So what is to be made of the 1990 merger between Concern for Dying and the Society for the Right to Die, the media attention given to Jack Kevorkian's suicide machine, and Derek Humphry's Final Exit reaching the top of the New York Times best-seller list in 1991 (and its video version appearing on Oregon television and in's inventory in 2000)? Have we reached the point where dying has become another form of consumer resistance? Certainly one common theme underlying these developments is the failure of the contemporary death ritual for both the dying and the bereaved.


Karen Ann Quinlan, Nancy Cruzan and Terri Schiavo

Though most euthanasia cases involve the elderly, it is interesting to note how often the right-to-die campaign has been dramatized in the cases of brain-damaged young women: Karen Ann Quinlan (1975-1985), Nancy Cruzan (1983-1990), and Terri Schiavo (1990- ).

The loss of control experienced by institutionalized terminally ill patients is a central motif of much thanatological research. Dying patients' basic human rights are seen to be violated when they lack the knowledge and power to make decisions which, in turn, diminishes dignity. Patients have the right to know their condition, to choose or to reject the treatment regimen, to choose or to reject attempts to prolong their life, and to decide fully as to the disposal of their remains. They also have the right to ritually vent their fears and frustrations. (Consider the findings of David Spiegel, whose study of women with metastic breast cancer found that those who belonged to a psychotherapy group survived almost twice as long on average as those who did not participate in a support group, and reported less depression, anxiety and pain.) For the moving story of John Graham's death check out Soundprint's "A Matter of Life and Death: Assisted Suicide in Australia" (Michael Lutsky, producer).

As is the case with any ending--whether it be music resolutions, the denouements of literature and drama, conclusion sections of research papers, the logic of desserts, or the completion of a human life--failure to culminate "correctly" jeopardizes the overall meaningfulness of the social product. Endings occasion special insight. Representing consummation and closure, endings reveal the connections between means and goals. They demand summations of the worthiness, coherence, and meaningfulness of their encounters with time. Further, the endings of role careers and lives can be the most individualizing of experiences: Individuals "in exit" no longer need to conform to trivialities of mass culture nor to the norms of the status hierarchy; one can say what one likes for there is nothing to lose. For these reasons, endings are highly ritualized.

From this perspective, the problem of our times is the apparent lack of cultural consensus over exactly how endings --whether from work, the family, or from life itself-- should be ideally conducted. It is for this reason that we now witness expanding political and legal involvements in status terminations. In 1997, the U.S. Supreme Court will decide if states can prosecute physicians for assisting in the suicides of their competent, terminally ill patients. We do know that "good" endings require personal control and the minimization of degradation. As a consequence, we're witnessing the emergence of the death awareness movement that features the right-to-die, euthanasia, and hospice movements as well as the public's receptivity to Kübler-Ross's stages of the death process. This, in turn, is regenerating a life awareness movement. As Martin Luther King said on the eve of his assassination, no one is truly free to live until one is free to die.

Click here to see

Given the results of an eight-year clinical study of dying in America, (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments, funded by the Robert Wood Johnson Foundation; William Knaus and Joanne Lynn principal investigators), revealing that one-half of conscious patients who died in hospitals reported moderate to severe pain at least one-half of the time, and given the survey results of 1,400 doctors and nurses at five major hospitals in different parts of the country (published in the January 1993 issue of the American Journal of Public Health) indicating that 81% agreed that "the most common form of narcotic abuse in caring for dying patients is undertreatment of pain" with nearly half of the attending physicians and nurses and 70% of resident physicians reporting having acted against their conscience by not aggressively treating terminally ill patients, perhaps we would not be faced with the euthanasia debate if adequate pain control had been administered. Check out the philosophy and resources at the Palliative Page.



