Patient choice at the end of life: Getting the language right

Journal of Legal Medicine

Volumn 28, Issue 3, 2007, Pages 305-325

  Tucker, Kathryn L ^a   Steele, Fred B ^b  

^a LEWIS AND CLARK LAW SCHOOL   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ASSISTED SUICIDE; EUTHANASIA; HUMAN; HUMAN DIGNITY; LEGAL ASPECT; LETHALITY; LIVING WILL; PATIENT RIGHT; PROPHYLAXIS; REVIEW; RIGHT TO DIE; TERMINAL DISEASE;

HUMANS; LEGISLATION, MEDICAL; RIGHT TO DIE; SUICIDE, ASSISTED; TERMINOLOGY AS TOPIC;

EID: 34648836944     PISSN: 01947648     EISSN: 1521057X     Source Type: Journal    
DOI: 10.1080/01947640701554427     Document Type: Review

References (149)

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2. Thomas Koenig, Reframing Frame Analysis: Systematizing the Empirical Identification of Frames Using Qualitative Data Analysis Software 2 (paper presented at the ASA Annual Meeting, San Francisco, CA, Aug. 14-17, 2004).
3. GEORGE LAKOFF, WOMEN, FIRE, AND DANGEROUS THINGS: WHAT CATEGORIES REVEAL ABOUT THE MIND 6 (1987).
4. GAIL T. FAIRHURST & ROBERT A. SARR, THE ART OF FRAMING: MANAGING THE LANGUAGE OF LEADERSHIP 4 (1996).
5. Id.
6. See, e.g., GEORGE LAKOFF, MORAL POLITICS: WHAT CONSERVATIVES KNOW THAT LIBERALS DON'T (1996) [hereinafter MORAL POLITICS];
7. GEORGE LAKOFF, DON'T THINK OF AN ELEPHANT! KNOW YOUR VALUES AND FRAME THE DEBATE (2004) [hereinafter ELEPHANT];
8. Scott Davies, From Moral Duty to Cultural Rights: A Case Study of Political Framing in Education, 72 SOC. EDUC. 1 (1999) (presenting a study of the use of framing in the battle between religion and education within Canadian politics).
9. Claes H. De Vreese, The Effects of Frames in Political Television News on Issue Interpretation and Frame Salience, 81 JOURNALISM & MASS COMM. Q. 37 (2004).
10. MORAL POLITICS, supra note 6, at 33.
11. Id. at 18.
12. ELEPHANT, supra note 6, at 15-26 (describing the birth in the 1970s of conservative think tank organizations such as the Heritage Foundation and the Olin Institute at Harvard, which has resulted in a refined approach to framing every political issue in a conservative mold).
13. See, e.g., ELEPHANT, supra note 6, at xv (discussing the work of the Rockridge Institute, of which Lakoff is a Senior Fellow, see http://rockridgeinstitute.org/aboutus, as the only liberal think tank focused on the reframing of issues dominated by conservative frames);
14. see also Longview Institute, http://www.longviewinstitute.org/ aboutus ("Our belief in individual liberty, accompanied by collective responsibility, is deeply rooted in the highest ideals of the American progressive tradition. Working with others, we seek to influence Americans to think about old problems in new ways and to change the terms of debate.");
15. The Opportunity Agenda, http://www.opportunityagenda.org ("By employing a coordinated strategy that includes communications work, research and policy analysis, and advocacy, The Opportunity Agenda ties together the work of diverse social justice and issue groups, and creates effective strategies to expand opportunity in America.");
16. Important Life Decisions, http://www.importantlifedecisions.org/about.htm (representing a newinitiative formed in 2006 between the Women Donors Network and the Communications Consortium Media Center with the intention of developing a new framing language for issues of reproductive health and other "issues that American voters overwhelmingly support such as birth control, stem cell research and end-of-life issues").
