The Evolution of America’s Right-to-Die Movement
The Hemlock Society Emerges
In 1975, Derek Humphry helped his wife, who was dying from breast cancer, take her own life. Five years later, Humphry founds the Hemlock Society, the first right-to-die organization in the U.S., in his garage in Santa Monica, Calif. Its mission is to help terminally ill people people die peacefully, and advocate for laws backing physician-assisted suicide. Humphry comes to be considered by many to be the father of the right-to-die movement, and within 12 years, the group grows to 80 chapters.
“And everybody said I was crazy — America was not ready for physician-assisted suicide. And I said, ‘Oh, I think it is.’ And so I started out on a lonely path back in 1980, campaigning for the right to choose to die when terminally ill.”
June: “Dr. Death’s” First Patient Dies
Dr. Jack Kevorkian, who will earn the nickname “Dr. Death,” is present at the death of Janet Adkins, a 54-year-old woman from Portland, Ore. with Alzheimer’s disease. Adkins is the first to die in his Volkswagen van, using a “suicide machine” that Kevorkian built in his Michigan apartment from $30 of scrap parts the year before. During the next eight years, Kevorkian would acknowledge helping an estimated 130 people in taking their lives.
”My ultimate aim is to make euthanasia a positive experience. I’m trying to knock the medical profession into accepting its responsibilities, and those responsibilities include assisting their patients with death.”
—Kevorkian, in an interview with The New York Times after Adkins’ death
April: Doctor Helps Woman to Die, Sparks Nationwide Debate
A grand jury ultimately declines to indict Dr. Timothy Quill, a palliative care physician, for prescribing a lethal dose of barbiturates to a terminally ill patient, who subsequently died. Quill said the woman, who was dying of leukemia, had expressed her wish to die and that he had directed the woman to the Hemlock Society. She then asked Quill for medication she knew would end her life. The case sparked a nationwide debate about doctor-assisted suicide.
“It was not that different in my mind and in my personal experience from helping other people to die when I had taken them off a ventilator or helped them stop dialysis or done other things. These are big decisions. …You do them when it’s driven by a patient’s suffering and their circumstance.”
—Dr. Timothy Quill
April: “Aid-in-Dying” Legislation Proposed in Oregon
The Oregon Hemlock Society joins with state Sen. Frank Roberts, who was himself dying of cancer, to propose an “aid in dying” bill, but it fails in committee. But its supporters, including Barbara Coombs Lee, a Senate staff member who will go on to become a major leader in the movement, help to craft a new law that will go before voters in 1994.
“[Roberts] was a man who was dying, he was a man who was revered by his colleagues, and he was married to the governor at the time. But his bill got no serious consideration at all. And it was that back-scenes look at how disparaged and unwelcome in the political arena our conversations about the end of life, that really opened my eyes. Frank did die of his illness a few years later. He did not live to see the rights, the choices that he wishes for himself and other terminally ill people to come into being.”—Barbara Coombs Lee
May: Final Exit is published
Humphry, the Hemlock Society founder, pens the best-selling book, which offers explicit instructions for what he calls “death by self-deliverance.” Unable to find a publisher, Humphry releases the book himself, and it becomes a best-seller.
“It’s a how-to, but it also goes into things like life insurance; family matters; suicide notes, yes or no; living wills. … There is a list of drugs, and there is the helium hood method described and illustrated, but it also goes into the sensitivities and the delicacies and the family responsibilities to do with end of life.”
November: California Rejects “Aid in Dying” Measure
Voters soundly defeat a ballot measure, backed by the Hemlock Society, that would have legalized physician-assisted suicide. Some supporters suggest Kevorkian’s very public assisted deaths may be frightening Americans away from the idea of “death with dignity.”
“The Hemlock Society was founded 10 years before Kevorkian came on the scene. And he did a great job in publicizing the right to choose to die. … [But] our tactics were different. I wanted to change the law, to permit physician-assisted suicide for the terminally ill. He wanted to shock the medical profession by his antics and his show-offs on television and his costumes and all the rest of it. But that’s not how things work. Doctors will not step outside the law if they can possibly help it.” —Derek Humphry
February: Michigan Bans Assisted Suicide
Partly in response to Kevorkian’s efforts, Michigan Gov. John Engler signs into a law a bill passed by the legislature banning assisted suicide. After a challenge by the American Civil Liberties Union on behalf of two terminally ill cancer patients and seven local doctors, the Michigan appeals court finds the law unconstitutional. Finally, in 1994, the Michigan Supreme Court upholds the ban on assisted suicide and rules that the act is illegal under the state’s common law.
