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‘Death With Dignity’ Has A Long And Storied History In The United States


For more than a century, states have wrestled with the idea of people’s right to choose how they leave this world. The first death with dignity (DWD) act dates back to 1906 when it failed to pass in Ohio. It wasn’t until the late ’90s that the first state allowed terminal patients to take life-ending medication. In the right-to-die (RTD) debate, public opinion has changed dramatically; in 1947, only 37% of Americans supported physician-assisted suicide (PAS), but by 1993, 73% of respondents were in favor.

From the infamous Dr. Death to well-known cases of people choosing assisted self-end, the RTD has sparked controversy for decades. People like Karen Ann Quinlan, Terri Schiavo, and Brittany Maynard made headlines across the country, driving political movements for new laws. In the year after 29-year-old Maynard chose to end her life after being diagnosed with terminal brain cancer, for example, more than half the states considered DWD acts. The long history of the DWD movement shows how medical technology, individual rights, and morality intersect.

Photo: Wellcome Images / Wikimedia Commons / CC-BY-4.0

New Medicines Raised Questions About End-Of-Life Care

The 19th-century inventions of morphine and chloroform brought groundbreaking medical tools to treat pain. Doctors used the compounds to offer a pain-free passing or even PAS. However, in 1885, the American Medical Association officially came out against mercy termination.

While morphine and chloroform could be used to relieve pain, the AMA opposed the idea of using them to expedite one’s passing.

Photo: Wellcome Images / Wikimedia Commons / CC-BY-4.0

The Euthanasia Society Invented Living Wills

In 1938, the Euthanasia Society of America (ESA) formed with the goal of changing laws about assisted terminations. For three decades, the group attempted to promote DWD acts, with no success. In the 1960s, the ESA shifted its focus to the individual right to consent to or refuse medical treatment.

In 1967, they worked with a lawyer named Luis Kutner to develop the first living will, a document that lets someone state what medical treatment they want – or do not want – if they become incapacitated. At the time, a living will was an entirely new concept that advanced individual rights. By 1970, the ESA distributed 60,000 living wills.

Photo: The Sun / Library of Congress

Participating In An Assisted Suicide Could Mean Jail Time

For much of the 20th century, the legal rules surrounding DWD remained unclear. While some officials promoted changes to the law to allow a “painless death for incurables,” as a headline in The Sun read in 1913, others pushed for harsh penalties for people who assisted in terminations.

In 1911, for example, a woman named Sadie Marchant struggled with a single lung and asked the Shaker colony where she lived to help her pass. When two of the Shakers assisted Marchant, they were apprehended for murder. While the case was ultimately dismissed, it indicated an uncertain legal status for anyone who knowingly assisted in the life-ending process.

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A 1970s Case Put End-Of-Life Care In The Headlines

The 1976 case of Karen Ann Quinlan became the first of many headlining stories on choosing RTD. After Quinlan fell into a coma in 1975, her family filed a lawsuit to remove her respirator, arguing there was no chance of recovery. The case went to the New Jersey Supreme Court, which ruled in a unanimous decision that the individual right of privacy extended to removing life-support systems.

According to the decision, Quinlan’s father should act in her interests, rather than letting doctors or a court decide. The ruling also held that criminal liability could not extend to the person who removed life support, because the passing was “expiration from existing natural causes.” Although the Quinlan family removed the young woman’s respirator in 1976, she didn’t pass until 1985.

Brittany Maynard Chose To Pass In Her 20s

Video: YouTube

In 2014, 29-year-old Brittany Maynard learned she had terminal brain cancer. Maynard was a newlywed planning a family with her husband, Dan Diaz. Maynard wanted to avoid the “nightmare scenario” of her family witnessing a long decline in hospice and instead chose to move to Oregon to use the state’s DWD laws to choose how to end her life. As Maynard wrote:

Having this choice at the end of my life has become incredibly important. It has given me a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty, and pain.

After Maynard’s passing, her family and supporters continued her work of promoting the legislation. In 2015, many more US states introduced DWD legislation.

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Ohio Proposed The First Euthanasia Bill In 1906

In 1906, the Ohio Legislature became the first to consider a euthanasia bill. The movement to pass a DWD act was driven by Anna Hall, a Cincinnati woman whose mother was struggling with a painful terminal illness. Later the same year, Dr. R.H. Gregory introduced a similar bill in Iowa.

The British Medical Journal declared Dr. Gregory either a “crank” or a “notoriety hunter.” The two early efforts to create legal protections for assisted terminations were known as the “chloroform bills,” but neither became law.

Photo: Halebtsi / Wikimedia Commons / Public Domain

Jack Kevorkian Became Known As ‘Dr. Death’ In The ’90s

By 1990, 65% of Americans supported PAS. That same year, Dr. Jack Kevorkian assisted in the passing of a woman suffering from Alzheimer’s disease. Kevorkian became the face of the PAS movement, traveling the country with a “death machine” and spurring conversations about the ethics and morality of assisted terminations.

In several cases, Kevorkian faced criminal charges for his actions, including the time he gave a tape to 60 Minutes that showed him administering life-ending medication to a patient. Kevorkian eventually received a sentence of 10 to 25 years in prison.

