I spoke at a town-hall event about end-of-life care recently that, unfortunately, devolved mostly into an intense debate on assisted suicide. When the time came for audience questions, a self-described “mentally ill” woman took the microphone and strongly declared that she too should have the right to doctor-prescribed death. More than half the audience applauded, validating the woman’s potential suicide.
Ten years ago, supporting suicide for the mentally ill would have been unthinkable, even among hardcore Hemlock Society types. Now, alas, giving approval — or shrugging indifferently — to all manner of suicidal desires is becoming increasingly common. Indeed, you probably didn’t know that Sept. 10, 2011, was “World Suicide Prevention Day,” it received such scant media attention.
Why the change from an anti-suicide culture to one that is, at minimum, suicide-tolerant? I am convinced that, at least in part, the assisted-suicide movement has eroded society’s commitment to suicide prevention. It has created an atmosphere where many people now see “dead” as better than “dying” and suicide as a valid remedy for the debilitations caused by serious illness, disability, or being frail, elderly, “tired of life,” or chronically — or even, as I have seen, mentally — ill. Indeed, rarely a day goes by without some story implicitly or explicitly supporting assisted suicide as “death with dignity” or a compassionate response to the problem of human suffering.
So far, the U.S. has mostly resisted the siren song of legalizing assisted suicide. But that is not cause for complacency. Assisted-suicide advocates never tire of offering the hemlock. And we mustn’t forget that during the 1990s, Jack Kevorkian assisted the suicides of mostly depressed, disabled people to general societal applause.
This is cause for great worry, for, once a society embraces doctor prescribed death as an acceptable answer to human suffering or as some kind of fundamental liberty right, there are no brakes. We need only look to European countries that have gone down the Euthanasia Highway to see how society is impacted deleteriously by accepting killing as a suitable answer to the problem of human suffering.
The Dutch trailblazed societal acceptance of euthanasia beginning in 1973, when a judge ruled that, if doctors followed certain guidelines when committing euthanasia, such as repeated death requests and acting lethally only when there is no other way to control suffering, they should not be punished. This led to an ever-expanding category of people receiving doctor-administered death, even before formal legalization by the Dutch parliament in 2001.
Since that fateful court ruling, Dutch doctors have gone from euthanizing the terminally ill to the chronically ill, to people with serious disabilities, to the emotionally and mentally ill (the last approved by the Dutch supreme court when it refused to punish a psychiatrist for assisting the suicide of a woman distraught over the deaths of her two children). Moreover, Dutch doctors murder infants born with serious disabilities or terminal conditions. Such euthanasia killings remain felonious under Dutch law, but the law goes almost wholly unenforced. Indeed, doctors at the Groningen University Hospital were so emboldened by the Dutch acceptance of infanticide that they published “The Groningen Protocol,” a bureaucratic checklist for deciding which babies qualify for euthanasia, in a range of journals, including The New England Journal of Medicine.
All of the above is bad news, but also relatively old news. More recent events in the Netherlands show that the ever-expanding Dutch euthanasia license set into motion in 1973 shows no indication of slowing down.
For example, the Dutch Medical Association (KNMG) wants to loosen the definition of “unbearable suffering” for euthanasia qualification to include non-medical issues. From a Radio Netherlands Worldwide report:
Until now, factors such as income or a patient’s social life played almost no role when physicians were considering a euthanasia request. However, the new guidelines will certainly change that. After almost a year of discussions, the KNMG has published a paper which says a combination of social factors and diseases and ailments that are not terminal may also qualify as unbearable and lasting suffering under the Euthanasia Act.
These social factors include matters such as “loneliness,” strained “financial resources,” and a “loss of social skills.”
Dutch doctors have now been told they may ethically supply “how to commit suicide” instructional materials to their patients who don’t qualify legally for euthanasia. The practice, known as “autoeuthanasia,” was blessed by the KNMG in an ethical position paper. From “The Role of the Physician in the Voluntary Termination of Life”:
There is no punishment for physicians and other persons if they provide information about suicide. Physicians are also legally permitted to refer patients to information that is available on the Internet or to publications sold by book vendors, or provide these on loan, and to discuss this information with patients.
But what about Dutch doctors who are morally opposed to euthanasia? As the old saying goes, tough toenails. The KNMG has decreed that dissenting doctors do not have a right to refuse participation in euthanasia on the basis of conscience. From the same KNMG position paper:
If a physician cannot or does not wish to honour a patient’s request for euthanasia or assisted suicide he must give the patient a timely and clear explanation of why, and furthermore must then refer or transfer the patient to another physician in good time.
If the Dutch parliament passes a law consistent with the KNMG’s ethical opinion, it will mean every physician in the Netherlands would be forced to be complicit in euthanasia — even if they are pro-life or believe in the Hippocratic Oath’s prohibition against physician-assisted suicide — by finding a doctor willing to kill their euthanasia-qualified patients. Either that, or quit the practice of medicine.
