In November, 1994, voters in Oregon approved the
Death with Dignity Act by a margin of 51 to 49 per-
cent. The act permitted physicians to provide drugs
to induce death in qualified patients. This was the
first (and still the only) law of its kind. A similar mea-
sure had been defeated in Washington in 1991 and
in California the following year, both by a 55 to 46
percent margin.
According to the act, a candidate for physician-
assisted suicide must be an adult and an Oregon resi-
dent and has to personally initiate the request to be
aided by a physician in inducing death. The suicide
candidate has to be free of documented depression
and has to be diagnosed by two doctors as terminally
ill, with a reasonable expectation of no more than six
months to live. Physicians have to inform the suicide
applicants of the prognosis regarding their condi-
tion; alternative options, including hospice care;
potential risks of the procedure (there have been
reports of prolonged periods between taking the
drugs and death); and medication that would con-
trol pain. The law also establishes a fifteen-day wait-
ing period between the patient’s request and the
signing of a consent form. Thereafter, the doctor
can prescribe lethal doses of drugs that the patient is
required to self-administer.
Oregon is a relatively secular state. A 1995 survey
found that 60 percent of the 2,761 Oregon doctors
responding had no ethical objections to prescribing
deadly drugs, and a sizeable number indicated that
in treating terminally ill patients in the past they had
prescribed drugs to control pain that also hastened
death.
Court and Congressional Action Injunctions held
up implementation of the results of the 1994 Ore-
gon Death with Dignity referendum. Meanwhile,
citizens in New York (inVacco v. Quill, 1997) and
Washington (inWashington v. Glucksberg, 1997) chal-
lenged the right of their legislatures to ban physician-
assisted suicide. The Supreme Court upheld the
states’ prohibition on assisted suicide. The Court
emphasized that the states are the proper forum for
the approval or disapproval of assisted-suicide laws.
The Court also declared that were a state to pass a
law endorsing physician-assisted suicide, this would
not violate the constitutional requirements of due
process and equal protection. A second referendum
was called for by the Oregon legislature seeking the
repeal of the original measure. It failed in the No-
vember, 1997, vote by a 60 to 40 percent margin.
Congressional disavowal of physician-assisted sui-
cide was expressed in the federal Assisted Suicide
Funding Restriction Act of 1997, which forbade the
use of federal moneys to support such programs.
This was followed in 1997 by a declaration from the
federal Drug Enforcement Administration (DEA)
stating that it would initiate actions under the Con-
trolled Substances Act to revoke the license of any
physician who prescribed death-inducing drugs.
That action, however, was overturned by the Depart-
ment of Justice on the ground that it was beyond the
authority of the DEA.
The Oregon Health Division monitors the phy-
sician-assisted suicide program. Its initial report
covered the period from November, 1997, through
December, 1998. During that time, twenty-three pa-
tients had applied for physician-assisted suicide
and fifteen had died by its use, while six died of
their illness, and two were still alive. Most patients
were suffering from cancer. Their average age was
sixty-nine, and all were white. In 1999, there were
thirty-three applications and twenty-seven deaths
by physician-assisted suicide. The average age that
year was seventy-one, and in both reports the pa-
tients were about evenly divided by gender. Neither
financial considerations nor pain were said to un-
derlie the decision to seek death but rather the is-
sue of personal autonomy and control over the
method of dying.
Pros and Cons Civil liberties advocates have gener-
ally hailed the Death with Dignity Act as providing
freedom from religious doctrines that insisted that
suicide was immoral because it represented a usur-
pation of divine prerogative to determine matters of
life and death. The American Medical Association
argued against physician-assisted suicide on the
grounds that it violated a doctor’s obligation to pro-
tect and preserve human life. Other opponents of
the process regard it as a “slippery slope,” an entry
point to authorize physicians to kill elderly incapaci-
tated persons and children born with disabilities. It
is also argued that the Oregon law might encourage
some persons to give up rather than to fight to con-
struct what could be a fulfilling existence. Also, the
desire to save money might result in pressure ex-
erted on terminally ill persons to end their lives.
Impact The physician-assisted program has had
more symbolic than practical importance outside ofThe Nineties in America Physician-assisted suicide 671