Task Force Members & Table of Contents

		       WHEN DEATH IS SOUGHT

		     ASSISTED SUICIDE AND EUTHANASIA
			 IN THE MEDICAL CONTEXT

				May 1994

		      THE NEW YORK STATE TASK FORCE
			   ON LIFE AND THE LAW

			MEMBERS OF THE TASK FORCE

		   Mark R. Chassin, M.D., M.P.P, M.PH.
				Chairman
			 Commissioner of Health
			    State of New York

			    Karl Adler, M.D.
		    Dean, New  York  Medical  College

		     Rev.  Msgr.  John A. Alesandro
			       Chancellor
	       Roman Catholic Diocese of Rockville Centre

			    John Arras, Ph.D.
		    Associate Professor of  Bioethics
		   Albert Einstein College of Medicine
		      Montefiore  Medical   Center

			  Mario L. Baeza, Esq.
			  Debevoise & Plimpton

		      The Right  Rev.  David  Ball
		   Bishop, Episcopal Diocese of Albany

			  Rabbi J. David Bleich
		 Professor of Talmud, Yeshiva University
		    Professor of Jewish Law and Ethics
		     Benjamin Cardozo School of Law

			   Evan Calkins, M.D.
		    Professor of  Medicine,  Emeritus
			      SUNY-Buffalo

		       Richard J. Concannon, Esq.
			  Kelley, Drye & Warren

		       Myron W	 Conovitz,   M.D.
			   Attending Physician
		    North Shore  University  Hospital
		 Clinical Associate Professor of Medicine
		    Cornell University Medical College

			  Saul J. Farber, M.D.
			    Dean and Provost
		    Chairman, Department of Medicine
		 New York University School of Medicine

		      Alan  R.  Fleischman,   M.D.
		    Director, Division of Neonatolog
		   Albeit Einstein College of Medicine

			 Samuel Gorovitz, Ph.D.
			 Professor of Philosophy
			   Syracuse University

			 Jane Greenlaw, J.D., R.N.
		Director, Division of the Medical Humanities
	University of Rochester School of Medicine and Dentistry


			 Beatrix A. Hamburg,   M.D.
		       President, WT Grant Foundation

			 Denise  Hanlon, R.N., M.S.
			Assistant Clinical Professor
		       SUNY Buffalo School of Nursing

			  Rev. Donald W. McKinney
		     Chairman Emeritus, Choice in Dying

			     Maria I. New, M.D.
		      Chief, Department of Pediatrics
		  New York Hospital-Cornell Medical Center

			  John J. Regan, J.S.D.
			    Professor of Law
		      Hofstra University School of Law

			  Rabbi A. James Rudin
	       National Director of Interreligious Affairs
		       The American Jewish Committee

			  Rev. Betty Bone Schiess
		   Episcopal Diocese of Central New York

			       Barbara Shack
		     The New York Civil Liberties Union

			  Rev. Robert S. Smith
	Director, Institute for Medicine in Contemporary Society

		 SUNY Health Science Center at Stony Brook

			     Elizabeth W. Stack
				Commissioner
			New York State Commission on
		 Quality of Care for the Mentally Disabled



			      TASK FORCE STAFF

Tracy E. Miller, J.D.			    Aaron L. Mackler, Ph.d
Executive Director			    Staff Ethicist

Carl H. Coleman, J.D.			    Elizabeth Peppe
Associate Counsel			    Administrative Assistant

Anna Maria Cugliari, M.S.		    Jean Pohoryles
Health Policy Analyst			    Administrative Secretary





		 CONSULTANTS TO THE TASK FORCE COMMITTEE ON
		  SUICIDE AND PROFESSIONAL RESPONSIBILITY


			 Nessa M. Coyle, R.N., M.S.
		    Director of Supportive Care Program
		   Pain Service, Department of Neurology
		   Memorial Sloan-Kettering Cancer Center

			  Jimmie C. Holland, M.D.
			 Chief, Psychiatry Service
		   Memorial Sloan-Kettering Cancer Center
	 Professor of Psychiatry, Cornell University Medical College

			    Diane E. Meier, M.D.
			    Associate Professor
	       Department of Geriatrics and Adult Development
			Mt. Sinai School of Medicine

			    Norton Spritz, M.D.
			   Chief, Medical Service
	       Department of Veterans Affairs Medical Center
			   Professor of Medicine
		   New York University School of Medicine




				Contents

     Preface......................................................  vii
     Executive Summary............................................   ix
     Introduction.................................................    1
     Part I - The Clinical, Legal, and Ethical Context
     1.	  The Epidemiology of Suicide.............................    9
	       Suicide and the General Population.................   10
	       Risk Factors for Suicide...........................   13
     2.	  Suicide and Special Patient Populations.................   23
	       Patients with Cancer...............................   24
	       Patients with AIDS.................................   28
	       The Elderly........................................   30
     3.	  Clinical   Responses to Pain and Suffering..............   35
	       Assessing Pain and Other Symptoms..................   36
	       Managing Pain......................................   37
	       Treating Other Symptoms of Illness.................   40
	       Current Clinical Practice..........................   43
     4.	  Decisions at Life's End: Existing Law...................   49
	       The Right to Decide About Treatment................   49
	       Suicide and the Law................................   54
	       Assisted Suicide...................................   55
	       Euthanasia.........................................   63
	       Professional Misconduct Proceedings................   64
	       The Constitutional Issues..........................   67
     5.	  The Ethical Debate......................................   77
	       An Historical Perspective..........................   77
	       Distinguishing Assisted Suicide and Euthanasia.....   82
	       The Appeal to Autonomy.............................   85
	       Benefiting the Patient.............................   91

	       Societal Consequences..............................   96

	       The Role and Responsibilities of Physicians........  103

	       Killing and Allowing to Die........................  109

     Part II - Deliberations and Recommendations of the Task Force

     6. Crafting Public Policy on Assisted Suicide and Euthanasia . 117

		The Question of Legal Change......................  119


		A Response to Proposed Guidelines
		to Legalize Assisted Suicide......................  142

		Distinguishing Decisions to Forgo
		Life-Sustaining Treatment.........................  146

     7. Developing Professional Medical Standards.................  149

     8. Caring for Severely III Patients..........................  153

		Decisions About Life-Sustaining Treatment.........  153

		Improving Palliative Care.......................... 158

		Diagnosing and Treating Depression................  175


		Responding When a Patient Requests
		Assisted Suicide or Euthanasia..................... 177


     Appendices
     A.  Initial Assessment for Cancer Pain.......................  185


     B.  Brief Pain Inventory.....................................  187

     C.  American Pain Society Quality Assurance
	   Standards for Relief of Acute Pain and Cancer Pain.....  191

     D.  Detection and Diagnosis of Depression....................  197

     E.  Questions to Ask In the Assessment of
	   Depressive Symptoms for Severely III Patients..........  207

     F.  Requests for Euthanasia and Assisted Suicide:
	   Nursing Management Principles........................... 209

     G.  Additional Resources...................................... 211