Safe, Legal, Rare? Physician-Assisted Suicide and Cultural Change in the Future

Abstract

Cultural change is well recognized in the recent history of death and dying. In the wake of Elizabeth Kübler-Ross’s 1969 work On Death and Dying, not only has it become socially acceptable to talk about death and dying with someone who is terminally ill, but, as traditional religious and legal strictures loosen, it is becoming possible for a person facing death to consider what role he or she wants to play in the forthcoming death. The United States has seen rapid evolution in attitudes and practices about death and dying over the last several decades, beginning with the early legal recognition in the California Natural Death Act (1976) of a patient’s right to refuse life-prolonging treatment in the face of terminal illness, expanding in increased public awareness of issues of personal autonomy in dying, raised by Derek Humphrey’s how-to book of lethal drug dosages, Final Exit, and blossoming in new sensitivity to physician roles in aiding dying, both in the maverick social activism of Dr. Jack Kevorkian and a New York grand jury’s refusal to indict the respected physician Timothy Quill. This process of cultural evolution has reached legal recognition: in 1997, the U.S. Supreme Court jointly decided the cases Washington v. Glucksberg and Vacco v. Quill, and while it held that physician-assisted suicide is not a constitutional right, it also left states free to make their own laws in this matter. Indeed, Oregon has made it legal for a physician to provide a terminally ill patient who requests it with a prescription for a lethal drug, thus bringing above ground the practical manifestation of a long process of cultural change.

This paper is a reframing of my “Physician-Assisted Suicide: Safe, Legal, Rare?”, which appeared in Margaret P. Battin, Rosamond Rhodes, and Anita Silvers, eds., Physician-Assisted Suicide: Expanding the Debate (New York and London: Routledge, 1998).