Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality



References:

1  Ludwig Edelstein, The Hippocratic Oath: Text, Translation and Interpretation (Baltimore, MD: Johns Hopkins University Press, 1943), http://guides.library.jhu.edu/content.php?pid=23699&sid=190555 (accessed January 28, 2015). [ Back ]

2  State legislation as of March 20, 2015: Alaska, HB 99; California, SB 128; Colorado, HB 15-1135; Connecticut, SB 668; Iowa, HF 65; Kansas, HB 2150; Maryland, HB 1021; Massachusetts, HD 1674; Minnesota, SF 1880; Missouri, HB 307; Montana, SB 202; Nevada, SB 336; New Jersey, AB 2270; New York, AB 02129; Oklahoma, HB1673; Utah, HB 391; Wisconsin, AB 67/SB 28; Wyoming, HB 119; and the District of Columbia, B21-0031. In the courts, a New Mexico appeals court will review a lower court's decision claiming to find a right to assisted suicide in the state constitution. [ Back ]

3  Neil M. Gorsuch, The Future of Assisted Suicide and Euthanasia (Princeton, NJ: Princeton University Press, 2006), p. 7. [ Back ]

4  Leon Kass elaborates on this point: "Physician-assisted suicide, once legal, will not stay confined to the terminally ill and mentally competent who freely and knowingly elect it for themselves. Requests will be engineered and choices manipulated by those who control the information, and, manipulation aside, many elderly and incurable people will experience a right to choose death as their duty to do so. Moreover, the vast majority of those who are said to 'merit' 'a humane and dignified death' do not fall in this category and cannot request it for themselves. Persons with mental illness or Alzheimer's disease, deformed infants, and retarded or dying children would thus be denied our new humane 'aid-in-dying.' But not to worry. The lawyers, encouraged by the cost-containers, will sue to rectify this inequity. Why, they will argue, should the comatose or the demented be denied a right to assisted suicide just because they cannot claim it for themselves? With court-appointed proxy consentors, we will quickly erase the distinction between the right to choose one's own death and the right to request someone else's." Leon R. Kass, "Dehumanization Triumphant," First Things , August 1996, http://www.firstthings.com/article/1996/08/002-dehumanization-triumphant (accessed January 28, 2015) (emphasis added). [ Back ]

5  See Emily Jackson and John Keown, Debating Euthanasia (Oxford: Hart Publishing, 2012), p. 102. [ Back ]

6  Gorsuch, The Future of Assisted Suicide and Euthanasia , p. 111 (emphasis in original). [ Back ]

7  See Glucksberg and Quill: Glucksberg v. Washington , 521 U.S. 702 (1997) (holding that "the asserted 'right' to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause"), and Vacco v. Quill , 521 U.S. 793 (1997) (holding that because refusing treatment is logically distinct from assisting suicide, New York State's prohibition on PAS treated all patients the same and so did not violate the Equal Protection Clause). For a helpful discussion of these cases and precedents, see Gorsuch, The Future of Assisted Suicide and Euthanasia , pp. 8-18. Oregonians legalized PAS through Ballot Measure 16, the Death with Dignity Act in 1994; see O.R.S. § 127.800-995 (1994), which took legal effect late in 1997. Washingtonians approved Initiative 1000, the Death with Dignity Act, in 2008; see R.C.W § 70.245 (2008). In 2013, the Vermont Legislature passed the Patient Choice and Control at End of Life Act; see 18 V.S.A. § 5289 (2013). In 2009, a Montana Supreme Court decision gave physicians the ability to raise the defense of consent to a charge of violating the state's assisted suicide law; see Baxter v. Montana, WL 5155363 (2009). New Mexico, meanwhile, is in the middle of court proceedings over physician-assisted suicide, with a lower court having ruled in its favor, but that ruling is being appealed. Eric Eckholm, "New Mexico Judge Affirms Right to 'Aid in Dying,'" The New York Times , January 13, 2014, http://www.nytimes.com/2014/01/14/us/new-mexico-judge-affirms-right-to-aid-in-dying.html (accessed January 28, 2015). [ Back ]

8  Jose Pereira, "Legalizing Euthanasia or Assisted Suicide: The Illusion of Safeguards and Controls," Current Oncology , Vol. 18, No. 2 (April 2011), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/ (accessed February 4, 2015). [ Back ]

