Intro 1963-88 1989-96 1997-2003 2004 - Bibliography To search within the timeline, or to print all 28+ pages, click here
2-page overview of
the history, in PDF format.
short version
Euthanasia Timeline
1963   Dame Cicely Saunders introduces "specialized care for the dying" to US.
1965   Florence Wald invites Saunders to join Yale as visiting faculty
1967   The term "hospice" is introduced in England (St. Christopher's hospice)

PfC historyThe first living will is written by the Euthanasia Society of America, and attorney Luis Kutner (who later founded Amnesty International).   The Euthanasia Education Council is created the same year.

[Dates for Euthanasia Society of America, and its descendent organizations, are taken from the Choice in Dying web site, now archived.]

1968   An ad hoc committee of Harvard faculty defines "brain death."
1969   Kubler-Ross, New Age spiritualist, produces book: On Death and Dying
1969   Hastings Center is founded in New York by Daniel Callahan and psychiatrist Willard Gaylin, MD. (For a concise history of Hastings and bioethics, see What is Bioethics by bioethicist Dianne Irving, Ph.D.)
1972   Kubler-Ross testifies to Senate on death with dignity
1972   PVS is defined
1974   Balfour Mount (Canada) substitutes the term "palliative care" for the term "hospice."
1976   May: Karen Ann Quinlan case decided; she was removed from respirator. (She died of pneumonia in 1985.)
1980   Overtly pro-PASHemlock Society is founded in California by Derek Humphry
1983 Mar

President's Commission for the Study of Ethical Problems in Medicine (established by Pres. Carter in 1979) publishes "Deciding to Forego Life-Sustaining Treatment." Alexander Capron, executive director; Joanne Lynn, project director. Both Capron and Lynn were board members of Concern for Dying.

The commission addressed living wills, "natural death acts," benefits of durable power of attorney. The commission also recommended model bill to establish hospital ethics committees.


Colorado Governor Richard Lamm, addressing the Colorado Health Lawyers Association, declares that elderly people have a "duty to die." 

"Like leaves which fall off a tree forming the humus in which other plants can grow, we've got a duty to die and get out of the way with all of our machines and artificial hearts, so that our kids can build a reasonable life."

1984 Apr Society for the Right to Die New England Journal of Medicine publishes "The Physician's Responsibility toward Hopelessly Ill Patients." ( 310, no. 15 pp. 955-9). The article was the result of a conference at the Countway Library in Boston, convened by the Society for the Right to Die. The article's ten authors were:
    • Sidney H. Wanzer, M.D., Department of Medicine, Emerson Hospital, Concord, Massachusetts.
    • S. James Adelstein, M.D., Professor of Radiology and Dean for Academic Programs, Harvard Medical School.
    • Ronald E. Cranford, M.D., Director, Neurological Intensive Care Unit, Hennepin County Medical Center, Minneapolis, and Chairman, Ethics Committee, American Academy of Neurology.
    • Daniel D. Federman, M.D., Professor of Medicine, Harvard Medical School, and past president, American College of Physicians.
    • Edward Hook, M.D., Chairman, Department of Medicine, University of Virginia Medical Center, Charlottesville.
    • Charles G. Moertel, M.D., Chairman, Department of Oncology, Mayo Clinic and Medical School, Rochester, Minnesota.
    • Peter Safar, M.D., Director, Resuscitation Research Center, University of Pittsburgh Medical School.
    • Alan Stone, M.D., Professor of Law and Psychiatry, Harvard Law School.
    • Helen B. Taussig, M.D., Professor Emeritus of Pediatrics, Johns Hopkins University School of Medicine.
    • Jan van Eys, M.D., Department of Pediatrics, University of Texas System Cancer Center and School of Medicine.

