Assisted suicide becoming less repugnant?

The NY Times has the story (and it involves a name change): ‘Aid in Dying’ Movement Takes Hold in Some States

"Helping the terminally ill end their lives, condemned for decades as immoral, is gaining traction. Banned everywhere but Oregon until 2008, it is now legal in five states. Its advocates, who have learned to shun the term “assisted suicide,” believe that as baby boomers watch frail parents suffer, support for what they call the “aid in dying” movement will grow further.

In January, a district court in New Mexico authorized doctors to provide lethal prescriptions and declared a constitutional right for “a competent, terminally ill patient to choose aid in dying.” Last May, the Vermont Legislature passed a law permitting it, joining Montana, Oregon and Washington. This spring, advocates are strongly promoting “death with dignity” bills in Connecticut and other states.

Public support for assisted dying has grown in the past half-century but depends in part on terminology. In a Gallup Poll conducted in May, for example, 70 percent of respondents agreed that when patients and their families wanted it, doctors should be allowed to “end the patient’s life by some painless means.” In 1948, that share was 37 percent, and it rose steadily for four decades but has remained roughly stable since the mid-1990s.

Yet in the same 2013 poll, only 51 percent supported allowing doctors to help a dying patient “commit suicide.”

About 3,000 patients a year, from every state, contact the advocacy groupCompassion & Choices for advice on legal ways to reduce end-of-life suffering and perhaps hasten their deaths.

Giving a fading patient the opportunity for a peaceful and dignified death is not suicide, the group says, which it defines as an act by people with severe depression or other mental problems."

Courts and assisted suicide in Britain

Here is a judicial philosophy that seems hard to sympathize with: Lord Chief Justice won't allow 'personal sympathy' to sway decision on assisted suicide

"The Lord Chief Justice, Lord Judge, said he and his fellow judges were “acutely aware of the desperate situation” faced by people such as Tony Nicklinson, the “locked-in” syndrome sufferer who starved himself to death last year after losing a right-to-die case.

"But he said “only basic principles of law” could decide whether or not there could ever be any relaxation of the ban on assisted suicide.

"He also challenged lawyers brandishing opinion poll findings pointing to strong public support for a change in the law, questioning how it was relevant, adding: “The public may change its mind next week.”

"He said the case could not be decided “on the basis of opinion polls”.

"Lord Judge was speaking as he, joined by the Master of the Rolls Lord Dyson and Lord Justice Elias, began to hear submissions as part of a wide ranging Court of Appeal challenge to the UK’s laws on euthanasia."

Physician assisted suicide on the ballot today in MA

On the ballot today in MA (where I'm no longer voting, since our move) is a proposition (Question 2) that would allow physician assisted suicide for some terminally ill patients. Another would decriminalize medical marijuana.  (If I were still living in MA I would vote for both; instead I get to vote in CA to raise my taxes...also a repugnant transaction in a way...)


Here's the question on the ballot:

This proposed law would allow a physician licensed in Massachusetts to prescribe medication, at a terminally ill patient’s request, to end that patient’s life. To qualify, a patient would have to be an adult resident who (1) is medically determined to be mentally capable of making and communicating health care decisions; (2) has been diagnosed by attending and consulting physicians as having an incurable, irreversible disease that will, within reasonable medical judgment, cause death within six months; and (3) voluntarily expresses a wish to die and has made an informed decision. The proposed law states that the patient would ingest the medicine in order to cause death in a humane and dignified manner.

The proposed law would require the patient, directly or through a person familiar with the patient’s manner of communicating, to orally communicate to a physician on two occasions, 15 days apart, the patient’s request for the medication. At the time of the second request, the physician would have to offer the patient an opportunity to rescind the request. The patient would also have to sign a standard form, in the presence of two witnesses, one of whom is not a relative, a beneficiary of the patient’s estate, or an owner, operator, or employee of a health care facility where the patient receives treatment or lives.

The proposed law would require the attending physician to: (1) determine if the patient is qualified; (2) inform the patient of his or her medical diagnosis and prognosis, the potential risks and probable result of ingesting the medication, and the feasible alternatives, including comfort care, hospice care and pain control; (3) refer the patient to a consulting physician for a diagnosis and prognosis regarding the patient’s disease, and confirmation in writing that the patient is capable, acting voluntarily, and making an informed decision; (4) refer the patient for psychiatric or psychological consultation if the physician believes the patient may have a disorder causing impaired judgment; (5) recommend that the patient notify next of kin of the patient’s intention; (6) recommend that the patient have another person present when the patient ingests the medicine and to not take it in a public place; (7) inform the patient that he or she may rescind the request at any time; (8) write the prescription when the requirements of the law are met, including verifying that the patient is making an informed decision; and (9) arrange for the medicine to be dispensed directly to the patient, or the patient’s agent, but not by mail or courier.

The proposed law would make it punishable by imprisonment and/or fines, for anyone to (1) coerce a patient to request medication, (2) forge a request, or (3) conceal a rescission of a request. The proposed law would not authorize ending a patient’s life by lethal injection, active euthanasia, or mercy killing. The death certificate would list the underlying terminal disease as the cause of death.

Participation under the proposed law would be voluntary. An unwilling health care provider could prohibit or sanction another health care provider for participating while on the premises of, or while acting as an employee of or contractor for, the unwilling provider.

