^{The Latest} The Wages of Death

Twenty-five years ago, Newsweek published my first essay. In the wake of my friend’s suicide under the influence of the Hemlock Society, I worried that some suicides would be “promoted as a virtue” if assisted suicide, or euthanasia, was ever accepted. (Assisted suicide involves a doctor’s knowingly prescribing drugs for use in the patient’s suicide; euthanasia involves a doctor’s lethally injecting the patient.) After that, I predicted, eligibility for hastened death would expand to those “who don’t have a good ‘quality’ of life,” “perhaps with the prospect of organ harvesting thrown in as a plum to society.”

I thought the essay would be uncontroversial. Then came the hate mail, at a decibel level that I had not experienced theretofore in my years of public-policy advocacy. Euthanasia is a human right, I was told angrily. Correspondents hoped that I would die slowly of a painful cancer. I was called a religious fanatic (even though I had not mentioned religion), an alarmist, a fantasist, and a sadist. Nothing like what I feared would ever happen if society legalized assisted suicide or euthanasia, I was reassured.

In the years since, however, doctor-administered lethal-injection euthanasia has been legalized in the Netherlands, Belgium, Canada, Luxembourg, and Colombia. Legal doctor-assisted suicide has followed in six U.S. states, plus the District of Columbia — the latest, Hawaii, enacted its statute in early April — as well as in the Australian  province of Victoria and in Germany, where it was imposed by court order. In Switzerland, the previously little-known 1942 law permitting assisted suicide has become the basis for a flourishing “suicide tourism” industry.

Tens of thousands of people have now been legally killed or assisted in suicide by doctors in these jurisdictions. Not only have many of the worst fears that I expressed in 1993 been realized, but, in some ways, things have become more radical than I ever dreamed of.

The Netherlands led the charge down the slippery slope. Assisted suicide was decriminalized in the 1970s as long as doctors followed supposedly strict guidelines, and the categories of those eligible to be killed expanded steadily thereafter. That process has accelerated especially since formal legalization in 2002. Currently, more than 6,000 people die in the Netherlands by euthanasia and assisted suicide each year. Killable people now range from the terminally ill and the chronically ill, such as a woman with serious tinnitus, to people with disabilities, such as people with paralysis and chronic alcoholics, dementia patients who ask to be euthanized in advance directives, the elderly with non-life-threatening health concerns or early dementia — and even 83 mentally ill patients in 2017. According to the medical journal JAMA Psychiatry, in recent years “depressive disorders were the primary issue” in 55 percent of Dutch mental-illness euthanasia cases. And babies born with serious disabilities, such as spina bifida, or with terminal conditions are lethally injected under a neonatal euthanasia protocol.

There have been many clear cases of abuse: the elderly woman euthanized for macular degeneration, the anorexic young woman put down because of the suffering she experienced from her eating disorder, the nursing-home doctor who euthanized a patient he thought had lung cancer before the diagnosis was confirmed.

A particular 2016 case stands out in its horror. Prior to becoming unable to care for herself, a woman with dementia wrote a note stating she never wanted to live in a nursing home. Despite that, she was institutionalized, where she became afraid and wandered the halls — typical symptoms of Alzheimer’s disease. Her doctor — without asking — decided the time had come for her life to end. The doctor drugged the woman’s coffee so that she would sleep while being killed, a violation of euthanasia rules. Then things really went awry. According to the Daily Mail, while the doctor was attempting to lethally inject her, the woman woke up and fought to save her life:

The paperwork showed that the only way the doctor could complete the injection was by getting family members to help restrain her. It also revealed that the patient said several times “I don’t want to die” in the days before she was put to death, and that the doctor had not spoken to her about what was planned because she did not want to cause unnecessary extra distress.

Can you imagine a woman struggling against being killed being held down by her own family? By any reasonable measure, that was murder. But a Regional Review Committee inquiry exonerated the doctor because she had “acted in good faith.”

The Belgians have taken their euthanasia regime to even more-radical extremes. Mentally ill patients have been voluntarily euthanized, and their organs immediately harvested, after which the Dutch started doing that, too. The Belgians also pioneered joint euthanasia deaths of elderly couples who would rather die than face widowhood. The death doctor in one of these cases was procured by the couple’s son, who told a reporter that this was the best thing to do because he could not care for them. Joint geriatric euthanasia has also ended the lives of elderly couples in the Netherlands, at a Swiss suicide clinic, and, most recently, in Canada.

