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."

• 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)

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 Conference.  Michael 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).

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).

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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