Euthanasia in the United States

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

Early history
The first major effort to legalize euthanasia in the United States arose as part of the eugenics movement in the early years of the twentieth century. 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 than leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

Euthanasia advocacy in the U.S. peaked again during the 1930's and diminished significantly during and after World War II. Euthanasia efforts were revived during the 1960's and 1970's, 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 (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.

Oregon
Ballot Measure 16 in 1994 established the Oregon Death with Dignity Act, which legalizes physician-assisted dying with certain restrictions, making Oregon the first U.S. state and one of the first jurisdictions in the world to officially do so. The measure was approved in the 8 November 1994 general election in a tight race. The final tally showed 627,980 votes (51.3%) in favor, and 596,018 votes (48.7%) against. The law survived an attempted repeal in 1997, which was defeated at the ballot by a 60% vote. In 2005, after several attempts by lawmakers at both the state and federal level to overturn the Oregon law, the Supreme Court of the United States ruled 6-3 to uphold the law after hearing arguments in the case of Gonzales v. Oregon.

California
The California Compassionate Choices Act was introduced in 2005, patterned after Oregon's Death with Dignity Act. After being defeated in 2006, it was launched with broader support in the leadership as AB 374 in 2007.

Texas
In 1999, the state of Texas passed the Texas Futile Care Law. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support on a patient whom they declare terminally ill. This is rare.

On March 15, 2005, six month old infant Sun Hudson was the first patient in which the "United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child's parent."

In December 2005, doctors removed Tirhas Habtegiris, a young woman and legal immigrant from Africa, from life support against her family's wishes.

U.S. public opinion on euthanasia
Reflecting the religious and racial 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 opinion research shows that views on euthanasia tend to correlate with religious affiliation and race, though not gender.

A recent Gallup Poll survey showed that 60% of Americans supported euthanasia.

Opinion by religious affiliation
In one recent study dealing primarily with Christians, 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 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.

Opinion by race and gender
Recent studies have shown European-Americans to be more accepting of euthanasia than African-Americans, though this difference may be explained by other factors. They are also more likely to have advance directives and to use other end of life measures. African-Americans are almost 3 times more likely to oppose euthanasia than European-Americans. The main reason for this discrepancy is attributed to the lower levels of trust in the medical establishment. Researchers believe that past history of medical abuses towards minorities (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. Studies have also found that there are significant disparities in the medical treatment and pain management that European-Americans and other Americans receive.

Among African-Americans, education correlates to support for euthanasia. African-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. Only African and European Americans have been studied in extensive detail. Although it has been found that non European-American groups are less supportive of euthanasia than European-Americans, there is still some ambiguity as to what degree this is true.

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

For further reading

 * Appel, Jacob M. 2004.  "A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906" in Bulletin of the History of Medicine, Volume 78, Number 3, pp. 610-634.


 * Emanuel, Ezekiel J. 2004. "The history of euthanasia debates in the United States and Britain" in Death and dying: a reader, edited by T. A. Shannon. Lanham, MD: Rowman & Littlefield Publishers.


 * Kamisar, Yale. 1977. Some non-religious views against proposed 'mercy-killing' legislation in Death, dying, and euthanasia, edited by D. J. Horan and D. Mall. Washington: University Publications of America. Original edition, Minnesota Law Review 42:6 (May 1958).


 * Magnusson, Roger S. “The sanctity of life and the right to die: social and jurisprudential aspects of the euthanasia debate in Australia and the United States” in Pacific Rim Law & Policy Journal (6:1), January 1997.


 * Stone, T. Howard, and Winslade, William J. “Physician-assisted suicide and euthanasia in the United States” in Journal of Legal Medicine (16:481-507), December 1995.