Courts reject physician-assisted suicide, while more states consider legislation

A California judge has upheld the state’s ban against physician-assisted suicide, rejecting pleas by three terminally ill patients to legally end their lives with the help of a doctor. In an Aug. 14 ruling, San Francisco Superior Court Judge Ernest Goldsmith ruled that granting the plaintiffs’ petition would essentially create a judge-made law.

The decision is the latest development in a renewed debate about the legality and ethics of physician-assisted dying. More states than ever before are considering legalization of physician-assisted suicide, and experts say both public and physician perceptions of the practice appear to be changing.

Physicians in Canada find themselves facing a more pressing reality. In February 2016, physician-assisted suicide will become the law of the land as a result of a ruling by the Supreme Court of Canada earlier this year. But for now, U.S. physicians are facing a situation in flux.

“Division still runs deep,” said Arthur L. Caplan, Ph.D., founding director of the division of medical ethics at New York University’s Langone Medical Center’s Department of Population Health. “But one of the most interesting developments is that organized medicine may be moving a little toward favoring assisted dying for the terminally ill. Some of the resistance among physicians is shifting.”

Oregon, Vermont, and Washington are the only states that have laws permitting physician-assisted death. Court rulings in New Mexico and Montana have allowed for the practice. However, litigation in both states is ongoing and the decisions have yet to be enforced. Historically, one or two states consider such laws each year, said Peg Sandeen, Ph.D., executive director for the Death with Dignity National Center. In 2015, 25 state legislatures and the District of Columbia considered some form of physician-assisted death law, according to data from the Death With Dignity National Center. The majority of bills failed, although legislation in California, New York, Maryland, and the District of Columbia are pending. Ms. Sandeen notes that Maine came within one vote of passing a physician-assisted death law this year.

“We have seen a dramatic increase in the number of state legislatures willing to take up death with dignity or willing to consider it,” Ms. Sandeen said in an interview. “We have seen more activity this past legislature than we have any year in the last 10 years.”

Recent high-profile cases involving terminally ill patients have contributed to reignited public interest in the issue, said Dr. Arthur R. Derse, director of the Center for Bioethics and Medical Humanities and a professor of bioethics and emergency medicine at the Medical College of Wisconsin in Milwaukee. California resident Brittany Lauren Maynard, for instance, became widely known in 2014 after she fought to legally end her life after being diagnosed with terminal brain cancer. Ms. Maynard eventually moved to Oregon to take advantage of the state’s death with dignity law. Since Ms. Maynard’s case, the issue has become poignant in California, Dr. Derse said.

“It was a very sympathetic case to people who viewed [Ms. Maynard’s] video,” he said.

In 2015, California legislators introduced the End of Life Option Act, a bill that would allow for physician-assisted death in certain cases. Bill sponsors pulled it from the Assembly Committee on Health because of insufficient support. Assembly members later introduced a new version of the bill, which on Aug. 27 was referred to the Committee on Public Health and Developmental Services. Court battles in California over the legality of physician-assisted suicide continue. In addition to Judge Goldsmith’s Aug. 14 ruling, San Diego Superior Court Judge Gregory Pollack dismissed a similar lawsuit on July 27. Plaintiffs in both cases plan to appeal.

The California Medical Association (CMA) was not involved in either case and declined to comment for this story. However, in May, the medical association became the first state medical society to change its stance against physician-assisted suicide to that of being neutral.

“The decision to participate in the End of Life Option Act is a very personal one between a doctor and their patient, which is why CMA has removed policy that outright objects to physicians aiding terminally ill patients in end of life options,” Dr. Luther F. Cobb, CMA president, said in a statement. “We believe it is up to the individual physician and their patient to decide voluntarily whether the End of Life Option Act is something in which they want to engage. Protecting that physician-patient relationship is essential.”

While physicians are becoming less opposed to the practice, strong reservations still remain among the majority medical community, said Dr. Derse.

“Even if it’s becoming increasingly understood and somewhat more accepted by physicians, the public is significantly ahead in their support of this practice than physicians,” Dr. Derse said in an interview. “Physicians tend to be more wary and the reasons why have to do with, in part, the availability of palliative care, other alternatives, and concerns about the prohibition by the Hippocratic oath of giving patients something that would cause their death.”

