Abuse of Assisted Suicide in Oregon

Diane Coleman
President and CEO of Not Dead Yet


One of the most frequently repeated claims by proponents of assisted suicide laws is that there is “no evidence or data” to support any claim that these laws are subject to abuse, and that there has not been “a single documented case of abuse or misuse” in the 18 reported years. These claims are demonstrably false.

Regarding documented cases, please refer to a compilation of individual cases and source materials pulled together by the Disability Rights Education and Defense Fund entitled Oregon and Washington State Abuses and Complications.

(For an in-depth analysis of several cases by Dr. Herbert Hendin and Dr. Kathleen Foley, please read Physician-Assisted Suicide in Oregon: A Medical Perspective.)

The focus of the discussion below is the Oregon Health Division data. These reports are based on forms filed with the state by the physicians who prescribe lethal doses and the pharmacies that dispense the drugs. As the early state reports admitted:

“As best we could determine, all participating physicians complied with the provisions of the Act … Under reporting and noncompliance is thus difficult to assess because of possible repercussions for noncompliant physicians reporting to the division.”

Further emphasizing the serious limits on state oversight under the assisted suicide law, Oregon authorities also issued a release in 2005 clarifying that they have no authority to investigate Death with Dignity cases.

Nevertheless, contrary to popular belief and despite these extreme limitations, the Oregon state reports substantiate some of the problems and concerns raised by opponents of assisted suicide bills.

Non-terminal disabled individuals are receiving lethal prescriptions in Oregon

The Oregon Health Division assisted suicide reports show that non-terminal people receive lethal prescriptions every year.

The prescribing physicians’ reports to the state include the time between the request for assisted suicide and death for each person. However, the online state reports do not reveal how many people outlived the 180-day prediction. Instead, the reports give that year’s median and range of the number of days between the request for a lethal prescription and death. This is on page 7 of the 2015 annual report. In 2015, at least one person lived 517 days; across all years, the longest reported duration between the request for assisted suicide and death was 1009 days. In every year except the first year, the reported upper range is significantly longer than 180 days.

The definition of “terminal” in the statute only requires that the doctor predict that the person will die within six months. There is no requirement that the doctor consider the likely impact of medical treatment in terms of survival, since people have the right to refuse treatment. Unfortunately, while terminal predictions of some conditions, such as some cancers, are fairly well established, this is far less true six months out, as the bill provides, rather than one or two months before death, and is even less true for other diseases. Add the fact that many conditions will or may become terminal if certain medications or routine treatments are discontinued – e.g. insulin, blood thinners, pacemaker, CPAP – and “terminal” becomes a very murky concept.

The state report’s footnote about “other” conditions found eligible for assisted suicide has grown over the years, to include:

“… benign and uncertain neoplasms, other respiratory diseases, diseases of the nervous system (including multiple sclerosis, Parkinson’s disease and Huntington’s disease), musculoskeletal and connective tissue diseases, cerebrovascular disease, other vascular diseases, diabetes mellitus, gastrointestinal diseases, and liver disease.”

Overall in 2015, 7 percent, or 68 individuals, had conditions classified as “other”. In addition, it should be noted that the attending physician who determines terminal status and prescribes lethal drugs is not required to be an expert in the disease condition involved, nor is there any information about physician specialties in the state reports.

The only certifiers of non-coercion and capability need not know the person

Four people are required to certify that the person is not being coerced to sign the assisted suicide request form, and appears capable: the prescribing doctor, second-opinion doctor, and two witnesses.

In most cases, the prescribing doctor is a doctor referred by assisted suicide proponent organizations. (See, M. Golden, Why Assisted Suicide Must Not Be Legalized, section on “Doctor Shopping” and related citations). The Oregon state reports say that the median duration of the physician patient relationship is 12 weeks. Thus, lack of coercion is not usually determined by a physician with a longstanding relationship with the patient. This is significant in light of well-documented elder abuse-identification and reporting problems among professionals in a society where an estimated one in ten elders is abused, mostly by family and caregivers. (Lachs, et al., New England Journal of Medicine, Elder Abuse.)

The witnesses on the request form need not know the person either. One of them may be an heir (which would not be acceptable for witnessing a property will), but neither of them need actually know the person (the form says that if the person is not known to the witness, then the witness can confirm identity by checking the person’s ID).

So neither doctors nor witnesses need know the person well enough to certify that they are not being coerced.