May: Compassion in Dying Emerges
Compassion in Dying, an organization to provide support and advice for terminally ill people, forms in Washington state. The group, which will later come to be called Compassion & Choices, works with terminally ill people to make sure that they are aware of all their options for a peaceful death, including refusing food and fluids, stopping medication or declining certain procedures, or taking medication that will end their lives. Founded in part by people connected to the AIDS epidemic, the group wanted to help those who were contemplating violent suicides to end their lives more peacefully.
“These were people who were on the front lines at the height of the AIDS epidemic. People whom they loved and people whom they served were jumping from balconies and using guns and doing all manner of horrific things to avoid the terrible death that they had witnessed their partners or their loved ones endure.”
—Barbara Coombs Lee
November: Oregon Becomes First State to Legalize Doctor-Assisted Suicide
Voters in Oregon approve the Death with Dignity Act, which allows terminally ill adults likely to die within six months to obtain a prescription for lethal medication from a doctor. Patients must be at least 18 and state residents, and able to demonstrate that they are capable of making their own decisions. The measure is backed by Compassion in Dying and the Hemlock Society. Legal appeals, however, keep the law from taking effect immediately.
“We’d had several failures in attempts to reform the law, but we learned from our mistakes and we gathered strength. And in 1994, our team, emanating from the Hemlock Society, passed the first law in America permitting physician-assisted suicide for the dying.”—Derek Humphry
November: Major Study on End-of-Life Care
The Journal of the American Medical Association publishes the SUPPORT study, a massive study of end-of-life care with the objective of improving end-of-life decision-making, and reducing the frequency of a “mechanically supported, painful and prolonged process of dying.” Conducted at five U.S. teaching hospitals, the study involves 9,105 adults hospitalized with one or more life-threatening diagnoses. It finds shortcomings in communication between doctors and patients about their wishes, such as whether patients want to avoid CPR or be resuscitated. It also reports that half of the conscious patients who died in the hospital had been in “severe or moderate pain,” according to their families. The study leads to the expansion of palliative care, which focuses on pain relief and prevention, in hospitals nationwide.
“To improve the experience of seriously ill and dying patients, greater individual and societal commitment and more proactive and forceful measures may be needed.”
– Report conclusion
November: Oregon Reaffirms Physician-Assisted Suicide
Oregon voters reject a ballot measure to repeal its doctor-assisted suicide law by a wide margin, 60 percent to 40 percent. The law is opposed by religious groups, the Oregon Medical Association, and Not Dead Yet, an advocacy group of people with disabilities that opposes assisted suicide on the grounds that it perpetuates the idea that disabled people cannot live full lives.
“I think policy makers would be wise to look to Oregon, because Oregon has defined that line between assisting a suicide and offering a medical practice of aid in dying, and defined it very, very well. … These people who are terminally ill are not suicidal. …They’re making a choice between this kind of death and that kind.”
– Barbara Coombs Lee
November: Michigan Assisted Suicide Proposal Fails
Local right-to-die advocates gather enough signatures to place a referendum allowing assisted suicide on the ballot in November, but voters reject the measure by a wide margin after a campaign by a coalition that includes the Right to Life of Michigan, the Roman Catholic Church and the Michigan State Medical Society. With the measure defeated, the legislature-imposed ban on the practice remains in place.
March: Kevorkian Convicted
Kevorkian is convicted of second-degree murder and delivery of a controlled substance in the death of Thomas Youk, a 52-year-old man who suffered from Lou Gehrig’s disease. The doctor is sentenced to 10-25 years in prison, but is released after eight years, upon promising not to assist in another suicide.
Maine Voters Reject Assisted Suicide
Voters in Maine narrowly reject a ballot initiative that would have allowed physician-assisted suicide. The American Medical Association called it a “flawed” proposal that would impose on physicians’ mandate to do no harm.
New Name for the Hemlock Society
The Hemlock Society changes its name to End-of-Life Choices.
“I kept out of it. I said I didn’t want it to disappear, but by then I had no control, and [didn’t] want control. But the mission remains basically the same. … Some people said that they didn’t like the name Hemlock Society because it was associated with Socrates, who took his life. But then our argument was Socrates made a choice between death or exile. … Some people felt that it was time to drop such a name and have much more respectable names, like Death with Dignity or Compassion & Choices.”
– Derek Humphry, who retired from the society in 1992
Final Exit Network Emerges
A group of radical right-to-die activists break from Compassion in Dying to form its own group, Final Exit Network. Taking their name from Humphry’s book, they aim to help not only people who are terminally ill, but anyone who wants to die. The group gains more than 3,000 members nationwide, and volunteers who call themselves “exit guides” have been present at hundreds of planned deaths.
“The network was designed to be supportive of anyone who was mentally competent and suffering more than they could bear. They did not have to be terminally ill. We feel this is an individual rights issue, that they should have the right to determine how they live and how they die. And we believe, at the heart of our mission, no person should die alone.”
