Testimony of Wesley J. Smith in Opposition to Legislation of Physician-Assisted Suicide in California (AB 651)
Before the Senate Judiciary Committee “Informational Hearing," June 20, 2006
Good afternoon. My name is Wesley J. Smith. I am an author and consumer advocate. I am a Senior Fellow at the Discovery Institute, an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant for the Center for Bioethics and the Culture.
For more some thirteen years I have been deeply engaged in public policy debates about the most important bioethical issues our nation and our states face. These include researching and writing about the ongoing erosion of Hippocratic medical values in bioethics involving areas such as assisted suicide. I am the author or coauthor of 11 books, including Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder and Culture of Death: The Assault on Medical Ethics in America, both of which deal substantially with the issue of assisted suicide. Culture of Death was named “Best Health Book of the Year" at the 2001 Independent Publishers Book Awards. Forced Exit has just been released in its third edition. Further details about my credentials are attached to my written testimony.
My work in the fields in which I advocate is entirely secular, which I believe is appropriate to the creation of public policy in a nation governed by the rule of law.
I have been invited to testify today as an opponent of AB 651, for which I thank the Committee. However, I have been specifically instructed not to testify about the specifics of AB 651—either as originally written or as amended less than a week ago—in this informational hearing, and so will instead address the issue of assisted suicide in a more general fashion focusing on its likely impact on society’s perception of the intrinsic equal value of all human life.
There are two intellectual pillars that proponents argue justify legalizing assisted suicide. The first is an assertion of a near-absolute right of personal autonomy. Accordingly, promoters of assisted suicide generally believe that “the individual’s right to self-determination—to control the time, place, and manner of death"—is a paramount liberty interest. 1 The second ideological foundation of assisted suicide advocacy is the belief that killing (ending life) can be an acceptable answer to the problem of human suffering.
Advocacy for legalizing assisted suicide in this country is usually couched in terms that would limit access to those who are terminally ill. But given the philosophical/ideological principles that underlie the assisted suicide movement—that autonomy is paramount and ending life is a valid answer to human suffering—restricting assisted suicide to the dying becomes utterly illogical. After all, many people experience far greater suffering and for a far longer period than people who are terminally ill. Thus, should the two fundamental premises of assisted suicide advocacy become generally accepted by a broad swath of the medical professions and among the public, there is little chance eligibility for “permitted" suicide would long remain limited to the terminally ill.2
This isn’t a process that would happen instantaneously. The belief in the intrinsic importance of human life is too deeply ingrained within our culture to collapse overnight. But the sheer power of logic may be one of the most irresistible forces in human affairs. Over time, a state sanctioned right of doctors or others to knowingly participate in the suicides or mercy killings of suffering people would lead inexorably to a broader application of hastened death and a steady erosion of the essential principle that each and every human life has equal moral value.
The Dysfunctional Context in Which Assisted Suicide Would be Practiced
In considering the cultural impact legalizing assisted suicide could have on our society, let us first explore the dysfunctional context of health care in California in which assisted suicides would be carried out. Arguments in favor of assisted suicide almost always depict the act as occurring in an idealized world that does not exist. We are told to presume that decisions to commit assisted suicide would take place in the bosoms of loving families, that suicides would be facilitated by family doctors who have known the patient for decades and are intimately familiar with their values, and that assisted suicide would only be used as a last resort engaged in with great reluctance when nothing else could be done to alleviate unbearable pain.
But this “euthanasia world," as I call it, doesn’t exist. There are 7.5 million people without health insurance in this state—more than the entire population of Oregon—which means almost by definition that they may not have access to quality medical treatment and proper care. The economics of health care are increasingly driven by the HMO in which profits are made by cutting costs, a system which many in this legislature have complained bitterly has resulted in the chipping away of quality care. Some doctors are so stressed by the current system that patients may have a mere 15 minutes or less within which to interact with their doctors.
