USA
IN FIVE years, Dr Jack Kevorkian also known as "Dr Death" has assisted in the suicides of 31 people. He has also been acquitted three times on criminal charges for his actions, most recently last May in Michigan where the jury was shown videos of the two women involved pleading to be allowed to die.
Earlier this year, federal appeals courts in New York and California struck down laws in those states which make it a crime for physicians to assist in suicides. The California court has become the first federal one to recognise a constitutional right to "determine the time and manner of one's own death.
The clear reluctance of juries to convict Dr Kevorkian and the rulings of the two appeals courts are seen to be opening the door to, if not a general legalisation of physician assisted suicide (PAS), then to its unofficial acceptance. But this trend is also arousing concern among churches, commentators and severely handicapped persons.
A group of the latter has set up an organisation called Not Dead Yet. One of the organisers, Mr Woody Osburn, is a full time civil rights specialist with the Pennsylvania Coalition of Citizens with Disabilities and is also a quadriplegic.
He says that Americana with disabilities do not want "pity or lethal mercy" but freedom and life. "Our deaths are being viewed as more desirable than providing services such as in home care that would allow us to live as free and independent citizens. Instead many of us are caged in nursing homes and other institutions or dependent on a family member the two main circumstances that lead to assisted suicide."
A recent article in the New Republic magazine expressed concern that seriously ill women may be more susceptible to using PAS than men and points out that most of Dr Kevorkian's clients are women. They have also had "more ambiguous complaints" than the men, who were usually declared terminally ill and in constant pain.
Most of the Kevorkian women were not diagnosed terminal and had not been complaining of severe or constant pain, according to the Chicago Suicide Research Centre. The author of the article, Stephanie Gutmann, asks. "Is it possible that a certain type of woman depressive, self effacing, near the end of a life largely spent serving others is particularly vulnerable to the rational `heroic' solution so forcefully proposed by Dr Death?"
The Not Dead Yet group is circulating a statement by Dr Kevorkian on the social value of assisted suicide which he presented to a Michigan court in 1990. In it he said. "The voluntary self elimination of individual and mortally diseased or crippled lives, taken collectively, can only enhance the preservation of public health and welfare."
For the Not Dead Yet group this is seen as pressure on them to eliminate themselves to avoid being a public burden.
The legal situation in the US is complicated by the federal system whereby the individual states are to pass their own laws in the matter subject to their being in accordance with the constitution.
Congress and the Supreme Court recognise the right to refuse unwanted medical treatment such as feeding tubes and hydration. But assisted suicide is still a criminal offence in 44 of the 50 states. It is described as being where a doctor prescribes medication which may ease pain or cause death (the double effect) but the patient administers the lethal dose.
The legal correspondent of the New Republic, Jeffrey Rosen, says that "more controversial is `voluntary passive euthanasia' which takes place when the doctor rather than the incapacitated patient administers the lethal dose with the patient's consent".
Between 1950 and 1993, only 11 doctors in the US were prosecuted for killing their terminally ill patients and none went to prison so the existing laws have little deterrent effect.
A survey by the American Society of Internal Medicine shows that one in five doctors say they have helped patients to commit suicide. Another survey in the New England Journal off Medicine shows that one in five nurses also say they have helped patients kill themselves.
At the same time, the American Medical Association two weeks ago "reaffirmed its adamant opposition" to PAS. "The medical profession will not tolerate being put in a position to judge the value of the lives of the patients we are trained to heal, comfort and care for," Dr Nancy Dickey chairwoman of the AMA Board of Trustees, says.
Referendums have been held in three states to allow PAS for the terminally ill. Voters in two states, Washington and California, rejected the proposal by margins of about 54 per cent to 46 per cent. Oregon voted narrowly in favour by 51 to 49.
Six state legislatures have recently rejected bills that would permit PAS and no state has decriminalised it. But the California and New York courts which have favoured PAS have cited public opinion polls such as a 1994 Harris survey which found that 73 per cent favoured it under certain conditions.
