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IgnoringItWillNotMakeItGo
Away:GuidelinesforStatutory
RegulationofPhysicianAssistedDeath

EMILYR.MASON*

ABSTRACT

Dr. Walter Sackett is credited with proposing the first aidindying

legislation to the Florida legislature in 1968. Since then the topic of death
anddyinghasreceivedmuchattentionandisnowahotlydebatedmodern
social issue. Over the course of the last sixteen years, two states, Oregon
andWashington,passedaidindyinglegislation,andonDecember5,2008,
Montanabecamethefirststatetoallowaidindyingbycourtorder.Judge
Dorothy McCarter of the district court ruled that the Montana
constitutional rights of individual privacy and human dignity, taken
together,encompasstherightofacompetentterminally[ill]patienttodie
with dignity. Judge McCarter ruled that physicianassisted death was
constitutional under Montanasstate constitution. This landmarkdecision
wasimmediatelyappealedtotheMontanaSupremeCourt.OnDecember
31, 2009, the court held that physicianassisted death was not statutorily
prohibited,althoughitdeclinedtoruleonthemuchdebatedconstitutional
issues. Montana, like Oregon and Washington, now allows for physician
assisteddeath. However,Montanaisin a unique position,as itallowsan
act that is, as of yet, not regulated by statute. To avoid such a situation,
states would benefit from enacting legislation to regulate physician
assisteddeathratherthanwaitingtofindthemselvesinthesameposition
Montanaisnowin.ThisNoteproposesguidelinesforstatutoryregulation.

* Candidate for Juris Doctor, New England School of Law (2011). Master of Social Work,

Salem State University (2006); B.A., Psychology and Social Work, Gordon College (2005). I
would like to thank my husband, Kevin, along with my entire family for their constant
supportandencouragement.Specialthanks totheauthorsof A ModelState ActtoAuthorize
and Regulate PhysicianAssisted Suicide, as it provided a template for my own proposal. This
Note is dedicated to all the patients I have encountered over the years who have braved
illnessanddeathwithgreatdignity.

139
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140 NewEnglandLawReview v.45|139

Itassertsthatstatutoryregulationisnecessary,bothtoprotecttherightsof
patients seeking aid in dying and to shield vulnerable patients from the
misuseandabuselikelytooccurintheabsenceofregulation.

INTRODUCTION

Ihavelivedagoodandalonglife,andhavenowishtoleavethisworld
prematurely. As death approaches from my disease, however, if my
sufferingbecomesunbearableIwantthelegaloptionofbeingabletodie
inapeacefulanddignifiedmannerbyconsumingmedicationprescribed
bymydoctorforthatpurpose.Becauseitwillbemysuffering,mylife,
andmydeaththatwillbeinvolved,Iseektherightandresponsibilityto
makethatcriticalchoiceformyselfifcircumstancesleadmetodoso.I
feelstronglythatthisintenselypersonalandprivatedecisionshouldbe
lefttomeandmyconsciencebasedonmymostdeeplyheldvaluesand
beliefs, and after consulting with my family and doctorand that the
government should not have the right to prohibit this choice by
criminalizingtheaidindyingprocedure.1

S
inceDr.WalterSackett2introducedthefirstaidindyinglegislationin
Florida in 1968, the topic of death and dying has gradually moved
towardtheforefrontofmodernsocialissues.3Overthecourseofthe
lastsixteenyears,twostates,OregonandWashington,havevotedtoallow
aidindying.4 On December 5, 2008 Montana joined them when Judge
Dorothy McCarter ruled that [t]he Montana constitutional rights of
individualprivacyandhumandignity,takentogether,encompasstheright
of a competent terminally [ill] patient to die with dignity.5 This district

1Baxterv.State,2009MT449,58&n.1,354Mont.234,58&n.1,224P.3d1211,1223&

n.1 (Nelson, J., concurring) (quoting Robert Baxter, the plaintiffappellee in this case, as he
discusseshisviewofassistancewithdeathandhisconsiderationsregardingthatoption).
2Dr.WalterW.Sackett,Jr.,aMiamiphysicianandFloridalegislator,wastheauthorand

leadingproponentof[thethen]controversiallegislationallowingterminallyillpeopletodie
ratherthanbe[]keptalivebylifesupportsystems.StatesDeathwithDignityBillWasWalter
Sacketts Legacy, MIAMI NEWS, Oct. 7, 1985 at 4A. In 1968 he offered an amendment to the
FloridaConstitutiontoaddthewordsdeathwithdignityafterthewordlife,andthenin
1969 Dr. Sackett filed his first DeathwithDignity bill, HB 3184, which provided that a
patient could claim a right to death with dignity and direct that his life shall not be
prolonged beyond the point of a meaningful existence. Margaret Moen, Right to Life
Retrospect, AM. SPECTATOR (Aug. 30, 2005, 12:07 AM), http://spectator.org/archives
/2005/08/30/righttoliferetrospect. This bill never became law, nor did any of Dr. Sacketts
otherantilifeproposals.Id.
3SeeIAN DOWBIGGIN, A MERCIFUL END: THE EUTHANASIA MOVEMENTIN MODERN AMERICA

xii(2003).
4See Milestones in the Modern EndofLife Choice Movement, COMPASSION & CHOICES,

http://www.compassionandchoices.org/learn/timeline(lastvisitedDec.13,2010).
5Baxter v. State, 2008 MT Dist. Ct. 482U, para. 64, No. ADV2007787, 2008 Mont. Dist.
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2010 Legislative Oversight for Physician-Assisted Death 141

court decision deemed physicianassisted death constitutional under

Montanasstateconstitution.6TheStatethenappealedthisdecisiontothe
Montana Supreme Court, and on December 31, 2009, it was held that
physicianassisteddeathwasnotstatutorilyprohibited,norwasitviolative
ofpublicpolicy.7However,thecourtdeclinedtoruleonthemuchdebated
constitutional issues.8 Montana, like Oregon and Washington, has
decriminalized physicianassisted death; however, unlike Oregon and
Washington,Montanalacksspecificregulationofphysicianassisteddeath
by statute.9 States, citizens, and doctors would benefit from enacting
legislationtoregulatephysicianassisteddeathratherthanwaitingtofind
themselves in the same position Montana now finds itself.10 This Note
proposes that statutory regulation is necessary to protect the rights of
patientsseekingaidindyingaswellastoprotectvulnerablepatientsfrom
themisuseandabuseofitsunregulatedlegalization.11
ThisNotewilldiscusstheimplicationsoftheMontanadecisionwhere
a hotly contested act, physicianassisted death, became legal yet remains
unregulated.12 Without speedy legislation, there may be a period of time
during which physicianassisted death is legal, but the boundaries within
which it may be carried out remain undefined.13 Given the potential for
abuse and misuse of physicianassisted death, statutory regulation of this
practiceisnecessarytowardagainstsuchharms,and,ataminimum,itis
preferable to no regulation at all.14 The statutory regulation proposed by
this Note will include safeguards that should be implemented to protect
vulnerable populations.15 Such regulations include defining the age and
competenceofthepatientandthecircumstancesandmannerinwhichthe
decision may be carried out.16 This proposed regulation seeks to ensure
thatsuchanoptionisonlyavailabletothosewhoarecompetent,informed,
andtrulyterminallyill.17

LEXIS482,at*36(Mont.Dist.Ct.Dec.5,2008),affdinpart,revdinpart,vacatedinpart,2009
MT449,51,224P.3dat1222.
6Id.
7Baxter,2009MT449,1314,224P.3dat1215.

8Id.

9StevenErtelt,MontanaSupremeCourtMakesStateThirdtoAllowUnlimitedAssistedSuicide,

LIFENEWS.COM(Dec.31,2009),http://www.lifenews.com/bio3027.html.
10SeeinfraPartVI.A.

11SeeinfraPartVI.A.

12SeeinfraPartsII.B,VI.A.

13SeeinfraPartVI.A.

14SeeinfraPartVI.A.

15SeeinfraPartVI.

16SeeinfraPartVI.

17SeeCharlesH.Baronetal.,AModelStateActtoAuthorizeandRegulatePhysicianAssisted
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142 NewEnglandLawReview v.45|139

PartIofthisNotewilldiscussthehistoryofphysicianassisteddeath.
Part II will discuss the current state of the law with respect to the
regulation of physicianassisted death. Part III will discuss the recent
MontanaSupremeCourtrulinginBaxterv.Stateaswellasthelowercourt
decision. Part IV will explain the similarities and differences between the
current statutes in both Oregon and Washington. Part V will discuss the
experience of physicianassisted death in other countries. Part VI will lay
out the common arguments for and against physicianassisted death.
Finally, Part VII will propose statutory regulation that will both protect a
patients right to have a physicianassisted death and protect against the
misuseofsuchanact.

I. AHistoryofPhysicianAssistedDeathintheUnitedStates

A. DefiningPhysicianAssistedDeath

PhysicianAssisted suicide occurs when a physician facilitates a

patients death by providing the necessary means and information to
enableapatienttoperformthelifeendingact.18Physicianassisteddeath
should not be confused with the more involved participation seen in the
caseofactiveeuthanasia,whichistheintentionalkillingofapatient,by
act or omission, as part of his... medical care.19 Patients who request
physician assistance with death are often those who are in the terminal
stageofanillness,butwhoseconditionsdonotaffectrespiration,nutrition,
or hydration.20 Since these patients are not on life support and are not in
respiratory distress, they do not have the option of refusing treatment or
requesting the removal of lifesupport to hasten their natural deaths.21
Thus, cognizant of their terminal illness and the potential for drawnout,
chronic suffering, these patients request a physicians assistance with
death,whichrequiresanactionindependentofthediseaseprocesstocause

Suicide,33HARV.J.ONLEGIS.1,12(1996).
18AM. MED. ASSN., CODE OF MEDICAL ETHICS, Op. 2.211 (2002). For a discussion of the

terminology used in the area of physicianassisted suicide, see ROBIN LUNGE ET AL., VT.
LEGISLATIVE COUNCIL, OREGONS DEATH WITH DIGNITY LAW AND EUTHANASIA IN THE
NETHERLANDS: FACTUAL DISPUTES 2 (2004), available at http://www.leg.state.vt.us/reports/
05Death/Death_With_Dignity_Report.htm. See also Ezekiel J. Emanuel, Euthanasia: Historical,
Ethical,andEmpiricPerspectives,154ARCHIVES INTERNAL MED. 1890, 189091, 1891 tbl.1(1994)
(distillingeuthanasiaintosixcategoriesthatcaptureintent,consent,andactions).
19See John Keown, Introduction to EUTHANASIA EXAMINED: ETHICAL, CLINICAL AND LEGAL

PERSPECTIVES,atI,I(JohnKeowned.,1995).
20BriefofRespondentsat9,Washingtonv.Glucksberg,521U.S.702(1997)(No.96110).

