Last November, Attorney General Ashcroft issued an interpretive ruling stating that, under the federal Controlled Substances Act (CSA), "assisting suicide is not a ‘legitimate medical purpose’" and that "prescribing, dispensing, or administering federally controlled substances to assist suicide violates the CSA." [Ashcroft, "Dispensing of Controlled Substances to Assist Suicide," 11/6/01, p. 1]

In its 43-page brief, filed with the Ninth Circuit, the USDOJ argued:

The ITF has submitted an amicus curiae brief to the Ninth Circuit Court of Appeals in support of Ashcroft’s directive. Among its many points, the ITF brief demonstrates why the Ashcroft ruling does not overturn Oregon’s Death with Dignity law (ODWDA).

Despite claims by the media, assisted-suicide advocates, and Judge Jones in his ruling, there is nothing in Ashcroft’s directive which would nullify the ODWDA or preempt provisions in that law.

Moreover, the ITF Brief argues,

The ITF Brief holds that Judge Jones erred in his ruling when he concluded that the U.S. Attorney General lacked the authority to determine that prescribing controlled substances for assisted suicide is not a legitimate medical purpose under the CSA. To the argument that Ashcroft’s directive oversteps his authority and usurps a state’s right to regulate the practice of medicine, the ITF brief states,

An investigation conducted by the BBC, which was aired on 8/12/02, revealed that Dignitas provides foreign nationals with a Swiss doctor who, after seeing the patient only once, will supply the lethal drugs if it appears that the patient’s death wish is the result of a "rational" decision. In Switzerland, only one doctor is needed to approve a candidate for assisted suicide. Once the deadly drugs have been supplied, Dignitas then provides the patient with a small apartment in Zurich for his or her death. The lethal drugs are prepared by a volunteer nurse; two witnesses are present for each death; and the local authorities are notified.

While there is nothing in Swiss law which formally legalizes assisted suicide, the practice is tolerated if the suicidal person self-administers the lethal drugs and the person’s suicide decision is deemed rational.

According to Andreas Brunner, Zurich’s chief prosecutor, "Some people have insufficient doctors’ records, insufficient documentation, and we must ask whether they were capable of making a rational decision to die. Sometimes it’s impossible to be sure." "Some arrive one day and die the next," he added. "We can’t always check whether their wish to die has been a long-term one or just a phase they’re going through."

Swiss authorities have voiced alarm at the rise in Dignitas’ membership, which last year reached 1,620. Of those who have died thus far, 61 were from Germany, 37 from Switzerland, 5 from France, 2 from Austria, 1 from Italy, 1 from the Netherlands, 1 from Spain, and 1 from the U.S.

Chief Prosecutor Brunner told reporters that Dignitas was giving Switzerland a bad name. "We are very concerned about suicide tourism which is not in our interests at all," he said. Furthermore, he noted, each assisted suicide ends up costing Swiss taxpayers up to 9,230 Swiss Francs (£4,000, $6,221US, EUR 6,301) in inspection fees.

Other Swiss euthanasia groups limit their clientele to Swiss citizens. But Minelli sees a need for extending death services beyond Swiss borders. "You must understand that you can no longer commit suicide today by swallowing pills," he said. "They are made today so they are no longer necessarily lethal when taken in heavy doses." Dignitas, he added, can ensure a certain death.

But Zurich ethicist Professor Oswald Ultz is critical of Dignitas. "It’s a very strange occurrence that someone wants to help to kill people," he told a reporter from National Public Radio (NPR). "They count their efficiency by the body count. It’s the ultimate execution of power over someone else. And I think that’s quite a pathology. And, therefore, many of these people should have psychological or psychiatric help," he explained.

