I am rarely encouraged by news out of Oregon about assisted suicide, where doctors may legally prescribe a lethal overdose to patients they diagnose as terminally ill. Over the years, the number of assisted suicides has increased, while the media studiously ignored studies demonstrating that abuses abound. For example, a major study in the Michigan Law Review (PDF) by Dr. Kathleen Foley—perhaps the country’s most respected palliative care physician—and suicide prevention expert, Dr. Herbert Hendin, found that the so-called protective guidelines are often violated with legal impunity. Further, the study found that the bureaucrats in charge of overseeing the law “do not collect the information it would need to effectively monitor the law” and worse, that “in its actions and publications [they] act as the defender of the law rather than as the protector of the welfare of terminally ill patients.”
I have also been distressed by assisted suicide advocates bragging that most people who receive doctor-prescribed death were in hospice when they died—as if that made it all okay. But now a study published by the Hastings Center shows that the assisted suicide agenda has not yet corrupted the state’s hospices. To the contrary: Most Oregon hospices do not participate actively in Oregon assisted suicide. From a Hastings Center Report study:
During 2009, in order to assess the extent to which Oregon hospice programs participate in physician-assisted death, we requested policy statements, program guidelines, and staff education materials that had been developed by sixty-four hospice programs affiliated with the Oregon Hospice Association to address patient inquiries about the Death with Dignity Act. We received forty documents representing fifty-six programs. Our examination of these documents suggests that individual hospice programs generally assume a minor role in the decision-making process of patients who exercise their rights to physician-assisted death—a role largely confined to providing information about the law in a “neutral” manner. Moreover, hospices claim they will not assist with providing the medications necessary to hasten a patient’s death. This limited role indicates that questions of legal compliance and moral complicity inhibit hospice collaboration with patients seeking physician-assisted death.
I hope the actual reason is more fundamental, that hospice workers in Oregon understand that facilitating assisted suicide is directly contrary to the hospice philosophy. Indeed, rather than facilitating doctor-prescribed death, hospice professionals are supposed to prevent the suicides of their patients by intervening to provide services or treatments the patient might be lacking, so that they no longer want to die immediately.
I can personally attest to how seriously this obligation is taken by hospice administrators. I was trained as a hospice volunteer, and I was told in no uncertain terms that if I even suspected that a patient was suicidal, I was to immediately inform the multidisciplinary team so they could provide preventive mental health and other services—just as medicine would for any other suicidal person.
This raises an important question: Why does hospice philosophy oppose assisted suicide? According to the late Dame Cecily Saunders—the creator of the modern hospice concept and one of the great medical humanitarians of the 20th Century—doctor-prescribed suicide denies the equal dignity of hospice patients. As she wrote in the 2002 book, The Case Against Assisted Suicide (chapter, “The Hospice Perspective”), hospice asserts on behalf of the dying patient his or her “common humanity and personal importance” to the moment of natural death.
The great American hospice physician, Ira Byock, is similarly opposed to assisted suicide, writing in the Journal of Palliative Care, “The hospice focus is on life and the alleviation of suffering,” whereas “the goal of assisted suicide and euthanasia is death.” Moreover, if a hospice cooperated in doctor-prescribed death, it would abandon that patient to his or her worst fears—that they will die in agony, that they are a burden, that their lives truly are no longer worth living.
Thus, when assisted suicide facilitators in Oregon brag that they have assisted the suicides of hospice patients, they are actually admitting that they interfered with the proper medical care of these patients. Indeed, boasting of helping hospice patients kill themselves is akin to patting themselves on the back for helping the patient die after denying them proper pain control—another crucial hospice medical service.
This is the bottom line: Hemlock (if you will) and Hospice cannot occupy the same philosophical space. That is why I am very pleased that Oregon hospices are generally keeping assisted suicide at arm’s length. Legal or not, doctor-prescribed death has no place in proper end-of-life care.
CBC Special consultant Wesley J. Smith is also a senior fellow in The Discovery Institute’s Center on Human Exceptionalism and a lawyer for the International Task Force on Euthanasia and Assisted Suicide.