The cost for the drugs used in assisted suicide is about $50. It could take $500,000 to provide the patient with proper care so they don’t want assisted suicide. Should assisted suicide become legalized and legitimized, the economic force of gravity is obvious. After all, what could be a “cheaper" medical treatment than hastened death?
Perhaps that is why you don’t see poor people demonstrating in the streets or demanding the right to assisted suicide: They are worried about receiving adequate care! Indeed, the terrible problem of poorer Californians obtaining fair access to medical treatment is one reason why LULAC, the largest Latino civil rights organization in the United States, has come out unequivocally in opposition to legalizing assisted suicide.
Meanwhile, many of our families are under increasing strain. Debt is at an all time high, and elder abuse is rampant. The temptation that would be posed by inheritance and life insurance when families pondered whether to support a family member’s request for assisted suicide is obvious. And think about now the despair caused by the all too frequent neglect of our seniors and disabled people—too many of whom languish abandoned in nursing homes and other care facilities—could affect a decision to seek a poison prescription when deciding whether to support the legalization of hastened death.
Assisted suicide would be wrong even under the most ideal conditions. But in light of these stark realities, and considering the frayed safety net in California, legalizing assisted suicide in our state could have catastrophic consequences for the weak, vulnerable, depressed, and unwanted.
Eventually, assisted suicide could come to be seen as a splendid way to save scarce medical resources. Indeed, one of the world’s most prominent assisted suicide proponents, Derek Humphry, the founder of the Hemlock Society (now, called Compassion and Choices), acknowledged this concern when he stated in his most recent book, Freedom to Die:
A rational argument can be made for allowing PAS [physician-assisted suicide] 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 and incurably ill adult. There will likely come a time when PAS becomes a commonplace occurrence for individuals who want to die and feel it is the right thing to do by their loved ones. 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 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 in the text.)3
Once this crass attitude seeped deeply into the culture, its stark utilitarian values could easily breach the levy of Hippocratic values and adversely impact normal health care decision making, further threatening the welfare of the elderly, disabled, and dying.
Guidelines Will Not Protect Against Abuse
The usual response to such concerns by assisted suicide advocates is the blithe assurance that “strict guidelines will protect against abuse." At best, this is extremely na´ve. Once we create classes of people whose suicides the state’s public policy states can be legally facilitated, it is easy for these people’s lives to come to be perceived as having less valuable than those who are required by state policies to receive suicide prevention.
We are told repeatedly that Oregon demonstrates that legalizing assisted suicide is “safe." Yet, elder and youth suicide are acute problems in Oregon and state attempts to prevent suicide are not aided by a law that explicitly validates the suicides of some Oregon residents—sending a clear mixed message to Oregon’s suicidal citizens.
But be that as it may, little is truly known about the actual practice of assisted suicide in Oregon since almost all of the information the state garners about what is happening depends on self-reporting by lethally prescribing doctors—who are about as likely to tell the state that they violated the law as they are to tell the IRS they cheated on their taxes. Further demonstrating the empirical unreliability of the “Oregon statistics," state agencies have no budget or authority to engage in any meaningful oversight of assisted suicide activities. As Dr. Katrina Hedberg—the lead author of most of the Oregon official annual reports—admitted to a British House of Lords fact finding committee, “Not only do we not have the resources to do it [independently investigate assisted suicide] but we do not have any legal authority to insert ourselves.4 Moreover, even the information that the state does collect is destroyed once the annual reports are published—meaning there is no way to independently verify the data that Oregon has reported since its law went into effect.5
Still, we know about a few cases of apparent abuse. One of the most disturbing is that of a cancer patient named Michael P. Freeland, who gave permission for his medical records to be reviewed for a peer-reviewed article published in the Journal of American Psychiatry. To the best of my knowledge, it is the only case so far in which professional investigators had access to the actual medical records of a patient who received a lethal prescription under Oregon’s law.
