A UNANIMOUS SUPREME COURT
The US Supreme Court ruled on this issue in June of 1997. While their opinion does allow for individual states to decide the issue on their own, this does not mean the Court found no problems with this issue. All nine justices agreed that it was too dangerous to create a constitutional right to assisted suicide. The Court was clear in communicating the dangers of creating a right to assisted suicide - especially among the elderly, disabled, and others who may feel pressure to commit suicide.
"The State's interest here goes beyond protecting the vulnerable from coercion; it extends to protecting disabled and terminally ill people from prejudice, negative and inaccurate stereotypes, and 'societal indifference.' The State's assisted suicide ban reflects and reinforces its policy that the lives of terminally ill, disabled, and elderly people must be no less valued than the lives of the young and healthy, and that a seriously disabled person's suicidal impulses should be interpreted and treated the same way as anyone else's."
U.S. Supreme Court in Washington v. Glucksberg, No. 96-110, 1997 WL 34094 (U.S. June 26, 1997)
WEAK PUBLIC SUPPORT
A Tarrance poll of October 1994 found that 47% of those polled opposed legalizing assisted suicide and 43% supported it. This indicated a dramatic change from the past where over 60% supported assisted suicide. Where polls suggest approval, support is very soft. Voters in California rejected an assisted suicide ballot question 54% to 46%, despite initial support of 75% of California voters. Washington state voters rejected a similar question by the same margin in 1991 after learning of the details of the proposal. And a poll commissioned by the American Medical Association found that a 5:1 margin of Americans said they would choose alternatives to assisted suicide if they were terminally ill.
DESTROYS THE PHYSICIAN-PATIENT RELATIONSHIP
Doctors take an oath to be healers, not killers. Granting doctors the power of law to participate in the death of their patients is not only morally wrong but is in direct violation to the Hippocratic oath. Legalizing assisted suicide would give doctors a radical new authority – deciding whether or not a patient should continue living.
"Physicians typically make recommendations about treatment options, and patients generally do what physicians recommend. Once a physician states or implies that assisted suicide would be 'medically appropriate,' some patients will feel that they have few, if any, alternatives but to accept the recommendation."
-N.Y. State Task Force on Life and the Law, Supplement to When Death Is Sought; Assisted Suicide and Euthanasia in the Medical Context, April 1997, p. 5.
25% OF THE SUICIDES MAY FAIL
Proponents of this legislation argue for a "humane and dignified death". Yet many of these same people admit that as many as 25% of those who try to kill themselves will fail and may linger for days before dying. This is clearly not "humane and dignified".
"Evidence I have accumulated shows that about 25 percent of assisted suicides fail, which casts doubts on the effectiveness of the new Oregon law.... The new Oregon way to die will only work if in every instance a doctor is standing by to administer the coup de grace if necessary. The only two 100 percent ways of accelerated dying are the lethal injection of barbiturates and curare or donning a plastic bag."
"In a controlled study in the Netherlands, 90 people were given, at their request, nine grams of barbiturate by mouth. Sixty-eight died quickly -- within two hours, The rest lingered as long as four days; in 15 instances the doctor gave a lethal injection because the oral drugs were causing protracted suffering to the patient, the family and himself [the doctor].""Here is where the Oregon law, which forbids injections could be disastrous."
Derek Humphry (co-founder of the Hemlock Society and author of the suicide manual, Final Exit), Letter to the Editor, New York Times, 12/3/94, p. 14
"[I]n 20% of the patients who received a barbiturate [orally], a muscular relaxant [curare-like injection] was needed to end life after the five hour time period." Many, though not all, attempts to legalize physician-assisted suicide, both in America and Australia, are limited to just physician-assisted suicide and do not allow euthanasia. From the above facts, it should be abundantly clear that this limitation is headed for disaster...."
G.K. Kisma, "Euthanasia and Euthanizing Drugs in the Netherlands," in M.P. Battin and A.G. Lipman, eds., Drug Use in Assisted Suicide and Euthanasia (New York: Pharmaceutical Products Press, 1996), pp. 200 & 207.
"One in four Oregonians who try to kill themselves under Measure 16 is likely to experience a lingering death that could go on for hours, maybe days, says a study by a leading euthanasia doctor [Dr. Pieter Admiraal] from the Netherlands."
In response to a question about whether a doctor would know what prescription and dosage to give a patient to "ensure a successful death": "I doubt anyone could say what dose would be successful. In the Netherlands, they initiate the suicide with drugs by mouth, but they have the option of moving to intravenous drugs. I don't think we would have that option, under Measure 16."