17. Davies, supra note 6, at 6 (citing David A. Snowet al., Frame Alignment Processes, Micromobolization, and Movement Participation, 51 AM. SOC. REV. 464 (1986)).
18. Paul Rogers, Opponents Able, to Stall initiatives from Bush, HERALD NEWS (Passaic Cty., N.J.), Apr. 23, 2006, at A01.
19. Paul Krugman, Forest Plan Is Another Gambit to Expand Corporate Welfare, SEATTLE POST-INTELLIGENCER, Aug. 28, 2002, at B6.
20. Clean-Air Charade: Bush's Plan Postpones Pollution Limits, THE RECORD (Bergen County, N.J.), May 6, 2002, at I06.
21. Margaret Krome, Editorial, No Child Left Behind Isn't Fixing Our Schools, CAPITAL TIMES (Madison, Wis.), Aug. 31, 2005, at 10A.
22. Editorial, Spying by Another Name, L.A. TIMES, Jan. 26, 2006, at B12.
23. ELEPHANT, supra note 6, at 100.
24. Id.
25. MORAL POLITICS, supra note 6, at 6.
26. Leslie Joan Harris, Semantics and Policy in Physician-Assisted Death: Piercing the Verbal Veil, 5 ELDER L.J. 251, 268-69 (1997).
27. See generally RAPHAEL COHEN-ALMAGOR, THE RIGHT TO DIE WITH DIGNITY: AN ARGUMENT IN ETHICS, MEDICINE, AND LAW (2001) (although making distinctions between physician-assisted suicide, death with dignity, and euthanasia, simultaneously using them interchangeably at times);
28. RAYMOND WHITING, A NATURAL RIGHT TO DIE: TWENTY-THREE CENTURIES of DEBATE 17 (2002).
29. See, e.g., James L.Werth, Mental Health Professionals and Assisted Death: Perceived Ethical Obligations and Proposed Guidelines for Practice, 9 ETHICS & BEHAV. 159 (1999);
30. Mary Ersek, The Continuing Challenge of Assisted Death, 6 J. HOSPICE & PALLIATIVE NURSING 46 (2004);
31. PHYSICIAN-ASSISTED DEATH (James M. Humber et al. eds., 1994).
32. See, e.g., Alan Meisel, Ethics and Law: Physician-Assisted Dying, 8 J. PALLIATIVE MED. 609 (2005);
33. Margaret P. Battin & Timothy E. Quill, Introduction, in PHYSICIAN-ASSISTED DYING: THE CASE FOR PALLIATIVE CARE & PATIENT CHOICE 1-2 (Margaret P. Battin & Timothy E. Quill eds., 2004).
34. See, e.g., James H. Pietsch, Health Care Decision Making and Physician-Aid-in-Dying in Hawaii, 25 J. LEGAL MED. 303 (2004).
35. See, e.g., Werth, supra note 23, at 141.
36. See, e.g., David J. Garrow, The Right to Die: Death with Dignity in America, 68MISS. L.J. 407 (1998); COHEN-ALMAGOR, supra note 22.
37. See, e.g., TOM PRESTON, PATIENT-DIRECTED DYING: A CALL FOR LEGALIZED AID IN DYING FOR THE TERMINALLY ILL (2006).
38. See, e.g., WHITING, supra note 22.
39. See, e.g., HAZELL BIGGS, EUTHANASIA, DEATH WITH DIGNITY AND THE LAW 60 (2001).
40. See, e.g., SUSAN M. BEHUNIAK & ARTHUR G. SVENSON, PHYSICIAN-ASSISTED SUICIDE: THE ANATOMY OF A CONSTITUTIONAL LAW ISSUE 1 (2003);
41. ASSISTED SUICIDE: FINDING COMMON GROUND (Lois Snyder & Arthur L. Caplan eds., 2002).
42. Leslie Bender, A Feminist Analysis of Physician-Assisted Dying and Voluntary Active Euthanasia, 59 TENN. L. REV. 519, 530 (1992) (explaining this use of "physician" in a discussion that should be about "the entire decision-making process and the dying person").
