The right-to-die movement: extrapolating from the National Hemlock Society U.S.A. membership survey

A national membership survey of Hemlock Society USA was conducted by Fox and Kamakahi (1995). Respondents (N=6398) were asked a variety of questions, but in this paper we perform a longitudinal analysis of the characteristics of Hemlock Society USA members. Hemlock Society USA members are divided into three 5-year cohorts: Early Joiners (11 or more years of membership), Middle Joiners (6 to 10 years membership), and Late Joiners (5 or fewer years of membership). Differences between cohorts are examined and extrapolations made regarding Hemlock Society USA and the Right-to-Die Movement. A series of one-way ANOVAs were used with Scheme post-hoc comparisons as heuristic tools for assessing between-cohort differences. Late Joiners are different from earlier members, but are more like other Hemlock Society USA members than the adult U.S. population at large. Hemlock Society USA members are essentially societal "elites" (based on socio-demographic variables) who work in social environments that are decidedly split on the issue of voluntary suicide and euthanasia.

False expectations? Expectations vs. probabilities for dying

It is widely recognized that the code of the physician has undergone dramatic changes in the last century--changes which have serious implications for the patient-physician relationship. This is an ethnographic study examining how certain changes in the role and abilities of biomedical physicians have affected patient attitudes and expectations about end-of-life care. In-home interviews were conducted with eighteen persons age fifty-five and older, including a sample of Hemlock Society members. Results indicate a broad spectrum of end-of-life concerns including capacity, autonomy, pain, and burden to loved ones. Most participants reported a reluctance to begin a discussion of death or future deteriorating capacity with their physicians. Instead, when conversations about death were reported, they had been largely limited to the scenarios of catastrophic illness (e.g., hospitalization, ventilator, etc.) and the Living Will. While this discussion does not overlook the utility of the Living Will, it proposes the reliance on this document for preparing patients for end-of-life care is inadequate.

Older women and mercy killing

Mercy killing is usually defined as intentional killing, often by family members or friends, with the stated intent to end perceived suffering. International evidence suggests that mercy killing typically involves an older man killing his ailing wife. In this study, we examined U.S. cases of mercy killing recorded by The Hemlock Society for the period 1960-1993. We found that the typical case involved an older woman being killed by a man, often her husband, with her poor health as the justification for the killing. A firearm was often used in these incidents. These patterns of mercy killing are consistent with patterns of homicide-suicide among older adults. Future research should seek to understand why women are typically the targets, and men the agents of mercy killing.

Who is fighting for the right to die? Older women's participation in the Hemlock Society

Who is fighting for the right to die? Past literature has been mixed as to the membership of this social movement. In the current study, 6,398 Hemlock Society members were surveyed in an effort to answer questions concerning who is participating in the right to die movement, whether these participants are rapidly approaching their own death or reacting to the death of a loved one, and whether the movement is invigorated by singular activists. The findings indicate that older, white, wealthy, highly educated, economically and politically active women are in the forefront of the right to die movement. These women report currently being mentally and physically healthy, yet already having taken the steps that will allow them to have an element of control over their death. Finally, right to die support seems to be part of a larger collective network concerning health care and political policy issues.

Conflicts of conscience. Hospice and assisted suicide

Proposals to legalize assisted suicide challenge hospice's identity and integrity. In the wake of Measure 16, Oregon hospice programs must develop practical policies to balance traditional commitments not to hasten death and not to abandon patients with dying patients' legal right to request lethal prescriptions.

Society needs MD-assisted death, Canadian-trained medical director of US right-to-die society says

The growth of an American organization that supports the right to die is proof that the public wants and needs physician-assisted death, says a University of Alberta alumnus who is medical director of the Hemlock Society. Dr. Richard MacDonald says he believes individual patients have the right to decide whether they want to live with a certain quality of life. Both the American Medical Association and the CMA have spoken out against physician-assisted death, but MacDonald says this opposition is out of touch with the opinions of individual physicians and patients.

Legalizing physician-assisted suicide: some thoughts and concerns

Surveys show that most Americans favor the decriminalization of physician-assisted suicide in certain circumstances. Several states are now considering legislation to bring this about and make the United States the first place in the civilized world where physician aid in dying is sanctioned. In the Netherlands, where physician-assisted suicide is practiced but officially remains illegal, 85% of assisted suicides occur in the elderly, and most involve the help of general practitioners. In the United States, family physicians provide health care to many older adults with chronic or terminal illness whose numbers will increase as the elderly population expands. The legalization of physician-assisted suicide would affect the way American physicians practice medicine in unpredictable ways, yet physicians are participating relatively little in deliberations concerning this issue. The problem of suffering in persons with chronic and terminal illness cannot be ignored. Compassionate, effective, and ethical solutions must be found. As a former family physician and now geriatric psychiatrist, I review the pros and cons of physician-assisted suicide (emphasizing arguments against legalization) and encourage family physicians to debate this matter.

Assisted suicide: where do nurses draw the line?

If a terminally or chronically ill patient chooses death, where does one draw the line between allowing suicide, encouraging suicide, assisting with suicide, or directly killing? How does one differentiate between injecting a consenting patient with a lethal injection for the purpose of causing death, from inserting the needle so that the patient may inject the lethal dose his or herself? Clearly there are differences between action, facilitation, encouragement, and mere information.

Final Exit: a wake-up call to hospice

The publication of Final Exit resulted in a public response that was exuberant, largely sympathetic and, to many within hospice, disquieting. The book and the public response it engendered can not be understood without exploring the Hemlock Society and the political agenda which both the Society and book advance. Hospice must begin a response to this book, and any discussion with Hemlock supporters, from a basis of consensus. Hospice must acknowledge that those within the euthanasia/assisted suicide movement believe as deeply as we in hospice in the need to address the suffering of people enduring the effects of terminal illness. We must further acknowledge that there remain unmet needs in the care of the dying which for primarily socio-political reasons hospice has been unable to resolve. There are several compelling reasons for hospice as an organized movement to oppose the political initiatives of the Hemlock Society--at least in their present form and within the current social context. These reasons involve core ethical issues and issues of direct social consequence, each of which seems sufficient to reject the current proposals. Hospice programs and personnel must enter this debate in earnest. Before serious consideration is accorded to legalization of euthanasia/assisted suicide, we must insist that genuine access to comprehensive hospice/palliative care becomes a reality for all dying patients and their families.

Euthanasia, the ultimate abandonment

In this issue we are pleased to publish the address given recently by Mrs Rita Marker of the Anti-euthanasia Task Force (USA) at a press conference in the House of Commons in London. It offers a most informative update on the development of euthanasia discussion in the United States. We must be grateful that the situation elsewhere is different. In Germany, as a recent correspondent told the Editor, the memory of euthanasia under the Nazis is still too fresh for there to be such a development. Even in Holland there are moves to develop a hospice programme, to offer a radically alternative approach to terminal care. Yet in Britain the idea of the living will is beginning to catch on, and we do well to take note of how it is being used in the United States as a gateway to euthanasia.