Ninth Circuit Court of Appeals Decision of March, 1996
Second Circuit Court of Appeals Decision of April, 1996: Quill v. Vacco
Rights of the Terminally Ill in Australia, 1995


Right to Die Society of Canada--"Advancing the Art & Science of Dying Well"'s Euthanasia World Directory
Hemlock Society USA
Yahoo's Euthanasia Listings: Proponents
Views of late Noel Earley, victim of ALS
Robert Neils's (President of Dying Well Network) book "Death with Dignity FAQs"
World Federation of Right to Die Societies' website (and a listing of members here)
EXIT (formerly Voluntary Euthanasia Society of Scotland)
Dying with Dignity (Canadian Society)
Voluntary Euthanasia Society (UK and Wales) --with daily international news items and a searchable news database
The Voluntary Euthanasia Society of New Zealand
Euthanasia in the Netherlands
LAST RIGHTS Electronic Journal


Yahoo's Euthanasia Listings: Opposing Views
International Anti-Euthanasia Task Force
Citizens United Resisting Euthanasia (CURE, Ltd.): "Practicing Compassion, Unity, Research, and Education"
Euthanasia (links from Ohio Right to Life)
Ezekiel Emanuel's "Whose Right to Die?" from The Atlantic Monthly
Ted Gerk's "The Kevorkian Papers"
Not Dead Yet! Disabled activists speak their opposition


There is a fine moral line between euthanasia and physician-assisted suicide.  Physicians still, however, control the final passage as terminally ill patients' ability to have legal access to lethal drugs is contingent on doctors' approval.  In the July 2000 edition of Reason magazine, Thomas Szasz speaks of "the galloping therapeutic state, where increasingly we are giving away our existential choices and responsibilities to doctors."  He notes that if one buys a rope to hang oneself we don't refer to it as "merchant- assisted suicide."  And is accelerating the inevitable really "suicide"?

Thomas A. Bowden's "Assisted Suicide: A Moral Right" produced by the Ayn Rand Institute's MediaLink


At the center of this moral hurricane is Dr. Jack Kevorkian, a Michigan pathologist (whose business card reads "Jack Kevorkian, M.D. Bioethics and Obitiatry. Special Death Counseling") who created suicide machines to allow terminally ill patients to kill themselves in supposedly humane and painless ways. In his 1991 book Prescription: Medicine--The Goodness of Planned Death, he speaks of the "Stone-Age ethics of space-age medicine" and of his personal crusade for physician- assisted suicide. His highly publicized activities have been viewed by others in a multitude of ways, from his being a godsend to a serial killer.

Kevorkian is not alone is his acceleration of the death process of the terminally ill. A 1996 study by David A. Asch of over 800 critical-care nurses, for instance, revealed nearly one in five admitting to hastening the deaths of terminally ill patients--16 percent by performing euthanasia or assisting in suicide, and another 4 percent by only pretending to live life- sustaining treatment ordered by physicians.

Patients helped to die by Dr. Jack Kevorkian


To what extent do Americans' orientations toward abortion, euthanasia, and the moral right of the terminally ill to take their own lives "hang together" in their minds? Does increasing social approval of one--say, approval of physician-assisted suicide--lead over time to increasing social approval of the others?

Increasingly public discourse features debates over semantics and either the blurring or sharpening of distinctions. For instance, in the case of euthanasia there is the distinction between mercy killing and the merciful use of drugs that, like the "morphine drip," may "unintentionally" hasten the death of a terminally-ill individual. At a public lecture at Trinity University (October 13, 1995), Ralph Miro argued that the difference between a pain-plagued terminally ill patient taking a legally prescribed lethal dose of pharmaceuticals and the suicide of one depressed is analogous to the difference between love-making and rape.

On the other hand, proponents of the slippery-slope thesis claim that such blurrings or new distinctions lead to ever-widening acceptances of death. Once terminal patients in pain are allowed to die, then does it not become harder to deny the same right to someone in terrible pain who faces not death but rather a life of torment? Further, if competent individuals are allowed to seek death, then does it not become harder to deny terminating the lives of sick infants or adults in comas? At some point, so the argument goes, we move from assisted suicide to homicide and then to genocide, the ultimate moral abyss.

In her 1994 ruling striking down a 140-year-old Washington State ban on assisted suicide, Judge Barbara Rothstein of U.S. District Court in Seattle said

The suffering of a terminally ill person cannot be deemed any less intimate or personal, or any less deserving of protection from unwarranted governmental interference than that of a pregnant woman. ... Like the abortion decision, the decision of a terminally ill person to end his or her life `involves the most intimate and personal choices a person can make in a lifetime,' and constitutes a `choice central to personal dignity and autonomy.'