43. WHITING, supra note 29, at 17 (discussing the "Evolution of Terminology").
44. Id. at 15.
45. Id. at 17.
46. Id. at 17-18.
47. Id. at 18 (providing that, "[g]iven the vague and ill-defined nature of the mere terminology linked to this issue, it is little wonder that many choose to create their own lexicon rather than use a term that may inadvertently endorse a view the author did not intend").
48. James L. Werth, The Relationships Among Clinical Depression, Suicide, and Other Actions that May Hasten Death, 22 BEHAV. SCI. & L. 627, 629 (2004).
49. Id.
50. Id.
51. Battin & Quill, supra note 24, at 2. However, after emphasizing the importance of using neutral terminology, they inconsistently accept the term physician assisted suicide "interchangeably."
52. PRESTON, supra note 28.
53. Id. at xvii.
54. Id.
55. Id.
56. Bender, supra note 32, at 534-39; see infra text accompanying notes 107-09.
57. See BEHUNIAK & SVENSON, supra note 31, at 1.
58. For detailed discussion, see infra text accompanying notes 79-100.
59. BIGGS, supra note 30, at 60.
60. John M. Strate et al., Physician-Assisted Suicide and the Politics of Problem Definition, 10 MORTALITY 23 (2005). The authors report on the results of the debate between the groups that participated in the state legislatively-mandated Michigan Commission on Death and Dying in 1993, with three distinct definitions of the issue (or "problem," as they refer to it) resulting. They label the first group the "personal autonomy faction" because of its support for legalizing assisted death with restrictions, the second group the "disabilities faction" for its recognition of (though opposition to) the possible legalization of assisted death, but with this faction's focus on having increased protections for the aged and disabled, and the third group the "sanctity-of-life faction" for its complete opposition to the legalization of any assisted death.
61. See generally ELEPHANT, supra note 6.
62. Harris, supra note 21, at 274.
63. Bender, supra note 32, at 529 (explaining "suicide" is incompatible with this discussion because of the belief that "[a]n act or decision is not inherently suicide" but that "[a] social context is needed to understand the act, making suicide a social construct," and if the context of "wrongfulness, irrationality, or coercion . . . [are] absent from the event," then suicide would not be applicable).
64. Id.
65. Many have recognized the troublesome connection of euthanasia with Nazi Germany. These include DANIEL HILLYARD & JOHN DOMBRINK, DYING RIGHT: THE DEATH WITH DIGNITY MOVEMENT 7 (2001); WHITING, supra note 22, at 17. However, Leslie Bender takes another step in recognizing that this "troublesome connection" actually results in an entirely new meaning of the word.
66. Bender, supra note 32, at 529.
67. See BIGGS, supra note 30, at 12; COHEN-ALMAGOR, supra note 22, at 81; CHARLES MCKHANN, A TIME TO DIE, THE PLACE FOR PHYSICIAN ASSISTANCE 4 (1999); HILLYARD & DOMBRINK, supra note 55, at 7; WHITING, supra note 22, at 17.
68. Bender, supra note 32, at 531 (discussing the typical distinctions made in breaking euthanasia down into four distinct categories, and dispelling these distinctions as "false dualisms"). The active versus passive and voluntary versus involuntary distinctions may also be found, for example, in BIGGS, supra note 30, at 12 (where "[d]efinitions of euthanasia include distinction between active and passive responses, which are drawn according to the manner in which death is procured and relate closely to the legal understanding of act and omission," and where "[e]uthanasia is sometimes also characterized as voluntary, non-voluntary and involuntary, where voluntary denotes that it is performed with the consent of the recipient. Non-voluntary euthanasia occurs where the person concerned has been unable to express an opinion, usually because she lacks the capacity so to do, but others consider that it is in her best interests to end her life at this time. Within this framework involuntary euthanasia occurs where the recipient has not agreed to the procedure and is an unwilling participant.").
