The movement to legalize euthanasia in England began in 1935 with the founding of the Voluntary Euthanasia Society by such well-known figures as George Bernard Shaw, Bertrand Russell, and H. G. Wells. In 1936 the House of Lords (one of the houses in the English Parliament) defeated a bill that would have permitted euthanasia in cases of terminal illness. Nonetheless, it was common knowledge that physicians practiced euthanasia. The same year, it was rumored that King George V, who had been seriously ill for several years, was "relieved of his sufferings" by his physician, with the approval of his wife, Queen Mary.
The Euthanasia Society of America was established in 1938. In 1967 this group prepared the first living will. Renamed the Society for the Right to Die in 1974, it merged in 1991 with another organization called Concern for Dying and the two became Choice in Dying (CID). While CID took no position on physician-assisted suicide, it "advocated for the rights of dying patients." It also educated the public about the importance of advance directives and end-of-life issues. In early 2000 CID dissolved, although many of its staff remained to found Partnership for Caring, Inc. and continue its programs. That organization's goal was to "ensure that everyone in this country soon has access to quality end-of-life care." Then, in early 2004, Partnership for Caring merged with Last Acts, a coalition of professional and consumer organizations that work to improve end-of-life care. The merged organization has been named Last Acts Partnership, and its mission is to provide education, service, and counseling to people who need accurate and reliable information about end-of-life care. Last Acts Partnership is also an advocate for policy reform in end-of-life issues.
Euthanasia and the Nazis
The Nazis' version of euthanasia was a bizarre interpretation of an idea espoused by two German professors, Alfred Hoche and Karl Binding, in their 1920 book The Permission to Destroy Life Unworthy of Life. While initially advocating that it was ethical for physicians to assist in the death of those who requested an end to their suffering, the authors later argued that it was also permissible to end the lives of the mentally retarded and the mentally ill.
Some contemporary opponents of euthanasia fear that a society that allows physician-assisted suicide may eventually follow the path of Nazi dictator Adolf Hitler's euthanasia program, which began with the killing of physically and mentally impaired individuals and culminated with the annihilation of entire religious and ethnic groups considered by the Nazis to be unworthy of life. However, those supporting euthanasia argue that unlike the murderous Nazi euthanasia program designed by Hitler and his followers, modern-day proposals are based upon voluntary requests by individuals in situations of physical suffering and would be sanctioned by laws passed by democratic governments.
