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At Liberty to Die

The Battle for Death with Dignity in America

By Howard Ball

Publication Year: 2012

Over the past hundred years, average life expectancy in America has nearly doubled, due largely to scientific and medical advances, but also as a consequence of safer working conditions, a heightened awareness of the importance of diet and health, and other factors. Yet while longevity is celebrated as an achievement in modern civilization, the longer people live, the more likely they are to succumb to chronic, terminal illnesses. In 1900, the average life expectancy was 47 years, with a majority of American deaths attributed to influenza, tuberculosis, pneumonia, or other diseases. In 2000, the average life expectancy was nearly 80 years, and for too many people, these long lifespans included cancer, heart failure, Lou Gehrig’s disease, AIDS, or other fatal illnesses, and with them, came debilitating pain and the loss of a once-full and often independent lifestyle. In this compelling and provocative book, noted legal scholar Howard Ball poses the pressing question: is it appropriate, legally and ethically, for a competent individual to have the liberty to decide how and when to die when faced with a terminal illness?


At Liberty to Die charts how, the right of a competent, terminally ill person to die on his or her own terms with the help of a doctor has come deeply embroiled in debates about the relationship between religion, civil liberties, politics, and law in American life. Exploring both the legal rulings and the media frenzies that accompanied the Terry Schiavo case and others like it, Howard Ball contends that despite raging battles in all the states where right to die legislation has been proposed, the opposition to the right to die is intractable in its stance. Combining constitutional analysis, legal history, and current events, Ball surveys the constitutional arguments that have driven the right to die debate.

Published by: NYU Press

Title Page, Copyright Page

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pp. vii-viii

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pp. ix-x

During research and writing of this book, I have had the great pleasure of meeting with a variety of medical practitioners across the nation. They include pathologists at the University of Vermont’s Medical School and the Dartmouth-Hitchcock Medical School. ...

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pp. 1-12

Dudley Clendinen is a sixty-six-year-old author and columnist dying of amyotrophic lateral sclerosis (ALS, known as Lou Gehrig’s disease). In a recent essay, he discussed his existential situation.1 There is no meaningful treatment for ALS nor is there a cure. “Lingering would be a colossal waste of love and money. ...

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1. The Changing Nature of Death in America

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pp. 13-26

Except for those who die suddenly, death is a gradual process3 common “to all living organisms in the earth’s biosphere.”4 The clinical definition of death, however, has evolved over the centuries because medical science developed new techniques and instruments that doctors used to treat their patients. ...

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2. The Plight of the Incompetent Patient in a “Permanent Vegetative State” (PVS)

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pp. 27-50

This chapter explores the initial set of questions that arose when one consequence of the medicalization of death—PVS—first appeared in state and federal courts. Because of the intensive media coverage of the cases, public discussions of the questions ensued. The answers are legal and constitutional stepping-stones ...

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3. Terri Schiavo’s Tragic Odyssey, 1990–2005

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pp. 51-66

Nancy Cruzan finally died on December 26, 1990. Months earlier, on February 25, 1990, Theresa Marie (Terri) Schiavo, a happily married twenty-seven-year-old woman suffered a major cardiac arrest as a result of a potassium imbalance. Like others who were felled by a cardiac arrest or other acute trauma, ...

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4. What Freedom Do We Have to Die with Dignity? The U.S. Supreme Court Decides, 1997

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pp. 67-104

There are two answers to the question of how a competent, terminally ill patient can legally hasten death with the assistance of a physician: (1) Push legislation creating a PAD bill. This path is the more arduous of the two, fraught with political, cultural, and medical pitfalls. ...

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5. The Second Path to PAD: Passing Legislation Allowing Death with Dignity

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pp. 105-130

Throughout the legal debates and the battles surrounding the controversial right-to-die issue, from Quinlan in 1976 through the 1997 cases from Washington State and New York State, the opposing forces were known. The large number of briefs filed on behalf of the two states in the 1997 cases represented ...

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6. The Pioneering PAD States: Oregon and Washington

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pp. 131-162

In 1997, the U.S. Supreme Court rejected the constitutional argument that liberty extends to a person’s right to die with the help of a physician. Even now, in 2011, there is little chance of pro-PAD advocates achieving success in the federal courts. However, use of state courts to legitimatize PAD is another matter. ...

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7. America’s Transplants

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pp. 163-172

The first three options are not problematical. It is the last one, premised on an expansive interpretation of liberty, that has generally eluded its advocates in all but two states. (In 2011, Montana’s situation is still indeterminate until further action is taken by legislators or by the state’s public health professionals.) ...


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pp. 173-204

Cases Cited

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pp. 205-206


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pp. 207-216


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pp. 217-228

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About the Author

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pp. 229

Howard Ball, a graduate of Hunter College-CUNY and Rutgers University, is Professor Emeritus/Political Science and University Scholar at University of Vermont. He has authored nearly three dozen books about the Supreme Court, judicial policy/politics, and international justice, ...

E-ISBN-13: 9780814769751
Print-ISBN-13: 9780814791042
Print-ISBN-10: 0814791042

Publication Year: 2012

Research Areas


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Subject Headings

  • Right to die -- Law and legislation -- United States.
  • Assisted suicide -- Law and legislation -- United States.
  • Euthanasia -- Law and legislation -- United States.
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