The authors of the study, psychiatrist N. Gregory Hamilton and Catherine Hamilton, a social worker, discovered that “Mr. A." (Freeland), had been issued a lethal prescription nearly 2 years before he actually died of natural causes.6 (Dr. Hamilton is the former president of Physicians for Compassionate Care, an organization dedicated to improving palliative care for the dying, but which also opposes Oregon’s law. He and Catherine Hamilton are married.) This is a matter of striking interest. Not only was Freeland apparently not terminally ill as defined by Oregon's law (which requires that a doctor reasonably believe that a patient will die within 6 months) when he first received his lethal prescription, but even more alarmingly, he was allowed to keep his cache of suicide pills even after being diagnosed as having "depressive disorder," "chronic adjustment disorder with depressed mood," "intermittent delirium," for which he was hospitalized and declared mentally incompetent by a court.7
Here are the details: Mr. Freeland was diagnosed with lung cancer in 2000. In early 2001 he received a lethal prescription from Dr. Peter Reagan, an assisted suicide advocate who is often referred patients whose own doctors refuse to assist the suicides of their patients. On January 23, 2002, more than a year after receiving Reagan's lethal script, Freeland was admitted to a hospital psychiatric ward for depression with suicidal and possibly homicidal thoughts. A social worker went to Freeland's home and found it "uninhabitable," with "heaps of clutter, rodent feces, ashes extending two feet from the fireplace into the living room, lack of food and heat, etc. Thirty-two firearms and thousands of rounds of ammunition were removed by the police." Amazingly, the "lethal medications" that had been prescribed more than a year before were left in the house.
Freeland was hospitalized for a week and then discharged on January 30. The discharging psychiatrist noted with approval that his guns had been removed, "which resolves the major safety issue," but wrote that Freeland's lethal prescription remained "safely at home." Freeland was permitted to keep the overdose even though the psychiatrist reported he would "remain vulnerable to periods of delirium." In-home care was considered likely to assist with this problem, but a January 24 chart notation noted that Freeman "does have his life-ending medications that he states he may or may not use, so that [in-home care] may or may not be a moot point."8
The day after his discharge, the psychiatrist wrote a letter to the court in support of establishing a guardianship for Freeland, writing, "he is susceptible to periods of confusion and impaired judgment." The psychiatrist concluded that Freeland was unable to handle his own finances and that his cognitive impairments were unlikely to improve. He lived under supervision for a brief time, but was soon home alone with ready access to his suicide drugs.
It was during this period that Freeland called Physicians for Compassionate Care for help. Rather than dying alone by assisted suicide, he was instead cared for by the Hamiltons and by his friends--who assured the now imminently dying man "that they valued him and did not want him to kill himself." Freeland was properly treated for depression with medication. He received good pain control, including a morphine pump. Best of all, he was reunited with his estranged daughter and died knowing she loved him and would cherish his memory.9
Based on their review of the facts and circumstances surrounding Freeland receiving a lethal prescription and being allowed to keep the drugs while psychotic, the Hamiltons reached important conclusions about the law’s discriminatory effect on patients and its impact on mental health professionals:
The legalization of doctor-assisted suicide in Oregon has resulted in the introduction of competing paradigms—the traditional clinical approach [Removing lethal means is central to the clinical treatment of suicide symptoms] and the assisted suicide competency model [providing lethal means]—for responding to suicidal thoughts and behaviors in seriously ill individuals…These competing models appear to be based on incompatible underlying assumptions about the value of protecting life depending on predictions of how long a patient might live…We conclude that the attempt to mix models is confusing to both clinicians and patients and endangers seriously ill patients, particularly those with a history of pre-existing mental illness.10
Or to put it another way, the very mental health professionals responsible for treating this delusional man expressed utter indifference to his committing suicide, whereas had he presented the same symptoms without having cancer he would undoubtedly have received rigorous suicide prevention and treatment. The only conclusion to draw from such a disparity is that because he had obtained a suicide prescription, the value of Mr. Freeland’s life was perceived to be of lesser value to his own psychiatrist.