Photo: Ted Eytan / Wikimedia Commons / CC-BY-SA-2.0

Congress Tried To Stop DC’s DWD Act

In 2016, the DC City Council passed the DWD Act. Before the act went into effect, the House Committee on Oversight and Government Reform Chairman Jason Chaffetz tried to block the law. He expressed his opposition: “I worry that assisted suicide will create a marketplace for death.”

The motion did not pass Congress, and the act took effect in February 2017. But several months later, Mary Klein, a retired journalist with terminal ovarian cancer, reported she was unable to find a DC physician willing to prescribe life-ending medication.

Photo: Joseph F. Fletcher / Princeton UniversityPpress

Some Christian Groups Struggled With The RTD

In 1954, Protestant theologian Joseph Fletcher published Morals and MedicineFletcher pointed out that advances in medicine and technology would inevitably raise new concerns over issues such as assisted terminations. His solution was to create an ethical code around life and death, based on the Christian system.

More significant than Fletcher’s conclusions was that he identified a future shift in American thinking. A decade later, in 1967, attorney Luis Kutner wrote the first living will, the same year Dr. Walter Sackett introduced an RTD bill in the state of Florida. Both signaled major shifts in American views about end-of-life care.

Opponents Of DWD Liken It To Third Reich Programs

The horrors of the SS euthanasia program, which targeted the physically and mentally disabled, raised the specter of coerced terminations for many. Some even spun attempts to provide universal access to health care, such as the Affordable Care Act, into arguments about “death panels” pushing people to take family members off life support.

Oregon’s DWD Act attempted to address the possibility of coercion by limiting the law to terminal patients who have less than six months to live according to two doctors, are mentally competent, and are fully informed about their diagnosis.

The Terri Schiavo Case Raised Questions About End-Of-Life Care

In 2005, the Terri Schiavo case put the national spotlight on DWD again. In 1990, Terri was just 26 years old when she suffered cardiac arrest that ended in a persistent vegetative state. A legal battle between her parents and her spouse raged, as Terri’s husband, Michael Schiavo, fought to remove his wife’s feeding tube. Both sides argued that they were speaking for what Terri’s wishes would have been, with Terri’s parents citing videos of her apparently smiling and interacting with them as proof that she wasn’t actually in the state that doctors claimed.

Michael first petitioned for the removal of Terri’s feeding tube in 1998. It was removed for the first time in April of 2001, but was reinserted two days later. After numerous legal proceedings, the tube was removed for a second time in 2003. However, Governor Jeb Bush ordered the the feeding tube reinserted, a move the Florida Supreme Court later ruled unconstitutional.

In 2005, with the case making national headlines, President George W. Bush and Congress got involved, attempting to move the proceedings from the state courts to the federal judiciary. But eventually, the state court ruling prevailed. The feeding tube was removed after Terri had spent 15 years in a vegetative state with no hope of recovery, according to doctors. Terri eventually passed on March 31, 2005, after the removal.

Terri’s autopsy revealed irreversible brain damage consistent with a persistent vegetative state. It showed she had no cerebral cortex function and would have had no awareness of self. She was blind, which disproved any perceived eye contact. Her brain weighed 615 grams, which is about half the normal weight for a woman her age. Based on the loss of neurons, doctors concluded that no amount of therapy or treatment would have changed her condition.

The Catholic Church Declared Euthanasia Morally Wrong

The Catholic Church’s position has remained steady in spite of the evolution in American opinions and policies around assisted terminations. In 1995, Pope John Paul II said, “Euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable [termination] of a human person.”

Earlier popes, like Pius XII, distinguished the line between mercy terminations and end-of-life care, as in the 1957 and 1980 declarations on euthanasia that separated ordinary care from extraordinary care.

The 1980 declaration reinforced the church’s opposition but stated people have a moral right to refuse extraordinary or aggressive medical interventions to preserve life. John Paul II also clearly barred assisted terminations when he stated, “True compassion leads to sharing another’s pain; it does not [end] the person whose suffering we cannot bear.”

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Two Ballot Measures In The 1990s Failed By A Close Margin

In 1991, Washington state voters weighed in on the DWD Initiative. The proposed law would legalize PAS, allowing competent, terminal patients to receive a lethal injection from their doctor.

The initiative came close to passing, according to opinion polls, but on election day, it failed by 54% to 46%. The following year, Californians voted on a similar act. It lost by the same margin.

Photo: Diane A. Reid / Wikimedia Commons / Public Domain

Recent Laws Brought DWD Acts To More States

In 1994, Oregon voters passed the first DWD Act, which offered a slightly different approach. Unlike the earlier Washington and California ballot initiatives, the Oregon proposal allowed doctors to prescribe lethal drugs, but patients had to take the dose unaided by a physician.

The act passed by a narrow margin of 51% to 49%, becoming the first law legalizing PAS in the world. Due to legal challenges, the act did not go into effect until 1997.

The West Coast continued to lead the movement for DWD, with physician aid becoming legal in Oregon, Washington, and California, as well as in Colorado, Montana, Vermont, and the District of Columbia. In 2018, Hawaii enacted an assisted dying law that will go into effect in 2019.