Historical, ethical, and legal aspects of assisted suicide.

This article explores the historical, ethical, and legal antecedents of assisted suicide. Following a differentiation between assisted suicide and euthanasia, the historical aspects of suicide in the United States and other countries are described. Four cardinal principles form the basis for the ethical consideration of practice: autonomy, beneficence, nonmaleficence, and justice. Respect for autonomy is essential to the care of dying patients. However, the exercise of autonomy does not necessarily place an obligation to act on others. This could be important in the consideration of a request to a nurse for assistance in suicide. Nonmaleficence may also be a principle involved in decisions to discontinue treatments that are unwanted by the individual. Beneficence, the prevention of harm or the doing of good, may be in conflict with the respect for autonomy when one considers assisted suicide. Although one may wish to alleviate the suffering, assisting with death as a means of ending the suffering may violate the principle of beneficence even though the individual may, in his or her autonomy, request death. Justice describes what individuals are legitimately entitled to, but individual justice may be abridged by the utilitarian model of justice for society overall. Most states send ambivalent messages about the legal status of assisted suicide. Although many states criminalize assisted suicide, state prosecution of assisted suicide is not common. Furthermore, many juries have found those accused of murder or manslaughter in these instances "not guilty." A summary of the laws of each state related to assisted suicide is included.