The United States assisted suicide movement claims that it wants only a limited “reform” of law and medical ethics, restricting what it euphemistically calls “aid in dying” to competent adults with terminal illnesses for whom nothing else can be done to alleviate their suffering. But this claim isn’t true. Currently, no law permitting doctors to write lethal prescriptions mandates any objective medical determination that the patient is actually suffering. Indeed, a 2008 study published in JAMA Internal Medicine found that patients sometimes receive lethal prescriptions even when they are not experiencing serious pain or other noxious symptoms.
The falsity of the “limited license” narrative is further demonstrated by current policies and legislative proposals that are likely to be instituted broadly, should the assisted suicide movement prevail nationally.
Assisted Suicide for the Mentally Incompetent
Legal assisted suicide is supposed to be available only to the mentally competent. But after California legalized doctor-prescribed death, the California State Department of Hospitals promulgated a regulation requiring state mental institutions to facilitate assisted suicides of institutionalized patients who are diagnosed with a terminal illness. As I have written previously, these are often people who have been involuntarily denied their freedom due to diagnosed mental illness, sometimes because of suicidal ideation. They are usually being treated with powerful psychotropic medications. In what universe could they possibly be deemed competent to make a reasoned decision in favor of assisted suicide?
California isn’t alone in opening the door to assisted suicide for the mentally incompetent. A pending bill to legalize assisted suicide in Delaware would allow the “intellectually disabled” who are terminally ill potentially to qualify for lethal prescriptions. Note how HB 160 defines the term:
“Intellectual disability” means a disability, that originated before the age of 18, characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills.
Such people can’t legally enter contracts. They can’t control where they live. They would require a guardian’s consent to receive most medical treatments. They can’t consent to getting a tattoo! But these same developmentally disabled people would be able to receive assisted suicide if a licensed clinical social worker wrote a letter to the lethally prescribing doctor confirming “that the patient understands the information provided.”
Expanding Assisted Suicide Beyond the Terminally Ill
The oft-repeated promise that assisted suicide is only for those who are already dying no longer holds overseas. Countries such as the Netherlands, Belgium, Switzerland, and Canada don’t limit assisted suicide and euthanasia to the dying. It’s only logical: If eliminating suffering justifies eliminating the sufferer, there are many people with disabilities, chronic pain, dementia, mental illnesses, and so on who may experience far greater suffering, and for a longer time, than do the terminally ill. It should be no surprise that many countries have steadily expanded their laws’ killable categories over the years—including, in Belgium, joint lethal injections of at least three elderly couples who wanted to die for fear of the future suffering they expected would be caused by widowhood.
Advocacy for loosening the restriction has begun here, too. As the Washington Post recently reported, Oregon legislators are planning a push to eliminate the six-months-to-live rule, and to extend the option of euthanasia to people diagnosed with dementia. True, that bill is opposed by Compassion & Choices; but, at least in part, they oppose it because it “could give ammunition to critics and frustrate their efforts to bring the narrowly defined statute to as many states as possible.” In this regard, it is also worth noting that Compassion & Choices issued a press release applauding Canada’s Supreme Court for granting a very broad legal and positive right to receive euthanasia that extended far beyond the terminally ill—a press release subsequently scrubbed, one suspects, because it revealed how radical the organization’s views really are.
Assisted suicide advocates promise to limit medicalized killing to adults. But we have already seen that same promise broken in the Netherlands and Belgium. In the Netherlands, severely disabled and dying babies are subjected to infanticide under the “Groningen Protocol”—a bureaucratic baby euthanasia checklist—and children aged twelve and above can legally be given a lethal jab. Next door in Belgium, there are no age limits! Meanwhile, Canada is beginning to debate whether to expand its euthanasia laws to include at least “mature” children.
Child euthanasia has now received the imprimatur of one of this country’s most prominent euthanasia and assisted suicide advocates, professor and prolific author Margaret P. Battin. She recently wrote in the Dutch medical journal Pediatrics that there are “no good reasons” for failing to expand eligibility for assisted suicide to minors under age twelve, and she believes that many factors favor the expansion—including, notably, “the suffering of parents.” As far as I know, none of her colleagues in the movement have objected to or publicly criticized her radical proposal.
The assisted suicide movement pretends to have a very limited agenda. It pretends to advocate only a minor change—a “safety valve,” as they sometimes call it—in traditional medical ethics and public policy. But advocates sometimes give us glimpses of the more radical and extensive ultimate intentions behind their blithe assurances. For those who have eyes to see, let them see.