The Promised End

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The Promised End

Constitutional Aspects of Physician-Assisted Suicide

Journal article

By: George J. Annas

Date: August 29, 1996

Source: George J. Annas. "The Promised End—Constitutional Aspects of Physician-Assisted Suicide." New England Journal of Medicine. vol. 335, no. 9 (1996): 683-687.

About the Author: George J. Annas is published in fields of bioethics, law, and public health. He received his Juris Doctorate and Masters in Public Health degrees from Harvard's schools of law and public health. Annas co-founded Global Physicians & Lawyers, a nongovernmental organization of lawyers and physicians who promote health and human rights around the globe. He is currently a professor of law and bioethics at Boston University.


Physician-assisted suicide refers to the practice of a physician prescribing or regulating, upon a patient's informed request, a lethal dose of medication for the purpose of ending that patient's life. Both advocates and opponents of the practice dispute the term physician-assisted suicide. Some favor calling the practice physician-assisted dying to avoid negative social and religious connotations of the word suicide.

Physician-assisted suicide differs from euthanasia in that patients, and not physicians, ultimately control their own means of death. Under Oregon's legalized Death With Dignity scheme, physicians prescribe the lethal dose of medication, while patients themselves administer the lethal dose. A patient's informed refusal of life-saving treatment is neither assisted suicide nor euthanasia, and is generally permitted under United States law.

The first law legalizing physician-assisted dying was passed in the state of Oregon in 1994. After a series of court challenges, the Death with Dignity measure was later reaffirmed by statewide voter referendum. Between 1998 and 2005, approximatly two hundred terminally ill Oregonians relied on the act to end their life.

Under Oregon's Death with Dignity Act, a person who desires a physician-assisted death must be eighteen years of age or obtain parental consent. Furthermore, the person must be a resident of Oregon who was diagnosed with a terminal illness that is expected to lead to death within six months. The person must give informed consent and cannot desire to utilize the law amid depression or other mental disorder. Two physicians and two other witnesses must verify the person's terminal diagnosis and clarity of mental state.

Proponents claim Oregon's law is ethical and compassionate. Opponents argue that physician-assisted suicide laws undermine social perceptions about the sancitity of life. The debate is certainly not limited to Oregon. The practice is widely debated in the United States and throughout the world. Neither the medical profession nor community of academic bioethicists are in agreement about the ethical implications of physician-assisted dying.


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The debate over physician-assisted suicide is fervent and complex. Proponents of physician-assisted dying assert that the practice is ethical because it relies on established notions of compassion, individual liberty and personal freedom, and justice. It is argued that competent individuals have the right to make decisions about the course of their life, and in the event of illness, the course of their medical treatment. Individuals also have the right to control how and when their life will end.

Most proponents of physician-assisted suicide agree that the practice must be regulated by both law and the medical profession to prevent abuse and promote safety. Proponents assert that assisting some patients to hasten their deaths does not violate the ethical duty of physicians. In limited circumstances, such as those enumerated in Oregon's Death with Dignity statute, the act is a compassionate means of alleviating suffering.

Opponents of physician-assisted suicide assert that the practice undermines in society the value of individual life. Many disability advocates claim that physician-assisted suicide enforces negative social stereotypes about what people consider a valuable and meaningful existence. They claim that by giving terminally ill patients a means of avoiding debilitation physicians are reinforcing attitudes that debilitation makes life unbearable or less worthy.

Many opponents claim that the practice of physician-assisted dying has an innate potential for abuse. Some worry that elderly and disabled patients may be pressured into choosing physician-assisted suicide, or that these patients may not be presented with the full range of available palliative (pain-relieving) care. Others worry that physician-assisted suicide laws will become more lax or will eventually expand to permit euthanasia.

In 2006, the Supreme Court of the United States upheld Oregon's Death with Dignity Act. The Court rejected a challenge to the law that claimed that physicians who prescribed lethal dosages of medications, in line with Oregon's policy, violated federal laws regulating controlled substances. The Court stood by its 1997 ruling that there exists no constitutional "right to die." Their 2006 ruling in Gonzalez v. Oregon leaves open the possibility for other states to legalize physician-assisted dying. As of 2006, three additional states were considering enacting legislation similar to that in Oregon. However, the Court's ruling also permits state legislatures—and perhaps the U.S. Congress—to explicitly ban the practice. Several states have proposed legislation that would outlaw physician-assisted dying within their borders.

As of 2005, Switzerland, The Netherlands, Columbia, and Belgium legally recognized or limitedly permitted physician-assisted suicide.



Annas, George J. American Bioethics: Crossing Human Rights and Health Law Boundaries. New York: Oxford University Press, 2004.

―――――. The Rights Of Patients: The Authoritative ACLU Guide To The Rights Of Patients. New York: New York University Press, 2004.


Longmore, Paul K. "Policy, Prejudice, and Reality: Two Case Studies of Physician-Assisted Suicide." Journal of Disability Policy Studies. vol. 16.1 (June 22, 2005): 38.

Web sites

Oyez. "GONZALES V. OREGON (04-623) 368 F.3d 1118, affirmed." 〈〉 (accessed February 7, 2006).

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