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    The right-to-die movement has taken our country by storm. From the public trial of Dr. Kevorkian to the grassroots efforts of assisted-suicide supporters, it has become clear that this is an issue that needs to be resolved. Here, I will discuss a brief history of the right-to-die movement, including Dr. Kevorkian’s work, recent Supreme Court rulings on assisted-suicide, and current definitions of what is, and is not, euthanasia.

    The idea of a person’s right to die has interested philosophers since ancient times, but before the 20th century it was not medically possible to keep someone alive by artificial means, and therefore denying or granting someone the right to end their life through medicinal intervention was a non-issue. By the 1950s, advances in medical technology allowed terminally ill and permanently unconscious patients, whose rapid demise was once inevitable, to be kept alive artificially. These patients who could not eat, drink or even breathe on their own now had their breath controlled by a ventilator, nourishment given through a feeding tube, and liquids delivered through an IV directly into their veins. The death that was once inevitable was now being controlled by the doctors and the family of the patient, people who had never had to deal with such a thing before.

    The first “right-to-die” case went before the court in 1975.    A woman named Karen Ann Quinlan suffered a respiratory arrest that put her into a permanent vegetative state. She could not breathe without a ventilator and could not eat without a feeding tube. Her family believed that, given the choice, she would not want to be kept alive in that way when there was no hope for recovery. At that time, there was no medical standard for ending life-sustaining treatment, so they took science to the courts. After a lengthy court battle, they won the right to discontinue life-support.

    It was during this time period that the term “right-to-die” became the term people use to describe a vast range of end of life decision making issues. Cases like that of Karen Ann Quinlan began an era of social change that challenged society’s views on end of life care. On the whole, our society is more comfortable with policies that authorize a passive role in an individuals right to die, like honoring a patient with a progressive non-curable illness’ request to withhold or withdraw aggressive medical interventions and/or procedures. Society is still not comfortable with an active role in hastening death, such as that of assisted-suicide. There is a balance that needs to be reached in which an individual patient has control over their final days and the authority to make their own medical decisions, but where societies interest in protecting life and the ability of medicine to cure and care for the ill is also protected.

Definitions of Current Right-to-Die Issues

Euthanasia - If we translate the word Euthanasia, it literally means a “good death”. The term has been traditionally used to describe a mercy killing.

Involuntary Active Euthanasia – An intervention that ends a person’s life without their informed consent.

Voluntary Active Euthanasia – And intervention requested by a legally competent patient that is administered to cause death, like a lethal injection. There is currently no law that authorizes voluntary active euthanasia, but recent polls have shown that a growing number of Americans support a patients right to die when they choose to.

Assisted-Suicide – The act of providing the means to commit suicide (like a prescription to overdose on pills) to someone, knowing that they plan to use them to end their life. Physician-Assisted Suicide refers to a doctor providing intervention (like medication) with the understanding that their patient intends to use them to commit suicide. In 1997 Oregon was the first state to permit Physician Assisted Suicide in certain conditional circumstances. Also in 1997, the Supreme Court made two decisions challenging the legality of individual state bans on assisted-suicide. The Court found that there was no constitutional right to assisted-suicide and gave the matter back to the individual states to decide. The Court held that state bans on physician-assisted suicide did not violate either the Equal Protection Clause or the Due Process Clause of the Fourteenth Amendment.

Equal Protection Clause – The provision in the 14th Amendment that prohibits any state from denying any person within its jurisdiction the equal protection under the laws. Persons under similar circumstances must be given equal protection in their enjoyment of personal rights and the prevention and redress of wrongs.

Due Process Clause – The provision in the 14th Amendment that guarantees that no person shall be arbitrarily deprived of life, liberty or property. Liberties that the Court found to be specifically protected by the Due Process Clause include the right to marry, to have children, to use contraception and to abortion.

Withdrawal or Withholding of Medical Treatment – An individual has the right to request withdrawal or withholding of treatment even if doing so will end the person’s life. This is the most widely accepted “right-to-die” policy in America today. The US Supreme Court authorized this method in several cases as recently as 1997. In all 50 states and the District of Columbia a patient’s right to refuse treatment is still valid if/when he/she becomes incompetent. Their rights are protected though a legal document called and Advance Medical Directive which must be signed by the individual before incompetence. Living wills and DNRs (Do Not Resuscitate orders) are examples of Advance Medical Directives.

Medical Battery – Any procedure performed by a medical professional that intentionally violates a patients advance medical directive. Procedures of any kind inflicted on a patient, including the life sustaining and the beneficial, that are not consented for by the patient (or an agent acting on their behalf) can be considered medical battery.