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Stephen Ziegler
School of Public and Environmental Affairs

Elisabeth Andrews
IU Media Relations

Last modified: Monday, February 12, 2007

Assisted death: how volunteers help limit physician involvement

Feb. 12, 2007

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Stephen Ziegler

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FORT WAYNE, Ind. -- "Physician-assisted suicide" may be a misnomer due to the central role in assisted death played not by physicians but by volunteers in right-to-die organizations, said Stephen Ziegler, a professor of public affairs at Indiana University-Purdue University Fort Wayne.

In an article in the British Medical Journal, Ziegler and co-author Georg Bosshard of the University of Zurich describe how non-governmental organizations in Oregon and Switzerland provide a variety of services in assisted deaths such as screening, consultation, referrals, ongoing support and, in some cases, preparation of lethal medication for ingestion. Understanding how NGOs limit the role of physicians in assisted suicide may help inform debates now underway in Arizona, California, Vermont and Washington, Ziegler said.

Reducing physician involvement in assisted dying: the role of NGOs in physician-assisted suicide in Switzerland and Oregon, published Feb. 10, demonstrates that the extent of NGO services in Oregon ranged from discussing eligibility requirements and counseling the family, to being present at the time of death and, in certain circumstances, mixing the lethal medication in soft food or liquid for ingestion. The role of the physician was generally limited to assessing the patient and, if appropriate, writing the prescription.

In Zurich, Switzerland, NGO services were similar but also included physician referral, storage of the prescribed medication, provision of a room for administration of lethal medication (if requested) and police notification at time of death. In both locations, patients must self-administer medication.

"Now that we know how these organizations work, involvement of non-physicians may help resolve some of the ethical matters facing physicians," Ziegler said. "The Swiss model in particular may be useful in providing a framework for shared responsibilities and potentially de-medicalizing death, because so much of the process is carried out by other parties."

The authors examined Compassion & Choices in Oregon and Exit in Switzerland to determine the practices of prototypical right-to-die societies. Both organizations are private, charitable associations with roughly 50,000 members each.

Oregon's Death with Dignity Act of 1997 allows physicians to prescribe a lethal dose of medication to terminally ill patients upon the oral and written request of the patient following a 15-day waiting period and a secondary assessment by a consulting physician. The act remains viable despite recent challenges by the U.S. Department of Justice that culminated in a Supreme Court ruling.

Swiss law does not specifically authorize physician-assisted suicide, but under Article 115 of the Swiss Penal Code an act is considered a crime only if it is driven by selfish motives. As long as Swiss physicians follow proper medical procedure, such as fully documenting the patient's condition and decisional capacity, they are not violating the criminal law when fulfilling a terminally ill patient's request for a lethal dose of medication.

Ziegler noted that the majority of lethal prescriptions requested in Oregon are never used. "It appears that just having this option increases peace of mind, giving people a sense of control over their circumstances even if they do not decide to go forward."

Ziegler can be reached at 260-481-6964 or

Ziegler, Stephen J. & Georg Bosshard, "Role of non-governmental organizations in physician assisted suicide," British Medical Journal, 334:7588: 295-298 (Feb. 10, 2007).