WHEN DEATH IS SOUGHT
ASSISTED SUICIDE AND EUTHANASIA
IN THE MEDICAL CONTEXT
May 1994
THE NEW YORK STATE TASK FORCE
ON LIFE AND THE LAW
MEMBERS OF THE TASK FORCE
Mark R. Chassin, M.D., M.P.P, M.PH.
Chairman
Commissioner of Health
State of New York
Karl Adler, M.D.
Dean, New York Medical College
Rev. Msgr. John A. Alesandro
Chancellor
Roman Catholic Diocese of Rockville Centre
John Arras, Ph.D.
Associate Professor of Bioethics
Albert Einstein College of Medicine
Montefiore Medical Center
Mario L. Baeza, Esq.
Debevoise & Plimpton
The Right Rev. David Ball
Bishop, Episcopal Diocese of Albany
Rabbi J. David Bleich
Professor of Talmud, Yeshiva University
Professor of Jewish Law and Ethics
Benjamin Cardozo School of Law
Evan Calkins, M.D.
Professor of Medicine, Emeritus
SUNY-Buffalo
Richard J. Concannon, Esq.
Kelley, Drye & Warren
Myron W Conovitz, M.D.
Attending Physician
North Shore University Hospital
Clinical Associate Professor of Medicine
Cornell University Medical College
Saul J. Farber, M.D.
Dean and Provost
Chairman, Department of Medicine
New York University School of Medicine
Alan R. Fleischman, M.D.
Director, Division of Neonatolog
Albeit Einstein College of Medicine
Samuel Gorovitz, Ph.D.
Professor of Philosophy
Syracuse University
Jane Greenlaw, J.D., R.N.
Director, Division of the Medical Humanities
University of Rochester School of Medicine and Dentistry
Beatrix A. Hamburg, M.D.
President, WT Grant Foundation
Denise Hanlon, R.N., M.S.
Assistant Clinical Professor
SUNY Buffalo School of Nursing
Rev. Donald W. McKinney
Chairman Emeritus, Choice in Dying
Maria I. New, M.D.
Chief, Department of Pediatrics
New York Hospital-Cornell Medical Center
John J. Regan, J.S.D.
Professor of Law
Hofstra University School of Law
Rabbi A. James Rudin
National Director of Interreligious Affairs
The American Jewish Committee
Rev. Betty Bone Schiess
Episcopal Diocese of Central New York
Barbara Shack
The New York Civil Liberties Union
Rev. Robert S. Smith
Director, Institute for Medicine in Contemporary Society
SUNY Health Science Center at Stony Brook
Elizabeth W. Stack
Commissioner
New York State Commission on
Quality of Care for the Mentally Disabled
TASK FORCE STAFF
Tracy E. Miller, J.D. Aaron L. Mackler, Ph.d
Executive Director Staff Ethicist
Carl H. Coleman, J.D. Elizabeth Peppe
Associate Counsel Administrative Assistant
Anna Maria Cugliari, M.S. Jean Pohoryles
Health Policy Analyst Administrative Secretary
CONSULTANTS TO THE TASK FORCE COMMITTEE ON
SUICIDE AND PROFESSIONAL RESPONSIBILITY
Nessa M. Coyle, R.N., M.S.
Director of Supportive Care Program
Pain Service, Department of Neurology
Memorial Sloan-Kettering Cancer Center
Jimmie C. Holland, M.D.
Chief, Psychiatry Service
Memorial Sloan-Kettering Cancer Center
Professor of Psychiatry, Cornell University Medical College
Diane E. Meier, M.D.
Associate Professor
Department of Geriatrics and Adult Development
Mt. Sinai School of Medicine
Norton Spritz, M.D.
Chief, Medical Service
Department of Veterans Affairs Medical Center
Professor of Medicine
New York University School of Medicine
Contents
Preface...................................................... vii
Executive Summary............................................ ix
Introduction................................................. 1
Part I - The Clinical, Legal, and Ethical Context
1. The Epidemiology of Suicide............................. 9
Suicide and the General Population................. 10
Risk Factors for Suicide........................... 13
2. Suicide and Special Patient Populations................. 23
Patients with Cancer............................... 24
Patients with AIDS................................. 28
The Elderly........................................ 30
3. Clinical Responses to Pain and Suffering.............. 35
Assessing Pain and Other Symptoms.................. 36
Managing Pain...................................... 37
Treating Other Symptoms of Illness................. 40
Current Clinical Practice.......................... 43
4. Decisions at Life's End: Existing Law................... 49
The Right to Decide About Treatment................ 49
Suicide and the Law................................ 54
Assisted Suicide................................... 55
Euthanasia......................................... 63
Professional Misconduct Proceedings................ 64
The Constitutional Issues.......................... 67
5. The Ethical Debate...................................... 77
An Historical Perspective.......................... 77
Distinguishing Assisted Suicide and Euthanasia..... 82
The Appeal to Autonomy............................. 85
Benefiting the Patient............................. 91
Societal Consequences.............................. 96
The Role and Responsibilities of Physicians........ 103
Killing and Allowing to Die........................ 109
Part II - Deliberations and Recommendations of the Task Force
6. Crafting Public Policy on Assisted Suicide and Euthanasia . 117
The Question of Legal Change...................... 119
A Response to Proposed Guidelines
to Legalize Assisted Suicide...................... 142
Distinguishing Decisions to Forgo
Life-Sustaining Treatment......................... 146
7. Developing Professional Medical Standards................. 149
8. Caring for Severely III Patients.......................... 153
Decisions About Life-Sustaining Treatment......... 153
Improving Palliative Care.......................... 158
Diagnosing and Treating Depression................ 175
Responding When a Patient Requests
Assisted Suicide or Euthanasia..................... 177
Appendices
A. Initial Assessment for Cancer Pain....................... 185
B. Brief Pain Inventory..................................... 187
C. American Pain Society Quality Assurance
Standards for Relief of Acute Pain and Cancer Pain..... 191
D. Detection and Diagnosis of Depression.................... 197
E. Questions to Ask In the Assessment of
Depressive Symptoms for Severely III Patients.......... 207
F. Requests for Euthanasia and Assisted Suicide:
Nursing Management Principles........................... 209
G. Additional Resources...................................... 211
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