Mr Rosen says that given the ambivalence that exists on the issue, it is wiser to allow state legislatures and voters to decide rather than the courts which are tending to use the Roe v Wade case which legalised abortion on the basis of a right to privacy as a precedent to legalise PAS. This is a dangerous path to follow, Mr Rosen says.
The AMA statement is unequivocal, however. "To allow or force physicians to participate in actively ending the lives of patients would so dramatically and fundamentally change the entire patient/physician relationship that it would undermine the principles we, as a society, hold most dear. We must never lose sight of the caveat that physicians are healers and where we cannot heal, our role is to comfort."
AUSTRALIA
THE Australian Northern Territory's law allowing doctors to administer lethal drug doses to terminally ill patients under certain strict conditions was passed by a single vote on May 25th last year. This was despite passionate opposition from the churches, from the Australian Medical Association (AMA), Aboriginal groups, and from state and federal MPs on both sides of politics.
However, the detailed regulations for the implementation of the new law, approved only last Friday, impose further restrictions which supporters of euthanasia say will exclude the majority of potential candidates and make the law almost unworkable.
In particular, the regulations stipulate that one of the two doctors required to approve the procedure must be both a resident of the Territory and a specialist in the disease from which the terminally ill patient is suffering. The Northern Territory, with a population of less than 600,000, has very few cancer specialists and many of the patients concerned are cancer sufferers.
Opponents of euthanasia had feared that patients from all over Australia would move or be sent to Darwin to take advantage of the new law. The regulations, however, suggest that given the relatively small number of doctors in the Territory, and the even smaller number who are not opposed to euthanasia in principle, the process will now be much slower and more costly than had been thought.
One of the main instigators of the NT legislation is Dr Philip Nitschke (48), who has resigned from the AMA because of its opposition to the law. Dr Nitschke has built a computerised "death machine" which enables a terminally ill person to decide their own moment of death by pressing a button that induces a lethal injection.
As the law was due to come into effect at the start of this week, two patients face additional mental agony. Mr Max Bell (65) and Mrs Jan Culhane (51) had come to Darwin last year in anticipation of the new legislation coming into force. Mr Bell is a retired taxi driver from the outback mining town of Broken Hill, suffering from terminal stomach cancer. Mrs Culhane, a mother from New South Wales, has had a tragic family life as well as her cancer.
The law is now undergoing a stiff and concerted challenge in the courts. A Supreme Court action launched by the chairman of the Australian Medical Association in the NT, Dr Chris Wake, and others, including Aboriginal groups, seeks to have the law declared unconstitutional.
A spokeswoman for the minister responsible, the NT Attorney General and Minister of Health, Mr Denis Burke, said on Friday that the NT government was confident the legal challenge would not succeed. Nevertheless, the minister had advised doctors that there was a possibility that acts of euthanasia carried out before the Supreme Court decision could be found to be illegal if the case were lost.
The case is almost certain to be referred from the NT Supreme Court to the High Court of Australia, the ultimate arbiter in constitutional matters.
However, the life of the legislation looks like being terminated even before it gets to the Highs Court.
A federal Liberal MP from Victoria, Mr Kevin Andrews, has announced his intention to introduce a Private Members Bill in the federal Parliament in Canberra to outlaw the NT legislation. He believes he can do this because under Australia's somewhat bizarre federal system, the Northern Territory is classified as a self governing territory of the Commonwealth of Australia. This means that the federal government in Canberra retains the ultimate right to legislate for the NT.
Mr Andrews (40) is himself a lawyer, who has specialised in bioethics. His proposal has infuriated the NT government and intensified the territory's push for full statehood. But both the Prime Minister, Mr John Howard, and the leader of the Opposition, Mr Kim Beazley, are personally opposed to euthanasia. The government has already assured Mr Andrews that time will be made available for his bill when parliament resumes at the end of August.
Although there will be a conscience vote on the issue, a poll of federal MPs conducted by the Weekend Australian newspaper suggests that an Andrews Bill to kill the NT Act would be passed by a majority of more than two to one.
. Three judges of the Northern Territory Supreme Court withdrew to deliberate on their decision when the two day hearing into the validity of the Right of the Terminally Ill Act concluded yesterday.