No evidence of consent or self-administration at time of death

In about half the reported cases, the Oregon Health Division reports also state that no health care provider was present at the time of ingestion of the lethal drugs or at the time of death. Footnote 6 clarifies this point:

“A procedure revision was made mid‐year in 2010 to standardize reporting on the follow‐up questionnaire. The new procedure accepts information about time of death and circumstances surrounding death only when the physician or another health care provider is present at the time of death. This resulted in a larger number of unknowns beginning in 2010.”

While the only specific example mentioned is the “time of death,” other “circumstances surrounding death” include whether the lethal dose was self-administered and consensual at the time of death. Therefore, although “self administration” is touted as one of the key “safeguards”, in about half the cases, there is no evidence of consent or self-administration at the time of ingestion of the lethal drugs. If the drugs were, in some cases, administered by others without consent, no one would know. The request form constitutes a virtual blanket of legal immunity covering all participants in the process.

Pain is not the issue; unaddressed disability concerns are

The top five reasons doctors give for their patients’ assisted suicide requests are not pain or fear of future pain, but psychological issues that are all-too-familiar to the disability community: “loss of autonomy” (92 percent), “less able to engage in activities” (90 percent), “loss of dignity” (79 percent), “losing control of bodily functions” (48 percent), and “burden on others” (41 percent).

These reasons for requesting assisted suicide pertain to disability and indicate that over 90 percent of the reported individuals, possibly as many as 100 percent, are disabled.

Three of these reasons (loss of autonomy, loss of dignity, feelings of being a burden) could be addressed by consumer-directed in-home long-term care services, but no disclosures about or provision of such services is required. Some of the reported reasons are clearly psycho-social and could be addressed by disability-competent professional and peer counselors, but this is not required either. Moreover, only 5.3 percent of patients who request assisted suicide were referred for a psychiatric or psychological evaluation, despite studies showing the prevalence of depression in such patients.

Basically, the law operates as though the reasons don’t matter, and nothing need be done to address them.

Conclusion

The Oregon assisted suicide data demonstrates that people who were not actually terminal received lethal prescriptions in all 18 reported years except the first, and that there is little or no substantive protection against coercion and abuse. Moreover, reasons for requesting assisted suicide that sound like a “cry for help” with disability-related concerns are apparently ignored.

Thus, the data substantiates problems with the implementation of assisted suicide laws and validates the concern that the risks of mistake, coercion and abuse are too great. Well-informed legislators on both sides of the aisle should vote against assisted suicide bills.

Bioethicists and Death Control

"Thousands of medical ethicists and bioethicists, as they are called, professionally guide the unthinkable on its passage through the debatable on its way to becoming the justifiable until it is finally established as the unexceptionable."—Richard John Neuhaus

Wesley J. Smith

If you want to see what is likely to go awry in medical ethics and public healthcare policy, pay attention to the advocacy of bioethicists—at least of those who don’t identify themselves as “conservative” or “Catholic.” In their many journal articles and presentations at academic symposia, they unabashedly advocate for discarding the sanctity- and equality-of-life ethic as our moral cornerstone. Instead, most favor invidious and systemic medical discrimination predicated on a patient’s “quality of life,” which would endow the young, healthy, and able-bodied with the highest moral value—and, hence, with the greatest claim to medical resources.

Thanks to the work of bioethics, life-taking policies that a few decades ago were “unthinkable” now are unremarkable. Withholding tube-supplied food and water from the cognitively disabled until they die—Terri Schiavo’s fate—is now legal and popularly accepted, much like abortion. The legalization of assisted suicide is a constant threat. Even where lethal prescriptions or injections cannot be legally provided, some of our most notable bioethicists urge that doctors be permitted to help the elderly and others commit suicide by self-starvation—a process known in euthanasia advocacy circles as VSED (Voluntary Stopping of Eating and Drinking).

Promoters of the culture of death never rest on their laurels. Listed below are a few of the more dangerous “advances” being promoted in bioethics.

Read it all here.

Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council. His new book, Culture of Death: The Age of “Do Harm” Medicine, was just published by Encounter Books.

Assisted Suicide in Switzerland: Women Most Vulnerable

An extensive survey of assisted suicide in Switzerland between 2003 and 2008 has found that the most vulnerable people are women, people who live alone or people who are divorced. People who ask for assisted suicide tend to be wealthier and better educated.

The results have been published in the International Journal of Epidemiology. The authors, from the University of Bern, conclude that disadvantaged sectors of the Swiss population are not more vulnerable to assisted suicide, because relatively fewer low-income people take advantage of it. Their principal recommendation is that the government should require better statistics.

However, other interesting findings also emerge.

* Fewer people with a religious affiliation, especially to the Catholic Church, seek assisted suicide. “The association with religion may reflect greater social integration among the religious as well as social norms and dogma,” they say.