The Debate
In the United States the debate over euthanasia distinguishes between active and passive euthanasia. Active euthanasia, also called voluntary active euthanasia by those who distinguish it from the kind of euthanasia practiced by the Nazis, involves the hastening of death through the administration of lethal drugs, as requested by
TABLE 6.1
Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2001
[Data are based on death certificates]
| Sex, race, Hispanic origin, and age | 19501 | 19601 | 1970 | 1980 | 1990 | 1995 | 2000 | 2001 |
| All persons | Death per 100,000 resident population | |||||||
| All ages, age adjusted2 | 13.2 | 12.5 | 13.1 | 12.2 | 12.5 | 11.8 | 10.4 | 10.7 |
| All ages, crude | 11.4 | 10.6 | 11.6 | 11.9 | 12.4 | 11.7 | 10.4 | 10.8 |
| Under 1 year | … | … | … | … | … | … | … | … |
| 1–4 years | … | … | … | … | … | … | … | … |
| 5–14 years | 0.2 | 0.3 | 0.3 | 0.4 | 0.8 | 0.9 | 0.7 | 0.7 |
| 15–24 years | 4.5 | 5.2 | 8.8 | 12.3 | 13.2 | 13.0 | 10.2 | 9.9 |
| 15–19 years | 2.7 | 3.6 | 5.9 | 8.5 | 11.1 | 10.3 | 8.0 | 7.9 |
| 20–24 years | 6.2 | 7.1 | 12.2 | 16.1 | 15.1 | 15.8 | 12.5 | 12.0 |
| 25–44 years | 11.6 | 12.2 | 15.4 | 15.6 | 15.2 | 15.1 | 13.4 | 13.8 |
| 25–34 years | 9.1 | 10.0 | 14.1 | 16.0 | 15.2 | 15.0 | 12.0 | 12.8 |
| 35–44 years | 14.3 | 14.2 | 16.9 | 15.4 | 15.3 | 15.1 | 14.5 | 14.7 |
| 45–64 years | 23.5 | 22.0 | 20.6 | 15.9 | 15.3 | 13.9 | 13.5 | 14.4 |
| 45–54 years | 20.9 | 20.7 | 20.0 | 15.9 | 14.8 | 14.4 | 14.4 | 15.2 |
| 55–64 years | 26.8 | 23.7 | 21.4 | 15.9 | 16.0 | 13.2 | 12.1 | 13.1 |
| 65 years and over | 30.0 | 24.5 | 20.8 | 17.6 | 20.5 | 17.9 | 15.2 | 15.3 |
| 65–74 years | 29.6 | 23.0 | 20.8 | 16.9 | 17.9 | 15.7 | 12.5 | 13.3 |
| 75–84 years | 31.1 | 27.9 | 21.2 | 19.1 | 24.9 | 20.6 | 17.6 | 17.4 |
| 85 years and over | 28.8 | 26.0 | 19.0 | 19.2 | 22.2 | 21.3 | 19.6 | 17.5 |
| Male | ||||||||
| All ages, age adjusted2 | 21.2 | 20.0 | 19.8 | 19.9 | 21.5 | 20.3 | 17.7 | 18.2 |
| All ages, crude | 17.8 | 16.5 | 16.8 | 18.6 | 20.4 | 19.5 | 17.1 | 17.6 |
| Under 1 year | … | … | … | … | … | … | … | … |
| 1–4 years | … | … | … | … | … | … | … | … |
| 5–14 years | 0.3 | 0.4 | 0.5 | 0.6 | 1.1 | 1.3 | 1.2 | 1.0 |
| 15–24 years | 6.5 | 8.2 | 13.5 | 20.2 | 22.0 | 22.0 | 17.1 | 16.6 |
| 15–19 years | 3.5 | 5.6 | 8.8 | 13.8 | 18.1 | 17.1 | 13.0 | 12.9 |
