HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, February 14, 2012

Physician-Assisted Suicide and the Slippery Slope

Last week's ruling by the Georgia Supreme Court provides further evidence that the slippery slope is not a real problem with a right to physician-assisted suicide. Since 1994, Georgia's assisted suicide ban prohibited the public promotion and provision of assisted suicide services, but did not reach the private decision of patient and physician to choose physician-assisted suicide. The court struck the law down on first amendment grounds--since it targeted those who publicly advertised or offered services but not others--but even while the law has been in force, there have not been any reports that physicians have misused their freedom to provide physician-assisted suicide privately.


According to a 1994 article in the Georgia State University Law Review, the legislature had rejected a broad ban, in part because it was worried about chilling palliative or other legitimate end-of-life care, but also because it did not want to interfere with private decisions of patient and physician for physician-assisted suicide.

The statute was passed at a time when Jack Kevorkian was actively assisting suicides in Michigan, and the legislature was concerned about him, or someone like him, promoting the practice in Georgia.

Georgia's experience with physician-assisted suicide adds to reassuring evidence about the slippery slope from other states and other end-of-life practices. Oregon has permitted assisted suicide by statute for nearly 15 years, and the state's annual reports tell us that patients rarely use physician-assisted suicide (about 1/5 of one percent of deaths in Oregon), and that it has not placed vulnerable patients at risk. Users of assisted suicide are just as likely to have health insurance or receive hospice care as other terminally ill patients, and they tend to be better educated. Washington and Montana have permitted assisted suicide by statute or court decision for only a few years, but in neither state is there evidence of a slippery slope.

One also can look to the experience with palliative sedation for reassurance about the slippery slope. As I have written, physicians can just as easily--and perhaps more easily--abuse their authority to palliatively sedate patients, and they have not done so. (Once called terminal sedation, palliative sedation is provided to terminally ill patients whose pain or other suffering can be addressed only by medicating the patient into an unconscious state. Once sedated, patients usually die soon, either from their illness or because artificial nutrition and hydration is withdrawn.) 

It will be interesting to see if the Georgia legislature adopts a new assisted suicide ban. After the Montana Supreme Court concluded in 2009 that "a terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a charge of homicide against the aiding physician," the legislature did not pass a prohibition. As they consider the issue, Georgia legislators can know that failing to pass a statute will not put patients in the state at risk of abuse.


[cross posted at The Faculty Lounge]

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