Wesley Smith on a movement which could get out of hand

It is hard to tell the truth about assisted suicide. Actually, the difficulty isn’t in the telling, it is in getting people to hear, or more precisely, to listen.

Most people are about as enthusiastic about the pondering the issue of assisted suicide as they are about working out the details of their own funeral. The subject hits too close to home, involving as it does, the ultimate issues of life: the reality of human mortality; fears about illness, disability, and old age; the loss of loved ones to the dark dampness of the grave. Thus simply getting people to pay close attention to assisted suicide – to truly grapple with its threat – is often a challenging task.

This is almost as true of people who are religious and/or pro-life, whose faith informs them that death isn’t the end but the beginning, as it is about those who identify more overtly with the popular culture. In my work as an anti-euthanasia activist, I have often appeared in front of pro-life and religious organizations to speak about assisted suicide, as well as in secular settings. More often than not, event organizers tell me that the audience is one-third to one-half of what it would have been had the program been about other issues of concern. This has happened so many times now that it is a clear pattern.

I don’t take the empty chairs personally. I understand the emotional dynamic at work. Life is difficult and worrisome enough without visiting the painful issues assisted suicide conjures. It is difficult, even for deeply religious people, to listen, to hear, to heed, and to care enough to become involved. Unfortunately, avoidance of the assisted suicide issue is a luxury that those believe in the infinite value of all human life can no longer afford.

The most effective weapons in the pro-assisted suicide arsenal are fear-mongering, distortions, euphemisms, half-truths, lies, and damn lies, along with constant chanting of the mantra, ‘choice.’ These are easily spread in the contemporary media that generally eschew depth and context and thrive on 30-second sound bite shallowness and the soap opera values of tabloidism. The best defence to this propaganda onslaught is to constantly be about the business of spreading truth. After eight years in the moral struggle against the medical culture of death, I can state confidently that the more people learn about assisted suicide, the less they support it. The key to victory, then, is education, education, and education.

Aiding and Withholding

Too many people support assisted suicide because they have watched in horror as loved ones were hooked up to medical machines and kept alive against their desires when they were in the last days of life. The threat of such abuse is fading as the economics of medicine moves inexorably toward slashing the level of services in an effort to cut costs. Still, for many non-ideological supporters of assisted suicide, ‘being hooked up to machines’ is the prime concern.

I can’t tell you how often in my experience supporters of assisted suicide turned into opponents once they learned that they have the legal right to refuse unwanted medical treatment – even if refusing care will probably lead to their deaths. If a dying person doesn’t want a ventilator or kidney dialysis, they don’t have to have it. If they want to die at home instead of in a hospital, they can. No one need commit suicide because of fears of falling prey to high tech medicine.

Eschewing unwanted treatment is the philosophical foundation of the hospice movement – which helps people die without killing them. In hospice, nurturing the patient and controlling his or her pain and other symptoms are the primary goals. Hospice does not seek to extend life but to help dying people live out their days in comfort and dignity and to care for them in a womb-like embrace of unconditional love. Hospice works so well that it is almost a cliché for the dying person to declare that their dying experience has been a ‘blessing.’ Here, then, is true death with dignity – and nobody hooked up involuntarily to machines.

Controlling the pain

Assisted suicide advocates often try to create a false moral equivalency between medically controlling pain and so-called mercy killing. Their argument goes something like this: since some people’s deaths are hastened by the powerful medications often required for effective palliation; and, since pain control is considered moral and ethical based on the ethics principle of ‘double-effect;’ then assisted suicide should also be viewed as moral and ethical since the intent of assisted suicide is similarly to alleviate suffering. There’s only one problem with this argument. It completely misapplies the principle of double effect.

Double effect recognizes that there are occasions when a person may intend to do a good thing while recognizing that a bad thing might occur despite all of their good intentions. Even if the bad outcome then occurs, so long as the original intention was good, then the action is deemed morally and ethically acceptable.

If properly applied pain control accidentally hastens a patient’s death, the palliative act remains ethical because the bad effect – death – was not intended. On the other hand, assisted suicide intentionally causes death, not the alleviation of suffering. Thus, killing utterly fails fall within the double effect principle because it explicitly intends a bad result. Thus, assisted suicide is an immoral and unethical act and a profound violation of the ‘do no harm’ values of Hippocratic medicine.

The terminal and the terminated

Most assisted suicide advocates do not want to limit death doctor services to people who are terminally ill. Advocates are well aware that popular support for assisted suicide evaporates when the legalization criteria involve chronically ill, elderly, depressed, or disabled people. This presents an acute political problem for them: they want a broad license for assisted suicide but know they can’t promote it openly because they will lose substantial public support. Thus, they will use words such as ‘incurable’ or ‘hopeless’ illness when describing the kinds of afflictions that would justify medicalized killing.

