Challenges and Dilemmas in the “Aging and Euthanasia” Policy Cocktail

  • Roger S. Magnusson
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 12)


There can be few more volatile policy debates than that of aging and euthanasia. If AIDS has come to be seen as the disease that “most justifies” the right to die (Magnusson 2002, 49), then old age must surely be one of the most difficult contexts in which to consider a policy of assisted death. Apart from the usual arguments about personal choice, pain and suffering, and compassion, versus arguments about palliative care, the role of medicine and the “slippery slope” (Miller 1996), looms the troubling issue of health care rationing (Callahan 1996). As the costs of chronic and end-of-life care continue to rise, some fear that even a well-intentioned policy permitting voluntary assisted death would become corrupted (Santamaria 1996). Depression and dementia, where evident in later life, further complicate the policy equation. Tobin predicts that doctors would become emboldened “to act on ascribed ‘autonomous wishes’, that is to say, on ‘what the patient would have wanted if only he [or she] were able to tell us”’ (Tobin 1995). Together, these factors generate a bleak (albeit imagined) scenario: one where death in old age becomes a subtly “persuaded act,” a choice disproportionately made by the vulnerable and self-effacing, those wishing to conserve the family silver and to spare loved ones the agony of waiting.


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  1. Alcorn, G. 1996. Cancer kills man who sought NT euthanasia. The Age (Melbourne), 5 August, A4.Google Scholar
  2. Amarasekara, K. 1997. Euthanasia and the quality of legislative safeguards. Monash University Law Review 23: 1–42.Google Scholar
  3. Andrews, K. 1996. Second Reading Speech to the Euthanasia Laws Bill 1996, Australian House of Representatives, 28 October.Google Scholar
  4. Anonymous. 1996. What is there to be frightened about? After all, it’s not like I am going to the dentist! Cambridge Quarterly of Healthcare Ethics 5: 83–7.Google Scholar
  5. Barbato, M. 1998. Death is a journey to be undertaken. Medical Journal of Australia 168: 296–7.PubMedGoogle Scholar
  6. Baron, C., C. Bergstresser, D. Brock, G. Cole, N. Dorfman, J. Johnson, L. Schnipper, J. Vorenberg, and S. Wanzer. 1996. A model state act to authorize and regulate physician-assisted suicide. Harvard Journal on Legislation 33: 1–34.PubMedGoogle Scholar
  7. Battin, M. 1995. Ethical Issues in Suicide. New Jersey: Prentice Hall.Google Scholar
  8. Baume, P. and E O’Malley. 1994. Euthanasia: Attitudes and practices of medical practitioners. Medical Journal of Australia 161: 137–44.PubMedGoogle Scholar
  9. Billings, J., and S. Block. 1996. Slow euthanasia. Journal of Palliative Care 12: 21–30.PubMedGoogle Scholar
  10. Billings, J. 2000. Recent advances: Palliative care. British Medical Journal 321: 555–558.PubMedCrossRefGoogle Scholar
  11. Blaikie, A. 1999. Ageing: Old visions, new times?. The Lancet 354: siv3.Google Scholar
  12. Block, S. (for the ACP-ASIM End of Life Care Consensus Panel). 2000. Assessing and managing depression in the terminally ill patient. Annals of Internal Medicine 132: 209–18.Google Scholar
  13. Brody, H. 1992. Assisted death–A compassionate response to a medical failure. The New England Journal of Medicine 327: 1384–8.PubMedCrossRefGoogle Scholar
  14. Burgess, J. 1993. The great slippery-slope argument. Journal of Medical Ethics 19: 169–74.PubMedCrossRefGoogle Scholar