9  See also John Keown's discussion of the Netherlands in Jackson and Keown, Debating Euthanasia , pp. 118-128. [ Back ]

10  Public opinion demonstrates that levels of support for PAS differ substantially along socioeconomic and ethnic lines. Those who support PAS tend to be white, affluent, and able-bodied, and those who are most worried about being killed in the name of compassion are in poorer and minority communities or are disabled. For example, a 1997 study that reviewed previous studies found that support for PAS is generally about 20 percent higher among white respondents than among black respondents. Patients who end their lives with doctor-assisted suicide are more likely to be white and college-educated. This gap may also be rooted in a disparity of palliative and hospice care available to minority groups. For instance, dementia patients in the poorest quartile for socioeconomic status are less likely to receive hospice services. Low-income black women receiving fee-for-service Medicare are also less likely than white women to receive hospice care. See Kathleen M. Fairfield et al., "Disparities in Hospice Care Among Older Women Dying with Ovarian Cancer," Journal of Gynecologic Oncology , Vol. 125, No. 1 (April 2012), pp. 14-18; Preethy Nayar et al., "Disparities in End of Life Care for Elderly Lung Cancer Patients," Journal of Community Health , Vol. 39, No. 5 (October 2014), pp 1012-1019; Melissa Lopresti, Fritz Dement, and Heather T. Gold, "End-of-Life Care for People with Cancer from Ethnic Minority Groups: A Systematic Review," American Journal of Hospice and Palliative Care , December 29, 2014; Ezekiel Emanuel, Diane L. Fairclough, and Linda Emanuel, "Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers," JAMA, Vol. 284, No. 19 (November 15, 2000), pp. 2460-2468, http://jama.jamanetwork.com/article.aspx?articleid=193281 (accessed March 4, 2015); Lilian Liou Cohen, "Racial/Ethnic Disparities in Hospice Care: A Systematic Review," Journal of Palliative Medicine , Vol. 11, No. 5 (June 2008), pp. 763-768; and Amanda Connolly, Elizabeth Sampson, and Nitin Purandare, "End-of-Life Care for People with Dementia from Ethnic Minority Groups: A Systematic Review," Journal of American Geriatric Society , Vol. 60, No. 2 (February 2012), pp. 351-360, http://www.ncbi.nlm.nih.gov/pubmed/22332675 (accessed February 23, 2015). [ Back ]

11  New York Department of Health, Task Force on Life and the Law, When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context , May 1994, https://www.health.ny.gov/regulations/task_force/reports_publications/when_death_is_sought/preface.htm (accessed January 28, 2015). The report continued: "We believe that the practices would be profoundly dangerous for large segments of the population, especially in light of the widespread failure of American medicine … to diagnose and treat depression in many cases. The risks would extend to all individuals who are ill. They would be most severe for those whose autonomy and well-being are already compromised by poverty, lack of access to good medical care, or membership in a stigmatized social group. The risks of legalizing assisted suicide and euthanasia for these individuals … are likely to be extraordinary." Ibid. (emphasis added). [ Back ]

12  Paul McHugh, "Dr. Death Makes a Comeback," The Wall Street Journal , January 22, 2015, http://www.wsj.com/articles/paul-mchugh-dr-death-makes-a-comeback-1421970736 (accessed January 28, 2015). [ Back ]

13  Kass, "Dehumanization Triumphant." [ Back ]

14  Herbert Hendin and Kathleen Foley, "Physician-Assisted Suicide in Oregon: A Medical Perspective," Michigan Law Review , Vol. 106, No. 8 (June 2008), p. 1622. In a study of 200 terminally ill cancer patients, the prevalence of depressive syndromes among patients who expressed a desire for death was 59 percent. Among those who did not desire death, only 8 percent demonstrated depressive syndromes. See H. M. Chochinov et al., "Desire for Death in the Terminally Ill," The American Journal of Psychiatry , Vol. 152, No. 8 (August 1995), pp. 1185-1191. [ Back ]

15  Herbert Hendin, Seduced by Death: Doctors, Patients, and Assisted Suicide (New York: W.W. Norton, 1998), pp. 34-35. [ Back ]

16  Hendin and Foley, "Physician-Assisted Suicide in Oregon," pp. 1625-1626. [ Back ]

17  Ibid., p. 1622. [ Back ]

18  Oregon Public Health Division, "Oregon's Death with Dignity Act - 2014," http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf (accessed February 24, 2015). [ Back ]

