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Euthanasia and assisted suicide: The Myth of Mercy Killing 3/5/2001 Revised: December 17, 2001
Introduction Over the past several decades, America has witnessed a strange and subtle shift in how society views life. In the 1960s, the shift began as some states began to remove the criminal penalties for abortion. In the 1970s, the U.S. Supreme Court Roe v. Wade decision put the federal government’s stamp of approval on abortion nationwide. Today, the value of life is being obscured at the other end of the spectrum as courts grant the elderly and sick the so-called “right to die.” This “right to die” movement has entered society in two forms: assisted suicide and euthanasia, with the former beginning to give way to the latter. Assisted suicide occurs when the doctor provides the patient the means to kill himself—the doctor acts as an accomplice in the self-murder, so to speak. Euthanasia is the active killing of the patient by the doctor—the physician is the murderer in this case. More often today, physicians are initiating the desire for death. The very laws once designed to protect a person’s inalienable right to life now permit the elimination of those deemed unworthy to live. And in the name of compassion, doctors trained to heal and to prolong life are shortening and even snuffing it out altogether. Killing the patient as the cure is becoming an acceptable medical procedure in some circles. Nonetheless, changing public opinion and advances in modern pain relief and end-of-life care are shifting the debate in favor of pro-life advocates. Many Americans view physician-assisted suicide as an acceptable practice. According to a March 1999 Gallup poll, 61 percent of all Americans believe physician-assisted suicide should be legal—down from 75 percent in a May 1996 USA Today poll. When the issue becomes personal, fewer Americans support it. Fifty-one percent of Americans said they would not consider physician-assisted suicide to end pain from a terminal illness, while 40 percent said they would. As may be expected, support for the idea of physician-assisted suicide diminished with age in the Gallup poll. While 62 percent of those between the ages of 18 and 29 supported physician-assisted suicide, 51 percent of those aged 65 said they do.1 While acceptance of euthanasia and assisted suicide has diminished somewhat, euthanasia advocates continue their campaign. The manipulation of terms in the debate reveals their strategy of courting acceptance. Introduction Christian writer C.S. Lewis coined the term “verbicide” to denote the murder of a word. That is what euthanasia advocates have done with the language of “compassion” and “mercy.” In order to advance their agenda with the public, euthanasia advocates are cloaking doctors’ deliberate homicide of patients in rosy phrases such as: quality of life, death with dignity, voluntary euthanasia, and the right to die. Even “euthanasia”—which the dictionary defines as “killing an individual for reasons considered to be merciful”—comes from two Greek words meaning “good death.” But no matter what they call it, euthanasia is still murder. Dr. Jack Kevorkian cast physician-assisted suicide and euthanasia into the national spotlight in the early 1990s. Kevorkian, a retired Michigan pathologist, claims to have helped approximately 130 people kill themselves. He calls his practice “medicide” and himself an “obitiarist.” The man they call “Dr. Death” also proposes professionally staffed, well-equipped “obitoriums”—where the sick, elderly, or depressed could go to their demise voluntarily. In 1996, he opened his first suicide center north of Detroit. Fortunately, the building owner terminated Dr. Kevorkian’s lease and his suicide center closed. Then, in 1999, after a nationally televised videotape showed Dr. Kevorkian ending the life of a terminally ill man, a Michigan jury convicted him and sentenced him to prison for murder. Introduction Although Dr. Kevorkian is no longer in the national spotlight, death as the option of choice—abortion, infanticide, euthanasia and suicide—now has high-profile, big-money organizational support. Some of the most visible pro-death groups are Planned Parenthood, the National Abortion and Reproductive Rights Action League, the Hemlock Society, Choice in Dying, Americans Against Human Suffering and EXIT. Derek Humphry, cofounder of Hemlock, voices a common viewpoint: “Individual freedom requires that all persons be allowed to control their own destiny. ... This is the ultimate civil liberty. ... If we cannot die by our choice, then we are not free people.” The decision to die is increasingly viewed as a civil “right.” In January 1997, lawyers representing some physicians and terminally ill patients urged the U.S. Supreme Court to rule that the Constitution allows individuals the right to terminate their lives with the assistance of a physician. This action came in response to appellate court rulings in Washington and New York, where state laws banned assisted suicide. Both rulings concluded that terminally ill patients had a right to a physician-assisted suicide. In its ruling, the U.S. Court of Appeals for the Ninth Circuit in Seattle said the constitutional “liberty” reasoning in Planned Parenthood v. Casey, which reaffirmed a woman’s “right” to choose abortion, influenced their decision. That so-called “right,” the judges concluded, also applied to the end of life. In the New York state ruling, the Federal Court of Appeals for the Second Circuit based its similar finding on the 14th Amendment’s “equal protection” clause. The judges argued that terminally ill patients had the right to hasten their own death by refusing treatment. Physicians therefore could lawfully order the removal of life-support systems. In addition, doctors should not be prosecuted for actively administering lethal drugs to patients when they request help in accelerating their deaths. The New York Times editorialized that the two courts “have issued humane and sound rulings.” In both cases, it noted the defendants “claimed a sovereign right over their own bodies.” Ernest Van Den Haag, an advocate of suicide, observed in the June 12, 1995, issue of National Review, “Only in our time has it come to be believed that individuals ... own themselves. ... Owners can dispose of what they own as they see fit.” The U.S. Supreme Court reversed both decisions, however, stating that neither state law violated the 14th Amendment of the U.S. Constitution.2 The Court noted, “They neither infringe fundamental rights nor involve suspect classifications.” Furthermore, the Court argued the Equal Protection Clause of the Fourteenth Amendment “creates no substantive rights,” including a so-called right to die. Introduction Francis Schaeffer, renowned Christian philosopher and theologian, credited the influx of humanistic thought in society for the increasing disrespect for human life. “If man is not made in the image of God, nothing then stands in the way of inhumanity. There is no good reason why mankind should be perceived as special,” he wrote in Whatever Happened to the Human Race?. “Human life is cheapened. We can see this in many of the major issues being debated in our society today: abortion, infanticide, euthanasia. …”3
As early as the 1920s, respected physicians wrote about “absolutely worthless human beings” and the urgently necessary “killing of those who cannot be rescued.”
Euthanasia advocates are also redefining what it means to be a person. In their book, In Defense of Life, Keith Fournier and William Watkins dissect “ethicist” Joseph Fletcher’s 15 “indicators of personhood.” These include: an IQ greater than 40; self-awareness; self-control; a sense of time; capability of relating to and concern for others; communication; control of existence and [degree of brain] function.4 Alarmed, Fournier and Watkins wrote: “When judged by these criteria, the preborn, newborn, and seriously developmentally disabled would be disqualified as human persons.”5 Sufferers of dementia or anyone brain-damaged would also be non-persons. “Ethicist” Peter Singer agrees that personhood should be defined according to what we can do, rather than who we are. He has even advocated allowing parents of severely disabled infants to put their children to death in some painless way.6 This kind of thinking about “defective humans” is disturbingly reminiscent of the euthanasia program that accompanied the rise of Nazism. Introduction In A Sign For Cain, the eminent Dr. Fredric Wertham documented exhaustively the physician-sponsored mass murder of civilians in pre-World War II Germany. Well before they were dismantled and moved to the concentration camps, gas chambers were installed in six leading psychiatric hospitals. Under the guise of “help for the dying,” “mercy killings,” and “destruction of life devoid of value,” university professors of psychiatry, hospital directors and their staff members systematically exterminated hundreds of thousands of “superfluous people”—mental patients, the elderly, and sick and handicapped children. Criteria for such “undesirables” included “useless eaters,” the unfit, unproductive and misfit. Wertham stressed the concept of “life not worth living” was not a Nazi invention. As early as the 1920s, respected physicians wrote about “absolutely worthless human beings” and the urgently necessary “killing of those who cannot be rescued.”7 In fact, even in 1895, a widely used German medical textbook advocated the “right to death.”8 However, in 1939, a note from Adolf Hitler to his own private doctor and chancellery officials extended “the authority of physicians” so that “a mercy death may be granted to patients who according to human judgment are incurably ill.”9 Nearly the same language has been used in the various “right to die” decisions of America’s high courts. Introduction In the Netherlands, the lower house of the Dutch parliament has passed a bill to permit euthanasia, paving the way for the open practice of giving doctors or relatives a “license to kill” unconscious patients. Dutch Dr. Karel Gunning, president of the World Federation of Pro-Life Doctors, revealed that official figures estimate approximately 3,200 cases of euthanasia occur each year. This practice has caused a number of sick and poor Dutch to start carrying a printed card in their pockets that states they do not want doctors to put them to death. According to Dr. Gunning, the euthanasia law simply legalizes what has been done secretly for years.10 “In the beginning, the explicit request of the patient was necessary,” he said. “Now, one can do