| 20–24 years | 9.3 | 11.5 | 19.3 | 26.8 | 25.7 | 27.0 | 21.4 | 20.5 |
| 25–44 years | 17.2 | 17.9 | 20.9 | 24.0 | 24.4 | 24.4 | 21.3 | 22.1 |
| 25–34 years | 13.4 | 14.7 | 19.8 | 25.0 | 24.8 | 24.8 | 19.6 | 21.0 |
| 35–44 years | 21.3 | 21.0 | 22.1 | 22.5 | 23.9 | 24.0 | 22.8 | 23.1 |
| 45–64 years | 37.1 | 34.4 | 30.0 | 23.7 | 24.3 | 22.2 | 21.3 | 22.5 |
| 45–54 years | 32.0 | 31.6 | 27.9 | 22.9 | 23.2 | 22.5 | 22.4 | 23.4 |
| 55–64 years | 43.6 | 38.1 | 32.7 | 24.5 | 25.7 | 21.8 | 19.4 | 21.1 |
| 65 years and over | 52.8 | 44.0 | 38.4 | 35.0 | 41.6 | 36.2 | 31.1 | 31.5 |
| 65–74 years | 50.5 | 39.6 | 36.0 | 30.4 | 32.2 | 28.5 | 22.7 | 24.6 |
| 75–84 years | 58.3 | 52.5 | 42.8 | 42.3 | 56.1 | 44.9 | 38.6 | 37.8 |
| 85 years and over | 58.3 | 57.4 | 42.4 | 50.6 | 65.9 | 62.7 | 57.5 | 51.1 |
| Female | ||||||||
| All ages, age adjusted2 | 5.6 | 5.6 | 7.4 | 5.7 | 4.8 | 4.3 | 4.0 | 4.0 |
| All ages, crude | 5.1 | 4.9 | 6.6 | 5.5 | 4.8 | 4.3 | 4.0 | 4.1 |
| Under 1 year | … | … | … | … | … | … | … | … |
| 1–4 years | … | … | … | … | … | … | … | … |
| 5–14 years | 0.1 | 0.1 | 0.2 | 0.2 | 0.4 | 0.4 | 0.3 | 0.3 |
| 15–24 years | 2.6 | 2.2 | 4.2 | 4.3 | 3.9 | 3.6 | 3.0 | 2.9 |
| 15–19 years | 1.8 | 1.6 | 2.9 | 3.0 | 3.7 | 3.1 | 2.7 | 2.7 |
| 20–24 years | 3.3 | 2.9 | 5.7 | 5.5 | 4.1 | 4.2 | 3.2 | 3.1 |
| 25–44 years | 6.2 | 6.6 | 10.2 | 7.7 | 6.2 | 5.8 | 5.4 | 5.5 |
| 25–34 years | 4.9 | 5.5 | 8.6 | 7.1 | 5.6 | 5.1 | 4.3 | 4.4 |
| 35–44 years | 7.5 | 7.7 | 11.9 | 8.5 | 6.8 | 6.4 | 6.4 | 6.4 |
| 45–64 years | 9.9 | 10.2 | 12.0 | 8.9 | 7.1 | 6.1 | 6.2 | 6.6 |
| 45–54 years | 9.9 | 10.2 | 12.6 | 9.4 | 6.9 | 6.6 | 6.7 | 7.2 |
| 55–64 years | 9.9 | 10.2 | 11.4 | 8.4 | 7.3 | 5.3 | 5.4 | 5.7 |
| 65 years and over | 9.4 | 8.4 | 8.1 | 6.1 | 6.4 | 5.4 | 4.0 | 3.9 |
| 65–74 years | 10.1 | 8.4 | 9.0 | 6.5 | 6.7 | 5.4 | 4.0 | 3.9 |
| 75–84 years | 8.1 | 8.9 | 7.0 | 5.5 | 6.3 | 5.4 | 4.0 | 4.0 |
| 85 years and over | 8.2 | 6.0 | 5.9 | 5.5 | 5.4 | 5.4 | 4.2 | 3.4 |
the patient or another competent individual who represents the patient's wishes.
Passive euthanasia, on the other hand, involves foregoing medical treatment, knowing that such a decision will result in death. This action is not considered illegal because the underlying illness, permitted to run its natural course, will ultimately cause death. It is generally accepted in the United States that terminally ill individuals have a right to refuse medical treatment, as do those who are sick but not terminally so. But some people think that allowing patients to forego medical treatment is a practice tantamount to enabling suicide and is therefore morally reprehensible.
