Medical Aid In Dying Is Not Assisted Suicide, Suicide or Euthanasia

Medical aid in dying is fundamentally different from euthanasia.

Medical aid in dying is a practice by which a terminally ill, mentally capable person with a prognosis of six months or less chooses to request, obtain and take medication that brings about a peaceful death. In all authorized jurisdictions, only the dying person can request an aid-in-dying prescription under the law, and if and when they decide to ingest the medication, they must self-administer it. Therefore, control stays with the patient from beginning to end. 

In contrast, euthanasia, sometimes called “mercy killing,” is an intentional act by which another person (not the dying person) acts to cause death. Euthanasia is illegal throughout the United States, and all medical aid-in-dying laws expressly prohibit euthanasia. Compassion & Choices does not support authorizing euthanasia because it would allow someone else — not the dying person — to cause the death of another.  

State legislatures and courts in states where the practice is authorized recognize medical aid in dying as differing from suicide, assisted suicide or euthanasia.

The conflation — intentional or accidental — of medical aid in dying with suicide perpetuates false, harmful and stigmatizing information. Suicide is a public health and medical concern that requires collective efforts to address. Medical aid in dying is available only to terminally ill people who are mentally capable with a prognosis of six months or less to live. Euthanasia and assisted suicide are both illegal in jurisdictions where medical aid in dying is authorized. Medical aid-in-dying laws on the books in California, Colorado, the District of Columbia, Hawai‘i, Maine, New Mexico, New Jersey, Oregon, Vermont and Washington state that actions taken in accordance with [the Act] 

do not, for any purpose, constitute suicide or assisted suicide. And in Montana, where assisted suicide is specifically illegal, the Montana Supreme Court ruled in Baxter v. Montana that “we find no indication in Montana law that physician aid in dying provided to terminally ill, mentally competent adult patients is against public policy.”

Leading medical organizations reject the term “physician-assisted suicide."

The American Academy of Hospice and Palliative Medicine, American Medical Women’s Association, American Medical Student Association, American Academy of Family Physicians and American Public Health Association have all adopted policies opposing the use of the terms “suicide” and “assisted suicide” to describe the medical practice of aid in dying. 

The most prominent professional society in the United States addressing issues that arise at the interface of law and medicine rejects the term “physician-assisted suicide.”

The American College of Legal Medicine filed an amicus brief before the United States Supreme Court in 1996 rejecting the term and adopted a resolution in 2008 in which they “publicly advocat[ed the] elimination of the word ‘suicide’ from the lexicon created by a mentally competent, though terminally ill, person who wishes to be aided in dying.”  

Resources

1. Oregon Death With Dignity Act. Oregon Revised Statute. Chapter 127. Enacted October 27, 1997. http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx
2. Washington Death With Dignity Act. Complete Chapter 70.245 RCW, Complete Chapter. Enacted November 4, 2008. http://www.wsha.org/wp-content/uploads/Death-with-Dignity_i1000-text.pdf
3. Vermont Patient Choice and Control at the End of Life Act. Act 039, Chapter 113. Enacted May 2013. http://www.leg.state.vt.us/docs/2014/Acts/ACT039.pdf
4. California End of Life Option Act. ABX2-15 End of life. Enacted October 2015. http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520162AB15
5. Colorado End of Life Options Act. Proposition 106. October 2016. Available from http://www.sos.state.co.us/pubs/elections/Initiatives/titleBoard/filings/2015-2016/145Final.pdf
6. District of Columbia, Death with Dignity Act, Available from  https://dchealth.dc.gov/sites/default/files/dc/sites/doh/page_content/attachments/Death%20With%20Dignity%20Act.FINAL_.pdf
7. American Public Health Association, Patients’ Rights to Self-Determination at the End of Life. October 28, 2008, Policy No. 20086. Available from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/29/13/28/patients-rights-to-self-determination-at-the-end-of-life
8. American College of Legal Medicine, ACLM Policy on Aid in Dying. Effective October 6, 2008. Available here ACLM Policy on Aid in Dying
9. American Medical Women’s Association, Position Paper on Aid in Dying. Approved September 9, 2007. https://www.amwa-doc.org/wp-content/uploads/2018/09/Medical-Aid-in-Dying-Position-Paper.pdf
10. American Medical Student Association, Principles Regarding Physician Aid in Dying. In: AMSA Preamble, Purposes and Principles, p.79. Available from http://www.amsa.org/wp-content/uploads/2015/03/PPP-2015.pdf
11. American Academy of Hospice and Palliative Medicine, Statement on Physician-Assisted Death. February 14, 2007. Available from http://aahpm.org/positions/pad
12. Reisch, T., et al. (1999) Efficacy of Crisis Intervention. J of Crisis Intervention and Suicide Prevention. 20(2): 78-85.
13. Linda Ganzini et al., Physicians’ Experiences with the Death With Dignity Act, The New England Journal of Medicine 342 (8); Linda Ganzini et al., Mental Health Outcomes of Family Members of Oregonians Who Request Physician Aid in Dying, 38 J. of Pain and Symptom Management 807 (2009); Linda Ganzini, et al.,Oregon Physicians’ Attitudes About and Experiences With End-of-Life Care Since Passage of the Oregon Death with Dignity Act, J. of the American Medical Association 285 (2001)
14. Neil, F.; Physician use of misinformation to speculate ‘assisted dying suicide contagion’ in Oregon, Journal of Assisted Dying 2016;1(1):1–6
15. Ann M. Mitchell et al., Complicated Grief in Survivors of Suicide, 25 (1) J. of Crisis and Suicide Prevention 12-18 (2004).
16. Orentlicher, D., Pope, T.M., Rich, B.A. (2015) Clinical Criteria for Physician Aid in Dying. Journal of Palliative Medicine. 18(x): 1-4. Available from https://cndcstaging.wpengine.com/wp-content/uploads/2024/03/journal-of-palliative-medicine-clinical-criteria-2015-1.pdf