This episode appears to be based on several different cases/incidents:
-The 1981-1997 Michael Swango case. Swango is an American serial killer and licensed Ohio physician who is estimated to have been involved in as many as 60 fatal poisonings of patients and colleagues, although he admitted to only causing four deaths. He was sentenced in 2000 to three consecutive life terms without the possibility of parole and is serving his sentence at ADX Florence at his own request.
- The 1970-1982 Genene Jones case. Jones is an American serial killer, responsible for the deaths of up to 60 infants and children in her care as a licensed vocational nurse during the 1970s and 1980s. In 1984, Jones was convicted of murder and injury to a child. She had used injections of digoxin, heparin, and later succinylcholine to induce medical crises in her patients, causing numerous deaths. The exact number of victims remains unknown; hospital officials allegedly misplaced and then destroyed records of Jones' activities, to prevent further litigation after Jones' first conviction.
- The 1993-1994 Robert Latimer case. Latimer is a Canadian canola and wheat farmer who was convicted of second-degree murder in the death of his daughter Tracy Lynn Latimer (born November 23, 1980 - October 24, 1993). This case caused a national controversy concerning the definition and ethics of euthanasia as well as the rights of people with disabilities, and resulted in two Supreme Court decisions, R. v. Latimer (1997), on section 10 of the Canadian Charter of Rights and Freedoms, and later R. v. Latimer (2001), concerning cruel and unusual punishments with reference to section 12 of the Charter. Latimer was released on day parole in March 2008 and was granted full parole in December 2010.
- The Dr. Jack Kevorkian case. Dr. Kevorkian became famous in the late 1980s and early 1990s as a supporter of assisted suicide. He became most noted for publicly championing a terminal patient's right to die via euthanasia; he claims to have assisted at least 130 patients to that end. He famously said that "dying is not a crime." Between 1999 and 2007, Kevorkian served eight years of a 10-to-25-year prison sentence for second-degree murder. His trial was a lengthy one because of several acquittals and a mistrial. He was released on June 1, 2007, on parole due to good behavior. He died on June 3, 2011.
- The controversial scandals of increasing risk to patient safety from trends of medical malpractice in medical centers and clinics.
- The legal and ethical debates of a person's right to die based on the burden of disease outweighing disability rights.
Maryann Plunkett has portrayed three different characters over the course of the series:
- Episode 6.21 Pro Se (1996) - Joanne Ellis.
- Episode 8.20 Burden (1998) - Lois Sutter.
- Episode 12.14 Missing (2002) - Mrs. Weldon.
Danny Burstein has played five different roles over the course of the series:
- Episode 5.19 Cruel and Unusual (1995) - Joe Garvey.
- Episode 8.20 Burden (1998) - Howe.
- Episode 11.12 Teenage Wasteland (2001)- A.D.A. Lester Rosenfeld.
- Episode 12.23 Oxymoron (2002) - Peter.
- Episode 19.11 Lucky Stiff (2009) - Surrogate Murray.
- Episode 20.12 Blackmail (2010) - Judge Sam Murray.