The Threat to the Disabled and Elderly
Disability rights activists are the most committed and effective opponents of legalizing assisted suicide. This is highly significant given that disability rights activists tend to be liberal politically, pro-choice on abortion, and secular in their world views. Thus like many assisted suicide opponents, their opposition isn’t based on religion, but rather, their understanding that legalizing assisted suicide—even if formally restricted to the terminally ill—would validate discriminatory public attitudes that are profoundly threatening to people with disabilities.
Paul Longmore, a nationally respected disability rights activist, writer, and associate professor of history at California State University at San Francisco, has put it this way:
Current euthanasia activists talk a lot about personal autonomy and choice. Well, for people with disabilities who have opted for assisted suicide, it was a spurious choice. These are people who have been denied the ability to choose about virtually every other option in their lives: They have been segregated out of society; they have been denied the right to work; they have been discriminated against in getting an education; they have been blocked from expressing themselves romantically and sexually; they have been penalized for marrying by having public benefits shut off, including desperately needed health insurance; they have been shunned by loved ones and friends. In virtually every case in which a person with a disability has sought legal assistance in ending their lives, they have been discriminated against in most if not all of these ways.11
Diane Coleman, one of the nation’s most prominent disability rights activists and founder of Not Dead Yet, a disability rights organization that opposes legalizing assisted suicide and advocates for equal treatment for disabled people in the health care system, has expressed similar views:
The widespread public image of severe disability as a fate worse than death is not exactly a surprise to the disability community. Disability rights activists have fought against these negative stereotypes of disability for decades in the effort to achieve basic civil rights protections. What has been a surprise for many advocates is the boldness with which these stereotypes are asserted as fact by proponents of assisted suicide, and the willingness of the press and the public to accept them, without even checking them against the views of people who themselves live with severe disabilities. …These stereotypes then become grounds for carving out a deadly exception to longstanding laws and public policies about suicide prevention.12
These prejudices seep into the delivery of health care undermining the quality of care received by the disabled. Examples of such biases are routinely reported in disability rights literature. The following excerpt from an article in the disability health and wellness journal, One Step Ahead’s Second Opinion, is typical of the impediments placed in the paths of disabled people:
Robert Powell has lived with partial paralysis since childhood and learned two years ago he has a heart condition. . . . [The] hospital staff repeatedly asked him how much he wanted done to save his life should his condition fail to respond to routine treatment. Having barely reached middle age, he assured them he wanted aggressive measures to save his life. Staff continued to question him about his decision. They finally requested a psychiatric consult because they felt he was ‘having trouble accepting death.’"13
Facing and overcoming this type of prejudice is difficult enough when the law values all lives equally. But with the assisted suicide movement now claiming that suicide should be sanctioned by the state in some cases, with the growing utilitarianism in bioethics, and in the context of society’s prejudice against people with disabilities, many in the disability rights movement are convinced that they are the actual targets of the assisted suicide movement.
The Dutch Experience
We need only look to the experience of the Netherlands to see that disability rights activists are right about the destructive social forces that assisted suicide ideology unleashes. The Dutch have permitted euthanasia and assisted suicide since 1973.14 Euthanasia and assisted suicide became an integral part of Dutch medicine after a court ruling that refused to meaningfully punish a physician, Geetruida Postma, who had euthanized her mother.15 The court accepted the premise—supported by both the prosecution and the defense—that most Dutch doctors favored euthanasia in some cases. Accordingly, even though convicted of murder, Dr. Postma received only a one-week suspended sentence and a year’s probation.
Other court decisions soon followed, with each widening and further liberalizing the conditions under which euthanasia and assisted suicide would not be punished. Thus, even though these life-terminating practices remained technically illegal until 2002, they became deeply entrenched in Dutch medical practice.