The use of these words is meant to make the reader or listener think ‘terminal,’ when they mean something quite different. For example, arthritis is an incurable illness, but it is not generally terminal. The same can be said about diabetes, multiple sclerosis, spinal injuries, and a plethora of other disabilities and afflictions that are part of the human condition.

The true agenda of the assisted suicide movement into rare focus in October 1998, when the World Federation of Right to Die Societies – an organization consisting of the world’s foremost euthanasia advocacy groups — issued its ‘Zurich Declaration’ after its biannual convention. (Among the signatories to the document was Dr Michael Irwin, one of the leaders of the British euthanasia movement.) The Declaration urged that people ‘suffering severe and enduring distress [should be eligible] to receive medical help to die.’ (My emphasis.) Finally, the actual goal of the assisted suicide movement is revealed: deaths on demand for anyone with more than a transitory wish to die.

Use and Abuse

A time-tested mantra of the assisted suicide movement is that abuses will be prevented by protective guidelines. But this promise of protection is as empty as the repeated assurances that assisted suicide will be restricted to people who are actually dying. One need only look to the experience of the Netherlands to see what scant protection protective guidelines actually give.

Euthanasia has been practiced openly since 1973 in the Netherlands, and the practice was recently formally. If doctors follow the legal guidelines enacted by the Parliament when they kill their patients, they will not be prosecuted. Among these guidelines are the necessity of repeated patient requests, unbearable suffering for which there are no reasonable alternatives, and the requirement of doctors to obtain second medical opinions. These have remained essentially unchanged for many years.

In actual practice, the so-called protections are ignored or have been expanded by court decisions that they are now utterly ephemeral. A recent study published in the Journal of Medical Ethics about euthanasia in the Netherlands, reveals that the Dutch policy is ‘beyond effective control’ since 59 percent of doctors do not report euthanasia or assisted suicide to authorities as required by law. Worse, the categories of people who doctors kill have expanded steadily since euthanasia entered Dutch medical practice. Today, in the Netherlands, not only are terminally ill people who ask to be killed euthanized but so are chronically ill people. (For example, an anorexic young woman in remission was assisted in suicide because she was worried about returning to abusing food and the doctor was not prosecuted.)

Doctors also kill depressed people. This resulted from the prosecution of a psychiatrist who had assisted the suicide of a grieving mother who wanted to be buried between her two dead children. The Dutch Supreme Court validated the psychiatrist’s decision; ruling that for purposes of judging the propriety of euthanasia, suffering is suffering and it does not matter whether the suffering is physical or emotional. Not only that, Dutch babies born with disabilities are killed by doctors at the request of parents, even though babies, by definition, cannot ask to die. According to a study published in the July 26, 1997 edition of the British medical journal, The Lancet, 8 percent of all infants who die in the Netherlands are injected with drugs by their doctors ‘with the explicit aim of hastening death,’ amounting to about 80–90 killed infants a year.

Finally, Dutch doctors practice involuntary euthanasia. According to several Dutch studies conducted during the last decade, more than 1,000 who do not ask to be euthanized are killed each year by Dutch doctors because the doctor’s values dictate that their deaths should be brought about—and this number does not include the many hundreds who are killed each year by intentional overdoses of morphine. As far as I know, no physician has ever been jailed for this practice.

The price of a life

In the end, assisted suicide would be less about ‘choice’ than about profits in the health care system and cutting the costs of health care to government. This is the conclusion of no less than Derek Humphry and pro-euthanasia attorney, Mary Clement, who in their book Freedom to Die, admit that cost containment may become the ultimate raison d’être for physician assisted suicide (PAS), that is, killing as a financial benefit to society:

A rational argument can be made for allowing PAS in order to offset the amount society and family spend on the ill, as long as it is the voluntary wish of the mentally competent terminally ill adult … . There is no contradicting the fact that since the largest medical expenses are incurred in the final days and weeks of life, the hastened demise of people with only a short time to left would free resources for others. Hundreds of billions of dollars could benefit those patients who not only can be cured but who want to live.’ (Emphasis within the text.)

Imagine a health care system in which the profit incentives favour killing as the best ‘treatment’ for cancer, motor neuron disease, multiple sclerosis, spinal injury, Alzheimer’s disease, and the many other medical conditions that eventually impact us all. Imagine the potential for abuse and coercion in a health care system in which killing is seen as a way to broaden accessibility to health care for others in society. The result could lead to a profound devolution of our culture and our moral values.

The time has come for all good people to come to the aid of their culture. Legalizing physician-assisted suicide would be to return us to equivalent practices of ancient societies that exposed disabled infants on hills and left the elderly and infirm by the side of the road. Beating back the tide is not only essential to this country but to the world.

Wesley J. Smith, an attorney for the International Task Force on Euthanasia and Assisted Suicide is the author of Culture of Death: The Assault on Medical Ethics in America, published by Encounter Books in 2000.