21Id.
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2010 Legislative Oversight for Physician-Assisted Death 143

the actual death.22 In the case of assisted death, the patient intends to die
fromaselfinflictedactratherthanfromtheunderlyingmedicalcondition,
which could take agonizing weeks, months, or even years.23 Those who
supportphysicianassisteddeatharguethatsincetheresultsoftherefusal
orwithdrawaloftreatment(i.e.passiveeuthanasia)andphysicianassisted
death are the same, both acts should be treated similarly.24 However,
opponents argue that it is too tenuous a connection to conclude that
refusingorwithdrawingtreatmentisthesameasactivelyhelpingapatient
diewithdignity.25Manyarguethatthecriticaldifferenceisthatphysician
assisteddeathinvolvestakingactivemeasurestobringaboutthedeathof
anindividualratherthanpassivelyallowingtheillnesstocausethedeath.26
However,otherswouldarguethat,inthecaseofaterminalillness,thisisa
differencenotworthnoting.27
In a jurisdiction where physicianassisted death is not statutorily
authorized, any physician who provides such assistance to a patient with
an intention to hasten death risks prosecution for manslaughter,28
murder,29orassistingasuicide.30Thesephysicianscouldalsobeliablefor
wrongfuldeath31andmedicalmalpractice.32Giventhefearofprosecution,
physiciansareoftenhesitanttoaidapatientsdeatheventhoughtheydo
notpersonallyobjecttothepractice.33However,thereareotherphysicians
that willassist with the practice, despite the potentialsanctions,and they

22See Assisted Suicide in the United States: Hearing Before the Judiciary Subcomm. on the

Constitution of the H. Comm. on the Judiciary, 104th Cong. 911 (1996) [hereinafter Hearing on
PhysicianAssisted Suicide] (statement of Kathleen M. Foley, M.D., Chief of Pain Service at
Memorial SloanKettering Cancer Center and Professor of Neurology, Neuroscience and
ClinicalPharmacologyatCornellUniversityMedicalCollege).
23SeeCatherineJ.Jones,DecisionmakingattheEndofLife,63AM.JUR.Trials1,2324(1997).

24Id.

25See142CONG.REC.S4642(dailyed.May2,1996)(statementofSen.Dole).

26Seeid.atS4643.
27See Jones, supra note 23, at 24; George P. Smith, II, Alls Well That Ends Well: Toward a

Policy of Assisted Rational Suicide or Merely Enlightened SelfDetermination?, 22 U.C. DAVIS L.

REV.275,34041(1989).
28See,e.g.,N.Y.PENALLAW125.15(3)(McKinney2009).

29See,e.g.,Peoplev.Kevorkian,527N.W.2d714,73839(Mich.1994).

30See, e.g., N.Y. PENAL LAW 120.30; MODEL PENAL CODE 210.5(2) (Proposed Official

Draft1962).
31See, e.g., MASS. GEN. LAWS ch. 229, 2 (2000); 42 PA. CONS. STAT. ANN. 8301(a) (West

2007).
32See,e.g.,PeoplesBankofBloomingtonv.Damera,581N.E.2d426,429(Ill.App.Ct.1991).

33See, e.g., Robyn S. Shapiro et al., Willingness to Perform Euthanasia: A Survey of Physician

Attitudes, 154 ARCHIVES INTERNAL MED. 575, 581 (1994) (discussing the fact that although
35.2% of physicians responding had been asked to perform euthanasia and 27.8% would be
willingtodoso,only2.2%hadactuallycarrieditout).
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144 NewEnglandLawReview v.45|139

dosobehindcloseddoorsandfreefromregulation.34

B. UnregulatedPracticeofPhysicianAssistedDeath

Physicianassisted death, physicianassisted suicide, and active and

passiveeuthanasiahavebeenpracticedcovertlyinthefieldofmedicinefor
manyyears.35Slowly,thetopicofassisteddeathhascometolightthrough
a series of small, yet important, strides.36 First, in 1988, an anonymous
physicianwroteanarticleintheJournaloftheAmericanMedicalAssociation
describing in detail how he administered a lethal dose of medicine to a
patient dying of cancer.37 This article marked the first open and public
account of physicianassisted death38 and created a stir within both the
medicalprofessionandthegeneralpublic.39ItwasnotlongbeforetheNew
EnglandJournalofMedicinepublishedasimilararticle,thistimebyanamed
physician,Dr.TimothyQuill,inwhichhedescribedhisparticipationinthe
deathofoneofhispatients.40AfterthepatientdiedandDr.Quilladmitted
tohisparticipation,thecasewaspresentedtoagrandjurythatrefusedto
indictthedoctor.41
Finally, and most recognizably, Dr. Jack Kevorkian, a Michigan
physician, has assisted openly in the deaths of over forty patients.42 Dr.
Kevorkian became a wellknown figure when, in 1990, he first used his
suicide machine43 to fulfill the wish of Janet Adkins by putting an end to

34Jones,supranote23,at7778.

35Id.at77.

36Id.at7778.

37Anonymous,ItsOver,Debbie,259JAMA272(1988).

38Seeid.

39See, e.g., Mark Bloom, Article Embroils JAMA in Ethical Controversy, 239 SCIENCE 1235,

123536(1988).
40SeeTimothyE.Quill,DeathandDignity:ACaseofIndividualizedDecisionMaking,324NEW

ENG. J. MED.691,69193(1991)(describingtheaccountofDr.TimothyQuill,whohadalong
professionalrelationshipwithhispatientandhaddiscussedwithheringreatdetailherclear
requestforhimtoprescribemedicationthatshecouldusetoendherlife).
41LawrenceK.Altman,JuryDeclinestoIndictaDoctorWhoSaidHeAidedinaSuicide,N.Y.

TIMES,July27,1991,at1,availableat1991WLNR3052257.
42Jones,supranote23,at78.

43Kevorkianssuicidemachineinvolvedanintravenoustube,insertedintothepatients

armwithharmlesssalinedrippingthroughit.LisaBelkin,DoctorTellsofFirstDeathUsing
His Suicide Device, N.Y. TIMES, June 6, 1990, at A1, available at 1990 WLNR 3036402. As
Kevorkian described the fatal mechanism, the patient would press[] a button that stopped
thesalineandreplaceditwiththiopental,whichcausedunconsciousness....Afteraminute,
the machine switched solutions again, to potassium chloride, which stopped the heart and
broughtdeathwithinminutes.Id.
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2010 Legislative Oversight for Physician-Assisted Death 145

her suffering; Mrs. Adkins was suffering from Alzheimers disease.44

Although he has been charged and tried in several cases, Kevorkian has
notbeenconvictedofeitherfirstdegreemurderorassistinginasuicide.45
Kevorkians participation in the death of his patients has had mixed
reviews in todays society, as evidenced by his inconsistent treatment by
thecourtsandthegeneralmedicalcommunity.46Forinstance,Kevorkians
medical license has been revoked in California,47 while authorities in
Michiganhavemerelysuspendedit.48Additionally,todate,Kevorkianhas
beenacquittedofallactscommittedinMichigan.49Thefailureofthecourts
toenforcestatutesprohibitingphysicianassisteddeathmaybeinterpreted
bothasdissatisfactionwithandlackofsupportforsuchlaws.50
Evenpriortotheaforementionedsituations,physicianshaveprovided
assistance with death, free from publicity, oversight and regulation.51
However, the publicity drawn by Dr. Kevorkians activity resulted in a
backlashofstatelegislationprohibitingassistanceindeath.52Interestingly,

44Id. Adkins contacted Kevorkian following publicity he received from a series of

newspaper interviews around the country about his suicide machine. Id. Kevorkian worked
withAdkinsphysicianoverseveralmonthsandspentaneveningwithherbeforefindingher
competenttomakethedecisiontoendherlife.Id.
45Jones,supranote23,at78(reportingthatKevorkianwasacquittedinfivecases).

46See, e.g., MICH. COMP. LAWS 752.1021 (2004). The Michigan Legislature responded to

Kevorkians assisted deaths by enacting this statute, which established a commission to

study voluntary termination of life and created a new crime of criminal assistance of
suicide.Kevorkianv.Thompson,947F.Supp.1152,1155(E.D.Mich.1997).
47Kevorkian v. Arnett, 939 F. Supp. 725, 727 (C.D. Cal. 1996). Here, a thirtyfive year old

gentleman with AIDS wished to procure the assistance of a physician to end his life. See id.
The court in this case upheld a California law that deemed aiding in a suicide illegal. Id. at
732.
48Thompson,947F.Supp.at1161.

49Id.at1157.
50Compassion in Dying v. Washington, 79 F.3d 790, 811 (9th Cir. 1996), revd sub nom.

Washington v. Glucksberg, 521 U.S. 702 (1997). In one of the only cases to recognize
constitutionalprotection fortheright toreceiveaidin dying,id.at81516,theNinthCircuit
investigatedsocietalattitudestowardphysicianassisteddeath.Id.at81011.Thecourtstated
thatthemerepresenceofacriminalsanctionforassistingindeathdoesnotnecessarilyimply
societal disapproval of that act. Id. at 811. Rather, the lack of enforcement shows that the
oppositemaybetrue.Id.
51Jones,supranote23,at77.