  15. Burgess, R. 1982. Field research: A sourcebook and field manual. London: George Allen & Unwin.CrossRefGoogle Scholar
  16. Byock, I. 1994. The hospice clinician’s response to euthanasia/physician assisted suicide. The Hospice Journal 9 (4): 1–8.PubMedGoogle Scholar
  17. Callahan, D. 1992. When self-determination runs amok. Hastings Center Report 22 (2): 52–5.PubMedCrossRefGoogle Scholar
  18. Callahan, D. 1994. Regulating physician-assisted death (letter). New England Journal of Medicine 331: 1656.Google Scholar
  19. Callahan, D. 1996. Controlling the costs of health care for the elderly–Fair means a foul. New England Journal of Medicine 335: 744–6.PubMedCrossRefGoogle Scholar
  20. Callahan, D. 1999a. Aging, death and population health. Journal of the American Medical Association 282: 2077.Google Scholar
  21. Callahan, D. 1999b. Good strategies and bad: Opposing physician-assisted suicide. Commonweal 126 (21): 7.Google Scholar
  22. Callahan, D. 2000. On tuming 70: Will I practice what I preach? Commonweal 127 (15): 10.Google Scholar
  23. Caplan, A., L. Snyder, and K. Faber-Langendoen. 2000. The role of guidelines in the practice of physician-assisted suicide. Annals of Internal Medicine 132: 476–81.PubMedGoogle Scholar
  24. Cheyfitz, K. 1999. Who decides? The connecting thread of euthanasia, eugenics and doctor-assisted suicide. Omega 40 (1): 5–16.PubMedGoogle Scholar
  25. Chochinov, H., D. Tataryn, J. Clinch, and D. Dudgeon. 1999. Will to live in the terminally ill. The Lancet 354: 816–19.Google Scholar
  26. Cooke, M., L. Gourlay, L. Collette, A. Boccellari, M. Chesney, and S. Folkman. 1998. Informal caregivers and the intention to hasten AIDS-related death. Archives of Internal Medicine 158: 69–75.PubMedCrossRefGoogle Scholar
  27. Coomaraswamy, R. 1996. Death, dying and assisted suicide. In Suicide and depression in later life, ed. G.J. Kennedy, 141–52. New York: John Wiley & Sons.Google Scholar
  28. Dworkin, R., T. Nagel, R. Nozick, J. Rawls, T. Scanlon, and J. Thomson. 1997. Assisted Suicide: The Philosophers’ Brief. The New York Review of Books 27 March 1997: 41–7.Google Scholar
  29. Ellard, J. 1998. Euthanasia: Over the rubicon already? Australian New Zealand Journal of Medicine 28: 57.PubMedCrossRefGoogle Scholar
  30. Emanuel, E. 2001. Euthanasia: Where the Netherlands leads will the world follow? British Medical Journal 322: 1376–7.PubMedCrossRefGoogle Scholar
  31. Emanuel, E., D. Fairclough, and L. Emanuel. 2000. Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. Journal of the American Medical Association 284: 2460–8.PubMedCrossRefGoogle Scholar
  32. Farsides, B. 1998. Palliative care–A euthanasia-free zone? Journal of Medical Ethics 24: 149–50.PubMedCrossRefGoogle Scholar
  33. Fitzgerald, J. 1999. Bioethics, disability and death: Uncovering cultural bias in the euthanasia debate. In Disability, divers-ability, and legal change, eds. M. Jones and L.A. Basser Marks, 267–81. The Hague: Martinus Nijhoff.Google Scholar
  34. Frey, R. 1998. The fear of a slippery slope. In Euthanasia and physician-assisted suicide, eds. G. Dworkin, R.G. Frey, and S. Bok, 43–63. Cambridge: Cambridge University Press.Google Scholar
  35. Ganzini, L., H. Nelson, T. Schmidt, D. Kraemer, M. Delorit, and M. Lee. 2000. Physicians’ experiences with the Oregon Death With Dignity Act. New England Journal of Medicine 342: 557–63.PubMedCrossRefGoogle Scholar
