The Profit of Hemlock

Originally published at The Weekly Standard

In Freedom to Die, suicide guru Derek Humphry, co-founder of the Hemlock Society, and Mary Clement, a pro-euthanasia attorney, describe the assisted-suicide movement as “a pure flame of revolution,” rising from the cultural upheavals of the 1960s. It is an era they proclaim to be of greater historic importance than the American and Russian Revolutions, and in the authors’ view, the last great unfinished business of those glorious days is legalizing assisted suicide and euthanasia. Indeed, they see the freedom to be killed as “the ultimate civil right.”

Freedom to Die is both a partisan history of euthanasia and propaganda for its legalization. To make their case, Humphry and Clement blend half-truths, fabrications, and tactical omissions, with a near-hysterical diatribe against the free-speech rights of Catholics. Taken as a whole, the book epitomizes the intellectual dishonesty of most assisted-suicide advocacy — which is exactly why it is so hard to explain the authors’ one major strategic mistake.

Although most of Freedom to Die is retreaded material, Humphry and Clement open up a new line of argument by advocating assisted suicide as a way to control medical costs. In doing so, they actually strengthen the anti-euthanasia cause. For years, opponents have warned that killing the sick and disabled will prove not to be about compassion or choice, but about money. And in response, euthanasia advocates have called them paranoids and fantasists.

But now Humphry and Clement admit that cost containment is one of their ultimate purposes:

A rational argument can be made for allowing [assisted suicide] in order to offset the amount society and family spend on the ill, as long as it is the voluntary wish of the mentally competent terminally ill adult. . . . The hastened demise of people with only a short time left would free up resources for others. Hundreds of billions of dollars could benefit those patients who not only can be cured but who want to live.

Imagine a health-care system that favors death as the best treatment for cancer, Lou Gehrig’s disease, or spinal injury. Imagine the money to be made if HMOs are spared the expense of caring for such patients. And imagine the potential for coercion when killing leads to the profits the authors envision. As Freedom to Die points out with approval, this means a return to the morality of the ancient practices of exposing disabled infants on the hillside and leaving the elderly and infirm to die by the trail — or, as Humphry and Clement candidly call it, “the abandonment of the unproductive.”

If only the authors had been so candid in the rest of their book. Unfortunately, they often merely chant the shopworn mantra that suicide is to be restricted to “the mentally competent, terminally ill adult.” On this point, Humphry’s own writings betray them. In the 1996 version of his how-to-commit-suicide guide, Final Exit, Humphry wrote, “Severely handicapped people have an inalienable right either to live or choose to die, just the same as anybody else.”

Humphry is not the only prominent ideologue who advocates suicide for those not terminally ill. His colleague Faye Girsh, executive director of the Hemlock Society, issued a 1998 press release stating that the Hemlock Society supported legalization of assisted suicide for “every person with an incurable illness and unbearable suffering.” That “incurable” is telling. It’s meant to make us believe it refers only to terminal illness, but it actually means something else. Osteoarthritis, for example, is incurable. So is diabetes. So is asymptomatic HIV infection. So is shingles.

Most of the nation’s assisted-suicide advocates have at one time or another endorsed euthanasia for patients without terminal illness. Timothy Quill, for example, has written that assisted suicide should be available for the disabled, though he later recanted the idea when confronted with it in front of a congressional committee. Last October, the World Federation of Right to Die Societies advocated in its Zurich Declaration legalized suicide for “all competent adults, suffering severe and enduring distress.” Death for the distressed? The declaration is a call for death on demand.

The idea that euthanasia will be limited to the mentally competent is equally bogus. In Final Exit, Humphry specifically called on states to authorize people to appoint surrogates empowered to order their deaths if they became incompetent. In response to the 1997 conviction of a Louisiana man who murdered his Alzheimer’s-diagnosed father, Girsh issued a press release stating, “A judicial determination should be made when it is necessary to hasten the death of an individual, whether it is a demented parent, a suffering, severely disabled spouse, or a child.” A red-faced Girsh subsequently issued a “clarification,” but she had already demonstrated that all the talk about limiting euthanasia to mentally competent patients suffering terminal diseases is nothing more than talk.