19  Aaron Kheriaty, "Apostolate of Death," First Things , April 2015, p. 19. [ Back ]

20  Hendin and Foley, "Physician-Assisted Suicide in Oregon," p. 1616. [ Back ]

21  Death with Dignity Act of 2015, B21-0038, Leg. Sess. 20, http://lims.dccouncil.us/Legislation/B21-0038 (accessed January 28, 2015). [ Back ]

22  Oregon, O.R.S. § 127.800-995 (1994); Washington, R.C.W § 70.245 (2008); and Vermont, 18 V.S.A. § 5289 (2013). [ Back ]

23  Alexander M. Capron, "Legalizing Physician-Aided Death," Cambridge Quarterly of Healthcare Ethics , Vol. 5, No. 1 (Winter 1996), p. 14. [ Back ]

24  Joanne Lynn et al., "Defining the 'Terminally Ill': Insights from SUPPORT," Duquesne Law Review , Vol. 35, No. 1 (Fall, 1996), p. 334. [ Back ]

25  Richard M. Doerflinger, "Flirting with Death," Public Discourse , January 5, 2015, http://www.thepublicdiscourse.com/2015/01/14217/ (accessed February 4, 2015). [ Back ]

26  Gorsuch, The Future of Assisted Suicide and Euthanasia , p. 124. [ Back ]

27  Doerflinger, "Flirting with Death" (emphasis in original). [ Back ]

28  Ibid. [ Back ]

29  Gorsuch, The Future of Assisted Suicide and Euthanasia , p. 119. [ Back ]

30  Diane Coleman, "Assisted Suicide Laws Create Discriminatory Double Standard for Who Gets Suicide Prevention and Who Gets Suicide Assistance: Not Dead Yet Responds to Autonomy, Inc.," Disability and Health Journal , Vol. 3, No. 1 (January 2010), p. 48, http://www.disabilityandhealthjnl.com/article/S1936-6574(09)00089-2/fulltext (accessed March 5, 2015). [ Back ]

31  Gorsuch, The Future of Assisted Suicide and Euthanasia , p. 180. [ Back ]

32  In some of the newly introduced bills, these problems are actually far worse, not better. For example, the California bill introduced in 2015 is modeled on Oregon's law but greatly weakens its provision on psychological counseling, dropping the requirement that, once referred for counseling, a patient must be found competent before the assisted suicide can proceed. The bill introduced in Maryland removes the language stating that an illness must be considered irreversible and incurable in order to be considered terminal and says a doctor need only find that it is "more likely than not" that the patient will die of the illness in six months. [ Back ]

33  See John Keown, "Euthanasia in the Netherlands: Sliding down the Slippery Slope?" Notre Dame Journal of Law, Ethics & Public Policy , Vol. 9, No. 2 (1995), http://scholarship.law.nd.edu/cgi/viewcontent.cgi?article=1427&context=ndjlepp (accessed March 5, 2015). [ Back ]

34  Ibid., p. 423 (emphasis in original). [ Back ]

35  John Finnis, The Collected Essays of John Finnis , Vol. 3, Human Rights and Common Good (Oxford: Oxford University Press, 2011), p. 255. [ Back ]

36  Government of Belgium, Commission Fédérale de Contrôle, Et D'évaluation de L'euthanasie, 2014, p. 7, http://www.health.belgium.be/filestore/19097638/Rapport_Euthanasie12-13_FR.pdf (accessed March 5, 2015). Commenting on the report, the European Institute for Bioethics noted, "The deaths caused today represent 1.7% of all deaths in Belgium." European Institute of Bioethics, "Belgian Euthanasia Increases by 89% in Four Years," September 15, 2014, http://www.ieb-eib.org/en/document/belgian-euthanasia-increases-by-89-in-four-years-382.html (accessed March 11, 2015). [ Back ]

37  Kenneth Chambaere et al., "Physician-Assisted Deaths Under the Euthanasia Law in Belgium: A Population-Based Survey," CMAJ , Vol. 182, No. 9 (June 15, 2010), p. 896, http://www.cmaj.ca/content/182/9/895.full (accessed March 5, 2015). [ Back ]

38  John Keown, "A Right to Voluntary Euthanasia? Confusion in Canada in Carter," Notre Dame Journal of Law, Ethics & Public Policy , Vol. 28, No. 1 (2014), p. 30, http://scholarship.law.nd.edu/ndjlepp/vol28/iss1/1/ (accessed March 5, 2015) (emphasis in original). [ Back ]

