Dependency or Death?

Assisted suicide in Oregon has operated in a shroud of secrecy since the procedure was legalized by a 1997 referendum. But a new study, published in the New England Journal of Medicine, purports to shed light on the law’s actual workings. Advocates of assisted suicide claim the report proves all is well. But a close reading reveals that many of the worries of assisted-suicide opponents are entirely justified.

Fifteen people in Oregon, we are told, legally committed suicide with the assistance of their doctors in 1998. According to the report, not one of them was forced into the act by intractable pain or suffering. Rather, those who died had strong personal beliefs in individual autonomy, and chose suicide based primarily on fears of future dependence.

That isn’t how assisted suicide was supposed to work. For many years, we have been told repeatedly by advocates that assisted suicide is to be a “last resort,” applied only when nothing else can be done to alleviate “unrelenting and intolerable suffering.” Yet pain wasn’t a factor in a single one of the Oregon suicides. Thus, rather than being a limited procedure performed out of extreme medical urgency, legalization in Oregon has actually widened the category of conditions for which physician-hastened death is seen as legitimate.

Disability-rights advocates point out that allowing assisted suicide based upon fear of needing help going to the toilet, bathing and performing other daily life activities will involve far more disabled and elderly people than terminally ill ones. They also note that dependency is an issue primarily for people who are not actually dependent, and that like other difficulties in life, dependency is a circumstance to which people adjust with time. To accept the notion that worry about the potential need for living assistance is a legitimate reason for doctors to write lethal prescriptions is to put disabled and elderly people at lethal risk. The dehumanizing message is that society regards such lives as undignified and not worth living. That is why nine national disability-rights organizations have come out strongly against legalizing assisted suicide and none support it.

The study also reports that the people who committed assisted suicide had “shorter” relationships with the doctors who prescribed lethally than did a control group of patients who died naturally. The exact time difference is not given, but we do know from earlier media reports that it may be quite short. The first woman to commit assisted suicide in Oregon had a 2 and 1/2-week relationship with the doctor who wrote her lethal prescription. Her own doctor had refused to assist her suicide, as had a second doctor who diagnosed her with depression. So she went to an advocacy group, which referred her to a doctor willing to do the deed. Hers was not a unique case. The report states that six of the 15 people sought lethal prescriptions from two or more doctors.

Assisted-suicide proponents told us this wouldn’t happen either. They promised that assisted suicide would only occur after a deep exploration of values between patients and doctors who had long-term relationships. Thanks to the study, we now know that death decisions are being made by doctors the patients barely know. This isn’t careful medical practice.

The study is as notable for what it omits as for what it includes. Information about the people who committed assisted suicide came from death-prescribing doctors. Treating doctors who did not participate in their patients’ deaths — professionals who could have provided invaluable information about the health of the people who died — were not interviewed. Nor were the doctors who refused to write lethal prescriptions. Family members were not contacted either. Significantly, the investigators made no attempt to learn whether the prescribing doctors were affiliated with assisted-suicide advocacy groups, a matter of some importance if we are to judge whether the decisions to prescribe lethally were based on medicine or ideology. Moreover, none of the patients were autopsied to determine whether they were actually terminally ill.

Near the end of the report, investigators admit that they do not know whether any unreported assisted suicides occurred. If history is any example, such deaths probably did happen. A recent Journal of Medical Ethics study about euthanasia in the Netherlands reveals that the Dutch policy is “beyond effective control” since 59% of doctors do not report euthanasia or assisted suicide to authorities as required by law. (In Oregon, there is no punishment for failing to report an assisted suicide.)

Moreover, killing by doctors in the Netherlands has expanded far beyond the rare case originally contemplated when euthanasia was first permitted in that country more than 20 years ago. Patients who are not terminally ill are routinely assisted in suicide. Depressed people can also be killed upon request even if they have no underlying organic disease. The lives of children born with birth defects are terminated by doctors based primarily on ” quality of life” considerations. Most chilling, in one out of five euthanasia cases — nearly 1,000 per year — the patient has not asked to be killed.

The New England Journal of Medicine study is a warning that Oregon has started down the same destructive path. Rather than alleviating concerns, the study reveals that assisted suicide is bad medicine and even worse public policy.