Suicide in the West

Published in The Weekly Standard

WHEN EUTHANASIA ENTHUSIASTS urged Oregon voters to legalize assisted suicide, they promised an open, rational, and carefully regulated system in which physician-hastened death would be a “last resort.” Voters were also assured that life termination would be conducted under the watchful and protective eye of the state, with rigorous guidelines strictly enforced to prevent abuse. Assisted suicide was to be only an adjunct to hospice and other beneficent forms of care for the dying. All in all, no cause for concern.

It hasn’t turned out that way. After twice being approved by voters and surviving a Supreme Court challenge, Oregon’s assisted-suicide regime is now in place. The first deaths were administered in March. And already it is clear that the suicide-advocates deceived voters. Oregon has shrouded the suicide procedure in secrecy. The state collects statistics after the fact, when it is too late to prevent abuses. And ideologues who favor the new law control the release of information.

Openness became the first casualty of the new law. The Oregon Health Division decreed in December that secrecy would be the suicide bureaucracy’s guiding principle. The only information that will be released publicly will be brief and nonspecific statistical data. Absolutely no information will be released about the time or place of any individual assisted suicide. The identities of those killed under the law will remain confidential. Death certificates will not list assisted suicide as a cause of death. The circumstances of individuals whose lives are ended through lethal prescriptions will not be disclosed. Bureaucrats who violate the gag order will be fired. All of this means, of course, that there will be no effective oversight and no way for the public to judge how the law works.

As if that weren’t enough, the Oregon Medical Association has sued the Oregon Board of Pharmacy in an effort to impose even greater secrecy. The medical association is angry at the board for requiring doctors to identify prescriptions intended for lethal use. The regulation is necessary to effectuate the assisted suicide law’s “conscience clause,” which permits medical professionals who don’t want to participate in the killing of patients to opt out. Doctors, of course, can easily exercise the conscience clause by just saying no. But pharmacists will be unable to exercise their rights under the law unless they know which prescriptions have a killing purpose. The medical association contends that its lawsuit merely seeks to protect patient confidentiality. But the secrecy litigation probably has more to do with the desire of doctors who kill patients not to leave a paper trail. And if the doctors prevail over the pharmacists, acts of assisted suicide will be virtually impossible to monitor effectively.

The shroud of secrecy gives a virtual information monopoly to organizations favoring assisted suicide, which intend to manipulate the Oregon experience into a propaganda tool to push their cause nationwide. Toward that end, a Portland organization misnamed Compassion in Dying — an offshoot of the Hemlock Society formed initially in the state of Washington to participate in clandestine, illegal assisted suicides — held a press conference in late March to announce the first legal assisted killing in the United States, of an unidentified woman who had cancer, painting the death in a warm hue. Not to be outdone, the Hemlock Society of Oregon quickly reported that it too had helped a woman with cancer find a doctor willing to assist in her suicide. Lacking any other data about these cases and starved for information about how the Oregon law is actually working, the media jumped on the story, duly reporting the spin of the pro-suicide groups.

This lock on the news allows Compassion in Dying and Hemlock to subvert objective journalism by releasing only those stories they believe will further the cause of assisted suicide. At the same time, it can be safely presumed that assisted suicides resulting in agonizing deaths or extended coma, which Hemlock Society co-founder Derek Humphry has warned will occur in approximately 25 percent of all cases, will not be disclosed. Nor in such cases is Compassion in Dying or Hemlock likely to issue a press release advising that a family member was forced to suffocate a loved one with a plastic bag — the Humphry prescription for completing “failed” assisted suicides — since that would expose their advocacy agenda to well-deserved criticism.

Ironically, the information that was released by Compassion in Dying and Hemlock about the first two deaths inadvertently revealed what thin protection is provided by the assisted suicide law’s “protective guidelines.” Assisted suicide, Oregonians were told, would only be performed in the context of a long-term meaningful relationship between doctor and suicidal patient. This assurance proved false from the starting gate. The personal physicians of both women refused to participate in their killings. But this proved to be no impediment. The women simply called Compassion in Dying and Hemlock, which referred them to doctors who were willing to administer the lethal drugs, despite having no long-term relationship with the patients.

Not only that: The woman whose death was announced by Compassion in Dying appears to have been depressed when she pursued self-destruction; this, despite continual assurances from suicide advocates that the lives of depressed people would be protected by the law’s guidelines. According to Compassion in Dying’s report, the woman they “helped” sought them out for a referral because two physicians had refused to prescribe a lethal dose, with at least one of these doctors specifically diagnosing depression. But what the personal physician viewed as depression, suicide-advocate Dr. Peter Goodwin, medical director of Compassion in Dying, blithely dismissed as mere frustration. Goodwin referred the woman to a rubber-stamp death doctor willing to write the lethal prescription despite the personal physician’s diagnosis.

Further evidence of the woman’s depression is found on a tape recording she left behind, which Compassion in Dying, stealing a page from Jack Kevorkian’s book, played for the media at its press conference. On the tape, the woman is heard to say that she wanted assisted suicide not because of pain but to be ” relieved of all the stress” at being informed her disease had entered a terminal stage. This statement gives strong support to the original diagnosis of depression. And whether the woman was clinically depressed or not, the stress and emotional toll of dying are difficulties that hospice programs and other end-of-life caregivers are quite adept at treating and alleviating. No matter. Compassion in Dying referred the woman to a death doctor rather than to a physician who would aggressively treat her emotional difficulties.

The assisted-suicide law has also begun to poison Oregon’s Medicaid system. Oregon taxpayers recently were told that they are going to have to pay for the assisted suicides of poor people, something advocates for legalized killing somehow neglected to mention previously. In an Orwellian twist of the language, the governing board of Oregon’s Medicaid voted 10 to 1 to declare assisted suicide a form of “comfort care.”

This is highly ironic. Oregon, the only state to legalize assisted suicide, is also the only state that rations medical care to Medicaid recipients. Comfort care, which used to comprise pain control and other symptom alleviation, is covered under Oregon Medicaid. But curative treatment for seriously ill people is sometimes denied — for example, treatment of late-stage cancer patients. Imagine the scenario: A cancer patient on Medicaid wants treatment not covered by the rationing plan. Denied treatment because she cannot pay for it herself, feeling hopeless and desperate, she turns instead to assisted suicide. The same doctor who refused to treat her because she did not have the money to pay can now hasten her death courtesy of Oregon taxpayers. And if that doctor refuses to help her kill herself, Compassion in Dying will happily refer her to a doctor who will.

Oregon is demonstrating that assisted suicide corrupts all it touches. In the few brief months in which doctors have been empowered to kill, freedom of information has been stifled, taxpayers have been told by state bureaucrats that they must foot the bill for the assisted suicides of poor people, and the media have been manipulated like wooden marionettes. Worse, two women are dead prematurely who might have changed their minds about self-destruction had they received suicide prevention, hospice intervention, treatment for depression, and other appropriate end-of-life care.

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.