Better OffDead?

But the legislation would do something else as well. It would restore the uniform application of the Controlled Substances Act, undoing the partial exemption attorney general Janet Reno extended to Oregon to accommodate its assisted suicide law. Doctors in Oregon, as in the other 49 states, who give patients controlled substances for the purpose of suicide could lose their federal license to prescribe such drugs or even suffer criminal sanctions. In effect, the Pain Relief Promotion Act would end Oregon’s nullification of a federal statute.

It is on this ground that Ron Wyden vows a filibuster. He is outraged, he says, that the legislation would interfere with “states’ rights” — though he also maintains, bizarrely, that a bill intended to encourage pain relief would have a “chilling effect” on doctors’ willingness to provide that very thing.

Senator Wyden doth protest too much. The Pain Relief Promotion Act would advance, not interfere with, the proper medical treatment of pain. That is why the American Medical Association, the National Hospice Organization, and many other medical groups enthusiastically support it. Experience in states like Rhode Island and Louisiana, moreover, shows that it is possible simultaneously to outlaw assisted suicide and promote aggressive pain control: After relevant laws went into effect in those states, doctors’ use of morphine to treat pain skyrocketed. Nor does the federal bill impinge in the least on states’ rights. As the (Portland) Oregonian editorialized, it is actually the Oregon law that “barges into an area of long-standing federal jurisdiction,” and not the other way around.

Wyden’s arguments, then, are off base, and his attempt to have it both ways with his constituents — to oppose assisted suicide personally while supporting the state’s right to legalize it — looks like posturing. Sure enough, it turns out that one of Wyden’s chief advisers in the fight against the Pain Relief Promotion Act is one James L. Werth, a Congressional Fellow working in Wyden’s office. Werth, who has a Ph.D. in counseling psychology, is a national leader of the movement for “rational suicide.”

Under the theory of rational suicide, mental health professionals do not have an unequivocal duty to prevent their patients from killing themselves. The only suicides they must stop are those that are impulsive or frivolous. If a mental health professional deems a patient to have a rational basis for wanting to die, the professional’s primary duty shifts from preventing suicide to ensuring that the patient thinks through the decision carefully.

Here is how rational suicide would work. If a patient expressed a desire to die, his mental health worker would nonjudgmentally help him use proper decision-making techniques to sort out whether or not “to suicide.” If the pros were perceived to substantially outweigh the cons, the mental health professional would stand back and refrain from impeding the patient’s self-destruction (although some rational suicide advocates believe the better response would be to help the patient die).

Mental health workers, in their professional associations and literature and symposia, are still debating the criteria for rational suicide, but a rough consensus has been crafted. Werth, in his book Rational Suicide? Implications for Mental Health Professionals, recommends a five-step approach for determining whether the patient’s decision-making process is “sound.” He also asserts that people should be allowed to commit suicide if they have a “hopeless condition,” which he defines as including, but “not necessarily limited to, terminal illnesses, severe physical and/or psychological pain, physically or mentally debilitating and/or deteriorating conditions, or quality of life no longer acceptable to the individual.”

Consider this definition closely: All suicidal people have severe psychological pain or mentally debilitating conditions. Every suicidal person by definition believes that his quality of life is unacceptable. In the name of nonjudgmentalism, rational suicide transforms self-destruction into just another choice. It is also a warrant for the abandonment of suicidal sufferers by psychologists, psychiatrists, and social workers, the very people who are often the last line of defense between a despairing person and a leap into eternity.

The rational suicide and assisted suicide movements are close allies in the struggle to make killing an accepted medical practice. Thus, it is not surprising that James Werth is also hip deep in the assisted suicide movement. He will be a featured speaker at the biennial convention of the World Federation of Right to Die Societies in Boston this fall, alongside Hemlock Society founder Derek Humphry, co-author of the Oregon assisted suicide law Barbara Coombs Lee, and the “Australian Kevorkian,” Dr. Philip Nitschke, whose first suicide machine was just purchased for display by London’s Science Museum. Werth’s curriculum vitae lists among his “hastened-death-related activities” his service on the board of directors of the Nebraska Hemlock Society, ending in July 1999, and his recent service on the board of the Death With Dignity National Center, two organizations that advocate assisted suicide. He also helped coordinate an amicus brief in the United States Supreme Court in the 1997 case of Washington v. Glucksberg, which, had it been heeded, would have produced the assisted suicide Roe v. Wade. So much for states’ rights.

There is a terrible irony in all of this. Last July, with Tipper Gore at his side, surgeon general David Satcher issued “a call to action” against suicide. In an alarming report, Satcher warned that suicide, the country’s eighth leading cause of death, is one of our most pressing public health concerns. Approximately 31,000 Americans die at their own hands each year, far more than the 20,000 who are murdered. Between 1952 and 1996, the number of suicides among adolescents and young adults tripled. More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. Suicide strikes older Americans particularly hard. On average, 18 older Americans kill themselves each day, with the rate highest among white males aged 65 and older. But how is Dr. Satcher to mount an effective anti-suicide campaign when mental health professionals and high public officials send mixed signals about preventing self-killing?

Those fighting the Pain Relief Promotion Act deny that their opposition is based on any support for assisted suicide. That is hard to believe. The fact that Sen. Wyden, the leader of the effort to defeat the bill, is working hand in glove with such a big shot in the rational suicide and assisted suicide movements strongly suggests that the opposition actually cares little about states’ rights or chilling effects. Its primary purpose is to protect the beachhead achieved for assisted suicide in Oregon, and so to advance a nationwide plan to legalize medical killing.

Wesley J. Smith is an attorney for the International Anti-Euthanasia Task Force. His Culture of Death: The Destruction of Medical Ethics in America is due out this fall from Encounter Books.