The Case Against Assisted Suicide For the Right to End-Of-Life Care edited by Kathleen M. Foley and Herbert Hendin Johns Hopkins Univ. Press, 392 pp., $49.95 Supporters of legalizing assisted suicide often claim religious belief is the only reason to oppose killing as an acceptable answer to human suffering. That being so, the argument goes, prohibitions against assisted suicide actually amount to the imposition of religious doctrine on statutory law, which violates the First Amendment’s establishment clause. The entire notion is ridiculous, of course. Laws prohibiting assisted suicide are no more religious than statutes outlawing theft. For that matter, why shouldn’t religious views have as much place in the marketplace of ideas as perspectives founded in philosophy, political ideology, or personal preference? But there’s another point to make, as well–which is that religion is only one of the reasons Americans oppose the euthanasia agenda. In fact, underreported in the popular press, opponents of assisted suicide have formed an alliance that cuts across ideological fissures and religious-versus-secular divisions. The Catholic church participates in this coalition with such distinctly secular national organizations as Not Dead Yet and the National Spinal Cord Injury Association. The pro-life movement opposes assisted suicide, but so do most of the world’s professional medical organizations, virtually all of which support a right to abortion. And consider this: One of the nation’s most vocal opponents of euthanasia is the venerable civil libertarian and atheist Nat Hentoff. This loose coalition of strange political bedfellows had not coalesced when Oregon passed its assisted suicide law by a vote of 51 to 49 percent in 1994. That event, combined with the predations of Jack Kevorkian, sparked its formation. Since then, the opposition to assisted suicide in the United States has strengthened. In 1998, Michigan, the home state of Kevorkian, rejected legalizing assisted suicide by a vote of 71 to 29 percent. In 2000, even liberal Maine turned it down by 51 to 49 percent. Jack Kevorkian is in a penitentiary. The United States Supreme Court and the state supreme courts of Florida and Alaska have all refused to recognize a constitutional right to assisted suicide. Meanwhile, people who assist in “private” suicides are increasingly being sent to prison for their crimes. Still, the myth persists that opposition to assisted suicide is based in religion, and the issue is often presented by the media as a clash between secular modernism and Luddite religion. That presumption will be impossible to maintain with the publication of “The Case Against Assisted Suicide,” edited by Kathleen Foley, one of the nation’s foremost experts in pain control and palliative care, and psychiatrist Herbert Hendin, medical director of the American Foundation for Suicide Prevention. “The Case Against Assisted Suicide” presents a compelling argument for improving the treatment of disabled and dying people. It is also particularly telling in its analysis of euthanasia in the Netherlands. “Virtually every guideline set up by the Dutch” designed to protect against abuse “has failed to protect patients or has been modified or violated,” the book concludes. Many critics have attacked Dutch physicians for killing patients who have not requested to be euthanized, but apologists for euthanasia claim the numbers of such deaths are decreasing. Now Hendin, who has spent years researching Dutch euthanasia, demonstrates that the reverse is actually true: Involuntary and nonvoluntary euthanasia rose from about 1 percent of all Dutch deaths in 1990 to 1.4 percent in 1995. One wishes we had similar statistics about how the Oregon law is actually working. In an essay in “The Case Against Assisted Suicide,” psychiatrist Gregory Hamilton, president of Oregon’s Physicians for Compassionate Care, reveals that rather than being an open experiment as promised by assisted suicide proponents, euthanasia in Oregon is practiced behind a shroud of secrecy. Most of what we know comes from forms filled out by the doctors who lethally prescribe, and even the Oregon Public Health Services admits it doesn’t know if physicians honestly or fully report on their activities. Hamilton examines what little we do have from published statistics and a few media reports. Many patients who have committed assisted suicide did not receive their prescribed overdoses from their own doctors. Why would the patients’ own doctors not participate in their assisted deaths? We simply don’t know. The Oregon Public Health Services, which will speak only with the doctors who prescribed the overdoses (many of whom are ideologically predisposed to assisted suicide and are affiliated with the assisted suicide advocacy groups), has yet to contact other doctors to learn why they refused to assist their patients’ suicides. Hamilton also describes the underreported case of Kate Cheney’s assisted suicide. (See “Suicide Unlimited in Oregon” in the November 8, 1999, Weekly Standard.) Cheney was a cancer-stricken eighty-five-year-old woman with growing dementia. When she requested assisted suicide, she was examined by a psychiatrist who, Hamilton reports, “found her ineligible for assisted suicide because of her obvious cognitive impairments and because her family appeared to be pressuring her.” If the guidelines worked as promised, that should have been that. But it wasn’t. Cheney’s daughter merely decided to get another opinion. Despite finding the daughter to be “somewhat coercive,” the second opinion, from a psychologist, approved the assisted suicide. The practice of doctor shopping until the wanted answer is found is troubling enough. But the person making the final decision whether to lethally prescribe in the Cheney case was not her own doctor but an administrator for Kaiser Permanente, her HMO. Did money influence the administrator’s decision? He denies it. But as Hamilton points out, “this case illustrates how once assisted suicide is legalized, there is no way to protect those who are vulnerable and mentally ill from social or even financial pressures.” In another essay in “The Case Against Assisted Suicide,” Diane Coleman, founder of the national advocacy organization Not Dead Yet, makes the case against legalizing assisted suicide from the perspective of the disabled. Not Dead Yet was formed in reaction to the popular applause at Kevorkian’s repeated assistance in the death of people with non-terminal disabilities. (Approximately 75 percent of Kevorkian’s victims were not terminally ill. At least five had no illnesses or disabilities determinable upon autopsy.) “It was as though ‘open season’ had been declared on disabled people,” Coleman writes. She convincingly argues that the assisted-suicide movement is not really about relieving the suffering associated with terminal illness but about the popular perception that it is better to be dead than disabled. That attitude often rubs off on disabled people who thus come to see themselves as burdens. In its final section, “The Case Against Assisted Suicide” provides proof that there is a better way to grapple with terminal illness and disability. Among the contributors to this portion of the book is Dame Cicely Saunders, the British humanitarian who founded the modern hospice movement. Autonomy, the ideological linchpin of the euthanasia movement, she writes, “must be seen in the context of a society that emphasizes youth and active achievement and so cannot be trusted not to bring pressure on those it considers an emotional or economic burden.” In another chapter, Hendin and Foley examine the physical symptoms, psychological distress, and existential dread of serious illness. Indeed, ill people who express a desire for assisted suicide do it more out of fear of being a burden or losing the ability to engage in enjoyable activities than because of pain. Moreover, these problems can generally be ameliorated. Unfortunately, too many doctors–and patients–are inadequately educated about such matters. Remedying this deficiency is a worthy project for a great nation, and the continuing struggle over assisted suicide is just getting in the way. “The Case Against Assisted Suicide” is not exactly beach reading, but the issues of medicalized killing and proper end-of-life care deserve the substance and seriousness that the contributors bring to this important volume. Its thorough documentation and powerful analysis provide a convincing–and wholly secular–case for refusing to allow doctors to kill their suffering patients. Wesley J. Smith, a frequent contributor to The Weekly Standard, is the author of “Culture of Death: The Assault on Medical Ethics in America.”