69. OR. REV. STAT. §§ 127.800-127.897. "Humane and dignified" is the language utilized within Oregon's Death with Dignity statute to describe the ending of one's life via a prescribed medication.
70. Id.
71. Implementation was obstructed for several years by a lawsuit brought by opponents who argued that a law permitting terminally ill patients to choose physician assistance in dying denied the terminally ill equal protection of the laws. The Ninth Circuit dismissed the case on the grounds that the plaintiffs lacked standing. See generally Lee v. Oregon, 891 F. Supp. 1429 (D. Or. 1995), vacated, 107 F.3d 1382 (9th Cir. 1997).
72. OR. REV. STAT. § 127.805 (2005).
73. Id. § 127.815.
74. Id. § 127.800 (12).
75. Id. § 127.800 (7).
76. Id. §§ 127.800 (8) & 127.820.
77. Id. §§ 127.840-127.850.
78. Id. § 127.885.
79. Id. § 127.865.
80. See DEP'T HUMAN SERV., OFFICE OF DISEASE PREVENTION & EPIDEMIOLOGY, EIGHTH ANNUAL REPORT ON OREGON'S DEATH WITH DIGNITY ACT (Mar. 9, 2006);
81. DEP'T HUMAN SERV., OFFICE OF DISEASE PREVENTION & EPIDEMIOLOGY, SEVENTH ANNUAL REPORT ON OREGON'S DEATH WITH DIGNITY ACT (Mar. 10, 2005);
82. DEP'T HUMAN SERV., OFFICE OF DISEASE PREVENTION & EPIDEMIOLOGY, SIXTH ANNUAL REPORT ON OREGON'S DEATH WITH DIGNITY ACT (Mar. 10, 2004);
83. DEP'T HUMAN SERV., OFFICE OF DISEASE PREVENTION & EPIDEMIOLOGY, FIFTH ANNUAL REPORT ON OREGON'S DEATH WITH DIGNITY ACT (Mar. 6, 2003);
84. DEP'T HUMAN SERV., OFFICE OF DISEASE PREVENTION & EPIDEMIOLOGY, FOURTH ANNUAL REPORT ON OREGON'S DEATH WITH DIGNITY ACT (Feb. 6, 2002);
85. DEP'T HUMAN RESOURCES, OR. HEALTH DIV. & CTR. FOR DISEASE PREVENTION & EPIDEMIOLOGY, OREGON'S DEATH WITH DIGNITY ACT: THREE YEARS OF LEGALIZED PHYSICIAN-ASSISTED SUICIDE (Feb. 22, 2001);
86. AMY D. SULLIVAN ET AL., DEP'T HUMAN RESOURCES, OR. HEALTH DIV. CTR. FOR DISEASE PREVENTION & EPIDEMIOLOGY, OREGON'S DEATH WITH DIGNITY ACT: THE SECOND YEAR'S EXPERIENCE (Feb. 23, 2000);
87. ARTHUR E. CHIN ET AL., DEP'T HUMAN RESOURCES, OR. HEALTH DIV. CTR. FOR DISEASE PREVENTION & EPIDEMIOLOGY, OREGON'S DEATH WITH DIGNITY ACT: THE FIRST YEAR'S EXPERIENCE, DEPARTMENT OF HUMAN RESOURCES (Feb. 18, 1999).
88. This experience is rich with information about whether the practice has posed any risks to patients or the medical profession. Discussion of what can be gleaned from the data is the focus of numerous articles. See, e.g., Kathryn Tucker, U.S. Supreme Court Ruling Preserves Oregon's Landmark Death with Dignity Law, 2 NAELA J. 291, 291 (2006);
89. Amy D. Sullivan et al., Legalized Physician-Assisted Suicide in Oregon: The Second Year, 342 NEW ENG. J. MED. 598 (2000);
90. Arthur E. Chin et al., Legalized Physician-Assisted Suicide in Oregon: The First Year's Experience, 340 NEW ENG. J. MED. 577 (2001);
91. Lawrence O. Gostin, Physician-Assisted Suicide: A Legitimate Medical Practice?, 295 J.A.M.A. 1941 (2006);
92. Timothy E. Quill & Christine K. Cassel, Professional Organizations' Position Statements on Physician-Assisted Suicide: A Case for Studied Neutrality, 138 ANNALS INTERN. MED. 208, 208-11, app. at 3 (2003).