At this point it is important to recall that when euthanasia was first accepted in the Netherlands, it was supposed to be a rare event, to be resorted to only in the most unusual cases of “intolerable suffering"—just as we are told it will be here in California. The guidelines were designed specifically to keep assisted suicide occurrences few and far between by establishing demanding conditions that had to be met, at the risk of criminal prosecution. Over time, however—precisely because suicide and mercy killing were deemed acceptable answers to human suffering—doctors began to interpret the death regulations loosely and even ignore them altogether. In the few circumstances where the law took notice, the courts accommodated expanded euthanasia through continual loosening of the meaning of the guidelines.
Expanding the Euthanasia License: In 1999, a statistical analysis of Dutch euthanasia practices published in Journal of Medical Ethics concluded that the Dutch promise of “effective regulation ring hollow" and that euthanasia in the Netherlands “remains beyond effective control."16 And for good reason: As University of Haifa’s Raphael Cohen-Almagoran a self-described ideological believer in euthanasia admitted in his 2004 book, Euthanasia in the Netherlands: The Policy and Practice of Mercy Killing, Dutch euthanasia policy, “does not work because all of the guidelines, without exception, are broken time and time again."17
But the issue goes much deeper than doctors refusing to obey and law enforcement authorities refusing to enforce the rules. What euthanasia really did to the Dutch was to profoundly alter the nation’s conception of right and wrong. With the widespread acceptance of assisted suicide consciousness in the Netherlands, the guideline limitations became mere window dressing that made little actual difference at the bedside to doctors or, indeed, to much of the general public. Finding the proverbial exception to the rule became a standard practice, which in turn, soon changed the exception into the rule. The official guidelines then expanded to formally authorize what was already being done.
The words of the late physician, Dr. K. F. Gunning, perhaps the most notable Dutch opponent of euthanasia, need to be heeded: “Once you accept killing as a solution for a single problem, you will find tomorrow hundreds of problems for which killing can be seen as a solution."18 And indeed, since 1973 Dutch doctors have gone from killing the terminally ill who ask for it, to the chronically ill who ask for it, to the disabled who ask for it, to depressed people who aren’t even physically ill who ask for it.
Assisting the suicides of the deeply depressed who are not physically ill received the explicit approval of the Dutch Supreme Court in the death of Hilly Bosscher. Bosscher wanted to kill herself because she had lost her two sons—one to suicide in 1986 and the other to brain cancer in 1991. Wanting to join her children in death, Bosscher moved the graves of her two sons to the same cemetery and purchased a burial plot for herself so that she could be buried between them.19
Bosscher began to attend meetings of the Dutch Euthanasia Society, where she met Dr. Boudewijn Chabot, a psychiatrist. She told Chabot that she didn’t want therapy, “because it would loosen the bonds with her deceased sons."20 Chabot took her as a patient anyway and met with her on four occasions between August 2 and September 7, 1991. Chabot did not attempt to treat her. Rather, he interviewed her to determine her prognosis. After these interviews and his consultations, believing her to be suffering from “incurable grief"—and despite the complete absence of any physical illness—he helped Bosscher kill herself on September 28, 1991.21
Chabot was prosecuted, although it was never contemplated that he would be jailed or otherwise meaningfully punished.22 Indeed, the government’s own witness supported the assisted suicide.23 The Dutch Supreme Court, with the minor caveat that Chabot erred by not having a colleague independently examine the patient, validated Chabot’s actions. The basis of the ruling was that the law cannot distinguish between suffering caused by physical illness and suffering caused by mental anguish—which, of course, is where the sheer logic of assisted suicide leads.
Non Voluntary Euthanasia and Eugenic Infanticide: Perhaps the clearest indication of how assisted suicide and euthanasia affects our perceptions of the value of human life can be seen in the non voluntary mercy killings that permeate Dutch euthanasia practice.