* The existence of right-to-die associations might possibly be increasing demand for suicide. Although one-third of doctors said that they had been confronted with a request for suicide, only 6% of then actually participated without the involvement of a right-to-die association.

* The right-to-die associations are not following the law, but the authorities do not seem to be reacting. “In a substantial minority of death certificates (16%), no underlying cause of death was recorded, despite the fact that only those who suffer from an incurable illness, intolerable suffering or a severe disability are eligible for assistance by the associations.”

* The authors believe that their data may disprove the danger of a “slippery slope” because lower socio-economic groups are less vulnerable than the wealthier and better educated. However, if the time frame encompasses the 1918 law on assisted suicide, the “slippery slope” seems more plausible.

Nowadays, Swiss assisted suicide is “marketed” as a remedy for an unendurable disability and an alternative to the pain of terminal illness. However, that is not why the legislators of 1918 proposed it and the legislators of 1937 approved it. They removed penalties for assisting a suicide if the motivation were altruistic. But, surprisingly for our generation, health was not a consideration. Legalised assisted suicide was for people suffering the pain of wounded honour or disappointed love.

But in 1982 two non-profit associations, one for French speakers, Exit Suisse Romande, and one for German speakers, Exit Deutsche Schweiz, were formed to help their members die. These were followed by EX International in 1996, which helps foreigners, and Dignitas in 1998, which helps both Swiss and foreigners. What began as a policy in the spirit of The Sorrows of Young Werther ended up as industrial death.

Source: BioEdge

Related reading: Trauma of Assisted Suicide Witnesses; Suicide Not a "Right" in Switzerland

Maine Rejects Physician Assisted Suicide

The Maine House of Representatives has decisively rejected a bill to legalize physician assisted suicide , just days after Vermont legalized it. The Patient Directed Care at End of Life bill was defeated 95-43. The legislation would have lifted criminal sanctions on doctors.

The bill was sponsored by the independent Rep. Joseph Brooks. Brooks gave an emotional address to the house about the slow death of his own father. Rep. Deborah Sanderson who used her mother’s death to argue the opposite case: “I sat with my mom the last five days of her life. I slept in a wheelchair by her bed,” she explained. “The night before my mother passed, my mother said, ‘It’s not like what I thought it would be.’ She said, ‘It’s peaceful.’”

The Maine Medical Association opposed the bill, as did the Maine Osteopathic Association, which called it "very dangerous public policy." Both groups strongly support better palliative care. Assisted suicide was defeated in a 1990 referendum.

Source: BioEdge

Trauma of Assisted Suicide Witnesses

Relatives and friends of a person who commits assisted suicide have a high rate of post-traumatic stress disorder and depression, according to a Swiss study in the latest issue of European Psychiatry. About 20% of respondents experienced full or sub-threshold PTSD and 16% had symptoms of depression after about 19 months after the death.

"Witnessing the unnatural death of a significant person thus seems to have a strong impact on the bereaved, which may lead to severe mental health problems at 14 to 24 months post-loss. Our findings suggest that relatives and family members who witness assisted suicide need to be better informed about and prepared for its possible consequences it for their mental health. Additionally, right-to-die organizations should offer them professional help focused on trauma-related symptoms."

The study was based on data on 146 people who died with the help of the right-to-die organisation Exit Deutsche Schweiz between October 2005 and September 2006. Of this group, 21 had died with no family members or friends as witness. ~World Radio Switzerland, Oct 4

Massachusetts Doctors Debate Assisted Suicide

On election day in November, Massachusetts will also vote on a referendum on assisted suicide - or, as its supporters call it, "assisted dying." On July 31 Boston Globe featured parallel statements by a leading advocate of the measure and a leading foe.

Marcia Angell is a former editor of the New England Journal of Medicine and a senior lecturer in social medicine at Harvard Medical School. She argues that because the proposed bill, which is "virtually identical" to Oregon's Death with Dignity law, has already been found roadworthy there, Massachusetts voters should have no hesitation in supporting it.

Although the Massachusetts Medical Society (MMS) staunchly opposes assisted suicide, Dr Angell believes conventional arguments, like "physicians are only healers", "physicians should never participate in taking life", and "patients who request assisted dying may be suffering from treatable depression", are wrong. She acknowledges that palliative care can relieve pain in most cases, but, she says, existential suffering can be even worse for patients:

"They know that their condition will grow worse day after day until their deaths, that their course is inexorably downhill, and they find it meaningless to soldier on. Why should anyone -- the state, the medical profession, or anyone else -- presume to tell someone else how much suffering they must endure while dying? Doctors should stand with their patients, not against them."