93. See Or. Dep't of Human Serv., Death with Dignity, http://www.oregon.gov/DHS/ph/pas/ar-index.shtml (last visited Mar. 21, 2007).
94. Kevin B. O'Reilly, Oregon Nixes Use of Term "Physician Assisted Suicide," AMEDNEWS.COM, Nov. 6, 2006 (quoting Katrina Hedberg, a DHS Public Health Division medical epidemiologist).
95. See Or. Dep't of Human Serv., Death with Dignity, http://www.oregon.gov/DHS/ph/pas/ar-index.shtml (last visited Mar. 21, 2007).
96. OR. REV. STAT. § 127.880 (2005).
97. See, e.g., Howard Wineberg & James L. Werth, Physician-Assisted Suicide in Oregon: What Are the Key Factors?, 27 DEATH STUDIES 501, 502 (2003). In footnote 1, the authors explain: "Although we do not think that deaths occurring under the Act constitute 'suicide' in the traditional sense, we use the term PAS for the same reasons as the Oregon Department of Human Services."
98. See, e.g., Jack. L. Landau, Interpreting Statutes Enacted by Initiative: An Assessment of Proposals, 34 WILLAMETTE L. REV. 487, 489 (1998) ("It is common for courts to explain that initiated statutes or constitutional amendments are construed by application of the same interpretive principles that govern the construction of legislatively enacted laws. Thus, a court will frequently attempt to ascertain legislative - that is, voter - intent, by applying various interpretive canons and by examining the text of the enactment and its 'legislative history,' as embodied in the voters' pamphlet and similar extrinsic materials.").
99. See OR. SEC'Y OF STATE, OREGON OFFICIAL 1994 GENERAL ELECTION VOTERS' PAMPHLET (1994). The Measure 16 ballot title is: "Allows Terminally Ill Adults to Obtain Prescription for Lethal Drugs." The explanatory statement provides: "This measure does not authorize lethal injection, mercy killing or active euthanasia. Actions taken in accordance with this measure shall not constitute suicide, assisted suicide, mercy killing, or homicide, under the law." All "Argument in Favor" statements reference "right to die," "right of dying," "a humane and dignified death," "Death with Dignity," "dying adults who wish to end their suffering," or "end-of-life decisions," but there was no mention of suicide or assisted suicide.
100. E. James Lieberman, Letter to the Editor, Death with Dignity, 41 PSYCHIATRIC NEWS 29, (Aug. 6, 2006).
101. Rhea K. Farberman, Terminal Illness and Hastened Death Requests: The Important Role of the Mental Health Professional, 28 PROF'L PSYCHOL.: RES. & PRAC. 544 (1997).
102. See generally CHARLES MCKHANN, A TIME TO DIE: THE PLACE FOR PHYSICIAN ASSISTANCE (1999) (renowned oncologist and professor of medicine at Yale University exploring the language issue extensively).
103. Id. at 3-5.
104. PRESTON, supra note 28, at xvi-xvii.
105. Tom Preston, Editorial, Medieval Thinking No Help to Dying, SEATTLE POST-INTELLIGENCER, May 3, 2006, at B7. Dr. Preston prefaces his explanations with the question: Who decides how and when will we die? We have pre-empted natural dying with our medical interventions, so why shouldn't the patient decide the mode and time of dying, consistent with his or her values, rather than leaving it to the ravages of "doing everything possible" or the whim of the medical resident on call?
