Death Be Not Proud

Original Article

One of the last things my friend Frances did on Nov. 1, 1992, was to send identical suicide letters to each of her friends: “Today is my 76th birthday,” it began. “Of my own free will, I have chosen to take my final passage.”

Why would she do such a thing? Frances was not terminally ill and had years of life to look forward to. But there was a darkness always lurking nearby. She was an admirer of Dr. Jack Kevorkian, then just beginning his now-notorious assisted suicide campaign. She was also a member of the Hemlock Society, a so-called “right to die” organization that would later merge with another group and change its name to Compassion & Choices.

After Frances’ death, we found her “suicide file,” containing dog-eared articles hailing suicide as an act of self-empowerment, a beneficial and even uplifting experience. One chilling article was a “how-to” piece, teaching the reader how to commit suicide with a drug overdose and plastic bag over one’s head — an exact description of Frances’ death.

Such is the face of “compassion,” as an international movement seeks to convince our culture that euthanasia and assisted suicide are in people’s best interest. However, the root meaning of “compassion” is to “suffer with.” Hence, in response to the culture of death, members of the Body of Christ must not only forswear killing, but also provide loving care — and principled defense — of the sick and suffering.

As Pope Francis noted in a September 2013 address, “A widespread mentality of the useful, the ‘throwaway culture’ that today enslaves the hearts and minds of so many, comes at a very high cost: It asks for the elimination of human beings, especially if they are physically or socially weaker. Our response to this mentality is a decisive and unreserved ‘yes’ to life.”


Whereas euthanasia involves the direct and intentional killing of another person, assisted suicide is legally defined as providing the means of death for another person to end his or her own life.

Legally, they are distinct realities, but the Catholic Church unequivocally opposes both. The Congregation for the Doctrine of the Faith’s 1980 Declaration on Euthanasia states, “No one can make an attempt on the life of an innocent person without opposing God’s love for that person, without violating a fundamental right, and therefore without committing a crime of the utmost gravity.”

The international euthanasia movement made a legislative impact in the United States beginning in 1990s. In the wake of publicity campaigns by the Hemlock Society, Oregon legalized assisted suicide for the terminally ill by voter referendum in 1994. To date, two other U.S. states have passed similar laws: Washington, also by referendum, in 2004, and Vermont, by the state legislature in 2012. Meanwhile, a muddled Montana Supreme Court decision in 2009 ruled that assisted suicide was not against public policy in the Big Sky State — but the exact nature and meaning of the ruling remains a matter of dispute. Similarly, in January 2014, a New Mexico trial judge declared that the state’s law against assisted suicide was unconstitutional, but that decision is in abeyance as the case is on appeal.

It is important to note that most states continue to explicitly outlaw assisted suicide. Indeed, California, Maine, Michigan — and most recently in 2012, Massachusetts — have refused to legalize doctor-prescribed death in voter initiatives in the last 20 years.

Advocates for assisted suicide claim that the U.S. experience demonstrates thus far that doctor-facilitated death can be conducted without abuses. But there have been abuses, in a sense. Just ask Barbara Wagner and Randy Stroup. Both were dying of cancer when their doctors prescribed a regimen of life-extending chemotherapy. Not only would Medicaid — which is rationed in Oregon — not pay for the prescription, but an administrator wrote both patients telling them that the state would fund their assisted suicides. An appalled Wagner said, Oregon “will pay to kill me, but they will not give me medication to try and stop the growth of my cancer.” Compassion!

Americans remain deeply divided on the issue of assisted suicide and euthanasia, while most physicians remain ambivalent about engaging in a death-causing practice. The nation stands at a crossroads, as proponents of doctor-prescribed death develop sleeker ways to market their agenda.

Canada is likewise acutely threatened by euthanasia consciousness. On June 5, Quebec became the first province to legalize doctor-assisted suicide by passing Bill 52, a law redefining the lethal practice as a form of health-care called “end-of-life care.” Meanwhile, the Supreme Court of Canada is being asked to declare the federal law against assisted suicide unconstitutional. Disturbingly — and perhaps showing the direction of the currents — the court has decided to hear the case even though it previously ruled that the law against assisted suicide was constitutional.


In order to better see the choice in front of them, North Americans need only look at the depravity in several European countries where euthanasia has been accepted.

Euthanasia was decriminalized in certain cases in the Netherlands after a 1973 court ruling permitted the practice as long as doctors followed protective guidelines — requiring, for instance, repeated requests, second opinions, and unbearable suffering that cannot otherwise be alleviated. This system continued until 2002, at which time lethally injecting or assisting the suicides of qualified patients was formally legalized.

