Writing 125: Euthanasia - Contemporary Issues in Law & Society

Euthanasia – Literally, “good death”; the act of putting to death someone who is suffering from an incurable or painful disease or condition.

Voluntary/Involuntary euthanasia – These terms refer to whether or not the patient intends euthanasia. "Voluntary" indicates the person has consented; "involuntary" indicates he or she has not.

Active/Passive euthanasia – These terms indicate whether the treatment resulting in death was administered or withheld. In "active euthanasia," death is hastened by the treatment given to a patient. In "passive euthanasia," treatments that are withheld or withdrawn hasten death.

Physician assisted suicide («PAS») – This term is distinguished from euthanasia in that in PAS, the physician merely provides the patient with a means to hasten death. PAS occurs when a physician's responds to a request from a mentally competent, terminally ill adult who desires the means to hasten death at a time of the patient's choosing.

Summary of the Case
By Sophie Kim '06

In 1983, a legal struggle occurred in Massachusetts over an incompetent patient’s “right to die a natural death without undue dependence on medical technology […] – in short, a right to ‘die with dignity.’” In Patricia E. Brophy v. New England Sinai Hospital, the Supreme Judicial Court of Massachusetts affirmed an individual’s right to decline extraordinary life-sustaining medical treatment, extending the law to an incompetent patient in a severe vegetative state. The Court further honored the judgment of the trial court judge in the case, respecting the hospital's right to abstain from a procedure that would ultimately lead to the patient’s death. The issue before the court in Brophy was whether to honor the substituted judgment of the patient’s guardian, who acted on behalf of the incompetent patient, seeking to discontinue artificial life sustaining treatment, and thereby ending his life.

After Paul Brophy, an active fire fighter and EMT, suffered a ruptured aneurysm in the spring of 1983, he underwent an unsuccessful surgery from which he never fully recovered. Unable to chew or swallow, Brophy was later sustained by a surgically inserted gastrostomy tube (G-tube), through which he would receive nutritional sustenance. The medical prognosis revealed a “persistent vegetative state,” a condition in which Brophy would be unlikely to regain cognitive functions, verbal and non-verbal communication, or the capability of interacting purposefully with his environment. Three years after the g-tube insertion procedure, the permanence of Brophy’s condition ultimately led his wife, as his legal guardian, to seek discontinuation of all life sustaining treatment, including artificial nutrition and hydration. When the hospital refused to recognize the substituted judgment of Mrs. Brophy to “clamp” or “remove” the G-tube, a legal battle ensued, concluding in the SJC's landmark decision in 1986.

Summary of the Case
By Sophie Kim '06

In 1983, Nancy Beth Cruzan was involved in a car accident that left her in critical condition. Cruzan would later have to be sustained by a surgically inserted gastrostomy tube (G-tube), through which she would receive nutritional sustenance. The medical prognosis revealed a “persistent vegetative state,” a condition from which Cruzan would unlikely ever recover. The permanence of Cruzan’s condition ultimately led her family to seek the discontinuation of life sustaining treatment. When the hospital refused to recognize the judgment of the Cruzan family to terminate the life support system, a legal battle ensued, concluding in a Supreme Court decision.

Upholding the Missouri Supreme Court ruling, the U.S. Supreme Court held in 1990 that incompetent persons were not able to exercise their right to refuse medical treatment under the Due Process clause of the Fourteenth Amendment. Absent any clear and convincing evidence of Cruzan’s wishes to withdraw such treatment, the Court upheld the Missouri Supreme Court’s heightened evidentiary requirements. Without any evidence of a patient’s expressed wishes to refuse medical treatment, the Court could not confidently accept the judgment of family members acting on behalf of the incompetent patient. Instead, the Court recognized the state’s interest in preserving human life. The case was remanded, and on rehearing, the Missouri courts gave great weight to convincing evidence that had she executed a living will, Cruzan would have rejected the g-tube feeding. Ultimately, the tube was clamped, permitting her to die, in accordance with what the court believed would have been her wishes.

Summary of the Case
By Dubravka Colic '06

In the state of Washington, promoting suicide had been a crime for many decades, when a group of Washington physicians stated they would help terminally ill patients end their lives but for the state’s assisted suicide ban. Together with three terminally ill patients and a non-profit organization counseling them, they filed suit against the state, seeking a declaration that the ban was unconstitutional. The petitioners relied upon the Fourteenth Amendment Due Process Clause, claiming that it extends a right to mentally competent, terminally ill patients to end their lives at the time of their choosing. The U.S. Supreme Court reversed the decisions of the Federal and Appeals Courts, which had declared the ban unconstitutional because it placed an undue burden on the exercise of what they found to be a constitutionally protected liberty. The Supremes held that the asserted right to assisted suicide is not a fundamental right. Chief Justice Rehnquist wrote that ruling otherwise would contravene centuries of legal doctrine and practice which is deeply rooted in the history of the United States, and would go against a legitimate governmental interest in preservation of human life.

Timeline and legal documents
Death with Dignity National Center

Summary of the Case
By Dubravka Colic '06

In this companion case to Washington v. Glucksberg, the Supreme Court took a somewhat different approach to upholding New York's ban on assisted suicide. Timothy Quill and other New York physicians who wanted the freedom to assist terminally ill patients in ending their lives, claimed that the state differentiated between patients who refused life-saving treatment and those who wished to hasten death by taking life-terminating medications. As it had in Glucksberg, the Supreme Court in Quill held that the ban on physician assisted suicide did not violate the Equal Protection Clause in any way, since the state did not treat like cases differently. The Court found it perfectly constitutional for New York to allow every competent person to refuse life-saving treatment, but to ban anyone wishing to assist in suicide from doing so.

Key terms | Background Information | Euthansia in Film | Related Cases