away with the comatose and children with severe malformations. Initially, euthanasia was allowed only for terminal patients, but later it was extended to people with psychic depression.” As happened in the United States, he also believes that this “path to death” began in 1971 when the Dutch Medical Association approved abortion. This act removed “the unconditional defense of human life.”11 America has been sliding down the same slippery slope as Holland, spurred by the same pro-euthanasia arguments and utilizing the same tactics. Just as Dutch doctors had secretly performed euthanasia before a law was passed allowing it, American doctors have done the same. In a Washington state survey, 26 percent of responding doctors anonymously admitted they had been asked to help a patient die. Those same doctors actually gave 24 percent of their ailing patients prescriptions that induced death. Although chronic pain was a factor, researchers found that patients were most often motivated toward suicide by nonphysical concerns, such as “losing control, being a burden, being dependent, and losing dignity.”12 In February 1999, columnist Nat Hentoff wrote of Oregon’s legalization of physician-assisted suicide and its decision to provide the service without cost to low-income residents. Noting the cruel hypocrisy of the decision, Hentoff quoted Ric Burger, spokesman for disabled citizens in Oregon, “The fact that the state of Oregon will not properly fund our personal-attendant services, yet will pay for us to die, amounts to nothing less than cultural genocide.”13 Introduction Secular medical ethicists also fear downright coercion in laws allowing doctors to help with suicide. They point out that not-so-subtle pressure—to save taxpayers’ money—could be placed on those patients who are poorest, most isolated, and least attended. The idea is, “if you can afford it, you [can] get good care,” said Zail Berry, former medical director of Hospice of Washington, D.C. “If you can’t, you get a prescription for [a barbiturate] from a Medicaid doc.” Renowned medical ethicist Dr. Arthur Caplan agrees, worrying that with an aging population and an overburdened health care system, physician-assisted suicide will become not the “option of last resort ... [but] the attractive solution of first resort.” In an interview with PBS’s “Frontline,” Dr. Caplan stated, “I worry ... that suddenly within the society, the notion will come that the older and disabled who are expensive should do the responsible thing and leave. I don’t want to be in that place, and I’m not persuaded that this culture or this society isn’t going to get us to that place.”14 In 1997, when the Supreme Court considered whether physician-assisted suicide was a constitutional right, Justice David Souter noted the slippery slope that followed. “A physician who would provide a drug for a patient to administer might well go the further step of administering the drug himself,” he stated in a concurring opinion, “so the barrier between assisted suicide and euthanasia could become porous as well as the line between voluntary [and involuntary] euthanasia.”15 Evidence in other nations demonstrates this. The Medical Journal of Australia published a 1996 study of deaths in Australia. Thirty percent of all deaths are “intentionally accelerated by a doctor,” by means such as withholding treatment. Moreover, only 4 percent of cases resulted from a direct response to a request from the patient—indicating the other patients were killed without consent.16 A patient’s true desires are not usually clear. A study in the British medical journal The Lancet revealed terminal cancer patients often have second thoughts about dying. Dr. Harvey Max Chochinov, a professor of psychiatry and family medicine at the University of Manitoba (Canada), said, “Will to live is a construct that is highly changeable.” Surveying 168 terminal cancer patients aged 31 to 89, Dr. Chochinov and his team found “a patient could have vast temporary changes in his outlook.” The study revealed causes of unwillingness to live, such as depression, were treatable.17 Introduction At its heart, the Hippocratic Oath taken by physicians enjoins “Do no harm” and states: “I will give no deadly medicine, even if asked.” Thomas Reardon, past president of the American Medical Association (AMA) said, “Physicians are healers. ... The inability of physicians to prevent death does not imply that they are free to help cause death.”18 Under-treatment has been a problem for many terminally ill patients, noted Dr. Richard Payne, chief of pain-control services at New York’s Memorial Sloan-Kettering Cancer Center.19 The AMA has consistently opposed any attempts to legalize or promote physician-assisted suicide. In a policy paper on the issue, revised in 1999, the AMA even states, “Requests for physician-assisted suicide should be a signal to the physician that the patient’s needs are unmet and further evaluation to identify the elements contributing to the patient’s suffering is necessary.”20 Physician-assisted suicide is “fundamentally incompatible with the physician’s role as healer,” states the AMA.21 Even more encouraging are results of a 1998 survey of the 3,299 members of the American Society of Clinical Oncology (ASCO), published in the October 3, 2000, issue of the Annals of Internal Medicine, concerning euthanasia and physician-assisted suicide of terminally ill cancer patients. In 1994, 23 percent of ASCO members supported euthanasia for “dying cancer patients in excruciating pain.” By 1998, that number dropped to below 7 percent. Likewise, 22 percent of the oncologists supported physician-assisted suicide in 1998, down from 45 percent in 1994. Lead researcher Ezekiel J. Emanuel, M.D., Ph.D., stated the survey’s results “emphasize the need to educate physicians about ways to provide high-quality pain management and palliative care to dying patients.”22