39   Fleming v. Ireland & Ors , IEHC 2 (2013), para. 102, http://www.bailii.org/ie/cases/IEHC/2013/H2.htm (accessed March 5, 2015). [ Back ]

40  The number of official euthanasia cases grows year by year in both the Netherlands and Belgium, the first European countries to legalize PAS. In 2013, according to the Netherlands official report, the total number of doctor-administered deaths was 4,829 - a 15 percent increase from the previous year. See Netherlands Regionale Toetsingscommissies, Euthanasie: Jaarverslag 2013 (Euthanasia: Annual report 2013), http://www.euthanasiecommissie.nl/Images/Jaarverslag2013_NL_tcm52-40686.pdf (accessed January 28, 2015). There were 1,807 reported cases of euthanasia in Belgium in 2013 - a 27 percent increase over 2012, which was a 25 percent increase above 2011. See Leo Cendrowicz, "Euthanasia and Assisted Suicide Laws Around the World," The Guardian , July 17, 2014, http://www.theguardian.com/society/2014/jul/17/euthanasia-assisted-suicide-laws-world (accessed January 28, 2015). [ Back ]

41  Keown, "A Right to Voluntary Euthanasia?" p. 23. [ Back ]

42  Ezekiel J. Emanuel, "Whose Right to Die?" The Atlantic , March 1, 1997, http://www.theatlantic.com/magazine/archive/1997/03/whose-right-to-die/304641/ (accessed January 28, 2015) (emphasis added). [ Back ]

43   Arrest Gerechtshof te Leeuwarden d.d.4 April 1996, in the Case Against K, 20.5 Tijdschrift Voor Gezondheidsrecht 284, 19 (1996). [ Back ]

44  Eduard Verhagen and Pieter J. J. Sauer, "The Groningen Protocol - Euthanasia in Severely Ill Newborns," The New England Journal of Medicine , Vol. 352, No. 10 (March 10, 2005), pp. 960-961, http://www.nejm.org/doi/full/10.1056/NEJMp058026#t=article (accessed February 9, 2015). [ Back ]

45  Ibid. [ Back ]

46  Press release, "Clear Criteria for Medical End-of-Life Decisions in Neonates with Very Serious Defects," Royal Dutch Medical Association, June 12, 2013, http://knmg.artsennet.nl/web/file?uuid=4406e682-5e7b-4a5b-9fca-a0454ef124e0&owner=a8a9ce0e-f42b-47a5-960e-be08025b7b04&contentid=134424 (accessed January 28, 2015). The pro-euthanasia mindset has been long established in the country, and the legal barrier is often ignored. As early as 1997, a study examined the causes of all infant mortalities in the country and discovered that "57% of all deaths had been preceded by a decision to forgo life-sustaining treatment; this decision was accompanied by the administration of potentially life-shortening drugs to alleviate pain or other symptoms in 23%, and by the administration of drugs with the explicit aim of hastening death in 8% ." Agnes van der Heide et al., "Medical End-of-Life Decisions Made for Neonates and Infants in the Netherlands," The Lancet , Vol. 350 (July 26, 1997), p. 251, http://dare.uva.nl/document/2/2127 (accessed January 29, 2015) (emphasis added). [ Back ]

47  U.N. Human Rights Committee, "Concluding Observations of the Human Rights Committee, The Netherlands," U.N. doc CCPR/CO/72/NET, July 19 and 23, 2001, http://www1.umn.edu/humanrts/hrcommittee/netherlands2001.html (accessed February 16, 2015). [ Back ]

48  Derek Blyth, "Federal Parliament Passes Euthanasia Law for Minors," Flanders Today , February 14, 2014, http://www.flanderstoday.eu/politics/federal-parliament-passes-euthanasia-law-minors (accessed January 29, 2015). [ Back ]

49  Open Letter, "Fin de vie des enfants : une loi inutile et précipitée" (End of life of children: unnecessary and hasty legislation), La Libre (Brussels)� January 29, 2014, http://www.lalibre.be/debats/opinions/fin-de-vie-des-enfants-une-loi-inutile-et-precipitee-52e93c5b3570e5b8eeea1a00 (accessed January 29, 2015). [ Back ]

50  Naftali Bendavid, "For Belgium's Tormented Souls, Euthanasia-Made-Easy Beckons," The Wall Street Journal , June 14, 2013, http://www.wsj.com/articles/SB10001424127887323463704578495102975991248 (accessed January 28, 2015). [ Back ]

