.J. Dionne, Jr., Washington Post blog, "Liberals should be wary of physician-assisted suicide." (11/12)
- Vickie Kennedy (widow of Sen. Edward Kennedy), Cape Cod Times op-ed, "Question 2 insults Kennedy's memory." (10/12). Note: Question 2 was a ballot initiative launched in Mass. to legalize PAS. It failed in November 2012.
- Harvey Chochinov, MD, The Providence (blog), "We (Canadians) have the right to die but no right to quality palliative care." (2/15)
- Wilson, J. (2014). “Suicide tourism” to Switzerland has doubled since 2009. CNN online news.
- Engber, M. (2005). How does assisted suicide work: A guide to Death with Dignity in Oregon. Slate, October 6. Online.
Articles and Studies in the Peer-Reviewed Literature
Copyright restrictions prevent us from linking to PDF or full-text articles, however if you would like to receive a reference copy of any of the materials listed here, please contact Jennifer Ballentine, email@example.com.
- Byock, I. (in press). The case against physician-assisted suicide. The Oxford Handbook of Death and Dying. New York: Oxford University Press.
- Byock, I. (2010). Dying with dignity. The Hastings Center Report offprint.
- Campbell, C. (2008, Fall). Ten years of “Death with Dignity,” The New Atlantis, 33–46.
- Campbell, C. S., & Black, M. A. (2014, Jan). Dignity, death, and dilemma: A study of Washington hospices and physician-assisted death. Journal of Pain & Symptom Management, 47(1), 137–153.
- Campbell, C. S., & Cox, J. C. (2010, Sept-Oct). Hospice and physician-assisted death: Collaboration, compliance, and complicity. Hastings Center Report, 26–35.
- Chambaere, K., et al. (2015). Recent trends in euthanasia and other practices in Belgium. Letter to the editor, New England Journal of Medicine, 372(12), 1179-1181.
- Emanuel, E. (2002). Euthanasia and physician-assisted suicide: A review of the empirical data from the United States. Archives of Internal Medicine, 162, 142–152.
- Ganzini, L. et al. (2001). Oregon physician’s attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. Journal of the American Medical Association, 285(18), 2363–2369.
- Ganzini, L., Goy, E. R., & Dobscha, S. K. (2008). Prevalence of depression and anxiety in patients requesting physicians' aid in dying: Cross-sectional study. British Medical Journal, 337, online publication. doi: 10.1136/bmj.a1682.
- Hendin, H., & Foley, K. (2008). Physician-assisted suicide in Oregon: A medical perspective. Michigan Law Review, 106, 1613–1639.
- Jackson, A. (2008). The inevitable—death: Oregon’s end-of-life choices. Willamette Law Review, 45, 137–160.
- Meier, D. et al. (2003). Characteristics of patients requesting and receiving physician-assisted death. Archives of Internal Medicine, 163, 1537–1542.
- Onwuteaka-Philipsen, B. D., et al. (2012). Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: A repeated cross-sectional study. Lancet, published online July 11, 2012; doi: 10.1016/S0140-6736(12)61034-4.
- Orentlicher, D. (2000). Implementation of Oregon’s Death with Dignity Act: Reassuring, but more data needed. Psychology, Public Policy, and Law, 6(2), 489–502.
- Pearlman, R. A., & Starks, H. 2004. Why do people seek physician-assisted death? In Quill, T. E., & Battin, M. P. (Eds.). 2004. Physician-assisted dying: The case for palliative care & patient choice. Baltimore: Johns Hopkins University Press, pp. 91–101.
- Quill, T. E., & Miller, F. G. (Eds.). 2014. Palliative care and ethics. New York: Oxford University Press.
- Steinbok, B. (2005). The case for physician-assisted suicide: Not (yet) proven. Journal of Medical Ethics 31, 235–41.
- Steinbrook, R. (2008). Physician-assisted death—From Oregon to Washington state. New England Journal of Medicine, 359(24), 2513–2515.
- Stevens, K. (2006). Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians. Issues in Law and Medicine, 21(3), 187–200.
- Tolle, S., et al. (2004, Summer). Characteristics of proportion of dying Oregonians who personally consider physician-assisted suicide. Journal of Clinical Ethics, 15(2), 111–122.
- Uhlmann, M. M. (Ed.) 1998. Last rights? Assisted suicide and euthanasia debated. Grand Rapids, MI: William B. Eerdmans Publishing Company.
- In February 2015, Compassion & Choices launced an attack (and, interestingly, fund raiser) against Dr. Byock for reportedly outrageous statements. They give no references for the admittedly outrageous statements, and Dr. Byock denies making any such statements.
For additional information, context, and detail, please contact Jennifer Ballentine, MA, at email firstname.lastname@example.org.