Over the decades, Dutch euthanasia expanded steadily — from the terminally ill who ask for it, to more seriously chronically ill who ask for it, to people with serious disabilities who ask for it, to those suffering from existential anguish or mental illness and who, in their despair, want to die.

The number of euthanasia deaths in the Netherlands is rising, including among the mentally ill, and the vulnerable elderly are increasingly at risk. Euthanasia is now permitted in the Netherlands for early dementia as well as those with non-life-threatening conditions, even those who want to die because they are “tired of life.”

Euthanasia has even entered the pediatric wards. While it remains technically murder under Dutch law, infanticide in the name of “mercy” has become so acceptable that a pediatrics professor published a bureaucratic checklist designed to help doctors determine which terminally ill or severely disabled infants could be euthanized. The Groningen Protocol, as it is known, was ratified by the Dutch National Association of Pediatricians and even published in the New England Journal of Medicine.

Belgium likewise formally legalized euthanasia in 2002. The law allows broad access to doctor-facilitated death when “the patient is in a medically futile condition of constant unbearable physical or mental suffering.” Some Belgian doctors have interpreted this liberal license so broadly that it amounts to death-on-demand.

Consider these well-documented examples: The euthanasia of elderly couples who preferred immediate death to eventual widowhood; of deaf twins, who asked to be killed together when both began losing their eyesight; of a depressed anorexia patient who wanted to die after being sexually exploited by her psychiatrist; of a transsexual repelled by the results of a sex-change operation.

Recently, in February 2014, the Belgian parliament expanded its law to include child euthanasia — with no lower age limit.

Lastly, Switzerland has taken Jack Kevorkian as its model, creating a cottage industry of “suicide tourism” — a term that describes the flow of people traveling to the country’s legal suicide clinics to end their lives with the assistance of doctors and nurses.

Like Kevorkian in the United States in the 1990s, these clinics do not restrict their services to the terminally ill. For example, in recent months, an elderly Italian woman committed suicide at a Swiss clinic because she was upset about losing her looks. Her family only learned about her death when the clinic mailed the urn containing her ashes.

Swiss death clinics are becoming increasingly popular. Dignitas, one of the most active of the Swiss suicide clinics, recently published its death statistics for the last year. They tell an alarming story: 1,705 have died in that one clinic alone since 1998, including 204 — about four per week — in 2013.


As the battle of between the culture of life and the culture of death wages on, it is essential to recognize the terms of the public debate. Proponents of euthanasia and assisted suicide use all sorts of propaganda to push and hide their agenda. This is particularly true in the United States, where disingenuous advocates play word games and deploy euphemisms as honey to help the poison go down. Thus, rather than using the accurate term “assisted suicide,” they will instead call doctor-prescribed death “aid in dying” or “death with dignity.” They even deny that the suicide of a terminally ill person is actually a suicide.

Assisted suicide activists also try to confuse the public by conflating the unethical acts they advocate with appropriate measures to alleviate suffering at the end of life. For example, some will claim that refusing unwanted medical treatment is the same as assisted suicide. But this, of course, isn’t true. In fact, the U.S. Supreme Court recognized in a unanimous 1997 decision that there is a crucial ethical and legal difference between assisting suicide — which states can outlaw — and refusing unwanted life-sustaining medical treatment.

This is also the position of the Catholic Church. As St. John Paul II wrote, citing the 1980 Declaration on Euthanasia: “When death is clearly imminent and inevitable, one can in conscience ‘refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted’” (Evangelium Vitae, 65).

Assisted suicide advocates also claim that causing death by overdose is permitted under the ethical principle of “double effect” — which states that an act that produces a bad result is still considered ethical if four conditions are met: 1) The action taken (in this case, treating pain) is “good” or morally neutral; 2) The bad effect (in this case, death) is not intended; 3) The good effect (in this case, the relief of suffering) cannot be brought about by an act designed to intentionally cause the bad effect (death); 4) There is a proportionate and sufficiently grave reason to perform the act (in this case, the presence of severe pain).

Euthanasia and assisted suicide unquestionably fail the requirements of double effect, since the hoped-for good — namely, relief of suffering — is accomplished by intentionally causing the bad effect, death.

Euthanasia and assisted suicide are bad medicine and even worse public policy. The Catholic Church favors a more humane, reasonable and compassionate vision that leads society toward a better way: Care, not kill. Embrace, not abandon. Suffer with, not dispose of.

As Pope Francis cogently noted in a message to the Pontifical Academy for Life in February 2014: “The gravest deprivation experienced by the aged is not the weakening of one’s physical body, nor the disability that may result from this. Rather, it is the abandonment, exclusion and deprivation of love.”

We must therefore respond to the culture of death not only with reasoned arguments, but also with loving actions that give testimony to the dignity of life.

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.