51  Editorial, "Belgian Helped to Die After Three Sex Change Operations," BBC News, October 2, 2013, http://www.bbc.com/news/world-europe-24373107 (accessed January 28, 2015). [ Back ]

52  Graeme Hamilton, "Death by Doctor: Controversial Physician Has Made His Name Delivering Euthanasia When No One Else Will," National Post , November 22, 2013, http://news.nationalpost.com/2013/11/22/death-by-doctor-controversial-physician-has-made- his-name-delivering-euthanasia-when-no-one-else-will/ (accessed January 29, 2015). [ Back ]

53  DutchNews.nl, "Woman, 70, Is Given Euthanasia After Going Blind," October 7, 2013, http://www.dutchnews.nl/news/archives/2013/10/women_70_gets_euthanasia_after/ (accessed January 28, 2015). [ Back ]

54  DutchNews.nl, "Euthanasia Clinic Criticized for Helping Woman with Severe Tinnitus to Die," January 19, 2015, http://www.dutchnews.nl/news/archives/2015/01/euthanasia-clinic-criticised-for-helping-woman-with-severe-tinnitus-to-die.php/ (accessed January 28, 2015). [ Back ]

55  Sue Reid, "The Country Where Death Is Now Just a Lifestyle Choice: A Mum with Ringing Ears. Babies Whose Parents Don't Want Them to Suffer. They've All Been Allowed to Die by Assisted Suicide in Holland," Daily Mail , January 1, 2015, http://www.dailymail.co.uk/news/article-2893778/As-debate-assisted-suicide-dispatch-Holland-thousands-choose-die-year.html (accessed March 11, 2015). [ Back ]

56  Joke Mat, "In the Netherlands, Nine Psychiatric Patients Received Euthanasia," NRC Handelsblad (Amsterdam), January 2, 2014, http://www.nrc.nl/nieuws/2014/01/02/in-the-netherlands-nine-psychiatric-patients-received-euthanasia/ (accessed January 28, 2015). [ Back ]

57  Kass, "Dehumanization Triumphant." [ Back ]

58  McHugh, "Dr. Death Makes a Comeback." [ Back ]

59  American Medical Association, "Opinion 2.211 - Physician-Assisted Suicide," June 1996, http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page (accessed January 28, 2015). [ Back ]

60  O. Carter Snead, "Physician Assisted Suicide: Objection in Principle and Prudence," Notre Dame Law School Faculty Lectures and Presentation , Paper 26, 2014, http://scholarship.law.nd.edu/cgi/viewcontent.cgi?article=1023&context=law_faculty_lectures (accessed January 28, 2015). [ Back ]

61  Leon R. Kass, "Neither for Love nor Money: Why Doctors Must Not Kill," Public Interest , Vol. 94 (Winter 1989), pp. 29 and 39. [ Back ]

62  Ibid., pp. 40 and 41. [ Back ]

63  McHugh, "Dr. Death Makes a Comeback." McHugh continues: "The fundamental premise of medicine is the vocational commitment of doctors to care for all people without doubting whether any individual is worth the effort. That means doctors will not hold back their ingenuity and energies in treating anyone, rich or poor, young or old, prominent or socially insignificant - or curable or incurable. This is the heart and soul of medical practice. The confidence with which patients turn to their physicians depends on it, and it is what spurs doctors to find innovative ways of helping the sick." Ibid. [ Back ]

64  Coleman, "Assisted Suicide Laws Create Discriminatory Double Standard," p. 46. [ Back ]

65  Finnis, The Collected Essays of John Finnis , Vol. 3, Human Rights and Common Good , p. 260. Finnis explains how a change in the law regarding physician-assisted suicide will change the mindset and dispositions of professionals who are operating within the new culture: "So do not think of the euthanasia law being administered by today's medical practitioners and nurses and hospital administrators, whose codes of ethics exclude killing as a treatment and management option.… [T]he ethics of all those professions and classes would - and would be bound to - change." Ibid., p. 260. [ Back ]

66  Kass, "Neither for Love nor Money," p. 35. Elsewhere, Kass adds: "Even conscientious physicians will have trouble caring wholeheartedly for patients once death becomes a 'therapeutic option.' The prohibition against killing patients, medicine's first principle of ethical self-restraint, recognizes that no physician devoted to the benefit of the sick can serve the patient by making him dead. The physician-suicide-assistant or physician-euthanizer is a deadly self-contradiction." Kass, "Dehumanization Triumphant." [ Back ]