The debate about euthanasia in the United States has been expanded to include the question of whether a competent, terminally ill patient has the right to physician-assisted
TABLE 6.1
Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2001
[Data are based on death certificates]
| Sex, race, Hispanic origin, and age | 19501 | 19601 | 1970 | 1980 | 1990 | 1995 | 2000 | 2001 | |
| White male3 | |||||||||
| All ages, age adjusted2 | 22.3 | 21.1 | 20.8 | 20.9 | 22.8 | 21.6 | 19.1 | 19.6 | |
| All ages, crude | 19.0 | 17.6 | 18.0 | 19.9 | 22.0 | 21.1 | 18.8 | 19.5 | |
| 15–24 years | 6.6 | 8.6 | 13.9 | 21.4 | 23.2 | 23.1 | 17.9 | 17.6 | |
| 25–44 years | 17.9 | 18.5 | 21.5 | 24.6 | 25.4 | 25.8 | 22.9 | 24.0 | |
| 45–64 years | 39.3 | 36.5 | 31.9 | 25.0 | 26.0 | 23.9 | 23.2 | 24.7 | |
| 65 years and over | 55.8 | 46.7 | 41.1 | 37.2 | 44.2 | 38.5 | 33.3 | 33.7 | |
| 65–74 years | 53.2 | 42.0 | 38.7 | 32.5 | 34.2 | 30.1 | 24.3 | 26.3 | |
| 75–84 years | 61.9 | 55.7 | 45.5 | 45.5 | 60.2 | 47.7 | 41.1 | 40.2 | |
| 85 years and over | 61.9 | 61.3 | 45.8 | 52.8 | 70.3 | 67.9 | 61.6 | 55.0 | |
| Black or African American male3 | Deaths per 100,000 resident population | ||||||||
| All ages, age adjusted2 | 7.5 | 8.4 | 10.0 | 11.4 | 12.8 | 12.4 | 10.0 | 9.8 | |
| All ages, crude | 6.3 | 6.4 | 8.0 | 10.3 | 12.0 | 11.7 | 9.4 | 9.2 | |
| 15–24 years | 4.9 | 4.1 | 10.5 | 12.3 | 15.1 | 17.8 | 14.2 | 13.0 | |
| 25–44 years | 9.8 | 12.6 | 16.1 | 19.2 | 19.6 | 18.3 | 14.3 | 14.4 | |
| 45–64 years | 12.7 | 13.0 | 12.4 | 11.8 | 13.1 | 11.5 | 9.9 | 9.7 | |
| 65 years and over | 9.0 | 9.9 | 8.7 | 11.4 | 14.9 | 14.6 | 11.5 | 11.5 | |
| 65–74 years | 10.0 | 11.3 | 8.7 | 11.1 | 14.7 | 13.8 | 11.1 | 10.7 | |
| 75–84 years4 | * | * | * | 10.5 | 14.4 | 16.7 | 12.1 | 13.5 | |
| 85 years and over | - - - | * | * | * | * | * | * | * | |
| American Indian or Alaska Native male3 | |||||||||
| All ages, age adjusted2 | - - - | - - - | - - - | 19.3 | 20.1 | 17.4 | 16.0 | 17.4 | |
| All ages, crude | - - - | - - - | - - - | 20.9 | 20.9 | 18.0 | 15.9 | 17.0 | |
| 15–24 years | - - - | - - - | - - - | 45.3 | 49.1 | 30.8 | 26.2 | 24.7 | |
| 25–44 years | - - - | - - - | - - - | 31.2 | 27.8 | 29.1 | 24.5 | 27.6 | |
| 45–64 years | - - - | - - - | - - - | * | * | 13.6 | 15.4 | 17.0 | |
| 65 years and over | - - - | - - - | - - - | * | * | * | * | * | |
| Asian or Pacific Islander male3 | |||||||||
| All ages, age adjusted2 | - - - | - - - | - - - | 10.7 | 9.6 | 9.6 | 8.6 | 8.4 | |
| All ages, crude | - - - | - - - | - - - | 8.8 | 8.7 | 9.0 | 7.9 | 7.7 | |
| 15–24 years | - - - | - - - | - - - | 10.8 | 13.5 | 14.4 | 9.1 | 9.1 | |
| 25–44 years | - - - | - - - | - - - | 11.0 | 10.6 | 10.8 | 9.9 | 9.3 | |
| 45–64 years | - - - | - - - | - - - | 13.0 | 9.7 | 8.7 | 9.7 | 8.2 | |
| 65 years and over | - - - | - - - | - - - | 18.6 | 16.8 | 18.9 | 15.4 | 18.3 | |