  36. Ganzini, L., H. Nelson, M. Lee, D. Kraemer, T. Schmidt, and M. Delorit. 2001. Oregon physicians’ attitudes about and experiences with end-of-life care since passage of the Oregon Death With Dignity Act. Journal of the American Medical Association 285: 2363–9.PubMedCrossRefGoogle Scholar
  37. Giddershoven, G., and R. Berghmans. 2001. Advance directives in psychiatric care: A narrative approach. Journal of Medical Ethics 27: 92–7.CrossRefGoogle Scholar
  38. Gillett, G. 1994. Euthanasia from the perspective of hospice care. Medical Law 13: 263–8.Google Scholar
  39. Glover, R. 1999. Why the vulnerable flock to dr death. Sydney Morning Herald 17 April: S2.Google Scholar
  40. Griffiths, J. 1995. Assisted suicide in the Netherlands: the Chabot Case. The Modern Law Review 58: 232–48.CrossRefGoogle Scholar
  41. Griffiths, J., A.Bood, and H. Weyers. 1998. Euthanasia law in the Netherlands. Amsterdam: Amsterdam University Press.CrossRefGoogle Scholar
  42. Harper, S. 1994. Terminal care in nursing homes. In Willing to listen, wanting to die, eds. H. Kuhse, 97114. Ringwood, Victoria: Penguin Books Australia.Google Scholar
  43. Hart, B. P. Sainsbury, and S. Short. 1998. Whose dying? A sociological critique of the “good death.” Mortality 3: 65–77.CrossRefGoogle Scholar
  44. Harvey, J. 1997. The technological regulation of death: With Reference to the Technological Regulation of Birth. Sociology 31: 719–35.CrossRefGoogle Scholar
  45. Heilig, S., and S. Jamison. 1996. Physician aid-in-dying: Towards a “harm reduction” approach. Cambridge Quarterly of Healthcare Ethics 5: 113–120.PubMedCrossRefGoogle Scholar
  46. Hoefler, J. 1994. Deathright: Culture, medicine, politics, and the right to die. Boulder, Colorado: Westview Press.Google Scholar
  47. Hughes, J. 2001. Views of the Person with Dementia. Journal of Medical Ethics 27: 86–91.PubMedCrossRefGoogle Scholar
  48. Hunt, R. 1994. Palliative care–The rhetoric/reality gap. In Willing to listen, wanting to die, eds. H. Kuhse, 115–37. Ringwood, Victoria: Penguin Books Australia.Google Scholar
  49. Jamison, S. 1996. When drugs fail: Assisted deaths and not-so-lethal drugs. In Drug use in assisted suicide and euthanasia, eds. M.P. Battin, and A.G. Lipman, 223–43. New York: Pharmaceutical Products Press.Google Scholar
  50. Kamisar, Y. 1995. Physician-assisted suicide: The last bridge to active voluntary euthanasia. In Euthanasia examined: Ethical, clinical and legal perspectives, ed. J. Keown, 225–60. Cambridge: Cambridge University Press.Google Scholar
  51. Kawas, C., and R. Brookmeyer. 2001. Aging and the public health effects of dementia. New England Journal of Medicine 344: 1160–1.PubMedCrossRefGoogle Scholar
  52. Kennedy, H. 1995. Plea from the grave. Sunday Herald-Sun (Melbourne), 8 October: 1, 4.Google Scholar
  53. Keown, J. 1995. Euthanasia in the Netherlands: Sliding down the slippery slope? In Euthanasia examined: Ethical, clinical and legal perspectives, ed. J. Keown, 269–96. Cambridge: Cambridge University Press.Google Scholar
  54. Kissane, D., A. Street, and P. Nitschke. 1998. Seven deaths in Darwin: Case studies under the rights of the Terminally Ill Act, Northern Territory, Australia. The Lancet 352: 1097–1102.CrossRefGoogle Scholar
  55. Kuhse, H., P. Singer, P. Baume, M. Clark, and M. Rickard. 1997. End-of-life decisions in Australian medical practice. Medical Journal of Australia 166: 191–6.PubMedGoogle Scholar
  56. Lewins, F. 1998. The Development of bioethics and the issue of euthanasia: Regulating, de-regulating or re-regulating?. Journal of Sociology 34: 123–34.PubMedCrossRefGoogle Scholar
