Remember Dr. Kevorkian?

For those of you who are too young, he was a retired pathologist back in the 1990s who helped terminally ill people end their lives as a sort of crusade. This was completely illegal at the time, everywhere in the country. He was prosecuted a couple of times, but juries would not convict -- apparently you couldn't find 12 people who thought that what he did deserved criminal sanction. This was despite his notably abrasive personality. He wasn't a persuasive person, but his actions spoke for themselves and most people evidently supported them.

He finally was convicted. The basic difference was that in the previous cases, he had set up his "suicide machine" -- a gas delivery system -- and let his customers (I don't know if you should call them patients) push the button themselves. In the case for which he was convicted, the client was paralyzed and unable to initiate the process, so the good doctor did it himself. This seems a trivial moral distinction to me -- the guy very clearly articulated his desire -- but it does seem to matter to many people.

Anyway, so-called Physician Assisted Dying (PAD) is now legal in Oregon, Washington, Vermont, Colorado and the District of Columbia, by law; and in Montana, by court decision. (A law in California was recently overturned on a technicality before it could take effect. We'll see where that goes.) Here's a summary history.

 I expect that PAD sounds better than physician assisted suicide, and I'll grant that there is a bit of a difference in that the person has to be dying already and we're just talking about hurrying it along. On the other hand we're all dying so it's only a matter of degree. The relevant laws have clear eligibility and procedural restrictions, and they try to guard against commonly evoked dangers such as people taking the option because they're afraid they'll be a burden to others, and possible attendant pressure; failure to provide adequate palliative care; and people who aren't really dying but only disabled using the option. By all accounts there are few if any abuses but of course there are gray areas and matters of degree involved here.

Physicians differ in whether they approve of this at all; and whether they would personally consider participating. Here Dr. Bernard Lo tries to offer ethical guidance. As far as I can tell this all comes out of his own head, based on extensive acquaintance with what people have written and argued about it. There hasn't been any high level committee. There also haven't been any studies about the best way to do it -- what drugs to use. I'm not sure how an Institutional Review Board would view a randomized controlled trial of procedures intended to cause death. This is a new ethical frontier which we have crossed without a whole lot of deep reflection, and surprisingly little public debate. I don't recall it being a big issue in electoral campaigns. I expect we'll see considerably more pronounced controversy at some point.

Update: In response to a comment, here is a compendium of relevant policies around the world. I haven't made any particular study of this myself. It's still illegal in most countries but a few have legalized it in recent years, particularly in northern Europe.