The proposed law states that no person would be civilly or criminally liable or subject to professional discipline for actions that comply with the law, including actions taken in good faith that substantially comply. It also states that it should not be interpreted to lower the applicable standard of care for any health care provider.

A person’s decision to make or rescind a request could not be restricted by will or contract made on or after January 1, 2013, and could not be considered in issuing, or setting the rates for, insurance policies or annuities. Also, the proposed law would require the attending physician to report each case in which life-ending medication is dispensed to the state Department of Public Health. The Department would provide public access to statistical data compiled from the reports.

Iraqi arranged marriages--the suicide constraint

The individual rationality constraint isn't very binding when individuals don't have good outside options, but it doesn't entirely go away. In Iraq, it's taking the form of suicide by unwilling brides in arranged marriages: Where Arranged Marriages Are Customary, Suicides Grow More Common

"In this desolate and tradition-bound community in the northwest corner of Iraq, at the foot of a mountain range bordering Syria, Ms. Merza’s reaction to the ancient custom of arranged marriage is becoming more common. Officials are alarmed by what they describe as a worsening epidemic of suicides, particularly among young women tormented by being forced to marry too young, to someone they do not love.

"While reliable statistics on anything are hard to come by in Iraq, officials say there have been as many as 50 suicides this year in this city of 350,000 — at least double the rate in the United States — compared with 80 all of last year. The most common methods among women are self-immolation and gunshots.

"Among the many explanations given, like poverty and madness, one is offered most frequently: access to the Internet and to satellite television, which came after the start of the war. This has given young women glimpses of a better life, unencumbered by the traditions that have constricted women for centuries to a life of obedience and child-rearing, one devoid of romance.
...

"Ms. Merza’s father, Barkat Hussein, interviewed later in private, said he was aware that the shooting was not an accident.

“We gave her to her cousin less than 20 days ago,” he said. “She accepted him. Like anyone who gets married, she should be happy.”

"He said he would not force her to return to her husband, who lives next door. But, he said: “I hope she will go back to him. His father is my brother.”

"He, too, blamed the Turkish soap opera for his daughter’s unhappiness, and he nodded toward the room where his wife was working. “I got married to my cousin,” he said. “I wasn’t in love with her, but we are here, living together. That’s what happens here, we marry our relatives.”

Assisted dying: still illegal, still controversial

The death yesterday of a British advocate for medically assisted death for terminally ill patients brings back the debate about whether physician assisted suicide should always be a repugnant transaction.

Here's the BBC's story: Right-to-die man Tony Nicklinson dead after refusing food

"Tony Nicklinson, a man with locked-in syndrome who fought for the right to legally end his life, has died.

"The 58-year-old was paralysed from the neck down after suffering a stroke in 2005 and described his life as a "living nightmare".

"Last week Mr Nicklinson, from Melksham, Wiltshire, lost his High Court case to allow doctors to end his life.

"Mr Nicklinson's family solicitor said that he had refused food from last week."
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Here's the NY Times: British Man Who Fought for Assisted Suicide Is Dead

"A 58-year-old British man suffering from so-called locked-in syndrome died on Wednesday, six days after the nation’s High Court rejected his request for help in ending his life. His death is certain to galvanize the already contentious debate about assisted suicide in Britain."
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And here's an article about the controversy, in favor of a change in the laws against assisted suicice, published a few days earlier (it appears): The case for assisted dying

"The case for a law to legalise the choice of physician-assisted dying for mentally competent people with terminal illness, who have expressed a settled wish to die, is very easily stated. Unbearable suffering, prolonged by medical care, and inflicted on a dying patient against their will, is an unequivocal evil. What’s more, the right to have your choices supported by others, to determine your own best interest, when you are of sound mind, is sovereign. And this is accepted by a steady 80-plus per cent of the UK population in successive surveys.

"Even so, after decades of campaigning, the law has yet to change. How can this be? The answer is simple: there has been a highly organised opposition by individuals and groups, largely with strong religious beliefs that forbid assistance to die. "

Death and choices

Two apparently unrelated stories in the NY Times both raise the issue of what choices about the end of life are and should be available, for the terminally ill, and for others.  One concerns the experience of Oregon and Washington* with physician assisted death for terminally ill patients, the other concerns the sale of life insurance contracts to investors.  Both involve transactions that used to be, and still often are, regarded as repugnant, in one case between doctors and patients, and in the other between patients (or simply the elderly) and anonymous investors.

Assisted suicide for the terminally ill has long been controversial, and the Washington law insists that prescription drugs be "self administered" which can be a problem when movement and swallowing become hard.  On the insurance side, "viatical settlements" are often regarded as repugnant because the investors win when you die, as opposed to life insurance companies which make their money while you live. But, of course, insurance companies also offer annuities, in which they win when you lose... (See my 2009 post on "Death Pools".)

Here are some quick summary quotes from the two stories...

A Surprise Reflection of Who Picks Assisted Suicide

"Washington followed Oregon in allowing terminally ill patients to get a prescription for drugs that will hasten death. Critics of such laws feared that poor people would be pressured to kill themselves because they or their families could not afford end-of-life care. But the demographics of patients who have gotten the prescriptions are surprisingly different than expected, according to data collected by Oregon and Washington through 2011.
...
"While preparing advance medical directives and choosing hospice and palliative care over aggressive treatment have become mainstream options, physician-assisted dying remains taboo for many people. Voters in Massachusetts will consider a ballot initiative in November on a law nearly identical to those in the Pacific Northwest, but high-profile legalization efforts have failed in California, Hawaii and Maine.