Matters are even worse in Belgium, which legalized euthanasia in 2002. Where the Dutch slid slowly down the slippery slope over decades, Belgium has leaped off the moral cliff head-first. Consider that Belgian doctors have coupled euthanasia with organ harvesting. The first reported case of organ harvesting following voluntary euthanasia was reported in 2008. It involved a completely paralyzed woman who first requested euthanasia, and when told she would be killed, asked to donate her organs after she was dead. In a blatant example of ethical bootstrapping, doctors who participated in the case validated their own good conduct in a 2008 letter in the medical journalTransplant International :
This case of two separate requests, first euthanasia and second, organ donation after death, demonstrates that organ harvesting after euthanasia may be considered and accepted from ethical, legal, and practical viewpoints in countries where euthanasia is legally accepted.
In the years since, Belgian doctors have expanded the kill-and-harvest agenda, even promoting it at medical symposia. For example, one group of advocates created a PowerPoint presentation, arguing that unlike, say, cancer patients, euthanizing people with serious neuromuscular diseases who want to die and donate should be accepted because such patients have “high quality” organs.
Most recently, four cases of euthanasia followed by organ harvesting were reported in the journal Applied Cardiopulmonary Pathophysiology. Note, three of the cases involved patients with neuromuscular disabilities, and one was a mentally ill patient. From the chilling paper, “Initial Experience with Transplantation of Lungs Recovered from Donors after Euthanasia”:
Three donors were offered by the transplant coordination team of the University Hospital Antwerp and one donor by our local donor office. Euthanasia request was granted by an independent team of physicians not taking care of the transplant recipients. The donors suffered from an unbearable physical or mental disorder. All donors explicitly and voluntarily expressed their wish to become an organ donor once their request for euthanasia was granted.
Tying euthanasia to organ donation crosses a very dangerous bridge, giving Belgian society a utilitarian benefit from mercy killing, as it informs despairing, disabled, or mentally ill people that their deaths have greater value than their lives. But rather than an outcry, as it would have have been the reaction not too long ago, we instead witness articles written by the harvesters in respected medical journals dispassionately describing the entire process.
But wait, there’s more: Belgian doctors have performed joint euthanasia of a non-terminal elderly couple who didn’t want to live apart should one die — and medical “ethicists” cheered, one telling an interviewer:
Non-terminal partners, as we call them, also have the option of dying together. It’s legally possible. There are no legal difficulties. People think that euthanasia can only be applied to terminal cancer patients. But the group is a lot bigger… And this is a beautiful example that allows us to provide a dignified death to this couple thanks to euthanasia and proper guidance.
But it’s all about “choice,” right? Not necessarily. Non-voluntary euthanasia is common in the Netherlands. So too now in Belgium, but at an even higher rate. For example, a study conducted by the Canadian Medical Association found that about half of the nearly 500 euthanasia deaths the authors investigated were non-voluntary. Some of the patients were even killed by nurses. Both killing without request and euthanasia by nurse violate Belgian law, but as in the Netherlands, the law is rarely enforced.
Meanwhile, the number of euthanasia deaths in Belgium is soaring, increasing 100 percent between 2008 (when there were about 500 reported euthanasia killings) and 2011, in which it is projected that there will be 1,000. That probably undercounts the actual toll significantly. A study in the British Medical Journal estimated that in Flanders, only about 50 percent of euthanasia deaths are actually reported, as required by law.
Assisted suicide has been legal in Switzerland since the early 1940s. But suicide entrepreneurs have taken the practice to a whole new level, opening for-pay suicide clinics where people from all over the world come to die — a phenomenon known in the media as “suicide tourism.”
Suicide tourism is not by any means limited to the terminally ill. For example, a recent death involved an active elderly woman with arthritis pursuing suicide as a prophylactic against, according to her suicide note, “a long period of decline.” There have also been, as in Belgium, joint suicides of elderly spouses who didn’t wish to live after the other passed away. In another case that garnered much press attention, U.K. parents took their son, who had become quadriplegic in a rugby accident, to Switzerland for suicide — and then used their grief as a means of promoting legalization in Britain, the idea being that the young man should have been able to have help in killing himself at home.
There are seemingly no limits to whom the Swiss suicide clinics can serve — including, apparently, the mentally ill. Indeed, in a case brought by one suicide clinic, the Swiss supreme court declared a constitutional right to assisted suicide for the mentally ill, which would please the audience members who applauded the disturbed woman demanding the legal right for help in killing herself at that town-hall meeting I described earlier.
All of this, by the way, in a nation that outlaws the flushing of live goldfish down the toilet.
To be sure, most countries in Europe have not followed the Dutch, Belgians, Swiss, and Luxembourgers down the legalized-euthanasia rabbit hole. But they might soon have no choice. The European Union guarantees the “right to family life.” When a German court refused to let a husband help his wife commit suicide, he took her to Switzerland to die. He then sued, stating that the German refusal amounted to an infringement of the couple’s right to private family decision making. Incredibly, the case has been accepted for adjudication by the European Court of Human Rights, which could issue a ruling decreeing that a right to family life includes, within its emanations and penumbrae, a concomitant liberty to assist in a family member’s death.
Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism, a legal consultant to the Patients Rights Council, and a special consultant to the Center for Bioethics and Culture.