Physician Assisted Suicide

Physician assisted suicide is a form of euthanasia where a doctor intentionally provides a terminally ill patient with the means to commit suicide—for example, by giving them a prescription for a lethal dose of medication which the patient then administers to him or herself.

Physician assisted suicide—called “death with dignity” by advocates—differs from the following:

• Voluntary, active euthanasia, where a doctor actually carries out a patient’s request to die, such as by injecting a lethal dose of a drug. This is illegal in all states.
• The withdrawal or refusal of life-supporting treatments, which is sometimes called passive euthanasia. This can include turning off a respirator, removing a feeding tube or IV, or allowing someone’s heart to stop without trying to resuscitate. The right of a patient to refuse life-support is protected by the Constitution and is therefore legal across the United States.

Several states have legalized physician assisted suicide under certain conditions.

Assisted suicide law in NH

Physician assisted suicide is illegal in New Hampshire. Helping someone commit suicide—whether a health care professional or a family member—can be punished by up to seven years in prison.

However, the following practices are allowed:

• As in all other states, it is legal in New Hampshire to create a living will or advanced directive that orders the withdrawal or refusal of life-saving treatments under certain conditions, allowing death to take place naturally. Your physician can help you to create a living will, as can a lawyer. There are also resources online that can help you. In New Hampshire, your living will must either be notarized or witnessed by two adults.
• Patients may also grant power of attorney to a family member or other trusted agent to make health care decisions for them in the event that they are not able to do so themselves. In the absence of an advanced directive, a designated health care agent can refuse life-saving treatment on a patient’s behalf. 

History

In recent years, supporters have made several attempts to pass legislation allowing physician assisted suicide in New Hampshire. So far, all of them have failed.

In 2015, a bill to create a committee to study the issue was vetoed by Gov. Maggie Hassan. A similar move died in the House in 2016. In 2020, HB 1659 also failed to advance.

Federal law

There is no federal law authorizing or prohibiting physician assisted suicide.

The Supreme Court has ruled that the Constitution doesn’t guarantee citizens a right to assisted suicide. However, the court did not say the Constitution forbids the practice, either. This leaves the door open for states to pass their own laws. 

In 1999, the federal government passed the Assisted Suicide Funding Restriction Act. This bans any use of federal money in support of physician assisted suicide—for example, spending Medicare dollars for medication intended to help a patient end her life.

Law in other states

California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, Washington, D.C., and Washington allow physician assisted suicide. 

All physician assisted suicide laws passed so far in the United States are very similar:

• Patients must be at least 18 years old and must be conscious and mentally competent—a family member or health care proxy can’t request physician assisted suicide on behalf of an unconscious or impaired patient.
• Two doctors must certify that the patient is a resident of the state, has less than six months to live, and is making the request voluntarily.
• Patients must make two oral requests for assisted suicide, spaced at least 15 days apart, as well as a written request signed by witnesses.
• Doctors are not required to participate in physician assisted suicide. If a doctor refuses a patient’s request, it’s the responsibility of the patient to find another doctor willing to help them.
• Doctors may prescribe, but may not administer, a lethal dose of medication.

The exception is in Montana, where physician assisted suicide became legal through a court ruling. 

In states where physician assisted suicide is illegal, charges vary from felony to manslaughter.

Policy Questions

Advanced directives and euthanasia

Some “death with dignity” advocates argue that patients should be able to request assisted suicide under certain conditions in their advanced health directives. They point to diseases like Alzheimers or advanced dementia that are painful, debilitating, and terminal, but that make a patient mentally incompetent at the time when they would hypothetically be able to request physician assisted suicide. They argue that allowing patients to request “death with dignity” ahead of time empowers them to make their own health care choices.

Opponents express concerns about the potential for abuse, and counter that physician assisted suicide should be limited to people who genuinely want to die, and who have the mental competence necessary to make that final choice when the time comes.

Doctor discretion

In every state that has so far legalized physician assisted suicide, doctors have the option to participate or to refuse. This has led some to complain that it can become difficult for suffering patients to find a physician willing to help them if their own doctor is morally opposed and unwilling to offer a referral.

On the other hand, many physicians feel that physician assisted suicide is a violation of their ethical responsibility to heal, not hurt, their patients, or have religious objections. They maintain that assisted suicide is not an essential health treatment, and that these physicians should therefore not be forced to act against their principles.

Palliative care and sedation

Sometimes in hospice or palliative end-of-life care, doctors will recommend using morphine or other drugs to sedate a patient who is in extreme pain, with the intent that the patient remain sedated until death occurs.

This is not considered a form of physician assisted suicide, as the doses are carefully controlled to cause sedation but not hasten death.

Doctors who support this practice argue that it relieves the suffering of patients whose pain is not responding to other treatments without crossing the ethical boundary into causing death.

Opponents counter that the drugs, while intended only to sedate, may actually lead patients to die sooner than they would otherwise, dubbing the practice “slow euthanasia”.