"Oregon put its Death With Dignity Act in place in 1997, and Washington’s law went into effect in 2009. Some officials worried that thousands of people would migrate to both states for the drugs.

“There was a lot of fear that the elderly would be lined up in their R.V.’s at the Oregon border,” said Barbara Glidewell, an assistant professor at Oregon Health and Science University.

"That has not happened, although the number of people who have taken advantage of the law has risen over time. In the first years, Oregon residents who died using drugs they received under the law accounted for one in 1,000 deaths. The number is now roughly one in 500 deaths. At least 596 Oregonians have died that way since 1997. In Washington, 157 such deaths have been reported, roughly one in 1,000.

"n Oregon, the number of men and women who have died that way is roughly equal, and their median age is 71. Eighty-one percent have had cancer, and 7 percent A.L.S., which is also known as Lou Gehrig’s disease. The rest have had a variety of illnesses, including lung and heart disease. The statistics are similar in Washington.
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Are You Worth More Dead Than Alive?
"Fiedler, who owns a firm called Innovative Settlements, knew that a life-insurance policy is an asset that can be resold to a friend or stranger just as a car, boat or house can. In a transaction known as a viatical settlement (for terminally ill patients) or a life settlement (for everyone else), the person selling his insurance gets an immediate cash payment. The buyer, in exchange, is named as the beneficiary and pays the premiums until the insured person dies. Life no longer afforded Robles a traditional way to make money, but to the right investor, Fiedler advised, his imminent death was worth a great deal.
...
"Betting on when somebody will die seems so creepy that it’s hard to believe the practice is legal. Sure, people pay good money to buy life-insurance policies, so perhaps that should confer the right to sell them as well. But the freedoms of ownership are not unlimited, especially when it comes to anything related to life and limb. Possession of and control over what happens to your own body is a fundamental human right. Nonetheless, that hasn’t stopped cultures from banning prostitution, organ sales or for-profit surrogate parenthood. The justification for such infringements upon bodily sovereignty is that people should be protected from financial incentives to harm themselves, and you could argue that a life settlement creates just such an incentive."




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*The Washington Death with Dignity Act, Initiative 1000, codified as RCW 70.245, passed on November 4, 2008 and went into effect on March 5, 2009.

This act 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.

Assisted suicide in the U.S.

Assisted suicide is a prototypically repugnant transaction, in the sense that there are people who want to engage in it, and others who object. Here's an article from yesterday's WSJ, about a doctor who benefited from his own efforts to legalize assisted suicide in Oregon: Right-to-Die Advocate Ends His Life

"Peter Goodwin, a family physician who wrote and campaigned for Oregon's right-to-die law in the 1990s, died Sunday after taking a cocktail of lethal drugs prescribed by his doctor, as allowed under the legislation he championed.

"Dr. Goodwin, 83 years old, had been diagnosed with a degenerative brain disorder similar to Parkinson's disease and had been given less than six months to live.

"The Oregon law was the first in the nation to authorize patients to end their lives with the assistance of physicians. It doesn't allow for doctors to administer euthanasia by injection, though it authorizes them to prescribe lethal drugs that the patient can choose to take.

 "The law has withstood legal challenges including a case brought by the Bush administration. In 2006, the Supreme Court ruled in favor of Oregon, saying that the federal government couldn't forbid doctors from prescribing drugs to help a patient die.
...
"Oregon voters approved the Death With Dignity Act at the polls in 1994, and voted down legislation that would have repealed it in 1997. A total of 597 people have died under its provisions, including 71 in 2011, according to Oregon state statistics.
...
"The act has had an impact beyond Oregon, serving as a model for a Washington State law that took effect in 2009. Massachusetts is scheduled to vote on a similar law in November, while Montana allows physician-assisted suicide as a result of a court case.

"John Kelly, director of Second Thoughts, a Massachusetts-based organization of disability activists who oppose the assisted-suicide ballot petition, said assisted suicide brings up big problems. "Dr. Goodwin "created a monster," Mr. Kelly said. "Assisted suicide is a deadly mix with the profit-driven health-care system. There are so many problems with assisted suicide. These bills sound good in some kind of a perfect-knowledge fantasy universe, but when we get down to real life they become a disaster."
...
"The Death With Dignity Act had a wide effect on end-of-life decisions, said Barbara Coombs Lee, executive director of Compassion & Choices, a national right-to-die organization that is a successor to the Hemlock Society. "Palliative care and hospice care got a big boost in Oregon," Ms. Lee said. "It levels the playing field between patients and physicians who are invested in giving more treatment."

Assisted suicide: the British debate continues

Allow assisted suicide for those with less than a year to live

"The independent Commission on Assisted Dying, whose members include several prominent peers and medics, wants GPs to be able to prescribe lethal doses of medication for dying people to take themselves."

Even the name of the Commission makes clear why assisted suicide is often regarded as a repugnant transaction, and why the discussion of how doctors may reasonably treat terminally ill patients is so fraught.

Peter Singer on suicide

Suicide, and doctor-assisted suicide, remains a subject of (repugnant transaction) controversy. Here's Princeton's Peter Singer: A Death of One's Own

"A friend told Clendinen that he needed to buy a gun. In the United States, you can buy a gun and put a bullet through your brain without breaking any laws. But if you are a law-abiding person who is already too ill to buy a gun, or to use one, or if shooting yourself doesn’t strike you as a peaceful and dignified way to end your life, or if you just don’t want to leave a mess for others to clean up, what are you to do? You can’t ask someone else to shoot you, and, in most countries, if you tell your doctor that you have had enough, and that you would like his or her assistance in dying, you are asking your doctor to commit a crime.