52Currently, at least thirtyfive states have legislation prohibiting assisting another to

commitsuicide.SeeALASKA STAT.11.41.120(2008);ARIZ. REV. STAT. ANN. 131103 (2010);
ARK. CODE ANN. 510104 (2006); CAL. PENAL CODE 401 (West 2010); COLO. REV. STAT. 18
3104(2010);CONN.GEN.STAT.ANN.53a56(West2007);DEL.CODEANN.tit.11,645(2007);
GA. CODE ANN. 1655 (2007); HAW. REV. STAT. 707702 (2007); 720 ILL. COMP. STAT.5/1231
(2002); IND. CODE 354212.5 (2009); IOWA CODE 707A.2 (2003); KAN. STAT. ANN. 213406
(2007); KY. REV. STAT. ANN. 216.302 (West 2006); LA. REV. STAT. ANN. 14:32.12 (2007); ME.
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146 NewEnglandLawReview v.45|139

whileKevorkiansopennessregardinghispositioncreatedapublicoutcry
againstassisteddeath,heandmanyothersstillbelievethatassisteddeath
should become a more open process available as a right to qualified
patients.53

C. RulingsImpactingPhysicianAssistedDeathintheUnitedStates

In 1990, the Supreme Court decided Cruzan v. Director, Missouri

Department of Health and recognized an individuals right to refuse or
withdraw lifesustaining treatment.54 In Cruzan, the Court reasoned that
underthecommonlaw,touchingapersonwithouttheirconsentwouldbe
consideredabattery.55Inkeepingwiththecommonlawandintheinterest
ofmaintainingandupholdingthenotionofbodilyintegrity,thereisnowa
generalrequirementofinformedconsent56forallmedicaltreatment.57The
Courtreasonedthatifonemustconsentinordertoreceivetreatment,one
must necessarily be allowed to refuse to consent to the treatment.58 The
CourtassumedthattherighttorefusetreatmentwasprotectedbytheDue
ProcessClauseoftheFourteenthAmendment.59Refusingorwithdrawing
treatmentallowsdeathtoproceednaturally;inthesecasesthediseaseitself
is reported as the cause of death rather than the refusal of treatment.60
Arguably,thepatientwouldhavediedoftheunderlyingdiseaseanyway,
sotherefusalorwithdrawaloftreatmentmerelyallowstheillnesstorun

REV. STAT. tit.17A,204(2006);MICH. COMP. LAWS 752.1027 (2004); MINN. STAT. 609.215
(2009); MISS. CODE ANN. 97349 (2006); MONT. CODE ANN. 455105 (2009); NEB. REV. STAT.
28307 (2008); N.H. REV. STAT. ANN. 630:4 (2007); N.J. STAT. ANN. 2C:116 (West 2005);
N.M.STAT. ANN.3024(2003);N.Y.PENALLAW120.30(McKinney2009);N.D.CENT.CODE
12.11604(1997);OKLA.STAT.tit.21,813815(2002);OR.REV.STAT.163.125(2009);18PA.
CONS. STAT. ANN. 2505 (West1998); R.I. GEN. LAWS 11603 (2002); S.D. CODIFIED LAWS
221637 (1998); TENN. CODE ANN. 3913216 (2006); TEX. PENAL CODE ANN. 22.08 (West
2001);WASH.REV.CODE9A.36.060(2009);WIS.STAT.940.12(2005).
53Jones,supranote23,at78.
54SeeCruzanv.Director,Mo.DeptofHealth,497U.S.261,279(1990).Inthiscase,Nancy

Cruzans parents sought permission of the Court to withhold the artificial nutrition and
hydrationfromtheirdaughter,whichhadbeeninitiatedfollowinganautomobileaccident.Id.
at265.
55Id.at269.

56Informed consent encompasses the patients right of selfdecision, as it represents [a]

persons agreement to allow something to happen, made with full knowledge of the risks
involvedandthealternatives.SeeBLACKSLAWDICTIONARY346(9thed.2009).
57Cruzan,497U.S.at269.

58Id.at270.

59Id.at27879(statingthattheconstitutionallyprotectedrighttorefusetreatmentcouldbe

inferredfrompriordecisions).
60See Hearing on PhysicianAssisted Suicide, supra note 22, at 14 (statement of Dr. Kathleen

Foley).
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2010 Legislative Oversight for Physician-Assisted Death 147

itsnaturalcourse.61Itisnowlegallypermissibletowithdraworwithhold
careattherequestofacompetentterminallyillpatient.62However,thelaw
has not taken the next logical step to allow physicianassistance in the
death of a competent terminally ill patient; this is still considered the
purposefultakingofalifebyaphysician.63
Just seven years after the Cruzan decision, in the 1997 landmark case
Washingtonv.Glucksberg,theSupremeCourtdistinguishedthewithdrawal
oftreatmentfromobtainingphysicianassistanceindeath.64TheCourtheld
that an individual does not have a constitutionally protected right to
receivetheaidofaphysicianinendinghisorherlife.65Thisdecision,while
foreclosing the hope of constitutional protection for physicianassisted
death, left the door open for states to make individual determinations
regardingwhethertopermitphysicianassisteddeath.66Whileconsidering
thecase,theCourtpolledthestatesforassistanceindeterminingwhether
toupholdphysicianassisteddeathforterminallyillcompetentadultsasa
fundamental right.67 The Court relied on the response from the states,
noting that what made a fundamental right fundamental was whether
statestreateditasarightworthyofprotection.68TheCourtthenwentonto
discuss the many concerns regarding allowing physicianassisted death
andtheabusesthatcouldresultfromsuchapractice.69Finally,inrejecting
a patients right to receive assistance with death, the Court cited the
underlying, albeit speculative, concerns, including: (1) the devaluing of
humanlifeandterminalhealthcare;(2)exposingvulnerablegroups(e.g.,

61Report of the Council on Ethical and Judicial Affairs of the American Medical Association, 10

ISSUESL.&MED.91,93(1994).
62See Cruzan, 497 U.S. at 27879 (inferring that a person has a constitutionally protected

libertyinterestinrefusingunwantedmedicaltreatment).
63SeeDavid J. Doukasetal., AttitudesandBehaviorson PhysicianAssistedDeath:AStudyof

MichiganOncologists,13J.CLINICALONCOLOGY1055,1055(1995).
64SeeWashingtonv.Glucksberg,521U.S.702,725(1997).
65Seeid.at735.
66See id. (Throughout the Nation, Americans are engaged in an earnest and profound

debateaboutthemorality,legality,andpracticalityofphysicianassistedsuicide.Ourholding
permitsthisdebatetocontinue,asitshouldinademocraticsociety.).
67Seeid.at71011(InalmosteveryStateindeed,inalmosteverywesterndemocracyit

isacrimetoassistasuicide.).
68See id. at 723; see, e.g., Reno v. Flores, 507 U.S. 292, 303 (1993) (rejecting the substantive

due process challenge to detention of juvenile aliens and stating that the alleged right
certainlycannotbeconsideredsorootedinthetraditionsandconscienceofourpeopleasto
be ranked as fundamental (quoting United States v. Salerno, 451 U.S. 739, 751 (1987))
(internalquotationmarksomitted));Moorev.CityofE.Cleveland,431U.S.494,50305(1977)
(invalidating a statute limiting housing to nuclear families in light of this Nations history
andtraditionofsupportingextendedfamilyhouseholds).
69SeeGlucksberg,521U.S.at72835.
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148 NewEnglandLawReview v.45|139

poor, elderly, disabled) to abuse or neglect; (3) undermining the integrity

and ethics of the medical profession; and (4) the fear of a slippery slope
leadingtowardinvoluntaryeuthanasia.70

II. Baxterv.State:ARecentRulingonPhysicianAssistedDeath

A. TheMontanaDistrictCourtDecision

Most recently, the legality and constitutionality of physicianassisted

deathwasaddressedintheMontanacaseofBaxterv.State.71Thiscasewas
broughtonbehalfofRobertBaxter,aseventyfiveyearoldgentlemanfrom
Montana who suffered from lymphocytic leukemia with acute
lymphadenopathy, a terminal cancer, along with other comorbidities.72
Over the course of his illness, Mr. Baxter, a retired truck driver, received
multiple rounds of chemotherapy.73 However, his condition had no cure
and he had no expectation of recovery.74 Given his diagnosis, Mr. Baxter
could expect a disease course wrought with suffering and agony.75 When
Mr. Baxters pain and suffering had become intolerable, he sought the
assistanceofaphysicianinhisdeath.76ThatdecisionplacedMr.Baxterat
the center of this case where he was joined as plaintiff by Compassion &
Choices77 and several boardcertified Montana physicians.78 The plaintiffs
claimed that, under the Montana Constitution, terminally ill patients
shouldbeallowedtheassistanceofaphysiciantohastentheirdeath.79
Inthiscase,aMontanaDistrictCourtJudge,DorothyMcCarter,wrote
that[t]heMontanaconstitutionalrightsofindividualprivacyandhuman
dignity,takentogether,encompasstherightsofacompetentterminally[ill]
patient to die with dignity.80 Judge McCarter was the first state court

70Seeid.at73035.

712009MT449,57,354Mont.234,57,224P.3d1211,1214.
72Id. 5, 224 P.3d at 1214 (reporting that Mr. Baxter received multiple rounds of

chemotherapyandexperiencedsymptomsofhisdiseaseandtreatment,includinginfections,
chronicfatigue,anemia,nightsweats,nausea,swollenglands,anddigestiveproblems).
73Id.

74Id.

75Seeid.

76Seeid.

77Compassion & Choices is a nonprofit organization seeking to improve[] care and

expand[] choice at the end of life. About Compassion & Choices, COMPASSION & CHOICES,
http://compassionandchoices.org/learn(lastvisitedDec.13,2010).
78Baxter,2009MT449,6,224P.3dat1214.

79Seeid.

80Baxter v. State, 2008 MT Dist. Ct. 482U, para. 64, No. ADV2007787, 2008 Mont. Dist.