In the Netherlands, infants are killed because they have birth defects, and doctors justify the practice. A 1997 study published in the British medical journal, The Lancet, revealed how deeply pediatric euthanasia had metastasized into Dutch neonatal medical practice. According to the report, doctors killed approximately 8 percent of all infants who died in the Netherlands in 1995. Assuming this to be typical, this amounts to approximately 80-90 infanticides per year. Of these, one-third would have lived more than a month. At least 10-15 of these killings involve infants who did not depend on life-sustaining treatment to stay alive. The study found that 45 percent of neo-natologists and 31 percent of pediatricians, who responded to study’s questionnaires, had killed infants.24 A follow up study of end-of-life decisions made for infants published in the April 9, 2005 issue found that nothing had changed. In 2001, “in 8%" of cases, drugs were administered to infants “with the explicit intention to hasten death."25
In 2004, Groningen University Medical Center made international headlines when it admitted to permitting pediatric euthanasia and published the “Groningen Protocol," infanticide guidelines the hospital had utilized when killing 15-20 disabled newborns.26 The Protocol creates three categories of killable infants: infants “with no chance of survival," infants with a “poor prognosis and are dependent on intensive care," and “infants with a hopeless prognosis," including those “not depending on intensive medical treatment but for whom a very poor quality of life…is predicted."27
In addition to killing babies, Dutch doctors routinely euthanize patients who have not asked to die. Repeated studies demonstrate that each year at least 900-1000 Dutch patients are non-voluntarily euthanized by their doctors. The practice even has a name, “termination without request or consent," and even though this is formally considered murder under Dutch law, it is rarely prosecuted and almost never meaningfully punished.
Making matters worse—and most germane to the purposes of this informational hearing—despite the clear abuses in the Netherlands, despite the uncontestable fact that doctors are now euthanizing babies and people who have not asked to be killed—the Dutch people support their country’s euthanasia policy. And here we see the greatest problem with opening the door to suicide as an answer to the problem of suffering caused by illness. Once the law states that assisted suicide is right, the people’s own values may soon follow—opening the door to a fall off of the vertical moral cliff.
Based on the above, what can we conclude? First, the slippery slope is very real. The Dutch have proved that Dr. Gunning was right; once killing is accepted as a solution for one problem, tomorrow it will be seen as the solution for hundreds of problems. Once we accept the assisted suicide of terminally ill patients, we will—over time—come to accept the killing of chronically ill patients, disabled people, depressed patients, and ultimately perhaps, even children. Indeed, we saw this slippery slope phenomenon during the assisted suicide spree of Jack Kevorkian, in which more than 70% of the people he assisted in suicide were not terminally ill—and five weren’t even ill upon autopsy.28
Second, adopting suicide as an acceptable answer to human suffering eventually changes popular outlooks. The law not only reflects our values, but in our diverse age, it tells us right from wrong. Accordingly, once suicide is redefined as medical treatment, it becomes transformed from “bad" into “good." Thus, the guidelines intended to “protect against abuse" eventually are viewed not as protections but instead as hurtles separating sick and dying patients from the beneficence of death. In such an intellectual and cultural milieu, it becomes easy to justify ignoring or violating “guidelines."
Third, legalizing assisted suicide can distort the attitude of medical professionals toward their sickest patients. This would be especially true in a medical economic system dominated by cost containment and managed care where profits come from reducing the level of services.
Fourth, legalizing assisted suicide sends the implied message that people who are diagnosed with a terminal illness have lives less worthy of being protected than those of other suicidal people. I have seen this very paradigm in action as a hospice volunteer.
Robert Salamanca of Pleasanton was a wonderful friend who I met as hospice volunteer when he was dying of Lou Geherig’s disease. Bob believed strongly that assisted suicide advocacy diminished the value of the lives of people like him. Indeed, he felt so strongly about this he wrote an important op/ed column in the San Francisco Chronicle (while completely paralyzed) which stated in part:
Euthanasia advocates believe they are doing people like me a favor. They are not. The negative emotions toward the terminally ill and disabled generated by their advocacy is actually at the expense of the ‘dying’ and their families and friends, who often feel disheartened and without self assurance because of a false picture of what it is like to die created by these enthusiasts who prey on the misinformed.