"Last month, an expert panel of the Royal Society of Canada, chaired by Udo Schüklenk, a professor of bioethics at Queens University, released a report on decision-making at the end of life. The report provides a strong argument for allowing doctors to help their patients to die, provided that the patients are competent and freely request such assistance.

"The ethical basis of the panel’s argument is not so much the avoidance of unnecessary suffering in terminally ill patients, but rather the core value of individual autonomy or self-determination. “The manner of our dying,” the panel concludes, “reflects our sense of what is important just as much as do the other central decisions in our lives.” In a state that protects individual rights, therefore, deciding how to die ought to be recognized as such a right.

"The report also offers an up-to-date review of how assistance by physicians in ending life is working in the “living laboratories” – the jurisdictions where it is legal. In Switzerland, as well as in the US states of Oregon, Washington, and Montana, the law now permits physicians, on request, to supply a terminally ill patient with a prescription for a drug that will bring about a peaceful death. In The Netherlands, Belgium, and Luxembourg, doctors have the additional option of responding to the patient’s request by giving the patient a lethal injection.

"The panel examined reports from each of these jurisdictions, with the exception of Montana (where legalization of assistance in dying occurred only in 2009, and reliable data are not yet available). In The Netherlands, voluntary euthanasia accounted for 1.7% of all deaths in 2005 – exactly the same level as in 1990. Moreover, the frequency of ending a patient’s life without an explicit request from the patient fell by half during the same period, from 0.8% to 0.4%."

Misc. repugnant transactions

A challenge to Canada's laws against assisted suicide:
  Group pushing B.C., Ottawa for the right to have planned suicides

"In Canada, the Criminal Code makes it an offence to help with suicide, punishable by a term of up to 14 years.

"But the Farewell Foundation is trying to have the law declared unconstitutional, with lawyer Jason Gratl arguing that it violates the Canadian Charter of Rights and Freedoms.

"The criminal prohibition on assisted suicide in Canada causes immeasurable physical and psychological suffering to persons of sound mind who are capable of making informed decisions and who wish to end their own lives in order to avoid that suffering,” states an affidavit filed by Mr. Ogden. “This suffering is certain and it is as extreme as any suffering humanity must endure. This case tests whether Parliament is entitled to cause such suffering to the people of Canada.”
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Ynet reports on a call by religious Israeli women for renewed polygamy.

"The ads distributed in the synagogues appeared in the "Shabbat B'Shabbato" weekly bulletin. They encourage Jewish Sephardic men to return to the ancient custom, and include a quote from a halachic paper written by Rabbi Ovadia Yosef several years ago, which does not rule out the polygamy phenomenon: "Courts imposing aggravated punishments on Sephardim over this matter are wrong."
...
"The Srugim website revealed that the ads were funded by a group of single religious women who have given up on finding a match.

"One of the women, 39, said: "I am a single religious woman who is afraid of losing the ability to become a mother." She added that there were 27 other women like her who would be happy to marry a married man."

*****

The WSJ reports "Buying and selling dogs is illegal in Iran, unless they are guard dogs or used by police. Dogs are considered "haram," or unclean, in Islam. "

And a black market has sprung up to fill the growing demand...
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Repugnant transactions involving life and death

A lot of repugnance is associated with transactions that involve the boundaries between the living and the dead--abortion, deceased organ donation (is brain death sufficient), assisted suicide...

In The New Republic, Eric Posner reviews The Law of Life and Death by Elizabeth Price Foley (Harvard University Press).

As he writes,
 
"The distinctions matter. Killing a human being is murder; discarding unwanted cell tissue is not.
 
"Familiar culture-war controversies have erupted over these issues. The law embodies uneasy truces and compromises, and, as is always the case, contains ambiguities and inconsistencies; and state laws vary a great deal. But a rough logic has emerged. The gestational blob gains stronger legal protections as it ascends the ladder of development. Sperm, eggs, and embryos lack rights; their owners enjoy the power to control how they are used. Fetuses do better. A woman may not abort the fetus late in pregnancy without good reason, such as risk to life or health, and a stranger commits a crime by assaulting and killing a fetus because the fetus has stronger rights than the stranger does. But the assaulter is not guilty of murder unless the fetus, in an odd turn of the law, manages to get born before it expires from its injuries. A partially born child enjoys stronger rights still.


"Death poses another set of challenges. In the old days, death meant that a person stopped breathing and his heart failed; now this is known as cardiopulmonary death. But when new technology made it possible to animate the heart and lungs in a person incapable of “waking up,” brain death was invented. Brain death enabled surgeons to carve off organs from people deemed alive under the cardiopulmonary definition, but it threw up a new set of problems. Some apparently brain-dead people would regain consciousness; technological advances later revealed that the brains of apparently brain-dead people often threw off occasional sparks—raising the question, how much brain functioning do you need to be alive? Or, if you wish, how much brain functioning does a person need for it to be wrong to kill him? Cryogenics enthusiasts insist that technicians will be able to reanimate a cryogenically preserved corpse by defrosting it. If someone destroys such a corpse, is that murder? If not, is it a wrong at all? The destruction of the corpse of a person disappoints that person’s original plan to reoccupy his body after a temporary vacancy, but prosecution of the wrongdoer would pose problems of metaphysics for which legal training leaves one sadly unprepared.