LEXIS482,at*36(Mont.Dist.Ct.Dec.5,2008),affdinpart,revdinpart,vacatedinpart,2009
MASON_FINALPG139166PROOFED(DONOTDELETE) 1/10/20119:36:53AM

2010 Legislative Oversight for Physician-Assisted Death 149

judge to recognize [a] patients right to die with dignity [that] includes
protection of the patients physician from liability under the States
homicide statutes.81 This case arose from Mr. Baxters complaint
challengingtheconstitutionalityoftheapplicationofMontanashomicide
statutestophysicianassistedsuicide.82Thecomplaintsoughttodeclarethe
homicide statutes unconstitutional as applied in the aforementioned
circumstances.83 Mr. Baxter alleged that competent terminally ill patients
have a constitutionally protected right to aid in dying or physician
assisted death.84 The State argued that assisting patients in ending their
lives would fall under the homicide statute, thereby implicating the
assistingphysiciansinacrime.85
Intheinstanceofphysicianassisteddeath,acompetentpersonwitha
terminalconditionexpectedtoresultindeathwithinsixmonthsmay,if
he or she wishes, obtain a prescription for a lethal dose of drugs which
wouldbeselfadministeredandwouldultimatelycausedeath.86Mr.Baxter
claimed that his right to physicianassisted death was protected by the
righttoindividualprivacy,personaldignity,andequalprotectionfoundin
Montanas Constitution.87 The district court concluded that there was in
fact a right to assistance with dying that was protected by Montanas
constitutional recognition of a right to individual dignity and privacy.88
ThedecisionwasannouncedonDecember5,2008,thesamedayMr.Baxter
died without ever learning of his victory.89 For a brief period of time,
Montana became the first state to find constitutional protection for
physicianassisteddeath.90

B. TheMontanaSupremeCourtDecision

The case was immediately appealed to the Montana Supreme Court,

wheretheholdingwasnotentirelyaffirmed.91OnDecember31,2009,the
Montana Supreme Court considered whether the lower court erred in its

MT449,51,224P.3dat1222.
81Id.

82Id.para.2,2008Mont.Dist.LEXIS482,at*1.

83Id.

84Id.

85See Brief of Appellants at 4, 7, Baxter v. State, 2009 MT 449, 224P.3d 1211 (No. DA 09

0051).
86SeeBaxter,2008MTDist.Ct.482U,para.2,2008Mont.Dist.LEXIS482,at*1.

87Baxter,2009MT449,6,224P.3dat1214.

88Baxter,2008MTDist.Ct..482U,paras.6264,2008Mont.Dist.LEXIS482,at*3536.

89Baxter,2009MT449,58n.1,224P.3dat1223n.1(Nelson,J.,concurring).

90SeeBaxter,2008MTDist.Ct.482U,paras.6468,2008Mont.Dist.LEXIS482,at*3637.

91SeeBaxter,2009MT449,6263,224P.3dat1224(Nelson,J.,concurring).
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150 NewEnglandLawReview v.45|139

decision to declare that physicianassisted death was a constitutionally

protected right under the Montana Constitution.92 The court, however,
declinedtoaddresstheconstitutionalissuesinvolved,statingthatthecase
couldbedecidedwithoutaddressingtheconstitutionalissues.93Thecourt
noted that in the instance of physicianassisted death the only party who
facesprosecutionisthephysician,assuicideisnotacrimeunderMontana
law.94Thecourtlookedtostatestatutestodeterminephysicianculpability
inaidingdeath.95Theyanalyzedthepotentialculpabilityofphysiciansby
examining whether the consent of the patient to his physicians aid in
dyingcouldconstituteastatutorydefensetoahomicidechargeagainstthe
physician.96Thecourtthenexaminedwhetherastatutoryconsentdefense
wouldapplytophysicianswhoassistedwithdeathandwhetherapatient
consent defense would apply.97 The court then considered whether
patient consent is rendered ineffective by 452211(2)(d), MCA, because
permitting the conduct or resulting harm is against public policy.98 In
considering whether physicianassisted death is against public policy, the
court stated that [t]he patients subsequent private decision whether to
takethemedicinedoesnotbreachpublicpeaceorendangerothers.99After

92Id.3,224P.3dat121314(majorityopinion).

93Id. 10, 224 P.3d at 121415 (While we recognize the extensive briefing by the parties

and amici on the constitutional issues, this Court is guided by the judicial principle that we
shoulddeclinetoruleontheconstitutionalityofalegislativeactifweareabletodecidethe
casewithoutreachingconstitutionalquestions.).
94Id.11,224P.3dat1215.

95Seeid.1314,224P.3dat1215.

96Id.11,224P.3dat1215.

97SeeBaxter,2009MT449,13,224P.3dat1215.

Section455102(1),MCA,statesthatapersoncommitstheoffenseof
deliberate homicide if the person purposely or knowingly causes the
deathofanotherhumanbeing....Section452211(1),MCA,establishes
consent as a defense, stating that the consent of the victim to conduct
charged to constitute an offense or to the result thereof is a defense.
Thus, . . . the physician may be shielded from liability pursuant to the
consentstatute.
Id.(quotingMONT.CODEANN.455102(1),452211(1)(2009)).
98Id.14,224P.3dat1215.

99Id.23,224P.3dat1217.

[A] physician who aids a terminally ill patient in dying is not directly
involved in the final decision or the final act. He or she only provides a
meansbywhichaterminallyillpatienthimselfcangiveeffecttohislife
endingdecision,ornot,asthecasemaybe.Eachstageofthephysician
patientinteractionisprivate,civil,andcompassionate.Thephysicianand
terminally ill patient work together to create a means by which the
patientcanbeincontrolofhisownmortality.
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2010 Legislative Oversight for Physician-Assisted Death 151

a complete analysis of the applicable law, the court determined that the
Montanalegislaturehadcreatedastatutoryschemethatgivesterminally
illMontananstherighttoautonomouslychoosewhathappenstothemat
theendofpainfulterminalillness.100Withthisanalysisthecourtvacated
the ruling of the district court and affirmed the grant of summary
judgment on statutory grounds.101 Although not the sweeping victory
proponents of physicianassisted death were hoping for, this ruling does
protectsphysiciansinMontanafromprosecutionforhelpingterminallyill
patientshastentheirdeaths.102

III.RegulationofPhysicianAssistedDeathintheUnitedStates

In Oregon, the Death with Dignity Act (DWDA)103 was passed in

1994 and was reaffirmed in 1997.104 The DWDA allows for mentally
competent,terminallyillpatientstoprocureprescriptionmedicationfrom
a physician, and selfadminister this prescription to cause a peaceful
death.105 Oregons DWDA is an example of a wellexecuted statute that
both protects vulnerable patients and reduces the risk of abuse.106 The
successoftheDWDAinOregonwasfollowedbythepassageofasimilar

Id.
100Id.45,224P.3dat1221.

101Id.51,224P.3dat1222.

102Kirk Johnson, Montana Ruling by Montana Supreme Court Bolsters Physician Assisted

Suicide,N.Y.TIMES,Jan.1,2010,atA17,availableat2010WLNR31931.
103OR. REV. STAT. 127.800127.995 (2009). Implementation of the DWDA was hindered

forafewyearsbyalawsuitarguingthatthelawwasunconstitutional.SeeLeev.Oregon,891
F.Supp.1429,1431(D.Or.1995),vacated,107F.3d1382,1386(9thCir.1997).
104See David J. Garrow, The Oregon Trail, N.Y. TIMES, Nov. 6, 1997, at A31, available at

1997WLNR4839205.
105OR. REV. STAT. 127.805. The Act requires that Oregon collect data about who uses

DWDAeachyear,andtopublishthedatainannualreports.OR. REV. STAT.127.865;seeOr.

Dept of Human Servs., Death with Dignity Act, OREGON.GOV, http://oregon.gov/dhs/ph/
pas/index.shtml(lastvisitedDec.13,2010).
106JosephB.Straton,PhysicianAssistancewithDying:ReframingtheDebate;RestrictingAccess,

15TEMP. POL. & CIV. RTS. L. REV.475,475(2006);seeMargaretP.Battinetal.,LegalPhysician

Assisted Dying in Oregon and the Netherlands: Evidence Concerning the Impact on Patients in
Vulnerable Groups, 33 J. MED. ETHICS 591, 59497 (2007); Linda Ganzini et al., Oregon
PhysiciansAttitudesAboutandExperienceswithEndofLifeCareSincePassageoftheOregonDeath
with Dignity Act, 285 JAMA 2363, 236768 (2001) (evaluating Oregons experience with its
Death with Dignity Act and concluding that no harm occurred to vulnerable populations);
MelindaA.Lee&SusanW.Tolle,OregonsAssistedSuicideVote:TheSilverLining,124ANNALS
INTERNAL MED. 267, 26869 (1996); Timothy E. Quill & Christine K. Cassel, Professional
OrganizationsPositionStatementsonPhysicianAssistedSuicide:ACaseforStudiedNeutrality,138
ANNALSINTERNALMED.208,209(2003).
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152 NewEnglandLawReview v.45|139

act in Washington in 2008, the Washington Death with Dignity Act,107 a

ballotinitiativethatwasapprovedby58%ofWashingtonvoters.108
As the second state to legalize physicianassisted death, Washington
created a subtly differentstatute from the Oregon model.109 Washingtons
Initiative 1000 (I1000), which passed in 2008, was actually the states
second attempt at legalization for aidindying.110 In 1991, voters had
rejected the first attempt, Initiative 119 (I119), because of its failure to
provide adequate safeguards against misuse.111 Oregons Death with
Dignity Act provided guidance for the framers of Washingtons I1000,112
whichreplicatedOregonsActinpracticallyeveryway.113Thesubstantial
provisions under I1000 include: (1) the patient must be a resident of
Washington114 aged eighteen years or older;115 (2) the patient must be
competent116 and dying from a terminal disease;117 (3) both an attending

107SeegenerallyWASH.REV.CODE70.245(Supp.2010).