The data strongly suggests that, when patients initially ask about PAS, it usually is not a request for induced death. "It may be a signal," Tolle said. "It really isn’t to be taken at face value, but as a call for exploration of the patient’s motivations for asking." Often times, the motivations can include the fear of being a burden to others and the loss of autonomy or control. [American Medical News, 7/29/02]

The study found that "most patients’ desires for PAS diminish as their underlying concerns are identified and addressed." Doctors should try to identify patients’ fears by taking the time to talk to them about, among other things, their concerns and expectations, their pain and physical symptoms, their family situation, their sense of meaning, and any symptoms of depression. "When this approach is taken, suffering can be optimally alleviated and, in almost all cases, the patient’s wishes can be met without PAS." [Bascom & Tolle, "Responding to Requests for Physician-Assisted Suicide," JAMA, 7/3/02. pp. 91-99]

The majority of those surveyed indicated that patients who obtained a prescription for lethal drugs were more afraid of losing control over the circumstances of death than other hospice patients. In addition to the loss of control, other reasons patients gave for requesting PAS were "a desire to die at home, the belief that continuing to live was pointless, and being ready to die." [Ganzini et al., "Experiences of Oregon Nurses and Social Workers with Hospice Patients Who Requested Assistance with Suicide," NEJM, 8/22/02, pp. 582-588]

Most people haven't yet made the money connection between assisted suicide and the increasing strains on health-care budgets. That may be because reporters, who are usually eager to expose potential financial conflicts of interest in other public-policy issues, tend to be blind to the economic stakes involved in the assisted-suicide controversy. They prefer to see it as a matter of "choice," or of "compassion," or of modernism-versus-religion. Yet, the realization that assisted suicide will, in the end, be largely about money, is becoming increasingly difficult to ignore.

Take Oregon, where assisted suicide is legal. While the assisted-suicide law does not compel any doctor or HMO to participate in the self-destruction of patients, only Catholic HMOs have said no. Indeed, Kaiser/Permanente Northwest's doctors are known to have written lethal prescriptions under the Oregon law.

Advocates of legalized assisted suicide might, at this point, smile happily and say that this is the way the law is supposed to operate: a vulnerable and perhaps incompetent woman's life had been protected. But proving that "protective guidelines" don't really protect, that wasn't the end of Cheney's story. Her daughter insisted that Kaiser permit another psychiatric opinion. Kaiser agreed to the request.

This time, the consultation was a clinical psychologist rather than an M.D. psychiatrist. Like the first report, the psychologist found that Cheney had significant memory problems. For example, she could not recall when she had been diagnosed with terminal cancer. The psychologist also worried that Cheney’s decision to die "may be influenced by her family's wishes." Still, despite these reservations, the psychologist determined that Cheney was competent to commit suicide.

After Smith, who was on a speaking tour in Australia, mentioned the bag in a talk, he was contacted by Australia’s national newspaper The Australian for an interview. The paper then ran the story on the front page, along with a picture of Smith holding an actual Exit Bag, which he had obtained by mail with no questions asked. [The Australian, 8/20/01. p.1]

Readers were outraged, but none more than Australia’s Justice and Customs officer Chris Ellison, who called for an investigation. As a result, the Right to Die Network of Canada, who developed the Exit Bag, stopped its shipments to Australia.

Nitschke now claims that, because the government, he’s been "forced" to develop a suicide bag for Australians. At a press conference he scheduled in Brisbane to unveil the new Exit Bag, Nitschke said that over 150 bags have already been ordered out of the first run of 500. "People don’t want to put bags over their heads," Nitschke said. "But we have governments, state and federal, that have painted people into desperate corners and desperate people do desperate things." Queensland Premier Peter Beattie told the state parliament that Nitschke’s newest attention getter, the bag, was "distasteful in the extreme." [news.com.au, 8/20/02; The Courier-Mail, 8/21/02, 8/20/02; The Australian, 8/22/02, 8/21/02]

In the Supreme Court petition Morganroth also argues that the Michigan Court of Appeals erred when it found that it was not up to the court to determine if there is a constitutionally protected right for individuals to be free of unbearable pain and suffering. That, the court ruled, was up to the legislature. [Detroit News, 7/18/02; UPI, 7/18/02]It is not likely that the U.S. Supreme Court will hear Kevorkian’s case.