"Then there is the question of suicide, the refusal of unwanted life-preserving medical treatment, physician-assisted suicide, and euthanasia. Some countries permit euthanasia—the killing of people with severe medical problems, including infants born with horrendous birth defects which condemn them to a short miserable life. In the United States, all states tolerate suicide; two states tolerate physician-assisted suicide; and no states permit euthanasia. The Supreme Court has recognized rights to abortion, contraception, and (obliquely) unwanted life-sustaining medical treatment, but not to assisted suicide. For reasons known only to the justices, a woman’s interest in abortion trumps contrary state law but a person’s interest in ending his life does not, unless he can do so by declining medical treatment. Interests pile up on both sides of each question; it is hard to understand why the Court balances them as it does."

Jack Kevorkian, 1928-2011

I've written before about assisted suicide as a repugnant transaction. Some of the history of the debate in the United States is captured in the life of Dr. Jack Kevorkian, sometimes nicknamed "Dr.Death," who died on Friday.

Dr. Jack Kevorkian Dies at 83; A Doctor Who Helped End Lives

"Dr. Jack Kevorkian, the medical pathologist who willfully helped dozens of terminally ill people end their lives, becoming the central figure in a national drama surrounding assisted suicide, died on Friday in Royal Oak., Mich. He was 83."
...
"In arguing for the right of the terminally ill to choose how they die, Dr. Kevorkian challenged social taboos about disease and dying while defying prosecutors and the courts. He spent eight years in prison after being convicted of second-degree murder in the death of the last of about 130 ailing patients whose lives he had helped end, beginning in 1990."
...
"His critics were as impassioned as his supporters, but all generally agreed that his stubborn and often intemperate advocacy of assisted suicide helped spur the growth of hospice care in the United States and made many doctors more sympathetic to those in severe pain and more willing to prescribe medication to relieve it.

"In Oregon, where a schoolteacher had become Dr. Kevorkian’s first assisted suicide patient, state lawmakers in 1997 approved a statute making it legal for doctors to prescribe lethal medications to help terminally ill patients end their lives. In 2006 the United States Supreme Court upheld a lower court ruling that found that Oregon’s Death With Dignity Act protected assisted suicide as a legitimate medical practice."
...
"In 1984, prompted by the growing number of executions in the United States, Dr. Kevorkian revisited his idea of giving death row inmates a choice. He was invited to brief members of the California Legislature on a bill that would enable prisoners to donate their organs and die by anesthesia instead of poison gas or the electric chair.

"The experience was a turning point. Energized by the attention of lawmakers and the news media, he became involved in the growing national debate on dying with dignity. In 1987 he visited the Netherlands, where he studied techniques that allowed Dutch physicians to assist in the suicides of terminally ill patients without interference from the legal authorities.

"A year later, he returned to Michigan and began advertising in Detroit-area newspapers for a new medical practice in what he called “bioethics and obiatry,” which would offer patients and their families “death counseling.” He made reporters aware of his intentions, explaining that he did not charge for his services and bore all the expenses of euthanasia himself.
...
"He also talked about the “doctrine” he had developed to achieve two goals: ensuring the patient’s comfort and protecting himself against criminal conviction. He required patients to express clearly a wish to die. Family physicians and mental health professionals were consulted. Patients were given at least a month to consider their decision and possibly change their minds. Dr. Kevorkian videotaped interviews with patients, their families and their friends, and he videotaped the suicides, which he called medicides.

"By his account, he assisted in some 130 suicides over the next eight years. Patients from across the country traveled to the Detroit region to seek his help. Sometimes the procedure was done in homes, cars and campgrounds.

"Prosecutors, jurists, the State Legislature, the Michigan health authorities and Gov. John Engler seemed helpless to stop him, though they spent years trying. In 1991 a state judge, Alice Gilbert, issued a permanent injunction barring Dr. Kevorkian from using his suicide machine. The same year, the state suspended his license to practice medicine. In 1993, Michigan approved a statute outlawing assisted suicide. The statute was declared unlawful by a state judge and the state Court of Appeals, but in 1994 the Michigan Supreme Court ruled that assisting in a suicide, while not specifically prohibited by statute, was a common-law felony and that there was no protected right to suicide assistance under the state Constitution.

"From May 1994 to June 1997, Dr. Kevorkian stood trial four times in the deaths of six patients. With the help of his young and flamboyant defense lawyer, Mr. Fieger, three of those trials ended in acquittals, and the fourth was declared a mistrial.

"Mr. Fieger based his winning defense on the compassion and mercy that he said Dr. Kevorkian had shown his patients. Prosecutors felt differently. “He’s basically thumbed his nose at law enforcement, in part because he feels he has public support,” Richard Thompson, the prosecutor in Oakland County, Mich., told Time magazine in 1993.