Peter Rasmussen, M.D., Testimony before the Oregon House Committee on Judiciary, Subcommittee on Family Law, 3/11/97
PROBLEMS WITH DEFINING TERMINAL ILLNESS
The assisted suicide bill applies to those with a "terminal disease" that is "incurable and irreversible" and will "produce death within 6 months". Predicting death is an inexact science at best. Doctors can and do make mistakes. And there is no requirement that death be expected to occur despite provision of lifesaving medical treatment. Therefore people with diabetes, kidney disease, or respiratory failure (they are terminally ill but will not die within six months) could be candidates for assisted suicide. In other words, LD 916 could apply to those with permanent disabilities.
"A total of 1375 [Oregon] physicians (50%) were not confident that they could predict that a patient had less than six months to live. Moreover, 761 (28 %) indicated that they were not confident they could recognize depression in a patient who requested a prescription for a lethal dose of medication."
Melinda A. Lee, M.D., et al., "Legalizing Assisted Suicide--Views of Physicians in Oregon." New England Journal of Medicine, 2/1/96, pp. 310-315.
"The fact that deaths were not nearly as predictable as most would think should radically change our comfortable assumptions that we know who is terminally ill, and that we could provide different care, and advise them with high confidence."
Joanne Lynn, M.D. (referring to a study on the accuracy of doctors' prognoses), "Doctors Poor at Predicting Time to Death," Reuters, 3/18/97.
"Statistical estimates of prognosis to designate a category of 'terminally ill' patients for policy purposes [like assisted suicide] is unavoidably arbitrary, will often be contested, and have differential effects upon those dying with differing disease."
Joanne Lynn, M.D. et al., "Prognoses of Seriously Ill Hospitalized Patients on the Days before Death: Implications for Patient Care and Public Policy," New Horizons, 2/97, pp. 56-61.
"SAFEGUARDS" ARE QUICKLY ERODED
It is impossible to limit assisted suicide to "terminally ill", competent patients. Legalizing assisted suicide would establish a strong likelihood that guardians of terminally ill incompetent patients be allowed to authorize the direct killing of their wards. One need only look to the Netherlands for an example of what is likely to happen.
"…Dutch efforts at regulating assisted suicide and euthanasia have served as a model for proposed statutes in the United States and other countries. Yet the Dutch experience indicates that these practices defy adequate regulation. Given the legal sanction, euthanasia, intended originally for the exceptional case, have become an accepted way of dealing with serious or terminal illness in the Netherlands. In the process, palliative care is one of the casualties, while hospice care lags behind that of other countries.
Herbert Hendin MD, American Foundation for Suicide Prevention
Chris Rutenfrans, PhD, Department of Justice, The Hague
Zbigniew Zylicz, MD, Hospice Rosenhuyvel
DOES NOT ADEQUATELY PROTECT VULNERABLE PATIENTS
The New York State Task Force on Life and the Law convened by former Governor Mario Cuomo issued a 220 page report in May 1994 unanimously recommending against practices similar to those proposed by LD 916. "No matter how carefully any guidelines are framed, assisted suicide and euthanasia will be practiced through the prism of social inequality and bias that characterizes the delivery of services in all segments of our society, including health care. The practices will pose the greatest risks to those who are poor, elderly, members of a minority group, or without access to good medical care."
"In light of the widespread failure of American medicine to treat pain adequately or to diagnose and treat depression, legalizing assisted suicide and euthanasia would be profoundly dangerous...The risks would be most severe for those who are elderly, poor, socially disadvantaged, or without access to good medical care. The risks for these individuals, in a health care system and society that cannot effectively protect against the impact of inadequate resources and ingrained social disadvantage, are likely to be extraordinary."
N.Y. State Task Force on Life and the Law, Supplement to When Death is Sought - Assisted Suicide and Euthanasia in the Medical Context, May 1994; p. xiii.
THE SLIPPERY SLOPE & THE NETHERLANDS EXPERIENCE
In the Netherlands, euthanasia has become an accepted part of Dutch medical practice. Euthanasia was originally adopted in much the same way as it is being introduced in America -- to increase patient autonomy and provide a compassionate solution for those who are suffering with terminal illness. Arguments that voluntary euthanasia would lead to involuntary euthanasia were dismissed.