108INTL TASK FORCE ON EUTHANASIA & ASSISTED SUICIDE, ATTEMPTS TO LEGALIZE

EUTHANASIA/ASSISTED SUICIDE IN THE UNITED STATES 1 (2009),availableathttp://www.interna

tionaltaskforce.org/pdf/200906_attempts_to_legalize_assisted_suicide.pdf.
109CompareOR. REV. STAT.127.800127.995,withWASH. REV. CODE70.245.Someofthe

differences between Washingtons I1000 and Oregons Death with Dignity Act include:
Washington addresses competent adults, while Oregon speaks of capable ones; Oregon
allowsataxreturntoproveresidency,whileWashingtondoesnot;Washingtonprohibitsthe
medicationsfrombeingdeliveredviathemail,whileOregonallowssuchamodeofdelivery;
Washington requires an annual review of all records maintained by the Act while Oregon
onlyrequiresanannualreviewofasampleofsuchrecords;and,finally,Washingtonrequires
theattendingphysiciantosignthedeathcertificatelistingtheunderlyingterminalillnessas
the cause of death, while Oregon does not require this. See Arthur G. Svenson, Death with
DignitysEmergingConceit:CouldVaccov.QuillBeLosingItsAppeal?,31U. LA VERNE L. REV.
45,5657(2009).
110JanetI.Tu,AssistedSuicideMeasurePasses:Initiative1000,SEATTLE TIMES,Nov.5,2008,at

A3,availableat2008WLNR21162801.
111SeeAndrewM.Jacobs,TheRighttoDieMovementinWashington:RhetoricandtheCreation

of Rights, 36 HOW. L.J. 185, 20305, 20809 (1993) (discussing the absence of psychological
evaluationsandwaitingperiodsintheprovisionsofI119).
112See
Rachel La Corte, State Moves to Implement AssistedSuicide Law, SEATTLE TIMES,
Nov.6, 2008, available at http://seattletimes.nwsource.com/html/localnews/2008360849_web
assisted06.html.
113Curt Woodward, AidinDying Initiative Likely to Make Ballot, Supporters Say, SEATTLE

TIMES, July 2, 2008, http://seattletimes.nwsource.com/html/localnews/2008029707_websuicide

02.html.
114WASH.REV.CODE70.245.130.

115Id.70.245.010(1).

116Id. 70.245.010(3) (stating that a competent patient possesses the ability to make and

communicateaninformeddecisiontohealthcareproviders).
117Id. 70.245.010(13) (defining a terminal disease as one that is incurable and

irreversible and will, within reasonable medical judgment, produce death within six
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2010 Legislative Oversight for Physician-Assisted Death 153

and consulting physician must confirm the patients diagnosis;118 (4) the
patientsdecisiontorequestthelethalprescriptionformedicationmustbe
an informed119 and voluntary one;120 (5) an informed decision is only
present when a physician discusses with the patient relevant facts
detailing diagnosis, prognosis, risks associated with taking the lethal
prescription,andalternatives,suchascomfortcare,hospicecare,andpain
control;121 (6) in cases where the physician suspects psychiatric or
psychological disorder or depression causing impaired judgment, the
patientmustbereferredtoprofessionalcounseling;122(7)further,[a]tleast
fortyeighthoursshallelapsebetweenthedatethepatientsignsthewritten
request and the writing of a prescription;123 (8) the attending physician
shallrecommendthatthepatientnotifynextofkin;124and(9)[a]person
shallnotbesubjecttocivilorcriminalliabilityorprofessionaldisciplinary
actionforparticipatingingoodfaithcompliancewith[it].125
While both are substantially similar, some important distinctions
between Oregons DWDA and Washingtons I1000, include the fact that,
while Oregons Act speaks of capable adults,126 Washingtons speaks of
competent adults.127 Another of the Washington Acts most significant
departures from Oregons is the reporting requirement.128 Washington
requires that the department of health... annually review all records
maintainedunder[theAct],129whileOregononlyrequiresthattheOregon
Health Authority, a state agency, annually review a sample of records

months).
118Id.70.245.050.

119Id.70.245.070.

120WASH.REV. CODE70.245.020,70.245.030.Inordertoprovethatthedecisiontohavea

dignified death was voluntary, the patient must make two oral requests for such dignified
death,fifteendaysapart,andonewrittenrequestthatissignedanddatedbythepatientand
witnessedbyatleasttwoindividualswho...attestthat...thepatientiscompetent,acting
voluntarily,andisnotbeingcoercedtosigntherequest.Id.70.245.030;seeid.70.245.090,
70.245.100.Theattendingphysicianmaynotbeawitness,andoneofthewitnessesmustbea
personwhoisneitherarelative,apersonwhowouldbeentitledtoanyportionoftheestate
of the qualified patient upon death, nor an owner, operator or employee of a health care
facility where the qualified patient is receiving medical treatment or is a resident. Id.
70.245.030.
121Id.70.245.010(7).

122Id.70.245.060.

123Id.70.245.110.

124Id.70.245.040(1)(f).

125Id.70.245.190(1)(a).

126OregonDeathwithDignityAct,OR.REV.STAT.127.800(3)(2009).

127WASH.REV.CODE70.245.010(3).

128Seeid.70.245.150.

129Id.70.245.150(1)(a).
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154 NewEnglandLawReview v.45|139

maintained pursuant [to the Act].130 Despite their differences, both Acts
willinevitablybeutilizedasreferencepointsinthedraftingofanyothers.

IV.RegulationofPhysicianAssistedDeathinOtherCountries

Physicianassisted death is not only a consideration in the United

States;manyothercountrieswrestlewiththisissueaswell.131In1984,the
Netherlandsbecamethefirstnationtoremovepenaltiesforeuthanasiaand
assisted death.132 This was affected by a decision of the Dutch Supreme
Court; guidelines by the Royal Dutch Medical Association quickly
followed.133Theseguidelinesallowedforeuthanasiaandassisteddeathto
put an end to unbearable suffering only upon the entirely free and
voluntary request of the patient.134 However, a survey of the practice
revealedthatin2005therewere500patients(0.4%ofalldeaths)whowere
givenalethalinjectionwithoutfirsthavingaskedforit.135Thisfindingruns
contrary to the promises of Dutch defenders of euthanasia who had
previously stressed that killings not made by explicit request would be
prosecutedasmurder.136AuthoritiesintheNetherlandsnowstatethatitis
the responsibility of competent patients to make it clearorally and in
writingthat they do not want to be given a lethal injection once they
become incompetent.137 While this movement seems to imply that the
original safeguards are eroding, no conclusive evidence of the slippery

130OR.REV.STAT.127.865(1)(a).

131See,e.g.,RaphaelCohenAlmagor,ReflectionsontheIntriguingIssueoftheRighttoDiein

Dignity, 29 ISR. L. REV. 677 passim (1995) (comparing law and policy on euthanasia in the
United States, Canada, Britain, and Israel); Pamela R. Ferguson, Killing Without Getting Into
Trouble? Assisted Suicide and Scots Criminal Law, 2 EDINBURGH L. REV. 288, 289, 293 (1998)
(explaining the current state of Scottish law concerning assistedsuicide and the likely
consequences in light of the opinions of the society and the medical community); Peter J.P.
Tak,RecentDevelopmentsConcerningEuthanasiaintheNetherlands,8TILBURG FOREIGN L. REV.
43, 4344 (2000) (examining the developments in euthanasia law in the Netherlands, where
multipleattemptshavebeenmadetoformulatearegulatoryscheme,butphysicianscontinue
toruntheriskofcriminalprosecution).
132NEILM.GORSUCH,THEFUTUREOFASSISTEDSUICIDEANDEUTHANASIA147(2006).

133John Keown, Euthanasia in the Netherlands: Sliding Down the Slippery Slope?, in

EUTHANASIAEXAMINED:ETHICAL,CLINICALANDLEGALPERSPECTIVES,supranote19,at261.
134Id.at265.

135Agnes van der Heide et al., EndofLife Practices in the Netherlands Under the Euthanasia

Act,356NEWENG.J.MED.1957,1961tbl.1(2007).
136See Keown, supra note 133, at 276 (stating that the Commission aimed to prevent the

killingofacompetentpatientwithoutrequest).
137JOHN KEOWN, CARE NOT KILLING ALLIANCE, CONSIDERING PHYSICIANASSISTED
SUICIDE: AN EVALUATION OF LORD JOFFES ASSISTED DYING FOR THE TERMINALLY ILL BILL 6
(2006),availableathttp://www.carenotkilling.org.uk/pdf/Keown_report.pdf.
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2010 Legislative Oversight for Physician-Assisted Death 155

slopehasbeencollected.138

V. ExperienceofPhysicianAssistedDeathintheUnitedStates

The debate over physicianassisted death has been compared to the

discussions and arguments around the legalization of abortion.139 In
CompassioninDyingv.Washington,JudgeReinhardtstatedthatevenwhen
physicianassisteddeathwasprohibited,asabortionwasformanyyears,it
was still performed behind closed doors.140 Proponents of physician
assisted death could argue, as the proponents of abortion did, that
condemnation, rather than legalization, results in more risk to the
patient.141 Opponents of physicianassisted death fear that legalization
wouldharmthepublicbecause,whenassisteddeathisnotalegaloption,
the focus of care remains on treatment of pain or the underlying disease,
rather than the termination of life.142 However, if assisted death is a legal
alternative, the system could shift its focus to considering whether
continuedcareisworthit.143
Oneofthemainargumentsagainstphysicianassisteddeathistherisk
of misuse by patients and physicians.144 Opponents argue that banning
physicianassisted death will protect patients that may otherwise be
coercedintoacceptingsuchassistancewiththeirdeaths.145Theyarguethat
theelderlyandthosewithoutmoneytopayformedicalcareareatriskfor
beingcompelledtoacceptthischoice.146Further,theyfearthatitcouldbea
slippery slope from physicianassisted death to involuntary

138Seegenerally,Keown,supranote133,at26289.