The question is not the worth of the imperfect infant, the retarded child, the defective adult, and the aging individual. ... The question is this: Are we worthy enough to extend ourselves to meet their needs? (Schaeffer, 117)
“Modern medicine was so brilliant at saving lives that we ... forgot our traditional role of providing comfort at the end of life,” said Christine K. Cassel, M.D., chair of the Henry L. Schwartz Department of Geriatrics at Mount Sinai School of Medicine. “Now we need to take the advances in modern medicine and apply them to relieving suffering.”23 The palliative care movement is growing. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pushed physicians in this direction in 1999 by implementing required palliative care (pain relief) standards. It gave hospitals, nursing homes and outpatient clinics accredited by JCAHO until January 2001 to comply. The new standards require that every patient’s pain be measured and relief be provided from the moment he checks into the facility. Otherwise, the health organization risks losing accreditation. Calling this a “watershed event,” Dr. Russell Portenoy, pain medicine chairman of New York’s Beth Israel Medical Center, commented, “No one has ever promised patients no pain.”24 Yet euthanasia advocates have fought tooth and nail to make it easier to kill those same patients. It is crucial the distinction be made between prolonging life artificially—with unwanted “heroic measures”—and terminating life prematurely through deliberate intervention. The first may be unacceptable to many. But the second is clearly murder. Rather, we must provide comforting care for the critically ill—food and water, pain medication, oxygen and a loving touch. Hospice programs nationwide offer medical, spiritual, legal and financial services for dying persons and their families. Introduction In a 1994 state referendum, Oregon voters voted to allow assisted suicide. In 1997, they reaffirmed the decision by an even larger majority. At least forty-six terminally ill people have since ended their lives with the assistance of their physician.25 In response, Sen. Don Nickles (R-Oklahoma) inserted the Pain Relief Promotion Act into a year-end tax bill in late 2000. It passed the U.S. House but died in the Senate. Instead of reviving the Act in the 107th Congress, pro-family groups worked to have Oregon’s assisted-suicide law stopped by another means. A directive from former Attorney General Janet Reno had effectively allowed Oregon to impose physician-assisted suicide by permitting doctors to prescribe lethal doses of narcotics, claiming this is a “legitimate medical use.” As soon as Sen. John Ashcroft was confirmed as President George W. Bush’s attorney general, representatives from Concerned Women for America met with Department of Justice officials to ask Mr. Ashcroft to rescind Janet Reno’s order. On November 6, 2001, Attorney General Ashcroft sent a letter to Drug Enforcement officials to ensure that Oregon complies with federal law, which must be uniformly followed by all the states, on the proper use of controlled substances. He clarified that any person who violates the Controlled Substances Act will lose his or her license to prescribe. “Oregon’s assisted suicide rate is 42 percent higher than the nation’s, and the suicide rate for those 75 or older is 63 percent higher,” said Suzanne Brownlow, Director of Concerned Women for America of Oregon. “Oregon’s vote for doctor-assisted suicide was a deadly mistake.” Still defiant, the pro-death movement in Oregon has, with the help of a sympathetic judge, temporarily stopped Mr. Ashcroft’s order in the courts. CWA will continue to work to stop Oregon’s physician-assisted suicide. By definition, a terminally ill person’s life will end—as will all our lives. The ethical challenge is how, when and at whose hand? Without question, watching a loved one waste away and suffer incurable pain is horrific. Along with them, we suffer intensely. But are we seeking to put others out of our misery? To end the life of another—or our own—because of wrenching debilitation or “lack of quality” is to deny the reality of death. Fundamentally, assisted suicide and euthanasia are issues concerning morals and ethics. Indeed, the so-called “right to die” mantra has become the “duty to die.” Professor David Currow, vice president of Palliative Care Australia, commented, “To make every person who’s facing death think about euthanasia is an enormous impost on people who are already feeling isolated and frightened.”26 The issue reaches to the very core of how a society views life. And it sets America sliding down a slippery slope toward destruction. Introduction |
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