This introductory chapter reviews the US Supreme Court's decisions regarding the refusal of unwanted medical treatment and the states' right to legalize assisted death. As of the time of writing, Oregon, Washington, and Montana allow physician-assisted suicide. The fact that until 1997 physician-assisted suicide was illegal in all states of the union explains the suicide practice of Dr. Jack Krevorkian—a pathologist with no special expertise in end-of-life care—whose conduct, until ended by his imprisonment, probably represented the worst case scenario of a maverick doctor on his own. Equally unsettling is the fact that despite its illegality in most jurisdictions, the deliberate ending of life by physicians occurs rather often. This euthanasia underground, an entirely unregulated aspect of medicine, reveals a pattern that not only is secretive and deceptive but also has great potential for abuse. The question therefore is probably not whether to permit physician-assisted suicide. The real choice we face is whether we seek to regulate and control the practice of assisted death, or whether it is left unregulated and unchecked, which creates great risks for both doctors and patients.
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