"But on March 26, 1999, after a trial that lasted less than two days, a Michigan jury found Dr. Kevorkian guilty of second-degree murder. That trial came six months after Dr. Kevorkian had videotaped himself injecting Thomas Youk, a patient suffering from amyotrophic lateral sclerosis (Lou Gehrig’s disease), with the lethal drugs that caused Mr. Youk’s death on Sept. 17, 1998."
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Subsequent stories make clear that Dr. Kevorkian was a difficult ally of the 'death with dignity' movement that has mobilized e.g. for the Oregon laws on assisted suicide: A Polarizing Figure in End-of-Life Debates

Misc. repugnant transactions

Minn. Voters Will Decide on Gay Marriage Ban
"After nearly six hours of emotional debate, a proposed constitutional amendment that would define marriage as between a man and a woman was approved in the Minnesota House late Saturday night. It was the last legislative step needed to put the question on the statewide ballot in November 2012.

"State law already prohibits gay marriage, but supporters of the proposed amendment said it's necessary to prevent judges or lawmakers from legalizing it in the future. Opponents said the constitution should be used to expand rights, not limit them, and predicted a long, divisive debate over the next 18 months.

"The House voted 70-62 mostly along party lines in the GOP-controlled chamber, though four Republicans crossed over to vote 'no' while two Democrats voted in favor of the ban."
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Meanwhile in New York, Donors to G.O.P. Are Backing Gay Marriage Push

"The newly recruited donors argue that permitting same-sex marriage is consistent with conservative principles of personal liberty and small government."

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Mercenaries in the UAE: Secret Desert Force Set Up by Blackwater’s Founder
"In outsourcing critical parts of their defense to mercenaries — the soldiers of choice for medieval kings, Italian Renaissance dukes and African dictators — the Emiratis have begun a new era in the boom in wartime contracting that began after the Sept. 11, 2001, attacks. And by relying on a force largely created by Americans, they have introduced a volatile element in an already combustible region where the United States is widely viewed with suspicion.
...
"Still, it is not clear whether the project has the United States’ official blessing. Legal experts and government officials said some of those involved with the battalion might be breaking federal laws that prohibit American citizens from training foreign troops if they did not secure a license from the State Department."
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Switzerland: Zurich votes on 'suicide tourism' laws
"While opinion polls indicate a majority of Swiss remain in favour of assisted suicide, they also suggest that 66% are against what has become known as suicide tourism."

In the end, Zurich Voters Keep 'Suicide Tourism' Alive
"Voters in the Swiss canton (state) of Zurich have rejected calls to ban assisted suicide or to outlaw the practice for nonresidents."
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Selling Educational 'Indulgences' in the U.K.  (HT Kim Krawiec)
"A fierce debate is raging in the U.K. about a new proposal to let wealthy students pay for places at top universities -- even if they've been rejected through the regular admissions process. As it stands now, British universities have firm quotas for the number of students they can admit, and those places are filled through meritocratic competition. Once you get in, you pay a low, flat fee to attend (about $6,000 a year to attend Oxford). But David Willets, the education minister, is proposing to create new, "off-quota" places, open to students who haven't made the cut, as long as they can afford to pay substantially higher fees. Rage and confusion have been the immediate results of his proposal."

Suicide and organ donation

Assisted suicide is one of the persistently repugnant transactions, although it is the subject of a good deal of modern debate around the world. Here's a story likely to give you pause to think: Lou Gehrig's victim: Kill me for my organs 

"he ... compares his situation to a soldier in a foxhole throwing himself on a grenade to save his comrades.

"I am not suicidal," he says. "I just know that it is a matter of time before I die and wish to do a good thing for those people who have a good life expectancy"

Assisted suicide, the debate continues in England and Switzerland

Assisted suicide, a widely repugnant transaction, continues to be the subject of public discussion in England. The Telegraph reports a new poll: Assisted suicide: 4 in 5 say do not prosecute.

"The public’s support for a change in the law on assisted suicide and euthanasia was uncovered by the YouGov poll following a succession of high profile court cases.
Three quarters of those polled said the law should be amended to allow assisted suicide, a crime punishable by up to 14 years in prison. "...

"Sir Terry Pratchett, the author who suffers from Alzheimer’s disease, is due to deliver a lecture in which he will call for assisted suicide "tribunals" that would give the terminally ill permission to end their lives. In the Richard Dimbleby Lecture, he will offer himself as a test case for just such a tribunal... Sir Terry, who prefers the term "assisted death", will say that permission to end his life will make each day more precious, and that doctors should not be forced to help the terminally ill to die. ... "If I knew that I could die, I would live. My life, my death, my choice." "

The WSJ has an article about the Swiss assisted suicide clinic Dignitas, and the debate going on in Switzerland about the the laws governing assisted suicide:
Assisted-Suicide Pioneer Stirs a Legal Backlash

"From the start, Mr. Minelli has kicked up controversy for his willingness to help foreigners die. Most groups in Switzerland don't assist foreigners. Dignitas only helps foreigners. 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." As of the end of last year, Dignitas had helped a total of 1,046 people to commit suicide. "...

"Under Swiss law, it is illegal for a person to assist a suicide for their own "selfish" reasons. But there are otherwise no limits on helping someone to die. By contrast, most countries allowing assisted suicide require the person to be terminally ill or demand that a doctor assist the suicide. Switzerland is also the only country permitting right-to-die organizations to help foreigners die.
"At the moment, there is really no law," says Andreas Brunner, a Zurich prosecutor who has fought for greater restrictions on right-to-die organizations, particularly Dignitas. "You have to have some rules and standards. The worst solution is what we have now."
As medical advances prolong lives even for the seriously ill, the debate over assisted suicide is surging elsewhere.
In Oregon—the one state in the U.S. where assisted suicide is legal—doctors are allowed to help only state residents who are expected to die within six months.
The U.K., which has restrictive laws on euthanasia, was forced in a court case last fall to clarify whether it would prosecute Britons who help family members make the trip to Switzerland to die. (It won't.) Luxembourg legalized euthanasia last year. Activists in Belgium and the Netherlands are pushing to broaden the group of patients who can avail themselves of assisted suicide to the elderly, minors and chronically ill. "...