  57. Little, M. 1998. Euthanasia–Crossing the Rubicon or at the cross roads? Australia New Zealand Journal of Medicine 28: 55–6.CrossRefGoogle Scholar
  58. Little, M. 1999. Assisted suicide, suffering and the meaning of a life. Theoretical Medicine and Bioethics 20: 287–98.PubMedCrossRefGoogle Scholar
  59. McCue, J. 1995. The naturalness of dying. Journal of the American Medical Association. 273: 1039–43.PubMedCrossRefGoogle Scholar
  60. Maddocks, I. 1996. Hope in dying: Palliative care and the good death. In An easeful death? Perspectives on death, dying and euthanasia, ed. J. Morgan, 57–70. Sydney: Federation Press.Google Scholar
  61. Magnusson, R. 1997. The sanctity of life and the right to die: Social and jurisprudential aspects of theeuthanasia debate in Australia and the United States. Pacific Rim Law Policy Journal 6: 1–83. (forthcoming, February 2002). Angels of death: Exploring the euthanasia underground, Melbourne: Melbourne University Press.Google Scholar
  62. Magnusson, R., and P. Ballis. 1999. The responses of health care workers to AIDS patients’ requests for euthanasia. Journal of Sociology 35: 312–330.PubMedCrossRefGoogle Scholar
  63. Meier, D., C. Emmons, S. Wallenstein, T. Quill, R.S. Morrison, and C.K. Cassel. 1998. A national survey of physician-assisted suicide and euthanasia in the United States. The New England Journal of Medicine 338: 1193–1201.PubMedCrossRefGoogle Scholar
  64. Miles, S. 1994. Physicians and Their Patients’ suicides. Journal of the American Medical Association 271: 1786–8.PubMedCrossRefGoogle Scholar
  65. Miller, R. 1996. Assisted Suicide and Euthanasia: Arguments For and Against Practice, Legalization and Participation. In Drug use in assisted suicide and euthanasia, eds. M.P. Battin, and A.G. Lipman, 1141. New York: Pharmaceutical Products Press.Google Scholar
  66. Mullen, P. 1995. Euthanasia: An impoverished construction of life and death. Journal of Law and Medicine 3: 121–8.Google Scholar
  67. O’Connor, M., D. Kissane, and O. Spruyt. 1999. Sedation in the terminally ill–A clinical perspective. Monash Bioethics Review 18 (3): 17–27Google Scholar
  68. Ogden, R. 2001a. Non-Physician Assisted Suicide: The Technological Imperative of the Deathing Counterculture. Death Studies 25: 387–401.PubMedCrossRefGoogle Scholar
  69. Ogden, R. 20016. Nutech and non-physician assisted suicide: A reply to Werth. Death Studies 25: 413–8.Google Scholar
  70. Pellegrino, E. 1995. Ethics. Journal of the American Medical Association 273: 1674–6.PubMedCrossRefGoogle Scholar
  71. Pollard, B. 1994. The challenge of euthanasia. Crows Nest, New South Wales: Little Hills Press.Google Scholar
  72. Pollard, B., and R. Winton. 1993. Why doctors and nurses must not kill patients. Medical Journal of Australia 158: 426–9.PubMedGoogle Scholar
  73. Quill, T., C. Cassel, and D. Meier. 1992. Care of the hopelessly ill: Proposed clinical criteria for physician-assisted suicide. New England Journal of Medicine 327: 1380–4.PubMedCrossRefGoogle Scholar
  74. Quill, T., D Meier, S Block, and J. Billings. 1998. The debate over physician-assisted suicide: Empirical data and convergent views. Annals of Internal Medicine 128: 552–8.PubMedGoogle Scholar
  75. Russon, L., and D. Alison. 1998. Palliative care does not mean giving up. British Medical Journal 317: 196–7.PubMedGoogle Scholar
  76. Reichel, W., and A. Dyck. 1989. Euthanasia: A contemporary moral quandary. The Lancet 2: 1321–3.CrossRefGoogle Scholar
  77. Roscoe, L., J. Malphurs, L. Dragovic, and D. Cohen. 2000. Dr. Jack Kevorkian and cases of euthanasia in Oakland County, Michigan, 1990–1998. New England Journal of Medicine 343: 1735–6.PubMedCrossRefGoogle Scholar