– Ted Goodwin, president from 2004-2009
Major Right-to-Die Groups Merge
End-of-Life Choices, formerly known as the Hemlock Society, merges with Compassion in Dying to become Compassion & Choices. It becomes one of the leading right-to-die organizations in the U.S., leading the fight to legalize physician-assisted suicide, or what the group prefers to call “aid in dying.” They also help people outside Oregon and Washington find ways to end their lives without breaking the law.
“It’s our position that people who are terminally ill, who are looking at their death’s approach not at some distant time in the future but ‘Here it is, I’m approaching it now,’ those people can’t and should not have to wait for absolute clarity on the law before they too are empowered with the means to control their suffering.”
– Barbara Coombs Lee, president, Compassion & Choices
January: Oregon Law Reaffirmed
The U.S. Supreme Court upholds Oregon’s Death with Dignity Act, 6-3, fending off a challenge from the Bush administration. The federal government, which opposed assisted suicide, had challenged the law by arguing that doctors in Oregon who helped patients die under the law could be arrested under federal drug laws. Supporters of the law in Oregon say the court’s ruling is a victory for voters in the state, who supported the measure twice, in 1994 and 1997.
November: Washington OKs Physician-Assisted Suicide
Washington becomes the second state to legalize doctor-assisted suicide with the passage of a bill modeled on Oregon’s law. It takes effect in 2009.
February: Final Exit Network Members Arrested
Four of the group’s members are arrested in connection with the death of John Celmer, a Georgia man suffering from cancer, after a multistate investigation into the network. Tom Goodwin, the president, is charged, along with Lawrence Egbert, the group’s medical director, and two others, for helping Celmer die. The same year, Egbert and three other Final Exit members are indicted for helping a mentally ill Arizona woman, Jana Van Voorhis, die in 2007.
“I think the larger issue it raised was, again, the actions of these people. To me, even though it was an unusual crime that they were committing, they were still nothing more than vigilantes; that they didn’t like what the law was, and that they chose to ignore it. … And that there are a lot of people out there who are vulnerable and susceptible, I think, to people like Final Exit, who, however well meaning they may be, they just don’t have any safeguards in place and don’t have any business doing what it is that they’re doing.”
– Penny Penn, Forsyth County, Ga. district attorney
December: Montana Supreme Court Upholds Doctors’ Role in Death
The Montana Supreme Court rules that doctors can’t be prosecuted for helping to hasten the deaths of terminally ill patients. But the court stops short of saying that the right to die is constitutionally protected in the state.
“Now the Montana medical community is putting that into practice and implementing it and incorporating [it in] end-of-life care, just as it incorporates any other end-of-life choice, just as they are incorporating palliative sedation, and incorporating the protocols for discontinuing ventilators on conscious patients.”
– Barbara Coombs Lee
April: Final Exit Network Survives Trial in Arizona
In the network’s first legal test, Arizona prosecutors argue that four Final Exit members, including Egbert, illegally helped Jana Van Voorhis to die. Van Voorhis, who had struggled most of her life with mental illness, wrongly believed she was terminally ill, and Egbert approved her application for help from the network. Two “exit guides” present at her death plead guilty to lesser charges, but Egbert, the group’s medical director, is acquitted. The jury cannot decide on the guilt of an exit guide, Frank Langser, and the judge declares a hung jury. Langser pleads guilty to a lesser to avoid a retrial. But the network remains intact.
June: Kevorkian Dies
Kevorkian dies of natural causes at the age of 83.
February: Final Exit Network Wins in Georgia
Goodwin and three others indicted in Georgia challenge state law, arguing that its ban on assisted suicide violates the First Amendment. The Georgia Supreme Court agrees, forcing prosecutors to drop the charges.
“When we founded the network, it was our desire to provide this activism to help dying people avoid the suffering death. I use the term ‘help’ not in the physical act, OK, but to support them — but also to effect change in legislation. And now the Georgia law has been thrown out. In a seven-to-zero ruling, the (state) Supreme Court said this was an unenforceable law. Our rights as American citizens had been more enshrined under the First Amendment because of this.”
– Goodwin, Final Exit Network
May: Final Exit Network Back in Court
Egbert, Final Exit’s medical director, and three other members are indicted in Minnesota for their alleged role in a 2007 suicide. The woman’s death is initially ruled to be from natural causes, but police begin investigating after they receive information from Georgia authorities about the network’s operations. The next hearing is scheduled for Dec. 18.
November: Mass. Rejects Physician-Assisted Suicide
Voters in Massachusetts narrowly reject a ballot initiative to legalize physician-assisted suicide. Support had initially been relatively strong for the measure, which is modeled on the Oregon law, but collapsed after an aggressive campaign led in part by a disability rights group, who argued that the law would be easily abused.