Let's begin by examining longitudinal trends in Americans' responses to the following three questions (recognizing the sensitivity of responses to question wording):

Combining responses from the NORC General Social Surveys between the years 1977 and 1998 (n=19,000+), we find Americans are more likely to approve of euthanasia (68%) than suicide (53%) or abortion on demand (40%). Click here to see Annual rates of approval of euthanasia, suicide and abortion. As can be seen in this figure, the moral issue with the greatest change in approval was suicide of the terminally ill, which Americans were nearly two-thirds more likely to approve of in 1998 (64%) than in 1977 (38%).

The number of Americans approving all three of these ways of ending life increased from 26% in 1977 to 38% in 1998, while the number disapproving of all declined from 33% to 26%. Click here to see Annual rates of number of approvals of euthanasia, suicide and abortion.

Since the greatest change was in approval of the moral right of the terminally ill to commit suicide, let's examine the relationship between attitudes toward euthanasia and abortion among those who do and do not approve of suicide and how this has changed over time. Click here to see The relationship between attitudes toward euthanasia and abortion by approval/disapproval of suicide. Several trends are worth noting:

Now let's examine the relationship between attitudes toward suicide and abortion among those who do and do not approve of euthanasia and how this has changed over time. Click here to see The relationship between attitudes toward suicide and abortion by approval/disapproval of euthanasia. Several trends are worth noting:

Finally, let's consider the relationship between attitudes toward suicide and euthanasia among those who do and do not approve the right of a pregnant woman to have an abortion and how this has changed over time. Click here to see The relationship between attitudes toward suicide and abortion by approval/disapproval of euthanasia. Trends:

Bottom line: there is a great moral polarization in American society on matters of euthanasia, suicide of the terminally ill, and abortion, and it is increasing over time. Further, as these death attitudes coalesce into polarized ideologies they are also becoming increasing correlated with individuals' positions within the status hierarchy (within social classes).

What does this polarization mean? There is emerging two ideological cores, each with its own rhetoric and each spawning (because of the existence of the other) its own extreme fringe elements. It is probably not the case that ideology leads to these social movements, but rather these movements are emerging in collective opposition to each other. Ideological themes emerge only later, as justifications for the movements' actions.

Core 1 is comprised of the "pro-life" folks: moral absolutists (who see the moral issues in black-and-white terms instead of shades of gray), politically conservative, religious fundamentalists (the Christian Coalition is out to legislate religious views), anti- euthanasia, pro-capital punishment, favoring the right to bear arms (Second Amendment Activists), anti-government (believing government should stay out of people's private lives), pro-business, anti-environmentalist, and favoring a strong military. Allying themselves with this emerging core are Christian home-schoolers and conspiracy theorists. These are the people who belief that the killing of abortionists is morally justified; it is not murder to murder a murderer. The extreme fringe of this core has found a voice in the millennial movements, like Christian Patriots and state militias (i.e., the Militia of Montana, who claimed that the UN plan to partition the United States into 9 zones appeared in 1994 on the back of Kix cereal boxes).

Core 2 is comprised of the "pro-choice" folks. They are moral relativists (who see many shades of moral grays); politically liberal, favoring gay rights, abortion rights, and right-to- die legislation; secular humanists; environmentalists; and favoring a scaled down military.


Have you noticed how debates over "good deaths" have put marijuana back in the news recently? And you thought the drug was basically safely locked away back in the sixties and seventies.

Percent approving of legalization of marijuana by responses to "When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient's life by some painless means if the patient and his family request it?"

1978 1983 1986 1988 1989 1990 1991 1993 1994 1996 1998


39% 25% 23% 22% 18% 20% 21% 28% 28% 33% 36%
NO 18 13 10 9 7 9 9 14 11 12 13
30 21 18 18 17 17 19 23 24 27 29
60 66 68 69 69 72 74 68 71 71 72

Looking at the YES and NO rows of the above table within the 1978 column we see how, for instance, of those supporting physician-assisted death in 1978, 39% approved of the legalization of marijuana, compared with only 18% of those opposing physician-assisted death. In that year 30% of Americans in total approved of the drug's legalization and 60% approved of euthanasia.

Return to Kearl's Death Index