"In 2008, when neighbors' complaints forced Dignitas out of the rented apartment it had long used for suicides, Zurich city officials refused permission for a new venue.
So, Mr. Minelli organized suicides in cars, a hotel room and his own home, drawing the ire of local officials. For a time, he was forced to use the industrial site criticized by Mr. Gall. "Someone who is used to a five-star hotel can't come to Dignitas and expect the same," Mr. Minelli says.
The Zurich prosecutor's office spoke with family members who complained about the 10,000-Swiss-franc fee Mr. Minelli charges people to die, but found insufficient grounds to open an inquiry. One rival right-to-die organization asks for nothing beyond a 45-Swiss-franc membership fee, while another charges 4,000 Swiss francs. Mr. Minelli says the fee helps with his legal and lobbying expenses. "...

"Mr. Minelli argues that making assisted suicide available removes a taboo around suicide, helping people who want to kill themselves open a dialogue and seek help. About 70% of people who get the green light from Dignitas for an assisted suicide never contact the group again, proving the palliative effect of knowing help is available, he says. "
...
"A vote is planned in March on a bill that would sharply restrict the activities of right-to-die organizations. For instance, two doctors must testify that a person is terminally ill, thus ruling out assistance for the chronically or mentally ill. The person seeking help must have given long consideration to his wish to die before doctors can prescribe lethal drugs. Moreover, right-to-die groups would be barred from accepting payments beyond those covering the costs of the suicide. The government also tabled a second bill that would ban assisted suicides altogether. "

The debate has taken a dramatic turn, beginning with a BBC narrator stating on air “I killed someone once.”
The Prime Minister has weighed in too: Gordon Brown: don't legalise assisted suicide.

Right to die in England

There has been some interim resolution of the continued debate in England about whether those who assist a terminally ill relative who wishes to commit suicide, in particular by accompanying them to a clinic in Switzerland, will face prosecution. The current resolution is, it's still illegal, but guidelines have been issued to give some legal safety.
Campaigners win the fight to legalise assisted suicide
Assisted suicide investigations will focus on who stood to benefit

"People who stand to benefit financially from a person’s death are likely to be the ones prosecuted for assisting a suicide, under guidelines to be issued this week. "...

"The policy...will aim to clarify when individuals are more likely to be prosecuted or more likely not to be, he said.
Mr Starmer told the Andrew Marr Show on BBC One that such factors will include whether the person has a clear and settled intention to commit suicide, whether they have been encouraged or just assisted to do so, and whether those helping them have anything to gain from their death."

..."As many as 115 people from Britain have gone to Dignitas, the Swiss clinic, to die, but no one has been prosecuted so far. Last month Mr Starmer said that the landmark guidelines would apply in the UK as well as overseas.
Under current legislation, those who “aid, abet, counsel or procure” someone else’s suicide can be prosecuted and jailed for up to 14 years. Ms Purdy, from Undercliffe in Bradford, West Yorkshire, wants to know what would happen to her Cuban husband, Omar Puente, if he helped her to travel abroad to end her life. She took her case to the Lords after the High Court and Court of Appeal held that it was for Parliament, not the courts, to change the law.
The Lords agreed that changes were a matter for Parliament, but upheld Ms Purdy’s argument that the DPP should put in writing the factors he regarded as relevant in deciding whether or not to prosecute."

The guidelines, which were issued on schedule, drew a predictably wide range of reactions, some of which can be found at the end of this story in the Times: Assisted suicide guidelines do not give immunity against prosecution, says DPP

Right to die in Montana?

May a physician help a terminally ill patient commit suicide? Or is that a terminally repugnant transaction, which even a willing patient and physician should be prevented by law from completing?

The question has been raised in Montana, and will go to the state supreme court: Montana Court to Rule on Assisted Suicide Case

"Washington and Oregon allow physicians to help terminally ill people hasten their deaths, but in those states the laws were approved by voters in statewide referendums, and neither state’s highest court has examined the issue of a constitutional right to die.
In Montana, the question will be decided by the seven-member State Supreme Court. A lower-court judge ruled in Mr. Baxter’s favor last December — on the very day Mr. Baxter died — and the State of Montana appealed the ruling."
...
"“There are moral arguments, philosophical arguments on both sides, bioethical arguments on both sides, even medical and public health arguments on both sides,” Anthony Johnstone, the state solicitor at the Montana attorney general’s office, who will argue the case for the state, said in defense of current laws that prohibit physician-assisted death. "
...
"“This case is part of a journey,” said Ms. Tucker, who is director of legal affairs for Compassion and Choices, a national group that advocates to protect and expand the rights of the terminally ill and is also one of the plaintiffs. “It’s about empowering patients and giving them the right to decide when they have suffered enough.”"

Update: Dec 31, 2009. Montana Ruling Bolsters Doctor-Assisted Suicide
"The Montana Supreme Court ruled on Thursday that state law protects doctors in Montana from prosecution for helping terminally ill patients die. But the court, ruling with a narrow majority, sidestepped the larger landmark question of whether physician-assisted suicide is a right guaranteed under the state’s Constitution."