What we, the terminally ill, need is exactly the opposite—to realize how important our lives are. And our loved ones, friends, and indeed society, need to help us feel that we are loved and appreciated unconditionally."29
Robert was right. The proper approach to death and dying is to increase our levels of care and compassion, not permit doctors to coolly write lethal prescriptions.
Moreover, whatever our beliefs might be about an idealized system of assisted suicide, in the real world of California today, legalizing assisted suicide would be dangerous and reckless. With our dysfunctional health care system, high rates of elder abuse, already alarming significant suicide levels, pronounced economic uncertainties, divisions of race, gender, religion, sexual orientation, class, and immigration status, and the concomitant lack of mutual trust, legalizing assisted suicide would be bad medicine and even worse public policy.
Thank you for your attention and I look forward to answering any questions you may have.
WESLEY J. SMITH
Award winning author and lawyer Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant for the Center for Bioethics and Culture. In May 2004, because of his work in bioethics, he was named by the National Journal as one of the nation’s top expert thinkers in bioengineering.
Smith left the full time practice of law in 1985 to pursue a career in writing and public advocacy. He has authored or co-authored eleven books. He formerly collaborated with Ralph Nader, co-authoring four books with consumer advocate: Winning the Insurance Game (1990), The Frugal Shopper (1991), Collision Course: The Truth About Airline Safety (1993) and No Contest: Corporate Lawyers and the Perversion of Justice in America (1996). He also co-authored (with Eric M. Chevlen, MD), Power Over Pain, a consumer’s guide to obtaining good pain control.
His book Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (1997), a broad-based criticism of the assisted suicide/euthanasia movement, has become a classic in anti-euthanasia advocacy. First published in 1997 and in revised paperback in 2003, it was updated again in 2006 and published by Encounter Books under the new title: Forced Exit: Euthanasia, Assisted Suicide, and the New Duty to Die.
Smith’s Culture of Death: The Assault on Medical Ethics in America, a warning about the dangers of the modern bioethics movement, was named one of the Ten Outstanding Books of the Year and Best Health Book of the Year for 2001 (Independent Publisher Book Awards). Smith’s Consumer’s Guide to a Brave New World (2005), explores the morality, science, and business aspects of human cloning, stem cell research, and genetic engineering. He is also conducting research for a planned book about the animal liberation movement.
Smith’s writing and opinion columns on assisted suicide, bioethics, the morality of human cloning, the dangers of animal liberation, legal ethics, and public affairs have appeared nationally and internationally, including in Newsweek, New York Times, The Wall Street Journal, USA Today, Forbes, The Weekly Standard, National Review, First Things, The Age (Australia), Western Journal of Medicine, and the American Journal of Bioethics. He has also been published repeatedly in regional publications including in the San Francisco Chronicle, the Seattle Times, the Dallas Morning News, the Rocky Mountain News, the Detroit News, the Orange County Register, the New York Post, and many other newspapers throughout the nation. He is also a frequent source for journalists reporting on issues about which Smith advocates.
Throughout the course of his career in public advocacy, Smith has appeared on thousands of television and radio talk/interview programs, including on such national programs as ABC Nightline, Good Morning America, Larry King Live, CNN Crossfire, CNN World Report, the CBS Evening News, Coast to Coast, the Dennis Prager syndicated radio show, the Mike Gallagher syndicated radio show, the Tony Snow radio show, Afternoons with Al Kresta, EWTN, CSPAN-Book TV, Fox News, and CNN Talk Back Live. He has also appeared internationally on Voice of America, CNN International, and on programs originating in Great Britain (BBC), Australia (ABC), Canada (CBC), New Zealand, Germany, China, and Mexico.
Smith is often called upon by members of legislative and executive branches of government to give advice upon issues within his fields of expertise. He has testified as an expert witness in front of federal and state legislative committees, and has counseled government leaders internationally about matters of mutual concern.
Smith is an international lecturer and public speaker, appearing frequently at political, university, medical, legal, disability rights, bioethics, religious, and community gatherings across the United States, Europe, Canada, South Africa, Mexico, and Australia.