139See, e.g., Compassion in Dying v. Washington, 79 F.3d 790, 801 (9th Cir. 1996) (citing

Planned ParenthoodofSe.Pa.v.Casey,505U.S. 833,851(1991))(stating that,like abortion,

the right to die is a matter involving the most intimate and personal choices a person may
make in a lifetime, choices central to personal dignity and autonomy), revd sub nom.
Washington v. Glucksberg, 521 U.S. 702 (1997). In addition, both activities will continue
despiteprohibition.Seeid.
140Id.
141Cf.BriefofRespondentsat3839,Washingtonv.Glucksberg,521U.S.702(1997)(No.96

110). Dr. Glucksbergs patient jumped from a bridge and Dr. Halperins patient suffocated
herself.Id.at27.
142Brief of Sen. Orrin Hatch et al. as Amici Curiae in Support of the Petitioners at 910,

Vaccov.Quill,521U.S.793(1997)(No.951858).
143Id. (The decision to cling to life may come to be regarded as wasteful, irrational, and

selfish.).
144See, e.g., Glucksberg, 521 U.S. at 732 (We have recognized . . . the real risk of subtle

coercionandundueinfluenceinendoflifesituations.).
145Jones,supranote23,at8081.

146Id.at81.
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156 NewEnglandLawReview v.45|139

euthanasia.147Criticsalsofearmisdiagnosis,wheretheprognosisisnotas
bleakasthephysicianoriginallydetermined;thusthepatientsdecisionto
terminate his or her life could be based on a faulty prognosis or
diagnosis.148
There is also a concern that depression or other factors could cloud a
persons capacity for rational decision making and that this could effect
competency evaluations.149 In 2006, the Royal College of Psychiatrists in
England stated that studies have clearly shown that the request for
assisted death among terminallyill patients is strongly associated with
depression.150Theyfurtherreportedthatthedepressionandeventhepain
can generally be relieved by medical and psychological treatments,
following which,[9899%] will subsequently change their mindsabout
wanting to die.151 Finally, critics argue physicians are bound by their
ethicalcode152torefrainfromtakingaffirmativestepstowardthehastening
of death, and if some physicians were to practice assistance in dying,
patientscouldcometodistrustallphysicians.153
InthefirstnineyearsoftheDWDA,only292Oregoniansutilizedit.154
Since going into effect, the rate of DWDA utilization has gradually
increased, although it still remains relatively low.155 In 2005, use of the

147SeeGlucksberg,521U.S.at732([T]heStatemayfearthatpermittingassistedsuicidewill

startitdownthepathto...involuntaryeuthanasia.).
148SeeJones,supranote23,at81.

149Id.

150StatementonPhysicianAssistedSuicide,ROYAL COLLEGEOF PSYCHIATRISTS,2.4(Apr.24,

2006),http://www.rcpsych.ac.uk/press/collegeresponses/physicianassistedsuicide.aspx.
151Id.

152See 2 THE GENUINE WORKS OF HIPPOCRATES 77980 (Francis Adams trans., London, C.

andJ.Adlard1849).
I swear by Apollo the physician, and sculapius, and Health and
Allheal, and all the gods and goddesses, that, according to my ability
and judgment, I will keep this Oath . . .. I will follow that system of
regimenwhich,accordingtomyabilityandjudgment,Iconsiderforthe
benefit of my patients, and abstain from whatever is deleterious and
mischievous. I will give no deadly medicine to any one if asked, nor
suggestanysuchcounsel....
Id.
153Jones,supranote23,at81.

154OR. PUB. HEALTH DIV., OR. DEPT OF HUMAN SERVS., OREGONS DEATH WITH DIGNITY

ACT2006,at1(2007),availableathttp://oregon.gov/DHS/ph/pas/docs/year9.pdf.
155OFFICE OF DISEASE PREVENTION & EPIDEMIOLOGY, OR. DEPT OF HUMAN SERVS., EIGHTH

ANNUAL REPORT ON OREGONS DEATH WITH DIGNITY ACT 45 (2006) [hereinafter EIGHTH
ANNUALREPORT],availableathttp://oregon.gov/dhs/ph/pas/docs/year8.pdf.
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2010 Legislative Oversight for Physician-Assisted Death 157

DWDArepresentedonlytwelveofevery10,000deaths.156The2008Death
with Dignity Annual Report shows that a total of 401 Oregon residents
haveinvokedtheActsinceitsenactment.157
Outside observers have remarked that the fears about physician
assisteddeathmayhavebeenunnecessaryinlightofthecurrentstudiesof
its implementation.158 A report prepared for the Vermont legislature
examiningtheexperienceinOregon,concluded:Itisquiet[sic]apparent
fromcrediblesourcesinandoutofOregonthattheDeathwithDignityAct
hasnothadanadverseimpactonendoflifecareandinallprobabilityhas
enhanced the other options.159 As one scholar has said: I worried about
peoplebeingpressuredtodothis.Butthisdataconfirms...thatthepolicy
inOregonisworking.Thereisnoevidenceofabuseorcoercion,ormisuse
ofthepolicy.160
Eventoitsfiercestopponents,thesuccessoftheDWDAinOregonhas
proven that the dire predictions about the results of this Act were
unfounded;theoptionofhavingadignifieddeathhasnotbeenforcedon
disadvantaged members of the population.161 A report analyzing whether
the DWDA put vulnerable patients at risk found no evidence to support
suchaconclusion.162Rather,thedatacollectedshowstheoppositeresult.163
Onereportevenrevealedaconnectionbetweenahigherlevelofeducation
andthosewhoutilizedtheAct;thosewithacollegedegreeorhigherwere
7.9timesmorelikelytorequestadignifieddeaththanthosewithoutahigh

156Id.

157OR. PUB. HEALTH DIV., OR. DEPTOF HUMAN SERVS., 2008 SUMMARYOF OREGONS DEATH

WITHDIGNITYACT2(2009),availableathttp://oregon.gov/DHS/ph/pas/docs/year11.pdf.
158SeeLUNGEETAL.,supranote18,3(E).

159 Id.
160William McCall, AssistedSuicide Cases Down in 04, COLUMBIAN (Vancouver, Wash.),

Mar.11,2005,atC2,availableat2005WLNR3866738(quotingArthurCaplan,Directorofthe
CenterforBioethicsattheUniversityofPennsylvaniaSchoolofMedicine).
161See,
e.g., Ctr. for Disease Prevention & Epidemiology, OR. DEPT OF HUMAN RES.,
OREGONS DEATH WITH DIGNITY ACT: THE FIRST YEARS EXPERIENCE 7 (1999), available at
http://www.oregon.gov/DHS/ph/pas/docs/year1.pdf (Patients who chose physicianassisted
suicide were not disproportionately poor (as measured by Medicaid status), less educated,
lackingininsurancecoverage,orlackinginaccesstohospicecare.).SeegenerallyKantPatel,
Euthanasia and PhysicianAssisted Suicide Policy in the Netherlands and Oregon: A Comparative
Analysis, 19 J. HEALTH & SOC. POLY 37 (2004) (finding no evidence of a slippery slope in
Oregon).
162SeeBattinetal.,supranote106,at59496(showingnoevidenceofheightenedriskforthe

elderly, women, the uninsured, people with low educational status, the poor, the physically
disabledorchronicallyill,minors,peoplewith psychiatricillnessesincludingdepression,or
racialorethnicminorities).
163SeeJones,supranote23,at8182.
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158 NewEnglandLawReview v.45|139

school diploma.164 Further, patients did not choose assisted death as a

resultofbeinguninsured;itwasfoundthatallpatientsusingaidindying
in Oregon in 2005 had some form of health insurance,165 and 92% were
receivinghospice166care.167Theprocedureofwithdrawingtreatmentfrom
the poor, elderly, incompetent, disabled, and disadvantaged groups has
notcometopassasfeared.168
Oregons experience with the DWDA demonstrates that patients are
not put at risk if a carefully drafted law is in place and that [it] has not
beenunwillinglyforcedonthepoor,uneducated,uninsured,orotherwise
disadvantaged,169andithasevenledsomemedicalorganizationstoadopt
a position in support of such laws.170 One study found that physicians in
Oregon granted only one in six requests for aid in dying; there is no
evidenceofthegrossoverusethatwasfeared.171Thestudyalsofoundthat
thealleviationofdepressionhadnoobservableimpactonapatientsendof
life decisions, as those decisions were based on long held beliefs and

164EIGHTHANNUALREPORT,supranote155,at12.

165Id.at23tbl.4.

166See generally Natl Hospice & Palliative Care Org., Hospice, CARING CONNECTIONS,

http://www.caringinfo.org/LivingWithAnIllness/Hospice.htm(lastvisitedDec.13,2010)(The
focus of hospice relies on the belief that each of us has the right to die painfree and with
dignity, and that our loved ones will receive the necessary support to allow us to do so.
Hospice focuses on caring, not curing and, in most cases; care is provided in the persons
home. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing
homesandotherlongtermcarefacilities.Hospiceservicesareavailabletopatientsofanyage,
religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private
insuranceplans,HMOs,andothermanagedcareorganizations.).
167EIGHTHANNUALREPORT,supranote155,at12.

168SeeJones,supranote23,at8182.