67  Kass, "Neither for Love nor Money," p. 35. [ Back ]

68  Finnis, The Collected Essays of John Finnis, Vol. 3, Human Rights and Common Good , p. 260. [ Back ]

69  Martin Beckford, "Baroness Warnock: Dementia Sufferers May Have a 'Duty to Die,'" The Telegraph , September 18, 2008, http://www.telegraph.co.uk/news/uknews/2983652/Baroness-Warnock-Dementia-sufferers-may-have-a-duty-to-die.html (accessed January 28, 2015). [ Back ]

70  Derek Humphry and Mary Clement, Freedom to Die: People, Politics, and the Right-to-Die Movement (New York: St. Martins, 2000), pp. 339, 340, and 353. [ Back ]

71  McHugh, "Dr. Death Makes a Comeback." [ Back ]

72  Doerflinger, "Flirting with Death." [ Back ]

73  New York Department of Health, Task Force on Life and the Law, When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context , chap. 6, quoted in Finnis, The Collected Essays of John Finnis , Vol. 3, Human Rights and Common Good , p. 265. [ Back ]

74  Gilbert Meilaender, "I Want to Burden My Loved Ones," First Things , October 1991, http://www.firstthings.com/article/1991/10/003-i-want-to-burden-my-loved-ones (accessed January 28, 2015). [ Back ]

75  Leon R. Kass and Eric Cohen, "Cast Me Not Off in Old Age," Commentary , January 1, 2006, http://www.aei.org/publication/cast-me-not-off-in-old-age/ (accessed January 28, 2015). Dr. Kass and Cohen conclude: "In the end, there is no 'solution' to the problems of old age, at least no solution that any civilized society could tolerate. But there are better and worse ways to see our aging condition. The better way begins in thinking of ourselves less as wholly autonomous individuals than as members of families; in relinquishing our mistaken belief that medicine can miraculously liberate our loved ones or ourselves from debility and decline, and instead taking up our role as caregivers; and in abjuring the fantasy that we can control the manner and the hour of our dying, learning instead to accept death in its proper season as mortal beings replaced and renewed by the generations that follow." Ibid. [ Back ]

76  Finnis, The Collected Essays of John Finnis , Vol. 3, Human Rights and Common Good , p. 261. [ Back ]

77  Ibid. Finnis continues: "[What] could remove or even appreciably diminish the patient's subjection to the pressure of the thought that my being killed is what my relatives expect of me and is in any case the decent thing to do, even though I utterly fear it and perhaps perceive it as the uttermost and ultimate indignity, an odious, devastating subjection to the needs and will of others? And likewise with the other sources of tyranny, the new power, opportunity, and ethic of doctors, and the real and novel power of the relatives." Ibid., p. 262. [ Back ]

78  Victoria Reggie Kennedy, "Question 2 Insults Kennedy's Memory," Cape Cod Times , November 3, 2012, http://www.capecodtimes.com/article/20121027/OPINION/210270347 (accessed March 5, 2015). [ Back ]

79  Ibid. [ Back ]

80  Ibid. [ Back ]

81  Herbert Hendin, "The Dutch Experience," in Kathleen Foley and Herbert Hendin, eds., The Case Against Assisted Suicide (Baltimore, MD: Johns Hopkins University Press, 2002), p. 109. [ Back ]

82  Ibid. Hendin and Foley write: "One can readily see how in the best of circumstances frail, elderly patients can feel coerced to die. Caregiver burden has been identified as a serious issue, particularly for women … who are asked to shoulder the work and responsibility of providing twenty-four-hour care to a parent." Kathleen Foley and Herbert Hendin, "The Oregon Experiment," in Foley and Hendin, The Case Against Assisted Suicide , p. 157. [ Back ]

83  Oregon Public Health Division, "Oregon's Death with Dignity Act - 2014." [ Back ]

84  Kheriaty, "Apostolate of Death," p. 19. [ Back ]

85  World Health Organization, Department of Mental Health and Substance Abuse, "Preventing Suicide: A Resource for Media Professionals," 2008, http://www.who.int/mental_health/prevention/suicide/resource_media.pdf (accessed March 5, 2015). [ Back ]