  78. Ryan, C. 1995. Velcro on the slippery slope: The role of psychiatry in active voluntary euthanasia. Australian and New Zealand Journal of Psychiatry 29: 580–5.PubMedCrossRefGoogle Scholar
  79. Salem, T. 1999. Physician-assisted suicide: Promoting autonomy–or medicalizing suicide? Hastings Center Report, 29 (3): 30–6.PubMedCrossRefGoogle Scholar
  80. Salmasy, D., B. Linas, K. Gold, and K. Schulman. 1998. Physician resource use and willingness to participate in assisted suicide. Archives of Internal Medicine 158: 974–978.CrossRefGoogle Scholar
  81. Santamaria, B. 1996. Euthanasia’s bell tolls for thee. The Weekend Australian, 13–14 July: 22. Seale, C. 1995. Heroic Death. Sociology 19: 597–613.Google Scholar
  82. Seale, C., and J. Addington-Hall. 1994. Euthanasia: Why people want to die earlier. Social Science Medicine 39: 647–54.PubMedCrossRefGoogle Scholar
  83. Sullivan, A., K. Hedberg, and D. Fleming. 2000. Legalized physician-assisted suicide in Oregon–The second year. New England Journal of Medicine 342: 598–604.PubMedCrossRefGoogle Scholar
  84. Sullivan, A., K. Hedberg, and D. Hopkins. 2001. Legalized physician-assisted suicide in Oregon, 1998–2000. New England Journal of Medicine 344: 605.PubMedCrossRefGoogle Scholar
  85. Syme, R. 1999a. Pharmacological oblivion contributes to and hastens patients’ deaths. Monash Bioethics Review 18 (2): 40–3.Google Scholar
  86. Syme, R. 1999b. Reply from Rodney Syme. Monash Bioethics Review 18 (3): 34–40.Google Scholar
  87. Tallis, R. 1996. Is there a slippery slope? Times Literary Supplement 12 January: 3.Google Scholar
  88. Tobin, B. 1995. Letter, The Australian 24 May: 10.Google Scholar
  89. Tulsky, J., R. Ciampa, and E. Rosen. 2000. Responding to legal requests for physician-assisted suicide. Annals of Internal Medicine 132: 494–9.PubMedGoogle Scholar
  90. Walker, T., J. Littlewood, and M. Pickering. 1995. Death in the news: The public invigilation of private emotion. Sociology 29: 579–96.Google Scholar
  91. Ward, B., and P. Tate. 1994. Attitudes among NHS doctors to requests for euthanasia. British Medical Journal 308: 1332–4.PubMedCrossRefGoogle Scholar
  92. Whitneym, S., B. Brown, H. Brody, K. Alcser, J. Bachman, and H. Greely. 2001. Views of United States physicians and members of the American Medical Association House of Delegates on physician-assisted suicide. Journal of General Internal Medicine 16: 290–6.CrossRefGoogle Scholar
  93. Woodruff, R. 1995. In The last right? Australians take sides on the right to die, eds. S. Chapman, and S. Leeder, 155–8. Port Melbourne, Victoria: Reed Books Australia.Google Scholar
  94. Van der Maas, P., G. van der Wal, I. Haverkate, C. de Graaf, J. Kester, B. Onwuteaka-Philipsen, A. van der Heide, J.M. Bosma, and L. Willems. 1996. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990–1995. New England Journal of Medicine 335: 1699–1705.PubMedCrossRefGoogle Scholar
  95. Zalcberg, J., and J. Buchanan. 1997. Clinical issues in euthanasia. Medical Journal of Australia 166: 1502.Google Scholar
  96. Zech, D., S. Grond, J. Lynch, D. Hertel, and K. Lehmann. 1995. Validation of World Health Organization guidelines for cancer pain relief: A 10-year prospective study. Pain 63: 65–76.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2001

Authors and Affiliations

  • Roger S. Magnusson
    • 1
  1. 1.Faculty of LawUniversity of SydneyAustralia

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