106. James E. Dallner & D. Scott Manning, Death with Dignity in Montana, 65 MONT. L. REV. 309, 314-15 (2004).
107. Harris, supra note 21, at 251.
108. Id. at 267-68 (generally discussing the "Language and the Law and Ethics of Dying," and recognizing the "rhetorical battle" that has encompassed debates about physician assisted death).
109. Bender, supra note 32, at 527-29.
110. Id. at 528-30 (discussing the "Power of Naming" and the use of various terms in the "assisted dying" debate, recognizing that "defining or naming a problem is a political act"). Id. at 527.
111. Garrow, supra note 27, at 408 (briefly introducing the language debates that occur on this topic, but specifically mentioning that use of the phrases "death with dignity" or "compassion in dying" evoke a largely affirmative public opinion polling response, whereas use of the words "suicide" or "kill" results in a 15-20% decrease in the affirmative responses in similar polling).
112. Harris, supra note 21, at 272.
113. Id. at 278.
114. Id.
115. Id. at 279.
116. Bender, supra note 32, at 520 (citing a Congressional Act, numerous cases, two reports on the topic, two organizations' guidelines for withholding life-sustaining or life-prolonging treatment, and a law review article).
117. Id. at 527.
118. Frederick R. Parker et al., Life Insurance, Living Benefits, and Physician-Assisted Death, 22 BEHAV. SCI. & L. 615, 616 (2004) (demonstrating the confusion that exists by linking PAD with "suicide," with the authors noting that the "suicide clause" of a life insurance policy precludes payments for physician-assisted deaths as well as suicide "because a physician's assistance in accelerating the moment of an insured's death would just as certainly remove fortuity," thus neglecting the fact that the diagnosis of a terminal illness meets the fortuity requirement and should consequently avoid any correlation with suicide in this context).
119. Compassion in Dying v. State of Washington, 79 F.3d 790, 824 (9th Cir. 1996), rev'd, 521 U.S. 702 (1997).
120. McNabb v. Dep't of Corrections, 112 P.3d 592 (Wash. Ct. App. 2005) (citing Campbell v. Order of Washington, 102 P. 410, 412 (Wash. 1909)). The inmate argued he was "merely allowing nature to take its course," but the court found he was "not suffering from any terminal and incurable illness" and that his action, therefore, met the definition of "suicide." "In the popular, as well as the legal, sense suicide means . . . the death of a party by his own voluntary act."
121. Washington v. Glucksberg, 521 U.S. 702, 735-36 (1997) (Stevens, J., concurring).
122. Diane E. Meier et al., A National Survey of Physician-Assisted Suicide and Euthanasia in the United States, 338 NEW ENG. J. MED. 1193 (1998).
123. Id. at 1193.
124. Id.; see also Robert Arnold et al., Consideration of Hastening Death Among Hospice Patients and Their Families, 27 J. PAIN SYMPTOM MGMT. 523 (2004).
125. A.L. Back et al., Physician-Assisted Suicide and Euthanasia in Washington State, 275 J.A.M.A. 919 (1996).
126. Legislation was introduced in the California legislature to permit assisted dying in 2005. A.B. 654, 2005-2006 Gen. Assem., Reg. Sess. (Cal. 2005). The state of Vermont has had the issue in the legislature and convened a task force that recently concluded, after thorough review of the Oregon experience: "It is [quite] apparent from credible sources in and out of Oregon that the Death with Dignity Act has not had an adverse impact on end-of-life care and in all probability has enhanced the other options." Robin Lunge et al., Oregon's Death with Dignity Law and Euthanasia in the Netherlands: Factual Disputes, Vermont Legislature Legislative Council, at http://www.leg.state. vt.us/reports/04Death/Death_With_Dignity_Report.htm (last visited Mar. 25, 2007).