    In 1989 NEJM would publish a sequel, titled The Physician's Responsibility toward Hopelessly Ill Patients: A Second Look, with many of the same authors. The 1989 article would be a defense of physician assisted suicide. (see March, 1989)

1984-85   Midwest Bioethics Center founded by  bioethicist Karen Ritchie, M.D. (former Chief of Psychiatry at U. Texas-MD Anderson; bioethics degree from Kennedy Institute of Ethics at Georgetown); Hans W. Uffelman, Ph.D. (bioethicist at Univ. of Missouri-Kansas City); and Mary Beth Blake, JD (attorney for University of Kansas Medical Center). Daniel Callahan at the Hastings Center provided guidance.
1984 Sep National Conference of Commissioners on Uniform State Laws drafts a ''Right to Decline Life-Sustaining Procedures Act."  The New York Times publishes an AP wire with the headline "The 'Living Will' Gains Acceptance" -- a puff piece on Luis Kutner and the Society for the Right to Die.

RWJF calls meeting to discuss dying in America:
"Fueled by a series of personal experiences that affected the leadership of the RWJF, a concern arose . . . that elderly, fatally ill persons were likely to be vigorously treated . . . at great financial cost and suffering, even if their families objected." -- Joanne Lynn, MD; Unexpected Returns: Insights from SUPPORT

The meeting led to recommendations from two researchers:

  1. Joanne Lynn, MD, a Kornfeld Scholar at Dartmouth University (later moved to George Washington Univ.). Kornfeld Foundation supports research for "the right of the individual to choose the time and manner of his or her death, without undue interference by doctors, hospitals, courts, churches, families or society." Dr. Lynn has won at least $6 million in funding from RWJF, approximately $127,000 from Fan Fox & Leslie R. Samuels Foundation for work at RAND, and a grant from Soros/PDIA for textbook reform.

Dr. Lynn is a proponent of withdrawal of nutrition and hydration. See, for example, the following from Handbook for Mortals, co-authored by Dr. Lynn:

    How do people die who choose not to be fed artificially? What evidence we have indicates that they do not die more quickly, and that they do not feel thirsty or hungry. Their dying without tube feeding, though, tends to have less struggling with restraints .
    . . . Persons with dementia die from an array of different complications, but mostly these are somewhat treatable. Yet, the treatments are frightening, even if only because they may require that the person leave familiar surroundings. And the life saved, at least at the end, seems so limited that it is often not clear exactly what should be included in "good care."
    . . . The courts have ruled, over and over, that using artificial nutrition or hydration is a treatment decision just like chemotherapy or surgery, and that families and doctors can choose to use or to forgo this kind of treatment.

  1. William Knaus, MD at George Washington University. After a year of internship in the US, he was sent by US Information Agency to work in the Soviet Union for a number of years. His book, Inside Russian Medicine, was published in 1981 by Everest House. He wrote (p.14): "There is no single right answer to the challenge of providing medical care. The Soviet Union has chosen a totally government-controlled system, an approach fundamentally unlike our own mixture of private and public services." Dr. Knaus went on to found a new department within School of Medicine at The University of Virginia: the Department of Health Evaluation Sciences. Dr. Knaus also developed a "prognostic scoring system for critically ill hospitalized patients: APACHE (Acute Physiology, Age, Chronic Health Evaluation).

[Next:  Jump to next page — SUPPORT research is launched in 1989]


American Health Decisions (AHD) is founded.  It is a "civic bioethics initiative" of the Hastings Center.  This "health decisions movement" was the pseudo-grass-roots movement upon which the Midwest Bioethics Center based their Community-State Partnerships end-of-life coalitions.  AHD's John Stanley (of Wisconsin Health Decisions; see Appleton Consensus, below), would be prominent in the second Last Acts Leadership ConferenceMichael Garland and Ralph Crawshaw (Oregon Health Decisions; founded 1982-3) would be featured in the first  Community-State Partnership policy brief, because Oregon Health Decisions provided a model for C-SP.  Oregon Health Decisions (OHD*) "carefully designs community meetings to help citizens identify values."

* "OHD" is also a commonly used abbreviation for Oregon Health Department. However, in the present website and timeline, we will refer to OHD as Oregon Health Decisions, following the lead of literature from the Midwest Bioethics Center (Center for Practical Bioethics).