Assisted suicide, Right to Die in England: new development

The long discussion in England about the circumstances in which assisted suicide will be prosecuted has moved a step forward with a ruling from the House of Lords:

'Right to die' campaigner Debbie Purdy wins House of Lords ruling

"Families who help terminally ill relatives to end their lives will be free from the risk of prosecution after a landmark ruling yesterday.
The Director of Public Prosecutions is to rush out urgent guidance to clarify the law after Debbie Purdy, a multiple sclerosis sufferer, won an historic judgment from the House of Lords.
The guidance will not remove the offence of assisted suicide under the Suicide Act 1961 but make the situation clearer for people who help relatives to die in circumstances of “compassionate” assisted suicide.
In their unanimous ruling, five law lords said that the DPP must issue a “custom-built” policy stating the circumstances that would lead him to prosecute in such cases, and those where he would not. It is the first time that the DPP has been asked by the courts to detail the circumstances under which he would prosecute. "
...
"To date, 115 people have travelled from Britain to a Swiss clinic to be helped to die. Eight cases have been referred to the DPP but no relatives have been prosecuted. However, the uncertainty has led some people to make their last journey alone, without family members, so as not to risk their being prosecuted, Lord Hope of Craighead, giving judgment yesterday, said. Others, he added, had given up the idea of assisted suicide and “been left to die what has been described as a distressing and undignified death”.
Sarah Wootton, chief executive of Dignity in Dying, said that the ruling would clear up “the current legal muddle”. She said: “A law which is not understood, enforced or supported by the majority of the public is not fit for purpose. The ruling distinguishes between maliciously encouraging someone to commit suicide and compassionately supporting someone’s decision to die, in order that these acts are treated differently. More and more people want choice about how they end their life. Yet, until now, the law has refused to say whether people would face prosecution for accompanying someone abroad to exercise this choice.”
This month, an amendment tabled by Lord Falconer of Thoroton to remove the threat of prosecution from those who go abroad to help the terminally ill to die was defeated by peers in the Lords sitting not as a court but as the second chamber of Parliament. "

Assisted suicide in England and Switzerland, continued

The British press continues to follow British citizens who choose to end their lives in Switzerland, where assisted suicide is legal. (In Britain, as in many if not most places, it remains a repugnant transaction: it's not a crime to attempt suicide, but it is a crime to assist.) In this case, one of the members of the couple who ended their lives was not terminally ill (although it sounds like his quality of life had been severely compromised): With Help, Conductor and Wife Ended Lives

"The controversy over the ethical and legal issues surrounding assisted suicide for the terminally ill was thrown into stark relief on Tuesday with the announcement that one of Britain’s most distinguished orchestra conductors, Sir Edward Downes, had flown to Switzerland last week with his wife and joined her in drinking a lethal cocktail of barbiturates provided by an assisted-suicide clinic."
...
"“After 54 happy years together, they decided to end their own lives rather than continue to struggle with serious health problems,” the Downes children said in their statement."
...
"“Even if they arrest us and send us to prison, it would have made no difference because it is what our parents wanted,” he said.
Attempting suicide has not been a criminal offense in Britain since 1961, but assisting others to kill themselves is. But since the Zurich clinic run by Dignitas was established in 1998 under Swiss laws that allow clinics to provide lethal drugs, British authorities have effectively turned a blind eye to Britons who go there to die.
None of the family members and friends who have accompanied the 117 people living in Britain who have traveled to the Zurich clinic for help in ending their lives have been charged with an offense. Legal experts said it was unlikely that that would change in the Downes case.
But British news reports about the Downes’ suicides noted one factor that appeared to set the case apart from most others involving the Dignitas clinic: Sir Edward appeared not to have been terminally ill. There have been at least three other cases similar to the Downes’, in which a spouse who was not terminally ill chose to die with the other. "

A subsequent story in the Times reveals changing sentiments: Huge public support emerges for the right to die

"Overwhelming public support for a change in the law to allow medically assisted suicide is revealed in a poll for The Times.
Almost three quarters (74 per cent) of people want doctors to be allowed to help terminally ill patients to end their lives. Support is particularly strong among those aged 55 to 64.
Six out of ten people also want friends and relatives to be able to help their dying loved ones to commit suicide without fear of prosecution.
Changing the law has always been opposed strongly by doctors, with two out of three against legalisation. But yesterday saw the first sign of change in the medical establishment. "

Assisted suicide, Right to Die

We say that a transaction that some people want to engage in is "repugnant" if other people don't want them to, and assisted suicide fits the bill; it remains a crime in most states. But the demand for dignified death by the terminally ill means that the issue raises its head time and again. The NY Times reports: 4 Charged in Multi-State Suicide Assistance Probe .

The organization in question in this case is the Final Exit Network, and the particular charge is that they offered advice and moral support to a terminally ill Georgia man.
"The Georgia man's mother, Betty Celmer, contended that the group shouldn't face charges if they helped her son.
''If they helped John to die, that is what he wanted. I would never find them guilty for helping him,'' she said. ''If someone helped him, I think that was in God's hands.''"

A quick search on the web reveals that the venerable Hemlock Society is no more, but that there remain non-profit organizations devoted to the idea of dignified death, its discussion, and to changing legislation on the subject: here is the website of the World Federation of Right to Die Societies.