Euthanasia is illegal in most of the United States. Assisted suicide/assisted death is legal in Washington, D.C.[1] and the states of California, Colorado, Oregon, Vermont, New Jersey (Starting August 1, 2019),[2] Hawaii, and Washington;[3][4] its status is disputed in Montana. The key difference between euthanasia and assisted suicide is that in cases of assisted suicide, the individual receives assistance, but ultimately voluntarily causes their own death. In euthanasia the individual does not directly end their life, but another person acts to cause the individual's death.[5]

Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pain of death. In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient's life. Over the next 35 years, debates about euthanasia raged in the United States which resulted in an Ohio bill to legalize euthanasia in 1906, a bill that was ultimately defeated.[6]

Euthanasia advocacy in the U.S. peaked again during the 1930s and diminished significantly during and after World War II. Euthanasia efforts were revived during the 1960s and 1970s, under the right-to-die rubric, physician assisted death in liberal bioethics, and through advance directives and do not resuscitate orders.

Several major court cases advanced the legal rights of patients, or their guardians, to practice at least voluntary passive euthanasia (physician assisted death). These include the Karen Ann Quinlan case (1976), Brophy and Nancy Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg (1997) and the Terri Schiavo case. The numerous legislative rulings and legal precedents that were brought about in the wake of the Quinlan case had their ethical foundation in the famous 1983 report completed by the President's Commission for the Study of Ethical Problems in Medicine, under the title "Deciding to Forgo Life-Sustaining Treatment."[7] The Commission sustained in its findings that it was morally acceptable to give up a life-supporting therapy and that withholding or withdrawing such a therapy is the same thing from an ethical stand-point, while artificial feeding and other life-supporting therapy are of the same importance for the patients and doctors. Before this report, to withdraw a medical therapy was regarded as much more serious decision than not to start a therapy at all, while artificial feeding was viewed as a special treatment. By 1990, barely a decade and a half after the New Jersey Supreme Courts historic decision, patients were well aware that they could decline any form of medical therapy if they simply choose to do that either directly or by expressing their wish via appointed representative.

In a 2004 article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. The driving force behind this movement was social activist Anna S. Hall. Canadian historian Ian Dowbiggen's 2003 book, A Merciful End, revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

In the 1983 case of Barber v. Superior Court, two physicians had honored a family's request to withdraw both respirator and intravenous feeding and hydration tubes from a comatose patient. The physicians were charged with murder, despite the fact that they were doing what the family wanted. The court held that all charges should be dropped because the treatments had all been ineffective and burdensome. Withdrawal of treatment, even if life-ending, is morally and legally permitted. Competent patients or their surrogates can decide to withdraw treatments, usually after the treatments are found ineffective, painful, or burdensome.[8]

On May 31, 2013, the Maine state legislature rejected decriminalization of physician assisted suicide and voluntary euthanasia (95-43).

In the United States legal and ethical debates about euthanasia became more prominent in the Karen Ann Quinlan case who went into a coma after allegedly mixing tranquilizers with alcohol, surviving biologically for 9 years in a "persistent vegetative state" even after the New Jersey Supreme Court approval to remove her from a respirator. This case caused a widespread public concern about "lives not worth living" and the possibility of at least voluntary euthanasia if it could be ascertained that the patient would not have wanted to live in this condition.[9] In April 2019, New Jersey became the 7th US state to allow assisted dying after the Governor of New Jersey signed the bill into law and goes into effect on August 1, 2019.[10]

In 1999, the state of Texas passed the Advance Directives Act. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support measures, such as mechanical respiration, from terminally ill patients when such treatment is considered to be both futile and inappropriate. This is sometimes referred to as "passive euthanasia".

In 2005, a six-month-old infant, Sun Hudson, with a uniformly fatal disease thanatophoric dysplasia, was the first patient in which "a United States court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child's parent".[11]

Attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and legislation bills within the United States in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, Oregon passed the Death with Dignity Act in 1994, and Michigan included Proposal B in their ballot in 1998.

Reflecting the religious and cultural diversity of the United States, there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States. During the past 30 years, public research shows that views on euthanasia tend to correlate with religious affiliation and culture, though not gender.

In one recent study dealing primarily with Christian denominations such as Southern Baptists, Pentecostals, and Evangelicals and Catholics tended to be opposed to euthanasia. Moderate Protestants, (e.g., Lutherans and Methodists) showed mixed views concerning end of life decisions in general. Both of these groups showed less support than non-affiliates, but were less opposed to it than conservative Protestants. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did. The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were not similar to those of non-affiliates. Within all groups, religiosity (i.e., self-evaluation and frequency of church attendance) also correlated to opinions on euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed to euthanasia than to those who had a lower level of religiosity.[12]

Recent studies have shown white Americans to be more accepting of euthanasia than black Americans. They are also more likely to have advance directives and to use other end-of-life measures.[13] African Americans are almost 3 times more likely to oppose euthanasia than white Americans. Some speculate that this discrepancy is due to the lower levels of trust in the medical establishment.[14] Select researchers believe that historical medical abuses towards minorities (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. One study also found that there are significant disparities in the medical treatment and pain management that white Americans and other Americans receive.[15]

Among African Americans, education correlates to support for euthanasia. Black Americans without a four-year degree are twice as likely to oppose euthanasia than those with at least that much education. Level of education, however, does not significantly influence other racial groups in the US. Some researchers suggest that African Americans tend to be more religious, a claim that is difficult to substantiate and define.[14] Only black and white Americans have been studied in extensive detail. Although it has been found that minority groups are less supportive of euthanasia than white Americans, there is still some ambiguity as to what degree this is true.

A 2005 Gallup Poll found that 84% of males supported euthanasia compared to 64% of females.[16] Some cite the prior studies showing that women have a higher level of religiosity and moral conservatism as an explanation for major opposition to euthanasia. Within both sexes, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that black American women are 2.37 times more likely to oppose euthanasia than white American women. African American men are 3.61 times more likely to oppose euthanasia than white American men.[17]

In "Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia" Susan M. Wolf warns of the gender disparities if euthanasia or physician-assisted suicide were legal. Wolf highlights four possible gender effects: higher incidence of women than men dying by physician-assisted suicide; more women seeking physician-assisted suicide or euthanasia for different reasons than men; physicians granting or refusing requests for assisted suicide or euthanasia because of the gender of the patient; gender affecting the broad public debate by envisioning a woman patient when considering the debate.[18]

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Euthanasia in the United States - Wikipedia