1987   In 1987, a conference was held in preparation for the Appleton Consensus conference.  The actual Consensus conference would be held in 1988.  Two concerns came from this 1987 conference:  "1) concerns regarding decisions to forgo medical treatment, including life-prolonging treatment, precipitated by autonomous requests by patients or their surrogates, and 2) concerns regarding decisions to forgo medical treatment as a result of pressures due to scarcity."  (Next:  May, 1988)
1987   Great Britain recognizes palliative care as a medical specialty, and describes palliative medicine as the "study and management of patients with active, aggressive, far-advanced disease for which prognosis is limited and the focus of care is quality of life."
1987   Decisions Near the End of Life -- medical education program founded by Bruce Jennings (Hastings Center) and Mildred Solomon (Center for Applied Ethics and Professional Practice at the Education Development Center). Funded initially by Kellogg Foundation. Soros's Open Society Institute sponsored projects in 1996-97.
1987   Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying
a report by the Hastings Center.  Briarcliff Manor, NY: The Center, copyright 1987.
xii, 159 p.; 28 cm.  Bruce Jennings; Bernard Lo.
1987   Donum vitae (The Gift of Life) -- Vatican provides instruction on respect for human life.
1988 May

Lawrence University Program in Biomedical Ethics (Appleton, Wisconson) invited representatives from ten countries to create "international guidelines for treatment abatement procedures."  Joanne Lynn (SUPPORT) was one of five writers on the drafting committee.  Other participants included:  Pieter V. Admiraal, M.D., Ph.D. (euthanasia advocate); Robert Arnold, MD (2005 president of AAHPM); Ronald Cranford, MD; Howard Brody, MD; Stuart Youngner, MD; Susan Wolf, JD (Hastings Center); John J. Paris, S.J., Ph.D., Ph.L; John Stanley, PhD.

This second conference discussed the two concerns that arose from the 1987 conference (see above).  A preliminary draft of  Appleton Consensus: Suggested International Guidelines for Decisions to Forgo Medical Treatment was drafted in 1988.  The document was revised, and was finally published in 1989; first in Denmark, then in the US.

Professor John Stanley's "study edition" of the 1988 Appleton Consensus statement is available at the Lawrence University web site, and includes commentary from conference members.   The final edition was published in the September 1992 edition of The Journal of Medical Ethics (Volume 18: Supplement, pp. 1-22).

Four "prima facie moral values or principles" of bioethics predicated the discussion:  autonomy; non-maleficence (avoid harm); beneficence (do good); justice.   We have provided a few samples from the final version, and have underscored some recurring themes.  There is a "conscience clause," but in this case the conscientious objector would be the physician who objects to requests to continue life-prolonging treatment.   Part II addresses "Active Euthanasia:

"Intervention with the primary intention of causing death (as distinguished from forgoing treatment that is deemed inappropriate) has no place in the treatment of permanently incapacitated patients. However, vigorous treatment to relieve pain and suffering may well be justified, even if these interventions lead to an earlier death."

Funding sources included:  The Novus Health Group, the Appleton Medical Center Foundation Inc; The Raymond Carlson Trust; St. Elizabeth Hospital (Ministry Health Care, Milwaukee, sponsored by the Sisters of the Sorrowful Mother); the Theda Clark Regional Medical Center; the Wisconsin Humanities Committee; The Henry J. Kaiser Family Foundation (Menlo Park, California); The Upjohn Company; the CIBA Pharmaceutical Company; Medtronic, Inc. (makes pacemakers); Lawrence University; the British Medical Association; the University of Leiden Medical School Programme in Medical Ethics, and The Madsen Foundation (Copenhagen, Denmark).


1988 Jun

Academy of Hospice Physicians is launched at an International Hospice Institute meeting in Granby, Colorado.  AHP would become  American Academy of Hospice and Palliative Medicine (AAHPM) in 1996.   AAHPM's web site notes:  "The Academy [of Hospice Physicians] was the first physicians' organization in the country to state publicly its position on what was to become one of the most widely discussed issues of the decade."   The site does not specify what the 1992 position was, but notes that it was revised in 1997 "to respond to the U.S. Supreme Court's decision on PAS."  The 1997 statement was neutral on PAS, but offered guidelines for consideration in case the states decide to legalize PAS.  (Next:  June, 1997)


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    Updated on September 22, 2009 7:16
Unpublished work © Copyright 2004-2009  I. Whitlock.