127. Pietsch, supra note 25, at 326-30.
128. Id. at 325-26.
129. The California Compassionate Choices Act was originally introduced as A.B. 654 in February of 2005, and was merged into A.B. 651 on June 6, 2005 and amended for final consideration on June 15, 2006. A.B. 654 passed out of committee in the Assembly and A.B. 651 passed out of committee in the Senate, but neither version received a full floor vote in either chamber in 2006. The bill was reintroduced in 2007, A.B. 374, but the Assembly declined to bring it to a vote.
130. Bender, supra note 32, at 533 (citing Deborah A. Wainey, Note, Active Voluntary Euthanasia: The Ultimate Act of Care for the Dying, 37 CLEVE. ST. L. REV. 645, 668-70 (1989));
131. DEREK HUMPHREY & ANN WICKET, THE RIGHT TO DIE: UNDERSTANDING EUTHANASIA (1986);
132. Eight Doctors on Euthanasia Charges, HEMLOCK Q., Jan. 1989, at 6.
133. Bender, supra note 32, at 534.
134. Id. at 540.
135. Frontline: Living Old (PBS television broadcast Nov. 21, 2006).
136. Frontline: Living Old, Interview with William Coch, M.D. (PBS television broadcast Nov. 21, 2006). Dr. Coch interprets a "good death" as one "where you're in a physically comfortable place, where you don't have a lot of intrusion of outsiders, where your family can gather and be with you," and a "bad death" as one "where you're actively being treated with blood tests and X-rays, with no attention paid to how you feel, right up to the end."
137. Frontline: Living Old, Interview with Jeffrey Farber, M.D. (PBS television broadcast Nov. 21, 2006). It described the process of treating the elderly as follows: [A] lot of our job is also kind of guidance and education and goal setting. Sometimes I think it's upon the physician to come out and say what they think: 'I would not recommend this course of action, or even offer this course of action, because it's not going to help achieve the goals that you told me you want to achieve.
138. Id.
139. Frontline: Living Old, Interview with David Muller, M.D. (PBS television broadcast Nov. 21, 2006). Dr. Muller, though specifically addressing issues of treating pain, provided a range of options that physicians have in assisting patients, stating: Helping can mean anything from making sure there's enough morphine around to control pain. Helping can mean what we sometimes call 'terminal sedation,' so when someone has refractory pain, and the only way to control it is to completely sedate them, sometimes you do that and it ends their life, but itwas because therewas no otherway to control their symptoms. And helping in other instances, with other people, can mean other things too - actively helping someone, providing them with the medication that they can take when they feel that the time has come to end their life. There's a pretty wide spectrum of help.
140. Id.
141. Id.
142. See, e.g., Frontline: Living Old, Interview with William Coch, M.D., supra note 113. Dr. Coch, relaying a message from his patients, answered a question asking about the hardest thing for those growing old. He stated: "Giving up independence is the worst. It is what everybody fears. It's what I fear. Probably at least once a week, and sometimes every day, people say,'If I ever get like that, take me out behind the barn, because I don't want to live that way.'"
143. See Garrow, supra note 27; see also BEHUNIAK & SVENSON, supra note 31, at 18, stating: "When the practice is described as a physician helping a patient end his or her life, support is in the 69% to 75% range. However, when respondents are asked about a doctor assisting a patient 'to commit suicide,' support drops to a slight majority."
144. See, e.g., Battin & Quill, supra note 24, at 1-2. Dr. Timothy Quill is a leading supporter of expanding choice to permit physician assisted dying, yet describes the terms aid in dying and physician assisted suicide as "synonymous" in this treatise on the topic.
145. AMERICAN COUNSELING ASSOCIATION CODE OF ETHICS § A.9.c. (2005).
146. AM. PUB. HEALTH ASS'N, SUPPORTING APPROPRIATE LANGUAGE USED TO DISCUSS END OF LIFE CHOICES, POL'Y NO. LB-06-02 (2006).
147. Id.
148. This policy is available at www.aahpm.org.
149. Brief for the Am. Coll. of Legal Med. as Amici Curiae, Vacco v. Quill, 521 U.S. 793 (1997) (No. 95-1858), 1996 WL 668827.