The Netherlands situation began with assisted suicide for terminally ill adult patients only. The practice soon was expanded to non-terminal, adult patients (those with cancer or advanced multiple sclerosis). Children were then allowed the right even if their parents disapproved. By 1990 the practice had been extended to include non-voluntary situations – patients who had not otherwise requested assisted suicide. And in June of 1994, the Dutch Supreme Court expanded lethal injections to those with mental suffering who were otherwise in good health.
According to Dutch physician, Richard Fenigsen, euthanasia is practiced "on a very large scale", not only in terminal cases, but also on people with various chronic ailments and with psychological disorders. "Many doctors arbitrarily terminate patients' lives without patient's request, consent or knowledge", says Dr. Fenigsen.
Data from a government study show that over 5000 people die each year by euthanasia -- 19.4% of all deaths. Over half of those deaths can be classified as involuntary euthanasia. "Low quality of life", "no prospect for improvement", and "the family could not take it any more" were among the reasons cited most often for terminating the patients life without his or her consent.
DEPRESSION and SUICIDE
Most terminal patients seek suicide not because they are ill, but because they are depressed. Depression is treatable and it is the depression, not the disease, which makes such persons suicidal. Suicide rates in persons with terminal illness are only between 2-5%.
The American Journal of Psychiatry in 1986 concluded: "The striking feature of (our) results is that all of the patients who had either desired premature death or contemplated suicide were judged to be suffering from clinical depressive illness; that is, none of those patients who did not have clinical depression had thought of suicide or wished that death would come early."
Suicidologist Dr. David C. Clark notes that depressive episodes in the seriously ill are not less responsive to medication than depression in others. And psychologist Joseph Richman, former president of the American Association of Suicidology, says "effective psychotherapeutic treatment is possible with the terminally ill, and only irrational prejudices prevent the greater resort to such measures."
"Lots of my dying patients say they grow in bounds and leaps, and finish all the unfinished business. (But assisting suicide) is cheating them of these lessons, like taking a student out of school before final exams. That's not love, it's projecting your own unfinished business."
Dr. Elisabeth Kubler Ross
"Psychiatrists' confidence in their ability to determine whether a psychiatric disorder such as depression was impairing the judgment of a patient requesting assisted suicide was low."
Linda Ganzini, M.D., et al., "Attitudes of Oregon Psychiatrists Toward Physician-Assisted Suicide," American Journal of Psychiatry, Nov. 1996, pp. 1469-1475.
"In addition, one third of the respondents (Oregon physicians) are not confident they could recognize depression in a patient asking for a lethal dose of medication."
The New England Journal of Medicine, Feb. 1, 1996, Vol. 334, No. 5, p. 313.
"The diagnosis of depression is difficult to make in medically ill patients."
K. M. Foley, M.D., Memorial Sloan-Kettering Cancer Center, Cornell University, in The New England Journal of Medicine, Vol. 336, p. 55-58.
"In my experience, cancer patients don't want suicide. They want help. They want to live" Dr. Carroll has treated approximately 8,000 cancer patients in 30 years and has experienced only 5 suicides.
Dr. Ron Carroll, Maine Center for Cancer Medicine
THE ALTERNATIVES - HOSPICE CARE….
Offering suicide to a dying patient is not compassionate care. Doctors who offer death communicate hopelessness, not compassion. It sends the message that the lives of elderly, disabled, and dependent citizens are not worth living. Hospice care is a positive alternative which addresses the emotional, spiritual and physical needs of dying patients. However, Hospice care is not well known or practiced.
Maine has the lowest rate of referral to Hospice care than any other state in the nation. So much for choices.
"From our extensive experience working with individuals who are dying, what they have asked for is good pain and symptom management, the support of family and friends, comprehensive, compassionate health care and resolution of spiritual issues. This piece of legislation is really a commentary about how we view death and dying in our culture. It would be ironic if this bill passed before we took responsibility to improve care at the end of life for Maine citizens."
Maine Hospice Council Executive Director, Kandyce Powell
…. AND PAIN MANAGEMENT
The better response to patients in pain is not to kill them but to make sure that the medicine and technology currently available to control pain is used more widely and completely.
A 1992 manual produced by the Washington Medical Association, Pain Management and Care of the Terminal Patient says "adequate interventions exist to control pain in 90- 99% of patients." (Research shows that only .04% of patients treated with morphine become addicted)
"We frequently see patients referred to our Pain Clinic who request physician assisted suicide because of uncontrolled pain. We commonly see such ideation and requests dissolve with adequate control of pain and other symptoms, using combinations of pharmacologic, neurosurgical, anesthetic, or psychological approaches.