169PatientsRightstoSelfDeterminationattheEndofLife, AM. PUB. HEALTH ASSN (Oct.28,

2008),http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1372.
170See,e.g.,id.;KathrynL.Tucker,AttheVeryEndofLife:TheEmergenceofPolicySupporting

AidinDyingAmongMainstreamMedical&HealthPolicyAssociations,AM.MED.WOMENSASSN
CONNECTIONS, Spring 2009, at 5, available at http://www.amwadoc.org/gallery268/Connections
ArchiveSpring2009 ([O]rganizations adopting policy in support of aid in dying include the
American Medical Womens Association (AMWA), the American Medical Student
Association (AMSA), the American College of Legal Medicine (ACLM), and the American
Public Health Association (APHA). . . . What prompted so many medical and health policy
associationstobreakwithtraditiononthisissuein2008?Theanswer,inshort,isevidence.);
seealsoJayCohen,CAPGSupportsAB374:TheCompassionateChoicesAct,CAPGUPDATE,Mar.
2007, at 9, available at http://www.capg.org/docs/capg_updatemarch_2007.pdf (supporting
passageofanOregontypeaidindyinglawinCalifornia).
171See Linda Ganzini et al., Physicians Experiences with the Oregon Death with Dignity Act,

342 NEW ENG. J. MED. 557, 56061 (2000) (finding that the availability of palliative care led
some,butnotall,patientstochangetheirmindsabouthasteneddeath).
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2010 Legislative Oversight for Physician-Assisted Death 159

morals.172Anotherfearwasthatphysicianswouldnolongerreferpatients
to hospice care, but would instead urge patients to receive aid in dying;
however, it was found that 30% of physicians increased their number of
referrals to hospice care and 76% worked to increase their knowledge of
painmedication.173HospicenursesandsocialworkerssurveyedinOregon
reportedthattheynotedanincreaseinphysiciansknowledgeofpalliative
care174andwillingnessofphysicianstoreferpatientstohospicecarefrom
1998to2003.175
Another concern of opponents of physicianassisted death is that it
couldstrainthedoctorpatientrelationship.176Thisviewisgroundedinthe
beliefthatphysicianassisteddeathisfundamentallyinconsistentwiththe
physiciansroleasahealerandthatsanctioningthepracticecouldserveto
undermine the patients belief that the physician is working
wholeheartedly for the patients health and welfare.177 Opponents claim
supportforthisfindingbycitingtheexperienceofphysicianassisteddeath
in the Netherlands,178 where physicians are allowed to assist with death
under strict guidelines, stating that some physicians are already
deliberately causing the death of their patients even when there has been
no request by the patient to do so.179 However, the fact that health care
providers regularly assist patients in dying has not yet diminished the
integrityofthemedicalprofessionorcausedthefearedresidualdistrustof
healthcareprovidersingeneral.180
Physicianassisteddeathhasenjoyedincreasedsupportinpartbecause

172Seeid.at557,560.

173Ganzinietal.,supranote106,at2365.

174Palliativecareisthestandardofcarewhenterminallyillpatientsfindthattheburdens

of continued lifeprolonging treatment outweigh the benefits. See generally Council on

ScientificAffairs,Am.Med.Assn,GoodCareoftheDyingPatient,275JAMA474,47677(1996).
175ElizabethR.Goyetal.,OregonHospiceNursesandSocialWorkersAssessmentofPhysician

Progress in Palliative Care Over the Past 5 Years, 1 PALLIATIVE & SUPPORTIVE CARE 215, 217
(2003).
176SeeJones,supranote23,at81.

177Seeid.

178Thesestatisticshavebeenrefutedinotherstudies,andtheaccuracyofreportsregarding

theexperienceintheNetherlandsisunclear.ROBERTP.JONES,LIBERALISMSTROUBLEDSEARCH
FOR EQUALITY: RELIGION AND CULTURAL BIAS IN THE OREGON PHYSICIANASSISTED SUICIDE
DEBATES 120 (2007) (noting that the Netherlands homogeneous population, universal
healthcare, and tendency to prefer euthanasia to other palliative care results in a difficult
comparisonwiththeUnitedStates).
179See
Washington v. Glucksberg, 521 U.S. 702, 786 (1997) (Souter, J., concurring)
(expressing concern that the Dutch experience cannot show conclusively that regulation of
physicianassisteddeathhascausedanincreaseordecreaseininvoluntaryactsofeuthanasia).
180Jones,supranote23,at82.
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160 NewEnglandLawReview v.45|139

most of the fears regarding the practice were not realized following the
enactment of the statutes in Oregon and Washington.181 Even prior to the
success of the DWDA, the majority of U.S. citizens supported assisted
dying, at least in some contexts.182 The statistics reveal that the primary
argumentagainstphysicianassisteddeath,theconcernthatsanctioningit
could result in a diminished value of and respect for life in general, is
unfounded.183

VI.ProposedRegulationofPhysicianAssistedDeath

A. TheNeedtoRegulatePhysicianAssistedDeath

Thepreferablewaytoestablisharighttophysicianassisteddeathisto
statutorilyauthorizeandregulatethepractice.184Furthermore,evenif,asin
thecaseofBaxterv.State,acourtdeterminesthatphysicianassisteddeath
shouldbepermitted,regulationsarenecessarytomanagethepracticeand
to provide protections against abuse.185 Some argue that there is no need
for legislation in states where assisting death is not specifically outlawed
because physicians may act without fearing prosecution.186 Additionally,
otherssaycreatingastatutetoregulateassistedsuicidewouldonlymake
suicidemoreaccessible,andconsequentlyitcouldbecomemorecommon,
perhapsleadingtoitbeingforcedonpatientswhohavenotrequestedit.187
ThisNoteassertstheopposite.188
ItisthepremiseofthisNotethatthemedicalprofessionandsocietyas
a whole will be better served by a clear statute expressly permitting
physicianassisted death only within specific and clearly defined
boundaries.189Anexpressstatuteisanecessaryresponsetoapracticethat,

181Seeid.at8182.
182SeeCompassioninDyingv.Washington,79F.3d790,810(9thCir.1996),revdsubnom.

Washingtonv.Glucksberg,521U.S.702(1997).
183Cf.Jones,supranote23,at8182.
184See,e.g.,Baronetal.,supranote17,at12.

185SeeGuyI.Benrubi,EuthanasiaTheNeedforProceduralSafeguards,326NEW ENG. J. MED.

197, 19798 (1992) (proposing safeguards such as certification and special qualification for
physiciansassistinginsuicide).
186See, e.g., Leonard H. Glantz, Withholding and Withdrawing Treatment: The Role of the

CriminalLaw,15L.,MED.&HEALTHCARE231,232(1987).
187See, e.g., George J. Annas, Death by PrescriptionThe Oregon Initiative, 331 NEW ENG. J.

MED. 1240,1243(1994)(describingthepotentialinvolvementofpharmacists,physicians,and
terminallyillpatientsinaregimeinwhichphysicianassistedsuicideispermitted).
188Seeinfranotes18997andaccompanyingtext.

189SeeinfraPartVI.B.
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2010 Legislative Oversight for Physician-Assisted Death 161

iflegalizedandleftunregulated,couldresultinseriousmisuse.190First,in
stateswhereassisteddeathisnotprohibitedbystatute,physiciansareleft
toinferthelegalityofcertainmeansofassistingwithapatientsdeath.191In
states which have specifically outlawed assisted death, physicians risk
felonyprosecutionforfulfillingapatientsrequestforaidindying.192Asa
result, patients seeking assistance with death are often denied such
assistance.193Second,physicianswhochoosetoassistapatientinhisorher
deathinsucharegimedosoinaclandestinemannertoavoidprosecution,
and could consequently fail to encourage the patient to fully explore all
aspects of their case with family, friends, and other medical
professionals.194 Third, physicians who currently provide assistance in
death where doing so is outlawed do so in a vacuumfree of
accountability, regulation, and guidelines.195 Fourth, patients who fail to
procuretheassistanceofaphysicianoftenchoosetoendtheirliveswithout
professional assistance and without access to the best means available.196
Finally, some patients may choose to end their own lives prematurely by
refusing treatment because they fear the decision will be unavailable to
them later, when their pain and suffering becomes intolerable.197 It is the
abovesituationsthatstatutoryregulationwilladdressandremedy.

B. StatutoryFrameworktoRegulatePhysicianAssistedDeath

A proper statute must strike a balance between protecting vulnerable

patientsandpopulationswhilesimultaneouslyprovidingpatientswiththe
choice of a dignified death in their final days.198 In Baxter v. State, the
Montana Supreme Court acknowledged that further regulation of
physicianassisted death would be necessary and urged the legislature of
Montanatorespond.199ThecourtinBaxtersimplyheldthatphysicianaid

190SeeTimothyE.Quilletal.,TheDebateOverPhysicianAssistedSuicide:EmpiricalDataand

ConvergentViews,128ANNALSINTERNALMED.552,556(1998).
191See,e.g.,Peoplev.Kevorkian,527N.W.2d714,73839(Mich.1994).

192SeeGlantz,supranote186,at23233.
193SeeDEREK HUMPHRY, LET ME DIE BEFORE I WAKE711,3444(1981)(discussingthestory

oftwopatientswhowishedtocommitsuicidebutstruggledwiththeirillnessesforyears).
194ContraQuill,supranote40.

195Seeid.

196See,e.g.,GEORGE HOWE COLD, THE ENIGMAOF SUICIDE373(1991)(discussingdisastrous

suicideattempts);HUMPHRY,supranote193,at4555(discussingabotchedsuicideattempt).
197See DEREK HUMPHRY, FINAL EXIT: THE PRACTICALITIES OF SELFDELIVERANCE AND

ASSISTEDSUICIDEFORTHEDYING10305(1991).
198SeesupraPartV.

199Baxterv.State,2009MT449,56,354Mont.234,56,224P.3d1211,1223(Warner,J.,

concurring)(Inmyview,thecitizensofMontanahavetherighttohavetheirlegislaturestep
uptotheplateandsquarelyfacethequestionpresentedbythiscase,dotheirjob,anddecide
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162 NewEnglandLawReview v.45|139

in dying is not illegal or against public policy.200 Since the additional

regulation that should follow such a decision has yet to be proposed and
passed,201thefollowingstatutewillprovideamodelforsuchregulation.202
InMontana,theonlycurrentregulationofphysicianassisteddeathisthat
itshouldnotviolatepublicpolicy.203Thosewhoopposephysicianassisted
death due to a fear of misuse or abuse should lend their support to
statutoryregulation,astheyhaveevenmoretofearinastatewheresucha
practiceisallowedbythecourtsyetunregulatedbythelegislature.204

justwhatisthepolicyofMontanaonthisissue.).
200Id.53,224P.3dat1222(TheCourtsopiniontodayanswersthestatutoryquestion:is

it,asamatteroflaw,againstthepublicpolicyofMontanaforaphysiciantoassistamentally
competent,terminallyillpersontoendtheirlife?Theanswerprovidedis:No,itisnot,asa
matteroflaw.).
201Inresponse totheMontanaSupremeCourt holding,Rep.DickBarrettof theMontana

HouseofRepresentativesstated:
I think that we need to amend the rights of the terminally ill statutes to
address [physicianassisted death] explicitly. Specifically, we need a
policy that establishes who may request [physicianassisted death],
protects vulnerable populations from being coerced into requesting
[physicianassisted death] against their will, protects physicians from
sanctions from hospitals and professional organizations, etc. [A] law,
rather than a court decision, is a better way to regulate the practice. In
fact, the Court decision does not affirmatively regulate PAD at all; it
decriminalizes it. From my point of view, that is as it should be, but ...
importantpublicpolicyissues[areleft]unaddressed.
EmailfromDickBarrett,Representative,Mont.HouseofRepresentatives,toauthor(Mar.16,
2010,12:13EST)(onfilewithauthor).Rep.Barrettplanstoproposeaphysicianassisteddeath
lawsimilartoOregonswhentheLegislatureconvenesinJanuary2011;thislawwillaimto
providedoctorswithprotectionfromcivilliabilityandtoinstitutewaitingperiods,reporting
requirements, and other patient protections. See Kevin B. OReilly, PhysicianAssisted Suicide
Legal in Montana, Court Rules, AMEDNEWS.COM, Jan. 18, 2010, http://www.ama
assn.org/amednews/2010/01/18/prsb0118.htm. For an update on Rep. Barretts efforts, see
CharlesS.Johnson,OpposingRighttoDieBillsLikelyHeadtoLegislature,HELENA INDEP. REC.,
(July 9, 2010, 12:08 AM) http://helenair.com/news/article_964ad35a8b2011dfb14f
001cc4c03286.html.
202SeeinfraPartVI.B.12.