The potential for abuse and overuse of physician-assisted suicide also remain a top concern. Such considerations were addressed in two studies and a commentary published in the Aug. 10 online issue of JAMA Internal Medicine. One study analyzed physician-assisted suicide and euthanasia cases at a Netherlands End-of-Life Clinic. The other reviewed the euthanasia rate in Belgium. Authors of the Netherlands study found that of 645 death requests made from 2012 to 2013, 25% were granted, 47% were refused, 9% withdrew their requests, and 19% died before their request were assessed. Notably, 7% of those approved for euthanasia or physician-assisted suicide were categorized as “tired of living.” Nearly 4% reported only psychological suffering. The Belgium study meanwhile, found the rate of euthanasia has increased from 1.9% of all deaths in Flanders, Belgium, in 2007, to 4.6% of all deaths in 2013.

“Both studies report worrisome findings that seem to validate concerns about where these practices might lead,” Dr. Caplan wrote in an associated commentary. “These findings, and other recent data regarding the speeding of patients’ deaths, make this a key moment to revisit efforts in the legalization of assisted dying in the United States and elsewhere, and, specifically, the role of the medical profession.”

U.S. doctors are also closely watching how the practice of assisted suicide unfolds in Canada. In striking down a federal law against physician-assisted suicide in February, the Supreme Court of Canada set a deadline of Feb. 6, 2016, for policies regarding the practice to be in place.

Dr. Derse said Canada’s use of the practice may present some good lessons for Americans, but will likely have a limited affect on the United States.

Dr. Caplan however, believes the legalization of physician-assisted suicide in Canada will have a big impact on the United States.

It’s “close by [and a] similar country,” he said. “We’ll be watching to see how they implement it.”

[email protected]

On Twitter@legal_med

A California judge has upheld the state’s ban against physician-assisted suicide, rejecting pleas by three terminally ill patients to legally end their lives with the help of a doctor. In an Aug. 14 ruling, San Francisco Superior Court Judge Ernest Goldsmith ruled that granting the plaintiffs’ petition would essentially create a judge-made law.

The decision is the latest development in a renewed debate about the legality and ethics of physician-assisted dying. More states than ever before are considering legalization of physician-assisted suicide, and experts say both public and physician perceptions of the practice appear to be changing.

Physicians in Canada find themselves facing a more pressing reality. In February 2016, physician-assisted suicide will become the law of the land as a result of a ruling by the Supreme Court of Canada earlier this year. But for now, U.S. physicians are facing a situation in flux.

“Division still runs deep,” said Arthur L. Caplan, Ph.D., founding director of the division of medical ethics at New York University’s Langone Medical Center’s Department of Population Health. “But one of the most interesting developments is that organized medicine may be moving a little toward favoring assisted dying for the terminally ill. Some of the resistance among physicians is shifting.”

Oregon, Vermont, and Washington are the only states that have laws permitting physician-assisted death. Court rulings in New Mexico and Montana have allowed for the practice. However, litigation in both states is ongoing and the decisions have yet to be enforced. Historically, one or two states consider such laws each year, said Peg Sandeen, Ph.D., executive director for the Death with Dignity National Center. In 2015, 25 state legislatures and the District of Columbia considered some form of physician-assisted death law, according to data from the Death With Dignity National Center. The majority of bills failed, although legislation in California, New York, Maryland, and the District of Columbia are pending. Ms. Sandeen notes that Maine came within one vote of passing a physician-assisted death law this year.

“We have seen a dramatic increase in the number of state legislatures willing to take up death with dignity or willing to consider it,” Ms. Sandeen said in an interview. “We have seen more activity this past legislature than we have any year in the last 10 years.”

Recent high-profile cases involving terminally ill patients have contributed to reignited public interest in the issue, said Dr. Arthur R. Derse, director of the Center for Bioethics and Medical Humanities and a professor of bioethics and emergency medicine at the Medical College of Wisconsin in Milwaukee. California resident Brittany Lauren Maynard, for instance, became widely known in 2014 after she fought to legally end her life after being diagnosed with terminal brain cancer. Ms. Maynard eventually moved to Oregon to take advantage of the state’s death with dignity law. Since Ms. Maynard’s case, the issue has become poignant in California, Dr. Derse said.

“It was a very sympathetic case to people who viewed [Ms. Maynard’s] video,” he said.

In 2015, California legislators introduced the End of Life Option Act, a bill that would allow for physician-assisted death in certain cases. Bill sponsors pulled it from the Assembly Committee on Health because of insufficient support. Assembly members later introduced a new version of the bill, which on Aug. 27 was referred to the Committee on Public Health and Developmental Services. Court battles in California over the legality of physician-assisted suicide continue. In addition to Judge Goldsmith’s Aug. 14 ruling, San Diego Superior Court Judge Gregory Pollack dismissed a similar lawsuit on July 27. Plaintiffs in both cases plan to appeal.