July 1991 Journal of Pain and Symptom Management, Dr. Kathleen Foley, chief of Pain Services at the Memorial Sloan Kettering Cancer Center in New York
WHAT SUICIDE PROPONENTS HAVE TO SAY….
"Predicting the outcome of social legislation with certainty may not be possible. It may be that the safeguards in the Act [Measure 16] do not exclude the possibility that a request for aid in dying could result from pressure on the patient from venal or cruel relatives. Nor can misdeeds by unethical physicians be excluded with certainty."
Peter Goodwin, M.D. (chairman of Oregon Right to Die during the 1994 Measure 16 campaign), "Oregon's Physician-Assisted Suicide Law: An Alternative Positive Viewpoint," Archives of Internal Medicine, August 11/29, 1997, pp. 1642-1644.
HEMLOCK SOCIETY ENDORSES NONVOLUNTARY DIRECT KILLING
In a "slippery slope" development long predicted by euthanasia opponents, the Hemlock Society USA, the leading group promoting the legalization of assisting suicide, on issued a statement endorsing killing individuals --such as people with Alzheimer's disease and children with disabilities--who are legally incapable of making the decision themselves. The statement was issued in the context of a Louisiana case in which a jury December 4 convicted David Rodriguez of second degree murder in the shooting death of his 90-year-old father, who had Alzheimer's disease.
"A judicial determination should be made when it is necessary to hasten the death of an individual whether it be a demented parent, a suffering, severely disabled spouse or a child. Consultants should evaluate what other ways might be used to alleviate the suffering and, if none are available or are unsuccessful, a non-violent, gentle means should be available to end the person's life."
Noting that the Oregon law legalizing assisting suicide (which Hemlock and its allies just successfully defended in a November referendum) applies only when "the person is mentally competent," the statement said
"Even with such a law, there are many people suffering from chronic and terminal illnesses who ... are not competent to make this decision and are in those instances assisted to die by a loved one." The statement said that in such cases "mercy killing is not a cold-blooded, malicious crime but one in which the motivation is kindness and relief of suffering."
"In the case of a minor or an incompetent adult, the law now allows life or death decisions to be made by a designated health care agent and/or a family member in most jurisdictions," the Hemlock USA statement said. "If the Rodriquez death had been the result of a decision to forego life- sustaining medical treatment no criminal liability would have ensued. In such instances, the person ‘dies naturally.' Some provision should be made for a situation in which life is not being sustained by artificial means but, in the belief of the patient or his agent, is too burdensome to continue."
Hemlock Society USA Executive Director Faye Girsh December 3, 1997
Burke J. Balch, J.D., Director of NRLC's Department of Medical Ethics, commented, "The first legal assisted suicide under Oregon's law has yet to be publicly reported, but the Hemlock Society is already casting off the ‘safeguards' it so loudly touted during the debate in November's referendum campaign over its potential repeal. It should be noted that Girsch's statement endorses the killing not only of those who are ‘terminally ill' but also just ‘chronically' ill--which in Hemlock's definition undoubtedly covers people with permanent disabilities. Then, Hemlock drops the requirement that euthanasia be voluntarily chosen by a competent adult. The agenda of the euthanasia movement is now in the open for all to see: not respect for individual choice, the slogan with which they deceived the people of Oregon, but elimination of those whose ‘quality of life' does not meet Hemlock's standards."
THE "RIGHT TO DIE" BECOMES THE "DUTY TO DIE"
"Simply put, an individual's so-called 'right to die,' over time, can be transformed into a demand by society that certain individuals have a 'duty to die.'"
C.T. Canady, "Physician-Assisted Suicide and Euthanasia in the Netherlands: A Report of Chairman Charles T. Canady to the Subcommittee on the Constitution of the Committee on the Judiciary," House of Representatives, 104th Congress, Sept. 1996, p. 21.
"There can be a duty to die before one's illnesses would cause death, even if treated only with palliative measures.... Finally, there can be a duty to die when one would prefer to live. Granted, many of the conditions that can generate a duty to die also seriously undermine the quality of life. Some prefer not to live under such conditions. But even those who want to live can face a duty to die."
John Hardwig, Ph.D., "Is There a Duty to Die?", Hastings Center Report, March-April 1997, pp. 34-42.
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