86  Kheriaty, "Apostolate of Death," p. 20. [ Back ]

87  Ibid., p. 20. [ Back ]

88  Patrick Lee and Robert P. George, Body-Self Dualism in Contemporary Ethics and Politics (Cambridge, U.K.: Cambridge University Press, 2008), p. 93. [ Back ]

89  Ibid., p. 155. [ Back ]

90  The Universal Declaration of Human Rights, http://www.un.org/en/documents/udhr/ (accessed February 24, 2015). [ Back ]

91  Council of Europe, Convention for the Protection of Human Rights and Fundamental Freedoms and Protocol, http://www.echr.coe.int/Documents/Collection_Convention_1950_ENG.pdf (accessed February 27, 2015). [ Back ]

92  Lee and George, Body-Self Dualism in Contemporary Ethics and Politics , p. 156. [ Back ]

93   Vacco v. Quill . The Supreme Court overturned a ruling of the 2nd Circuit Court that, among other things, argued that because patients could deny care resulting in their death, they should be able to have assistance in killing. [ Back ]

94  Coleman, "Assisted Suicide Laws Create Discriminatory Double Standard," pp. 40 and 48. [ Back ]

95  Ibid., p. 41. [ Back ]

96  Ibid., p. 43. [ Back ]

97  Ibid. The brief continues: "Central to the civil rights of people with disabilities is the idea that a disabling condition does not inherently diminish one's life; rather, surrounding barriers and prejudices do so. In contrast, assisted suicide gives official sanction to the idea that life with a disabling condition is not worth living." Ibid., p. 44. [ Back ]

98  Leon R. Kass, Life, Liberty and the Defense of Dignity: The Challenge for Bioethics (San Francisco: Encounter Books, 2002), pp. 203, 212, and 214. [ Back ]

99  Ibid., p. 203. [ Back ]

100  Lee and George argue that "it makes no sense to hold that the fulfillment of entity is intrinsically valuable, and yet the entity itself is not." Lee and George, Body-Self Dualism in Contemporary Ethics and Politics , pp. 160-161. [ Back ]

101  Kass, Life, Liberty and the Defense of Dignity , p. 216. [ Back ]

102  Finnis, The Collected Essays of John Finnis , Vol. 3, Human Rights and Common Good , p. 257 (emphasis in original). [ Back ]

103  Ibid., p. 258 (emphasis in original). [ Back ]

104  Ibid., p. 259. Finnis later explains how assisted suicide laws threaten the very justice of a political community: "A just society cannot be maintained, and people cannot be treated with the equal concern and respect to which they are all entitled, unless we hold fast to the truth … that none of us is entitled to act on the opinion that the life of another is not worth living. To trash this truth … is to discard the very foundations of just and equal respect for persons in their liberty, their pursuit of happiness, and their life." Ibid., p. 270 (emphasis in original). [ Back ]

105  Ibid., p. 259. [ Back ]

106  Ibid., pp. 262 and 264 (emphasis in original). [ Back ]

107  Dr. Kass explains: "Ceasing medical intervention, allowing nature to take its course, differs fundamentally from mercy killing. For one thing, death does not necessarily follow the discontinuance of treatment…. Not the physician, but the underlying fatal illness becomes the true cause of death. More important morally, in ceasing treatment the physician need not intend the death of the patient, even when the death follows as a result of his omission. His intention should be to avoid useless and degrading medical additions to the already sad end of a life. In contrast, in active, direct mercy killing the physician must, necessarily and indubitably, intend primarily that the patient be made dead. And he must knowingly and indubitably cast himself in the role of the agent of death." Kass, "Neither for Love nor Money," pp. 43-44. [ Back ]

108  Kheriaty, "Apostolate of Death," p. 19. [ Back ]

109  Kennedy, "Question 2 Insults Kennedy's Memory." [ Back ]

110  Oregon Public Health Division, "Oregon's Death with Dignity Act - 2014." [ Back ]

111  Kass, "Dehumanization Triumphant." Elsewhere, Kass adds that "death with dignity, understood as living dignifiedly in the face of death, is not a matter of pulling plugs or taking poison." Kass, Life, Liberty and the Defense of Dignity , p. 249. [ Back ]

112  R. Sean Morrison and Diane E. Meier, "America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals," Center to Advance Palliative Care and the National Palliative Care Research Center, May 2011, p. 9, http://reportcard.capc.org/pdf/state-by-state-report-card.pdf (accessed January 30, 2015). [ Back ]

113  Hendin and Foley, "Physician Assisted Suicide in Oregon," p. 1616. [ Back ]

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