The California Medical Association (CMA) was not involved in either case and declined to comment for this story. However, in May, the medical association became the first state medical society to change its stance against physician-assisted suicide to that of being neutral.

“The decision to participate in the End of Life Option Act is a very personal one between a doctor and their patient, which is why CMA has removed policy that outright objects to physicians aiding terminally ill patients in end of life options,” Dr. Luther F. Cobb, CMA president, said in a statement. “We believe it is up to the individual physician and their patient to decide voluntarily whether the End of Life Option Act is something in which they want to engage. Protecting that physician-patient relationship is essential.”

While physicians are becoming less opposed to the practice, strong reservations still remain among the majority medical community, said Dr. Derse.

“Even if it’s becoming increasingly understood and somewhat more accepted by physicians, the public is significantly ahead in their support of this practice than physicians,” Dr. Derse said in an interview. “Physicians tend to be more wary and the reasons why have to do with, in part, the availability of palliative care, other alternatives, and concerns about the prohibition by the Hippocratic oath of giving patients something that would cause their death.”

The potential for abuse and overuse of physician-assisted suicide also remain a top concern. Such considerations were addressed in two studies and a commentary published in the Aug. 10 online issue of JAMA Internal Medicine. One study analyzed physician-assisted suicide and euthanasia cases at a Netherlands End-of-Life Clinic. The other reviewed the euthanasia rate in Belgium. Authors of the Netherlands study found that of 645 death requests made from 2012 to 2013, 25% were granted, 47% were refused, 9% withdrew their requests, and 19% died before their request were assessed. Notably, 7% of those approved for euthanasia or physician-assisted suicide were categorized as “tired of living.” Nearly 4% reported only psychological suffering. The Belgium study meanwhile, found the rate of euthanasia has increased from 1.9% of all deaths in Flanders, Belgium, in 2007, to 4.6% of all deaths in 2013.

“Both studies report worrisome findings that seem to validate concerns about where these practices might lead,” Dr. Caplan wrote in an associated commentary. “These findings, and other recent data regarding the speeding of patients’ deaths, make this a key moment to revisit efforts in the legalization of assisted dying in the United States and elsewhere, and, specifically, the role of the medical profession.”

U.S. doctors are also closely watching how the practice of assisted suicide unfolds in Canada. In striking down a federal law against physician-assisted suicide in February, the Supreme Court of Canada set a deadline of Feb. 6, 2016, for policies regarding the practice to be in place.

Dr. Derse said Canada’s use of the practice may present some good lessons for Americans, but will likely have a limited affect on the United States.

Dr. Caplan however, believes the legalization of physician-assisted suicide in Canada will have a big impact on the United States.

It’s “close by [and a] similar country,” he said. “We’ll be watching to see how they implement it.”

[email protected]

On Twitter@legal_med

A California judge has upheld the state’s ban against physician-assisted suicide, rejecting pleas by three terminally ill patients to legally end their lives with the help of a doctor. In an Aug. 14 ruling, San Francisco Superior Court Judge Ernest Goldsmith ruled that granting the plaintiffs’ petition would essentially create a judge-made law.

The decision is the latest development in a renewed debate about the legality and ethics of physician-assisted dying. More states than ever before are considering legalization of physician-assisted suicide, and experts say both public and physician perceptions of the practice appear to be changing.

Physicians in Canada find themselves facing a more pressing reality. In February 2016, physician-assisted suicide will become the law of the land as a result of a ruling by the Supreme Court of Canada earlier this year. But for now, U.S. physicians are facing a situation in flux.

“Division still runs deep,” said Arthur L. Caplan, Ph.D., founding director of the division of medical ethics at New York University’s Langone Medical Center’s Department of Population Health. “But one of the most interesting developments is that organized medicine may be moving a little toward favoring assisted dying for the terminally ill. Some of the resistance among physicians is shifting.”

Oregon, Vermont, and Washington are the only states that have laws permitting physician-assisted death. Court rulings in New Mexico and Montana have allowed for the practice. However, litigation in both states is ongoing and the decisions have yet to be enforced. Historically, one or two states consider such laws each year, said Peg Sandeen, Ph.D., executive director for the Death with Dignity National Center. In 2015, 25 state legislatures and the District of Columbia considered some form of physician-assisted death law, according to data from the Death With Dignity National Center. The majority of bills failed, although legislation in California, New York, Maryland, and the District of Columbia are pending. Ms. Sandeen notes that Maine came within one vote of passing a physician-assisted death law this year.