| Hispanic or Latino male3,5 | |||||||||
| All ages, age adjusted2 | - - - | - - - | - - - | - - - | 13.7 | 12.7 | 10.3 | 10.1 | |
| All ages, crude | - - - | - - - | - - - | - - - | 11.4 | 10.9 | 8.4 | 8.3 | |
| 15–24 years | - - - | - - - | - - - | - - - | 14.7 | 16.0 | 10.9 | 9.5 | |
| 25–44 years | - - - | - - - | - - - | - - - | 16.2 | 14.5 | 11.2 | 11.8 | |
| 45–64 years | - - - | - - - | - - - | - - - | 16.1 | 14.2 | 12.0 | 11.4 | |
| 65 years and over | - - - | - - - | - - - | - - - | 23.4 | 21.0 | 19.5 | 18.5 | |
| White, not Hispanic or Latinomale5 | |||||||||
| All ages, age adjusted2 | - - - | - - - | - - - | - - - | 23.5 | 22.3 | 20.2 | 21.0 | |
| All ages, crude | - - - | - - - | - - - | - - - | 23.1 | 22.2 | 20.4 | 21.4 | |
| 15–24 years | - - - | - - - | - - - | - - - | 24.4 | 24.0 | 19.5 | 19.6 | |
| 25–44 years | - - - | - - - | - - - | - - - | 26.4 | 27.1 | 25.1 | 26.4 | |
| 45–64 years | - - - | - - - | - - - | - - - | 26.8 | 24.5 | 24.0 | 25.9 | |
| 65 years and over | - - - | - - - | - - - | - - - | 45.4 | 39.0 | 33.9 | 34.4 | |
| White female3 | |||||||||
| All ages, age adjusted2 | 6.0 | 5.9 | 7.9 | 6.1 | 5.2 | 4.7 | 4.3 | 4.5 | |
| All ages, crude | 5.5 | 5.3 | 7.1 | 5.9 | 5.3 | 4.8 | 4.4 | 4.6 | |
| 15–24 years | 2.7 | 2.3 | 4.2 | 4.6 | 4.2 | 3.8 | 3.1 | 3.1 | |
| 25–44 years | 6.6 | 7.0 | 11.0 | 8.1 | 6.6 | 6.3 | 6.0 | 6.2 | |
| 45–64 years | 10.6 | 10.9 | 13.0 | 9.6 | 7.7 | 6.7 | 6.9 | 7.3 | |
| 65 years and over | 9.9 | 8.8 | 8.5 | 6.4 | 6.8 | 5.7 | 4.3 | 4.1 | |
suicide, in which a physician provides the means (such as lethal drugs) for the patient to self-administer and commit suicide. The distinction between the two actions, euthanasia and physician-assisted suicide, is at times difficult to define: a patient in the latter stages of Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's disease), for example, is physically unable to kill him or herself; therefore, a physician who aids in such a person's suicide would technically be committing euthanasia.
TABLE 6.1
Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2001
[Data are based on death certificates]
| Sex, race, Hispanic origin, and age | 19501 | 19601 | 1970 | 1980 | 1990 | 1995 | 2000 | 2001 |
| Black or African American female3 | ||||||||
| All ages, age adjusted2 | 1.8 | 2.0 | 2.9 | 2.4 | 2.4 | 2.0 | 1.8 | 1.8 |
| All ages, crude | 1.5 | 1.6 | 2.6 | 2.2 | 2.3 | 2.0 | 1.7 | 1.7 |
| 15–24 years | 1.8 | * | 3.8 | 2.3 | 2.3 | 2.2 | 2.2 | 1.3 |
| 25–44 years | 2.3 | 3.0 | 4.8 | 4.3 | 3.8 | 3.3 | 2.6 | 2.6 |
| 45–64 years | 2.7 | 3.1 | 2.9 | 2.5 | 2.9 | 2.0 | 2.1 | 2.6 |
| 65 years and over | * | * | 2.6 | * | 1.9 | 2.1 | 1.3 | 1.6 |
| American Indian or Alaska Native female3 | Deaths per 100,000 resident population | |||||||
| All ages, age adjusted2 | - - - | - - - | - - - | 4.7 | 3.6 | 3.9 | 3.8 | 4.0 |
| All ages, crude | - - - | - - - | - - - | 4.7 | 3.7 | 3.8 | 4.0 | 4.1 |
