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The deliberate taking of one's own life.

Under COMMON LAW, suicide, or the intentional taking of one's own life, was a felony that was punished by FORFEITURE of all the goods and chattels of the offender. Under modern U.S. law, suicide is no longer a crime. Some states, however, classify attempted suicide as a criminal act, but prosecutions are rare, especially when the offender is terminally ill. Instead, some jurisdictions

require a person who attempts suicide to undergo temporary hospitalization and psychological observation. A person who causes the death of an innocent bystander or would-be rescuer while in the process of attempting suicide may be guilty of murder or MANSLAUGHTER.

More problematic is the situation in which someone helps another to commit suicide. Aiding or abetting a suicide or an attempted suicide is a crime in all states, but prosecutions are rare. Since the 1980s the question of whether physician-assisted suicide should be permitted for persons with terminal illnesses has been the subject of much debate, but as yet this issue has not been resolved.

The debate over physician-assisted suicide concerns persons with debilitating and painful terminal illnesses. Under current laws a doctor who assists a person's suicide could be charged with aiding and abetting suicide. Opponents of decriminalizing assisted suicide argue that decriminalization would lead to a "slippery slope" that would eventually result in doctors being allowed to assist persons who are not terminally ill to commit suicide.

The debate on physician-assisted suicide intensified after 1990 when Dr. JACK KEVORKIAN, a retired Michigan pathologist, began to attend many suicides. Kevorkian admitted to obtaining carbon monoxide and instructing persons who suffered from terminal or degenerative diseases on how to administer the gas so they would die. Despite the efforts of Michigan legislators and prosecutors to convict Kevorkian of murder, the pathologist, who was dubbed "Doctor Death," successfully fought the charges. Three murder charges were dismissed by Michigan courts, and in 1994 Kevorkian was acquitted of violating Michigan's assisted suicide law (Mich. Comp. Laws § 752.1021 et seq.). Despite Kevorkian's acquittals other assisted suicide advocates believe his methods have actually hurt the cause. In 1997 the U.S. Supreme Court held that neither the DUE PROCESS CLAUSE (WASHINGTON V. GLUCKSBERG, 521 U.S. 702, 117 S. Ct. 2258, 138 L. Ed. 2d 772) nor the EQUAL PROTECTION CLAUSE (Vacco v. Quill, 521 U.S. 743, 117 S. Ct. 2293, 138 L. Ed. 2d 834) of the FOURTEENTH AMENDMENT includes a right to assisted suicide.

After four acquittals, Kevorkian was convicted in March 1999 of second-degree murder and delivery of a controlled substance by a jury in Pontiac, Michigan. Kevorkian administered a lethal injection in September 1998 to Thomas Youk, a 52-year-old man who suffered from amyotrophic lateral sclerosis, or Lou Gehrig's disease, a fatal neurological disorder that slowly disables its victims. Kevorkian performed the procedure on the CBS television program 60 Minutes amid great controversy.

At the time of his trial, Kevorkian represented himself, insisting that only he could explain to the jury that he did not intend to kill Youk but to end his suffering. The jury nevertheless reached a guilty verdict. Although he could have been sentenced to life in prison, he was sentenced to ten to 25 years in prison. He sought unsuccessfully for three years to appeal his conviction.

Kevorkian was not entirely alone in his crusade to legalize assisted suicide. In 1994, Oregon voters passed the Oregon Death with Dignity Act (DWDA), which allows physicians to prescribe lethal medication to Oregon residents who request it. The statute requires that the patient must be 18 years or older, must be able to make and communicate HEALTHCARE decisions, and have been diagnosed with a terminal illness that likely will result in death within six months. While physicians may make the prescription, patients must self-administer it, since the DWDA specifically prohibits "lethal injection, mercy killing, or active euthanasia." Oregon is the only jurisdiction in the world that has legalized physician-assisted suicide.

The Oregon legislature enacted the DWDA after residents voted in favor of the law twice, 51 percent in favor in 1994, then 60 percent in 1997. The law originally went into effect in 1994 but immediately was suspended by court injunctions pending legal challenges. After the Supreme Court rendered its decisions in Glucksberg and Vacco, the Ninth Circuit Court of Appeals lifted the INJUNCTION. The Oregon law went into effect on October 27, 1997.

Between 1998 and 2001, between 70 and 96 patients—the exact numbers are disputed—committed suicide under the act. In November 2001, U.S. attorney general JOHN ASHCROFT issued a directive stating that physicians who prescribe lethal doses of drugs to end the lives of terminally ill patients would be subjected to criminal charges and have their medical licenses revoked or suspended. Ashcroft issued this directive pursuant to the Controlled Substances Act and reversed the position previously taken by former attorney general JANET RENO, who determined that the Oregon statute was outside the scope of the Controlled Substances Act. Members of Congress, including Senator Orrin Hatch (R-Utah) and Representative Henry Hyde (R-IL), also unsuccessfully sought to pass federal legislation that would have revoked the registration of Oregon physicians who participated in assisted suicide efforts.

In response to Ashcroft's order, the state of Oregon brought suit against the attorney general, seeking a permanent injunction to prevent him and the U.S. JUSTICE DEPARTMENT from enforcing the directive. In April 2002, U.S. District Court Judge Robert E. Jones issued the injunction and also criticized Ashcroft for his handling of the directive. According to Jones, the Controlled Substances Act was not intended to override a state's decision concerning what constitutes legitimate medical practice, at least in the absence of federal law prohibiting such a practice. The judge also found that Congress never intended, through the Controlled Substances Act or other federal law, to grant blanket authority to the attorney general or the Drug Enforcement Agency to define what constitutes the legitimate practice of medicine.

The DWDA has strict requirements that are designed to prevent abuse of the act. Patients must make two verbal requests for lethal medication separated by at least 15 days, plus a written request. Two physicians must independently confirm that the patient has a terminal illness likely to result in death within six months and that the patient is capable to make and communicate healthcare decisions. If either physician believes the patient suffers from depression or any other psychiatric disorder, he or she must refer the patient for counseling. The prescribing physician must request, but not require, the patient to inform his or her next of kin of the suicide decision. The prescribing physician also must inform the patient of alternatives to suicide, including hospice care and pain control, and give the patient the opportunity to change his or her mind after the 15 day waiting period.

The strict DWDA requirements have not silenced its critics. Opponents in the medical community, including Physicians for Compassionate Care, believe that physician-assisted suicide is contrary to the profession's purpose—to promote health. Religious opponents, including the Roman Catholic Church, Mormons, and Christian fundamentalists, feel that suicide of any kind devalues life. Not Dead Yet, an organization of DISABLED PERSONS, believes that states should instead enact legislation to improve access to health and hospice care, and the over-all quality of life, for terminally ill patients. Many opponents are concerned that poor or uneducated patients will be pressured by family members or the healthcare insurance industry to chose death over life with its medically expensive consequences.

To the supporters of physician-assisted suicide, the issue is a matter of personal autonomy and control. The Hemlock Society, an organization that supports physician-assisted suicide, claims that terminally ill patients must be allowed to end their lives voluntarily rather than suffer through the painful and disabling effects of a terminal illness.

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