Barbara A.Rockett, a physician at Newton-Wellesley Hospital and a former president of the Massachusetts Medical Society, argues that "To substitute physician-assisted suicide for care represents an abandonment of the patient by the physician."

Rockett reminds readers that, by and large, doctors do not support assisted suicide. In Massachusetts, more than 75% of member of the MMS oppose it. And this is true at a national level as well. At a meeting in 2003, the AMA went on record to say, "Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would impose serious societal risks." She concludes:

"Physician-assisted suicide has been falsely advertised as death with dignity. Believe me, there is nothing dignified about suicide. I ask the voters of this Commonwealth, as they enter the voting booth, to vote for dignity for life and not for death. Please vote no on physician-assisted suicide."

What is at stake? If Massachusetts voters approve the referendum, other New England states could follow suit. The Massachusetts Medical Society is the oldest of its kind in the United States and the publisher of the New England Journal of Medicine, the nation's leading medical journal.

Related reading:  Oregon Physician Assisted Suicide Stats Released; Utilitarian Euthanasia; Suicide Not a Right in Switzerland; Bulgaria Rejects Assisted Suicide; France Says No to Assisted Suicide; The Dutch Crazy About Euthanasia; Italians Debate End of Life Options

Oregon PAS Death Stats Released

Oregon's public health division has released statistics on deaths under its physician-assisted suicide (PAS) legislation. It shows a steady increase in the number of lethal prescriptions and in the number of deaths. In 1998, the first year after PAS was legalised, there were 24 prescriptions and 16 deaths. In 2011, there were 114 prescriptions and 71 deaths. A total of 935 people have had lethal prescriptions and 596 have died.

The Physicians for Compassionate Care Education Foundation, a staunch foe of the legislation, analysed the 2011 figures. Here are some of its comments:

62 doctors wrote 114 prescriptions, with some writing up to 14 prescriptions each. Some doctors knew the patient for only one week before writing the prescriptions. It is known that some doctors are prominent prescribers of lethal barbiturates for assisted suicide.

The report states "9 people with prescriptions written in previous years ingested medication during 2011". The term "previous years" indicates that some received prescriptions during multiple years prior to 2011 (such as in 2010, 2009 or earlier). In short, some individuals had the prescription for longer than a year before ingesting the drugs, far longer than the law's 6-months life expectancy guidelines. Some patients lived as long as 872 days after requesting assisted suicide. Clearly, the law's guidelines are meaningless; not all who receive these prescriptions are terminal.

As has occurred in prior years, not all who attempt to take the drugs will die. Two patients ingested the medication but failed to die. Each regained consciousness and died more than a day later, 30 hours and 38 hours respectively, of their underlying illness; they were not considered to have died from the ingested drugs. These are not easy drugs to take, they are bitter and foul-tasting, and vomiting does occur despite anti-emetics.

As in previous years, there was virtually no formal evaluation for underlying depression, anxiety or other serious mental health issue. Only one of the 71 patients was referred for psychiatric evaluation. OHSU researchers in 2008 reported that 25% of patients requesting assisted suicide were considered to be depressed. Are we failing to recognize and address the despair that is frequently found in patients near the end of life? What are we doing to protect these vulnerable Oregonians?

As in previous years, pain has not been a major concern; only one third of patients had inadequate pain control or concern about it. The most commonly expressed concerns of those dying from physician-assisted suicide were unchanged from previous reports: less able to engage in activities making life enjoyable, losing autonomy, and loss of dignity.

In only 6 cases was the prescribing physician present at the time of ingestion, in 3 other cases another provider was present. Thus, very little is known or reported regarding events at the time of ingestion of the medications. For 62 patients there was either no provider present or the information regarding presence of a provider was unknown. Physicians appear to be disengaged with patients at the end.

In essence then, complications were unknown for 59 patients, and any information regarding minutes between ingestion and unconsciousness and death was unknown for 63 patients.

The shroud of secrecy surrounding assisted suicide is heavier than ever. With each passing year, Oregonians know less and less about what is really happening with assisted suicides in the state. The proper practice of all aspects of medicine requires adequate oversight and peer review. We do not have that with physician-assisted suicide in Oregon.


Related reading:  Timo Konietzka Died by Assisted Suicide; Assisted Suicide Booms in Switzerland

Guidelines for British doctors asked to assist suicides

The British body for regulating doctors, the General Medical Council, has announced that it is working on guidelines for telling doctors what they should do if a patient asks for help in committing suicide. There is an increasing number of Britons seeking to go to Switzerland to seek death at suicide clinics. There will be a public consultation early next year. Niall Dickson, the Chief Executive of the General Medical Council, said:


"The issue of assisted suicide is complex and sensitive. We already have clear guidance for doctors that they must always act within the law and assisting or encouraging suicide remains a criminal offence. This guidance will not in any way change the legal position for doctors. It is not our role to take a position on whether or not the law should be changed; that is a matter for the relevant legislature.