| 15–24 years | - - - | - - - | - - - | * | * | * | * | * |
| 25–44 years | - - - | - - - | - - - | 10.7 | * | 6.4 | 7.2 | 6.1 |
| 45–64 years | - - - | - - - | - - - | * | * | * | * | * |
| 65 years and over | - - - | - - - | - - - | * | * | * | * | * |
| Asian or Pacific Islander female3 | ||||||||
| All ages, age adjusted2 | - - - | - - - | - - - | 5.5 | 4.1 | 4.1 | 2.8 | 2.9 |
| All ages, crude | - - - | - - - | - - - | 4.7 | 3.4 | 3.7 | 2.7 | 2.8 |
| 15–24 years | - - - | - - - | - - - | * | 3.9 | 4.8 | 2.7 | 3.6 |
| 25–44 years | - - - | - - - | - - - | 5.4 | 3.8 | 3.6 | 3.3 | 2.9 |
| 45–64 years | - - - | - - - | - - - | 7.9 | 5.0 | 4.7 | 3.2 | 3.8 |
| 65 years and over | - - - | - - - | - - - | * | 8.5 | 8.6 | 5.2 | 4.9 |
| Hispanic or Latino female3, 5 | ||||||||
| All ages, age adjusted2 | - - - | - - - | - - - | - - - | 2.3 | 2.0 | 1.7 | 1.6 |
| All ages, crude | - - - | - - - | - - - | - - - | 2.2 | 1.8 | 1.5 | 1.5 |
| 15–24 years | - - - | - - - | - - - | - - - | 3.1 | 2.4 | 2.0 | 2.3 |
| 25–44 years | - - - | - - - | - - - | - - - | 3.1 | 2.5 | 2.1 | 2.0 |
| 45–64 years | - - - | - - - | - - - | - - - | 2.5 | 2.8 | 2.5 | 2.3 |
| 65 years and over | - - - | - - - | - - - | - - - | * | * | * | * |
| White, not Hispanic or Latino female5 | ||||||||
| All ages, age adjusted2 | - - - | - - - | - - - | - - - | 5.4 | 4.9 | 4.7 | 4.9 |
| All ages, crude | - - - | - - - | - - - | - - - | 5.6 | 5.1 | 4.9 | 5.0 |
| 15–24 years | - - - | - - - | - - - | - - - | 4.3 | 4.0 | 3.3 | 3.3 |
| 25–44 years | - - - | - - - | - - - | - - - | 7.0 | 6.6 | 6.7 | 6.9 |
| 45–64 years | - - - | - - - | - - - | - - - | 8.0 | 6.9 | 7.3 | 7.8 |
| 65 years and over | - - - | - - - | - - - | - - - | 7.0 | 5.8 | 4.4 | 4.3 |
| … Category not applicable. | ||||||||
| *Rates based on fewer than 20 deaths are considered unreliable and are not shown. | ||||||||
| - - - Data not available. | ||||||||
| 1Includes deaths of persons who were not residents of the 50 states and the District of Columbia. | ||||||||
| 2Age-adjusted rates are calculated using the year 2000 standard population starting with Health, United States, 2001. | ||||||||
| 3The race groups, white, black, Asian or Pacific Islander, and American Indian or Alaska Native, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Death rates for the American Indian or Alaska Native and Asian or Pacific Islander populations are known to be underestimated. | ||||||||
| 4In 1950 rate is for the age group 75 years and over. | ||||||||
| 5Prior to 1997, excludes data from states lacking an Hispanic-origin item on the death certificate. | ||||||||
| SOURCE: "Table 46. Death Rates for Suicide, according to Sex, Race, Hispanic Origin, and Age: United States, Selected Years 1950–2001," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, 2003 | ||||||||
User Comments Add a comment…