“We have seen a dramatic increase in the number of state legislatures willing to take up death with dignity or willing to consider it,” Ms. Sandeen said in an interview. “We have seen more activity this past legislature than we have any year in the last 10 years.”

Recent high-profile cases involving terminally ill patients have contributed to reignited public interest in the issue, said Dr. Arthur R. Derse, director of the Center for Bioethics and Medical Humanities and a professor of bioethics and emergency medicine at the Medical College of Wisconsin in Milwaukee. California resident Brittany Lauren Maynard, for instance, became widely known in 2014 after she fought to legally end her life after being diagnosed with terminal brain cancer. Ms. Maynard eventually moved to Oregon to take advantage of the state’s death with dignity law. Since Ms. Maynard’s case, the issue has become poignant in California, Dr. Derse said.

“It was a very sympathetic case to people who viewed [Ms. Maynard’s] video,” he said.

In 2015, California legislators introduced the End of Life Option Act, a bill that would allow for physician-assisted death in certain cases. Bill sponsors pulled it from the Assembly Committee on Health because of insufficient support. Assembly members later introduced a new version of the bill, which on Aug. 27 was referred to the Committee on Public Health and Developmental Services. Court battles in California over the legality of physician-assisted suicide continue. In addition to Judge Goldsmith’s Aug. 14 ruling, San Diego Superior Court Judge Gregory Pollack dismissed a similar lawsuit on July 27. Plaintiffs in both cases plan to appeal.

The California Medical Association (CMA) was not involved in either case and declined to comment for this story. However, in May, the medical association became the first state medical society to change its stance against physician-assisted suicide to that of being neutral.

“The decision to participate in the End of Life Option Act is a very personal one between a doctor and their patient, which is why CMA has removed policy that outright objects to physicians aiding terminally ill patients in end of life options,” Dr. Luther F. Cobb, CMA president, said in a statement. “We believe it is up to the individual physician and their patient to decide voluntarily whether the End of Life Option Act is something in which they want to engage. Protecting that physician-patient relationship is essential.”

While physicians are becoming less opposed to the practice, strong reservations still remain among the majority medical community, said Dr. Derse.

“Even if it’s becoming increasingly understood and somewhat more accepted by physicians, the public is significantly ahead in their support of this practice than physicians,” Dr. Derse said in an interview. “Physicians tend to be more wary and the reasons why have to do with, in part, the availability of palliative care, other alternatives, and concerns about the prohibition by the Hippocratic oath of giving patients something that would cause their death.”

The potential for abuse and overuse of physician-assisted suicide also remain a top concern. Such considerations were addressed in two studies and a commentary published in the Aug. 10 online issue of JAMA Internal Medicine. One study analyzed physician-assisted suicide and euthanasia cases at a Netherlands End-of-Life Clinic. The other reviewed the euthanasia rate in Belgium. Authors of the Netherlands study found that of 645 death requests made from 2012 to 2013, 25% were granted, 47% were refused, 9% withdrew their requests, and 19% died before their request were assessed. Notably, 7% of those approved for euthanasia or physician-assisted suicide were categorized as “tired of living.” Nearly 4% reported only psychological suffering. The Belgium study meanwhile, found the rate of euthanasia has increased from 1.9% of all deaths in Flanders, Belgium, in 2007, to 4.6% of all deaths in 2013.

“Both studies report worrisome findings that seem to validate concerns about where these practices might lead,” Dr. Caplan wrote in an associated commentary. “These findings, and other recent data regarding the speeding of patients’ deaths, make this a key moment to revisit efforts in the legalization of assisted dying in the United States and elsewhere, and, specifically, the role of the medical profession.”

U.S. doctors are also closely watching how the practice of assisted suicide unfolds in Canada. In striking down a federal law against physician-assisted suicide in February, the Supreme Court of Canada set a deadline of Feb. 6, 2016, for policies regarding the practice to be in place.

Dr. Derse said Canada’s use of the practice may present some good lessons for Americans, but will likely have a limited affect on the United States.

Dr. Caplan however, believes the legalization of physician-assisted suicide in Canada will have a big impact on the United States.

It’s “close by [and a] similar country,” he said. “We’ll be watching to see how they implement it.”

[email protected]

On Twitter@legal_med