Difficult to Define Whose Suffering is Worthy of Death

Here we go again. For the fourth time in eight years, a bill is moving through the California Legislature to legalize physician-assisted suicide.

If history is any guide, assisted-suicide proponents and the media will cast the debate in strictly religious terms — as the Catholic Church versus rational modernists. But the coalition opposing AB374 is a broad and diverse political alliance that vividly reflects California’s unique multiculturalism.

Leading the charge against the latest assisted-suicide bill ) are disability rights advocates — the nation’s most effective anti-euthanasia campaigners — who are overwhelmingly secular in perspective, liberal in politics and pro-choice on abortion. They will be working closely with civil rights activists. (The League of United Latin American Citizens, the country’s largest Latino civil rights organization, is on record as firmly opposing assisted suicide.)

These groups will be joined by medical, nursing and hospice professionals — with organizations such as the California Medical Association and the American Medical Association adamantly opposed to transforming assisted suicide into a medical treatment.

Add advocates for the poor, such as Oakland’s Coalition of Concerned Medical Professionals, mix in religious conservatives, and it becomes clear that assisted-suicide opponents have forged a potent, strange political bedfellow alliance that bridges the usual liberal versus conservative, secular versus religious, and pro-choice versus anti-abortion disputes that divide the country.

Why would people who fundamentally disagree about other issues ally against assisted suicide? One of the most important reasons is that assisted suicide ultimately devalues those it supposedly protects from so-called “bad deaths.” Indeed, legalizing and popularly legitimizing assisted-suicide opens the door to an epochal shift in the way society perceives dying, disabled and other suffering people.

To see why this is so, consider the pillars of assisted-suicide ideology. The first is a fervent devotion to personal autonomy that views “choice” as the be all and end all of liberty. The second is the conviction that ending life is a legitimate answer to the problems of human suffering.

Advocates of assisted suicide may claim that hastened death is “only” for the dying. But given the conjoined beliefs that drive assisted-suicide advocacy, other than as a temporary political expediency, why should the “ultimate civil right” — as some assisted-suicide proponents call it — be limited to those diagnosed with terminal illnesses? After all, many people suffer far more intensely and for a longer period than the dying.

Thus, once this first category of suffering people is granted the license to have their suicides assisted, other anguished people will naturally ask: “Why not me? Why shouldn’t I be also allowed to end my suffering on my own terms?”

And indeed, once suicide is transformed into a mere “medical treatment,” the answer — whether supplied by future legislation or the courts — is likely to be: “Yes, why not you?”

This isn’t alarmist rhetoric but is clearly discernible in the flow of recent events. Why, just in February, the Swiss Supreme Court ruled in a case involving a depressed man suffering with bipolar disease, that the mentally ill have a right to assisted suicide. The reason? As reported in the International Herald Tribune, the court ruled, “It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term.”

The Swiss decision was no fluke. More than 10 years ago, the Dutch Supreme Court similarly expanded that country’s assisted-suicide guidelines to allow doctors to facilitate death for the depressed and grieving.

When faced with the undeniable steady expansion of assisted-suicide practices in the Netherlands and Switzerland, assisted-suicide advocates in California point to the experience in Oregon as proof that we will not fall off the same ethical cliff. It’s a good advocacy tactic, and proponents of AB374 may even believe it. But a close examination reveals that nobody really knows much about what is actually going on with assisted suicide in Oregon.

Wait just a darned a minute, proponents of assisted suicide will exclaim: The state publishes an annual report about assisted suicides.

True. But the information upon which the state relies is almost worthless from an empirical standpoint. This is because there is no direct oversight by Oregon over the practice of assisted suicide. Rather, the state’s entire regulatory system — which will also be true in California if AB374 becomes law — depends on self-reporting by lethally prescribing doctors.

The state has no authority to even investigate whether patients were actually terminally ill. If a patient’s own physician refuses to assist in a suicide and the patient receives a lethal prescription from another doctor — which often happens — the state will not even inquire why the patient’s long-term physician said no. In fact — and this is very telling — after each annual report is published, all of the supporting data are destroyed.

One Oregon patient’s story brings to mind the Swiss and Dutch Supreme Court cases involving the mentally ill. The man’s name was Michael J. Freeland. His case was reported in the June 2005 peer-reviewed Journal of the American Psychiatric Association. (The authors, Gregory Hamilton and his wife, Catherine Hamilton, a psychiatrist and social worker respectively, are affiliated with Physicians for Compassionate Care, a group that opposes assisted suicide.)

After being diagnosed with lung cancer, Freeland received a lethal prescription. Subsequently, he became psychotic and had to be hospitalized. A social worker went to Freeland’s home and found it “uninhabitable” with “heaps of clutter, rodent feces … lack of food, heat, etc.” The police removed Freeland’s guns, but despite his obvious mental illness, his prescribed fatal overdose was left in the house.

Freeland was hospitalized for a week. The discharging psychiatrist noted with approval in Freeland’s records that his guns had been removed but that the lethal prescription remained “safely at home.” Freeland was permitted to keep the fatal overdose even though the psychiatrist reported that he would “remain vulnerable to periods of delirium” and would “be susceptible to periods of confusion and impaired judgment.”

In the end, Freeland did not commit suicide. Instead, he received hospice-type support from Physicians for Compassionate Care. During that time, he was reunited with his estranged daughter and came to see that his life was worth living to its natural conclusion. And even though patients are only supposed to receive assisted suicide if they will die within six months, Freeland lived for almost two years after receiving the lethal prescription. More to the point, we didn’t learn about the abuses in Freeland’s case from Oregon’s statistical reports, which obscure far more than they enlighten.

Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture.