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Assisted Suicide Laws in the U.S. and Abroad

In 1997, the U.S. Supreme Court unanimously ruled that an individual is not guaranteed the right to commit suicide with the help of a physician -- that's for the states to decide. Only two, Oregon and Washington, have passed laws allowing physician-assisted suicide to varying degrees, but recently Montana's State Supreme Court opened the door for such a law. In addition, several European countries allow forms of assisted suicide and euthanasia. Here's some background:

Oregon

This state passed its Death with Dignity Act in 1994 by a margin of 51 percent to 49 percent, but the law didn't go into effect until 1997 after a lengthy legal battle and an additional referendum.

According to the act, terminally ill Oregon residents can "end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose." From the time the law was enacted through the end of 2008, 401 people have committed suicide in this manner. Data for 2009 will be released in March 2010; you can read all of the Death with Dignity annual reports here.

Washington State

Its Death with Dignity Act passed by a margin of 58 to 42 percent on Nov. 4, 2008 and went into effect on March 5, 2009. The law "allows terminally ill adults seeking to end their life to request lethal doses of medication from medical and osteopathic physicians. These terminally ill patients must be Washington residents who have less than six months to live." Statistics on how many people have died via this act are collected and analyzed by the state's Department of Health and are not made public, though you can see how many request forms were received by the department here. Request forms range from an initial "Written Request for Medication to End My Life in a Humane and Dignified Manner form" to an "Attending Physician's After Death Reporting form."

This 2007 New York Times Magazine article, by Daniel Bergner, chronicles former governor Booth Gardner's efforts to pass the 2008 law. Gardner became an advocate for the law after being diagnosed with Parkinson's disease. This in-depth piece includes the narrative history of right-to-die issues in the United States, and raises important questions regarding the relationship between assisted suicide, race and gender.

Montana

On Dec. 31, 2009, the state Supreme Court ruled by a narrow majority that doctors have protection from prosecution if they help a terminally ill patient die. But the court did not specifically state that physician-assisted suicide is a right guaranteed under the state's Constitution. The ruling was in response to a case filed by Robert Baxter, a retired truck driver and leukemia sufferer who has since passed away. He claimed that his Constitutional rights were violated when a doctor refused to help him die.

Switzerland

Commonly seen as having the most liberal interpretation, Switzerland has allowed assisted suicide, either with or without a physician present, since the early 1940s. The person committing suicide may or may not be resident of Switzerland, but must be of sound mind. Any person assisting in the suicide must not stand to gain from the other person's death. In response to recent concerns about the lack of regulation of "suicide tourism," the Swiss cabinet proposed two new laws; one would tighten regulations, while the other would ban assisted suicide entirely. According to The Wall Street Journal, the state of Zurich has already mandated that anyone seeking assisted suicide be approved by two doctors.

The Swiss parliament, however, wants to set strict guidelines for assisted dying groups, such as Dignitas and Exit Switzerland. New rules would require patients to get two doctors' opinions that their illness is incurable and imminently fatal, and assurances that the person seeking assisted suicide is of sound mental capacity and has repeatedly expressed a desire to die. New record-keeping mechanisms would also be put into place to monitor groups' actions and finances.

Euthanasia is not legal in Switzerland.

Netherlands

Based on 1995 medical guidelines, the Dutch enacted their euthanasia and physician-assisted suicide law in April 2002. According to the Canadian Broadcasting Corporation, doctors can end a life or assist in a suicide in a medically appropriate fashion as long as the patient requests it and his suffering is deemed lasting and unbearable. All other solutions to ease or end this suffering must be exhausted, and the physician involved must consult with at least one other doctor before assisting in a suicide.

According to The Guardian, there are on average 3,500 deaths per year, and doctors generally reject two-thirds of requests to die.

Belgium

Based on the law in the Netherlands, physician-assisted suicide and euthanasia were legalized in September 2002 under the requirements that "the patient must request to die, the suffering must be unbearable, and the clinical course hopeless. An independent physician must be consulted, and a third physician must be brought in for non-terminal cases."

Luxembourg

Its parliament voted to legalize euthanasia and physician-assisted suicide in February 2008. The law allows "a person who is suffering unbearably from an illness to request medical assistance to die."

Dignitas -- "Suicide Tourism" and Recent Controversy

A Swiss nonprofit founded in 1998 by Ludwig Minelli, Dignitas has helped more than 1,000 people die. The organization is financed primarily through member donations, and it is reported that Minelli currently charges approximately 10,000 Swiss francs [$10,500] for assisting a suicide. Dignitas is the only organization in Switzerland that regularly assists in the deaths of foreign citizens. According to The Wall Street Journal, "the number of foreigners Dignitas helps each year -- 132 in 2007, compared to 91 in 2003 -- has increasingly left the Swiss uncomfortable with the country's growing reputation for 'suicide tourism.'"

Three high-profile British cases

In September 2008, 23-year-old British citizen Daniel James traveled to Zurich with his family after being paralyzed in a rugby match. He was granted a prescription that ended his life, but his death sparked controversy because of his age and the fact that he was not suffering from a terminal illness. His parents were questioned by the police -- assisting in a suicide is illegal in England under the 1961 Suicide Act -- but never charged.

In 2009, Dignitas was in the news again for helping former BBC Philharmonic Conductor Sir Edward Downes and his wife Lady Joan Downes commit suicide. Although Lady Downes was in late stages of terminal cancer, Sir Downes was in good health, aside from major problems with his hearing and vision. According to The New York Times, there have been at least three similar cases where the healthy spouse of someone who was terminally ill chose to die alongside their partner.

Debbie Purdy, a British citizen who suffers from multiple sclerosis, asked the country's high court in June 2009 to clarify whether or not her husband would be prosecuted for helping her travel to Dignitas for her assisted suicide -- a conviction under U.K law can mean up to 14 years in prison. In late February 2010, British Director of Public Prosecutions Keir Starmer, issued a list of conditions outlining the conditions under which someone aiding in suicide could be prosecuted, but observers believe such prosecutions will be unlikely.

Allegations of misconduct

The accounts of one former Dignitas employee, Soraya Wernli, have taken the British media by storm, despite the fact that her allegations were proven false by authorities. According to The Guardian, "[the] estranged colleague … who worked for several years with the suicides, lost faith in the organization and told police … that Minelli was making money from death and the fear of it, and criticized him for running 'a production line concerned only with profits.' Police investigations found nothing suspicious."

The Future of Dignitas

In an in-depth article for The Atlantic, Bruce Falconer observes a Swiss nation growing weary of Minelli's outspoken and sometimes brazen tactics. He notes that despite polls showing 80 percent of Swiss citizens supporting assisted suicide, Minelli is "almost universally reviled." Falconer addresses rumors circulating around Dignitas, Minelli's recent use of poison gas in assisted suicides, and the larger historical and ethical questions about suicide tourism.

In addition, Falconer cites Dignitas' Betty and George Coumbias case -- watch their story here. They wanted to die together, even though she was in good health. A Swiss doctor refused to give them the lethal prescription, and, writes Falconer, "Minelli is now using their case to pressure Zurich's medical authorities into granting doctors permission to prescribe lethal drugs for virtually anyone who might want them."

Since the making of this film, some laws in Switzerland have changed. Anyone seeking assisted suicide must be approved by two doctors per a 2007 mandate by the chief physician in the state of Zurich. Since then, Dignitas has had a decrease in the number of people it's helped die -- only 90 in 2009 as compared to previous yearly averages of about 135. In March 2010, according to The Wall Street Journal, a vote is planned in Switzerland to set new rules for assisted suicide organizations that would require patients to get two doctors to testify that a person is terminally ill and has long expressed the desire to die. Right-to-die groups would also be banned form accepting payments surpassing the basic costs of assisting a suicide.

Minelli is still confident about his organization and the cause he believes in, and tells FRONTLINE that 70 percent of people who get the green light from Dignitas for an assisted suicide never go through with it, demonstrating that just knowing the option is out there is comforting for most.

In her Q&A with FRONTLINE, Mary Ewert, whose husband Craig committed suicide in 2006, says she believes Dignitas, and Minelli, "have been demonized by the media and by political opponents." She also found Dignitas to be "the most honest and forthright" organization she dealt with after her husband Craig's ALS diagnosis, as compared to doctors and ALS support groups.

Additional Readings on Assisted Suicide

posted march 2, 2010

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