203SeeBaxter,2009MT449,49,224P.3dat1222.

204See, e.g., Paul J. van der Maas et al., Euthanasia, PhysicianAssisted Suicide, and Other

Medical Practices Involving the End of Life in the Netherlands, 19901995, 335 NEW ENG. J. MED.
1699,16991705(1996).
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2010 Legislative Oversight for Physician-Assisted Death 163

1. Definitions205

Some important terms will be defined as follows: adult shall be

understoodtomeananindividualwhoiseighteenyearsofageorolder;an
informed decision shall mean that an individual has made a decision
based on a full appreciation for and knowledge of the relevant facts
regarding diagnosis, prognosis, risks, results and alternatives; capable
shallbedeterminedbythecourtortheindividualsphysician,psychiatrist,
or psychologist and shall mean that the patient has the ability to
communicate their health care decisions; a terminal disease is one that
will, within reasonable medical judgment, result in death within six
months; medical shall mean use of a medical substance or device
prescribedforthepatientandsuppliedtothepatientbyaphysicianrather
thananunapproveddrugorfirearmorothersuchnonmedicalmeans.206

2. NecessaryProvisionsThatShouldbeIncludedinaStatute
RegulatingPhysicianAssistedDeath

Under this statute, the patient may make either a written or verbal
requestforaprescriptionmedicationthatheorshewillusetobringabout
death.207 The patient shall request such prescription from his or her
physician.208 While the Oregon Death with Dignity Act provides for
requests in writing only,209 this proposed statute recognizes that during
sufferingattheendoflife,theabilitytowriteorevensignarequestmay
beimpossible.210Thusarequest,previouslywrittenandsigned,intheform
of a health care proxy or living will, is acceptable documentation of the
patients immediate request for aid in dying.211 However, to safeguard
against the risk of coercion by interested individuals who stand to gain
financiallyin the event of the patients death, two disinterested witnesses
mustbepresentwhentherequestismade.212Underthisproposedstatute,

205TheworkofProfessorBaronandhiscolleaguesservesasatemplateforthisproposal.

SeeBaronetal.,supranote17passim.
206Seeid.at10,1718(providingsimilardefinitions).
207See id. at 17 (stating that the identification of prescription medication is important, as

othernonmedicalmeanssuchasfirearmswillnotbeallowedunderthisstatute).
208Seeid.

209OregonDeathwithDignityAct,OR.REV.STAT.127.805(2009).

210 See TaiYuan Chiu, End of Life Decision Making in Taiwan, in ENDOFLIFE DECISION

MAKING: A CROSSNATIONAL STUDY, at 169, 176 (Robert H. Blank & Jenna C. Merrick eds.,
2005).
211 See, e.g., id. at 17677 (discussing an act in Taiwan allowing the use of consent forms

signed beforehand regarding a patients wish not to be resuscitated or to access hospice or

palliativecare).
212 SeeBaronetal.,supranote17,at19.
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164 NewEnglandLawReview v.45|139

the request shall be made no less than seven days prior to the patient
obtaining the prescription.213 In the Oregon DWDA, the waiting period is
fifteen days from the date of the patients oral request, a delay that for
somemaybetoolong.214Whilethewaitingperiodisputinplacetoensure
that the patients desire for assistance with death is enduring, too long a
waiting period may prevent patients in their final days from achieving
suchrelief.215
Theparticipatingphysicianwillberesponsibleforensuringthatallof
the conditions above have been met, including that the request was
informedandthatthepersonwascompetentwhenmakingthedecision.216
Similar to the informed consent that is required for ordinary medical
treatment,thephysicianmustdeterminewhethertherequestiscompetent,
fully informed, voluntary, and enduring.217 This section of the statute is
important because it safeguards against coercion and ensures that the
patientisactivelyparticipatinginandcontrollinghisorherowndecision
making, rather than passively complying with the recommendations of
others.218 Finally, the physician must ensure that the patient consults a
second physician to confirm both the patients competency and the
terminalityofhisorherillness.219
Toavoidasituationwhereapatientrequestsassistanceindyingonly
as a result of an underlying depression or other mental illness, the
physician should refer any appropriate patients to a counselor prior to
providing assistance with death.220 However, a patient suffering with
depression may still make an informed and competent decision to have
assistance with death, provided the depression is not distorting the
patientsjudgmentonthatspecificmatter.221Apsychiatristorpsychologist

213 See David Casarett, Understanding and Improving Hospice Enrollment, LEONARD DAVIS

INST. HEALTH ECON., Dec. 2005/Jan. 2006, at 1,1, available at http://www.upenn.edu/ldi/

issuebrief11_3.pdf(notingthatthemedianlengthofstayinahospiceislessthanthreeweeks).
214OR.REV.STAT.127.850.

215SeeBaronetal.,supranote17,at19(discussingthebalancebetweenpreventinghasty

decisionmakingandtheprolongingofunbearablesuffering).
216Seeid.

217Baronetal.,supranote17,at18.Toenablepatientstomakecompetent,fullyinformed,

and voluntary decisions, physicians have a duty to disclose to patients all material
information relevant to their decision. See Canterbury v. Spence, 464 F.2d 772, 78687 (D.C.
Cir. 1972); Cobbs v. Grant, 502 P.2d 1, 1011 (Cal. 1972); Harnish v. Childrens Hosp. Med.
Ctr.,439N.E.2d240,243(Mass.1982).
218SeeBaronetal.,supranote17,at17,19.

219SeeOR.REV.STAT.127.820.

220Id.127.825.

221SeeLindaGanzinietal.,TheEffectofDepressionTreatmentonElderlyPatientsPreferences

for LifeSustaining Medical Therapy, 151 AM. J. PSYCHIATRY 1631, 163435 (1994) (revealing a
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2010 Legislative Oversight for Physician-Assisted Death 165

must ensure that the patients decision is one that is in keeping with the
patients wishes and not resulting from the mental and emotional
distortionthatresultsfromdepression.222Thephysicianmusthaveagood
faithbeliefthatalloftheaforementionedconditionshavebeenmetpriorto
providingtheprescription.223
Oneofthemostimportantrequirementsoftheproposedstatuteisthat
the physician must document the request and the fulfillment of that
request in the patients medical record, along with any other
documentation ordinarily required by physicians in that state.224 The
Oregon DWDA unnecessarily goes further to require that the physician
documentthereportofthecounselor,anoffertothepatienttorescindhis
or her request, and note by the physician attesting that all the conditions
havebeenmet;225thoserequirementsareintentionallyexcludedhere.Such
information, however, must be made available to the Department of
Health, which will annually collect and review the data.226 Finally, the
statute must explicitly provide that physicians assisting patients in dying
intheabovementionedcircumstancesshallnotbeprosecutedorsubjectto
criminalorcivilliabilityinanyway.Theaforementionedregulationswill
provide a process by which physicians may assist patients who request a
dignified death; physicians will be free from fear of prosecution and the
riskofabuseandmisusewillbeminimal.

CONCLUSION

Since 1996, the option of physicianassisted death has been legal and
availableinOregon.227TwelveyearslaterthestateofWashingtonvotedto
legalize and regulate physicianassisted death.228 By the end of 2008,
Montana joined them and now allows physicianassisted death.229 Thus,
over the last fourteen years, three states have voted, or courts in those

studythatfoundthatremissionofdepressiondidnotchangethepatientswishtorefuselife
sustainingtreatment).
222MelindaA.Lee,DepressionandRefusalofLifeSupportinOlderPeople:AnEthicalDilemma,

38J.AM.GERIATRICSSOCY710,712(1990).
223OR.REV.STAT.127.825.

224 See MARGARET PABST BATTIN, ENDING LIFE: ETHICS AND THE WAY WE DIE 27 (2005)

(discussing the possibility of abuse by physicians and asserting that legalization is the best
waytoimplementthenecessaryoversightandpreventinstancesofabuse).
225 Id.127.855.
226 See BATTIN, supra note 224, at 94 (revealing a need for record keeping to monitor for

instancesofabuseor,alternatively,tohighlightsuccessofcertainsafeguards).
227Garrow,supranote104.

228Tu,supranote110.

229SeeBaxterv.State,2009MT449,1214,354Mont.234,1214,224P.3d1211,1215.
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166 NewEnglandLawReview v.45|139

stateshavedecided,toallowthisoptiontoterminallyillresidents.230Ifthis
trendcontinues,thiscouldbethelastcenturyinwhichphysicianassisted
deathisillegalinthemajorityofstates.Inordertowardagainstabuseand
misuse of this practice while also ensuring it is available to those who
requestit,statesshouldproactivelyregulatephysicianassisteddeath.The
regulation proposed in this Note provides safeguards and guidelines
whichwillensuresuccessfulimplementationofphysicianassisteddeath.

230Seesupratextaccompanyingnotes22729.