No book of this sort would be complete without discussing Holland, where euthanasia has been allowed since 1973. Quoting the 1991 Remmelink Report, a Dutch government-sponsored study of euthanasia practices, Humphry and Clement write that “only” 2.3 percent of Dutch deaths are caused by euthanasia and 0.4 percent by assisted suicide, totaling approximately 2,700 deaths per year. At best, these statistics are misleading. The Remmelink Report applies the term “euthanasia” only to those deaths in which a doctor lethally injects a patient with a poison. But that isn’t the only manner in which Dutch doctors intentionally kill their patients. Far more often, they use intentionally massive overdoses of morphine, not to reduce pain but with the primary purpose of ending life. According to the Remmelink Report, there were 8,100 such killings in 1990.

Humphry and Clement also publish the Remmelink statistic that approximately 1,000 people who had not requested euthanasia were killed in 1990 by Dutch doctors. But, the report itself explains that of the admitted 8,100 intentional morphine overdoses, 4,491 were without request or consent. Thus, out of the approximately 11,400 people killed by Dutch doctors in 1990 (about 8.5 percent of the 130,000 Dutch deaths), more than half (5,981) were involuntary. In America, this would amount to about 85,000 involuntary killings per year. This part of the Remmelink Report was considered so significant that the United States Supreme Court cited it in its 1997 refusal to create a constitutional right to assisted suicide.

Freedom to Die acknowledges that Dutch doctors also euthanize depressed people with no organic illness. But far be it from Humphry and Clement to condemn that. They merely ask whether such euthanasia for depression isn’t a “step toward a more progressive medical understanding” of human suffering.

They also omit completely the fact that Dutch euthanasia has entered the pediatric wards, where doctors kill babies for “quality-of-life” considerations. According to a July 1997 article in the British medical journal Lancet, approximately 8 percent of infant deaths in Holland are at the hands of doctors. Of the neonatologists surveyed, 45 percent “had administered drugs with the explicit intention of ending life,” as had 31 percent of Dutch pediatricians. The study also found that most such infant killings are not reported to the authorities, a clear violation of Holland’s much-vaunted “protective guidelines.”

Along with misrepresenting their intentions and distorting their data, Humphry and Clement exaggerate the influence of the Catholic Church. It’s true that the Catholic Church has been an effective opponent, but primarily by joining with disability-rights activists, hospice associations, advocates for the poor, right-to-life groups, and most medical and nursing associations. This coalition is so young that it hadn’t fully come together when Oregon voters legalized assisted suicide in 1994. It had, however, by last November’s election in Michigan, when voters rejected a similar proposal by 71-29 percent.

The authors’ focus on the Catholic Church, to the exclusion of all other opponents except the “greedy” American Medical Association, fits the typical strategy of euthanasia advocates, who portray their enemies as religious zealots. The authors claim, for instance, that the Catholic Church acts unconstitutionally merely by objecting to legalization. They even attack the late Joseph Cardinal Bernardin, who in his dying days in 1996 wrote a letter to the Supreme Court opposing assisted suicide, which the authors condemn as “an unprecedented religious foray into politics . . . in violation of the constitutional clauses that prohibit both promoting and establishing one religion over another and favoring religious over non-religious beliefs.” That an ideologue like Humphry could write this is bad enough. But that Clement, a lawyer, would allow her name to be associated with such nonsense is remarkable.

Misleading arguments, distorted evidence, and attacks on religion are par for the course in euthanasia propaganda. What makes Freedom to Die stand out is its frank discussion of the financial benefits of legalization. Paying heed to the book’s unintentional warning about euthanasia as a form of medical-cost containment is a good place to start for anyone interested in the killing culture that will be created if assisted suicide and euthanasia become imbedded in our health-care system and our law.

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.