1Derek Humphry and Mary Clement, Freedom to Die: People Politics and the Right-to-Die Movement, (New York, St. Martin’s Press, 1998), p. 30..
2See, for example, Elliot Cohen, Ph.D., “Permitted Suicide: Model Rules for Mental Health Counseling," Journal of Mental Health Counseling, Vol. 23, No. 4, October 2001, pp. 279-294.
3 Derek Humphry and Mary Clement, Freedom to Die: People, Politics, and the Right to Die Movement, (1998, St. Martin’s Press, New York, NY), p. 333.
4 Witness testimony before House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, published in House of Lords Select Committee, Vol. II: Evidence. April 4, 2005, p. 266, Q. 615.
5 Id. p. 363, Q. 592.
6 N. Gregory Hamilton and Catherine Hamilton, “Competing Paradigms of Response to Assisted Suicide Requests in Oregon," American Journal of Psychiatry, June 2005; pp. 1060-1065.
7 Id, p. 1062.
9 Id., p. 1063.
10 Id., p. 1064
11 As quoted in, Wesley J. Smith, Forced Exit: Euthanasia, Assisted Suicide, and the New Duty to Die, (New York, Encounter Books, 2006), p. 193-94.
12 Diane Coleman, “Not Dead Yet," in Kathleen Foley, MD, and Herbert Hendin, MD, (eds.), The Case Against Assisted Suicide: For the Right to End of Life Care, (2002, Johns Hopkins University Press, Baltimore, MD), p. 221.
13 Advanced Directives and Disability, One Step Ahead’s Second Opinion, 2 No. 1, (Winter 1995).
14 For purposes of this testimony, euthanasia is when a physician lethally injects a patient. Assisted suicide occurs when a physician knowingly provides the lethal means for a patient to commit suicide.
15 Euthanasia Case Leeuwarden-1973" (Excerpts from court’s decision), trans. Walter Lagerway, Issues in Law and Medicine 3 (1988) pp. 429, 439-42.
16 Henk Jochemsen and John Keown, Journal of Medical Ethics, 1999; 25: 16-21.
17 Raphael Cohen-Almagor, Euthanasia in the Netherlands: The Policy and Practice of Mercy Killing, Dordrecht, Kluwer Academic Publishers, 2004), p. 176.
18 My interview with Dr. Gunning in preparation for writing Forced Exit, October 18, 1995.
19 Gene Kaufman, “State v. Chabot: A Euthanasia Case Note," Ohio Northern University Law Review, 20 No. 3 (1994), p. 816-17.
20 Id. P. 817.
21 Kathleen Foley and Herbert Hendin, The Case Against Assisted Suicide, (Baltimore, Johns Hopkins University Press, 2002), p. 110.
22 Wesley J. Smith, Forced Exit: Euthanasia, Assisted Suicide, and the New Duty to Die, (New York, Encounter Books, 2006), p. 118.
23 Foley, Hendin, The Case Against Assisted Suicide, p. 110.
24 Agnes van der Heide, et. al., “Medical End-of-Life Decisions Made for Neonates and Infants in the Netherlands," The Lancet, 350, 1997.
25 Astrid M. Vrakiing, et. al., “Medical End-of-Life Decisions Made for Neonates and Infants in the Netherlands, 1995-2001," The Lancet, Vol. 365, April 9, 2005.
26“No Prosecution for Dutch Baby Euthanasia," Reuters, January 22, 2005.
27 Eduard Verhagen and Peter J. J. Sauer, “The Groningen Protocol—Euthansia in Severely Ill Newborns," New England Journal of Medicine, Marcy 10, 2005.
28 L.A. Roscoe, et. al., “Dr. Jack Kevorkian and Cases of Euthanasia in Oakland County, Michigan, 1990-1998," New England Journal of Medicine, 343: 1735-1736, December 7, 2000
29 Robert Salamanca, “I Don’t Want a Choice to Die," San Francisco Chronicle, February 19, 1997.