Belgian euthanasia has grown so wild that a doctor who had supported legalization and served as an oversight official resigned from his responsibilities because of the number of abuses that had passed through his committee with nothing done to hold the wrongdoers to account. He wrote about one case in particular:

The most striking example took place at the meeting of Tuesday, September 5, 2017: a euthanasia of a deeply demented patient with Parkinson’s disease, by a general practitioner who is totally incompetent, has no idea of palliation, done at the request of the family. The intention was to kill the patient. There was no request from the patient.

Canada is racing down the same road. After the Canadian supreme court conjured a right to receive euthanasia if the patient has a diagnosed condition causing irremediable suffering, including psychological suffering as defined by the patient, meaning that there is no objective test, the country embraced what is known as “MAID” — medical assistance in dying — with great gusto.

The Canadian parliament legalized euthanasia across the country in response but limited euthanasia to circumstances where death is “foreseeable” — whatever that means. Even that condition has come under legal attack as too restrictive. In any case, the College of Physicians and Surgeons of British Columbia issued an ethics opinion that a patient who doesn’t qualify for euthanasia can make himself eligible simply by starving himself or refusing treatment to the point where he can be judged to be “declining toward death.”

An Oregon bureaucrat has made a similar determination under that state’s assisted-suicide statute. Under the law, to receive doctor-assisted suicide, the patient — for now — must be reasonably expected to die within six months. (Demonstrating the uncertainty of such a diagnosis, some patients who received lethal prescriptions but didn’t take them lived for years afterwards.) When asked by a Swedish researcher whether diabetic patients who stopped taking insulin or patients who could not afford curative treatment could thereby qualify for a lethal prescription under the law, Craig New, a research analyst at the Oregon Health Authority, answered in the affirmative:

In your two examples, both patients would qualify for the DWDA [Death with Dignity Act]. Patients suffering from any disease (not just those that typically qualify one for the DWDA) may not be able to afford some treatments or medication, and may choose not to pursue some treatments or take some medication for personal reasons. . . . If the patient does not receive treatment or medication (for whatever reason) and is left with a terminal illness, then s/he would qualify for the DWDA. [Emphasis added].

“I think you could also argue,” New continued, “that even if the treatment/medication could actually cure the disease, and the patient cannot pay for the treatment, then the disease remains incurable.” In other words, the six-months-to-live restriction has already been stretched to include people who would live longer, perhaps indefinitely, if they received medical treatment.

And what about the doctors? What qualifications must they have to participate in assisted suicide? They do not need to have any significant experience in treating the patient’s malady leading to the death request. Thus, Lonnie Shavelson, a California part-time emergency-room physician and assisted-suicide activist — who had in recent years mostly practiced advocacy journalism rather than medicine — opened a death practice in which he charges $2,000 to counsel patients and write a lethal prescription. And what experience would an ER doctor have in treating terminal illnesses such as cancer, ALS, or renal disease? Beyond medical school and residency, not much. Similarly, a Belgian oncologist lethally injected Godelieva De Troyer — who did not have cancer but suffered from long-term depression, a malady clearly outside the doctor’s specialized training. The first that De Troyer’s son, Tom Mortier, heard about the planned death was when the hospital called to have him pick up his mother’s corpse.

Here’s the moral of the story. The “strict guidelines” that activists promise will protect against abuse don’t, and, indeed, the restrictions erode with time. Legalizing assisted suicide and euthanasia shifts mindsets, and, as a consequence, people don’t much care about the steady increases in assisted suicide that follow legalization, or about clearly abusive cases, which they would once have found abhorrent, that come to light. Finally, euthanasia and assisted suicide corrupt everything they touch: the doctor–patient relationship, familial bonds, and our embrace of the intrinsic value of human life. This includes society’s commitment to suicide-prevention services, which these days are usually not offered to those who are suicidal as the result of a terminal illness.

The debate over assisted suicide should encompass what the regime of death will become and where it will lead. There is more to this argument than simply whether assisted suicide should be legalized for certain categories of individuals. It is a pretense that the practice will always be limited to the dying for whom nothing else can be done to alleviate suffering. Those with eyes to see, let them see.