"We recognise however that there are a range of actions which could be considered as assisting in a suicide, such as providing information to a patient about suicide or providing practical assistance for someone to travel to a clinic such as Dignitas. Some of these actions may not lead to criminal charges but may still lead to complaints to us about a doctor's fitness to practise."

The guidance considers factors that might be relevant in determining the seriousness of each case, in the context of the different actions doctors may take in assisting patients who wish to end their lives. The new guidance will not cover euthanasia (in which a doctor's actions have directly led to a patient's death), as standards on this are clear.

The legal position of assisted suicide in England and Wales is unclear. It is clearly illegal, but there are doubts about whether charges would be brought against a doctor who assisted someone in a suicide. In 2010 Keir Starmer, the public prosecutor, issued liberalised guidelines which focused on the intention of the person assisting. There is a case currently in the courts which could raise the issue of whether doctors could help with impunity. ~ GMC, Dec 14, Guardian, Dec 15
 

More Euthanasia, Assisted-Suicide Propaganda

Margaret Somerville (Reprinted from here.)

The Royal Society of Canada Expert Panel on End-of-Life Decision Making recently released its Report to much media attention. The parts of that report we can all agree on, for instance, the need for much better access to palliative care and pain management for terminally ill patients, was not the media’s focus. The panel’s recommendation that euthanasia and physician-assisted suicide (PAS) should be legalized was.

It has generated many calls for a national debate in Canada on these latter issues – mainly, I would guess, if not entirely, from people advocating the legalization of euthanasia. In entering such a debate and deciding whether they agree with this recommendation, it’s important for Canadians to understand the weaknesses of the Report.

The Panel’s mandate included the following direction: “The public would… benefit greatly from having a careful, balanced review of various pros and cons of decriminalization of physician-assisted death from well-reasoned ethical and legal standpoints.” The Report comes nowhere near fulfilling this mandate. It’s a pro-euthanasia manifesto – to paraphrase an advocate for disabled people speaking in another context, it’s “thinly veiled euthanasia and assisted suicide propaganda disguised as an expert report”.

This is not surprising in view of who the authors are. Many are well-known pro-euthanasia advocates and, as the Report is unanimous, one can assume all agree with this stance. The people I know whom the Panel lists as consulting to them are, likewise, pro-euthanasia -- three of them world-leading advocates.
 
It’s important to understand this is not a Report of the Royal Society of Canada, as many have mistakenly assumed, as that gives it an unmerited credibility. It’s a Report of an expert panel (only one member of which is a fellow of the Royal Society) set up by the Royal Society. The fairness and wisdom of the Royal Society’s choice of panel members must, however, be questioned.

The Report is very far from being a “balanced review” or adequately comprehensive. The arguments against the legalization of euthanasia and PAS are almost entirely absent. Issues are considered almost entirely at the level of the individual. There is almost no discussion of the impact of legalizing euthanasia and PAS at the institutional level -- in particular, the impact on healthcare institutions and professions, and the law – or at the societal level, in particular, on important shared values, such as respect for life. In fact, this value is not discussed, an extraordinary omission considering the topic of the report.


Discussion of abuses is deficient and selective

The discussion of the practices in jurisdictions that have legalized or allow euthanasia and assisted-suicide are seriously deficient and very selective so as to minimize the Report’s coverage of abuses, expansions of justifications for the practices, and other problems or controversies.

For example, the Report indicates there has been one case of the use of euthanasia on disabled babies in the Netherlands. This is probably correct in the short time since the Groningen protocol allowing such euthanasia was formally accepted. But, prior to that, an article in the New England Journal of Medicine documents 22 cases of babies with spina bifida being euthanized, which is not mentioned. Such “pro-euthanasia presentations” of the facts are concerning and misleading. Likewise, the availability in the Netherlands of euthanasia for children is not mentioned. The combination of euthanasia and donation of organs for transplant in Belgium and the recent case in Flanders of “joint euthanasia” of a terminally ill man and his healthy wife are ignored. And a survey of Belgian physicians who had carried out euthanasia, published in the Canadian Medical Association Journal, which showed 32 percent of those physicians had carried out euthanasia without the patient’s request or consent is never mentioned.

The system set up under the Oregon Death with Dignity Act is presented as largely problem-free. The literature describing problems, for instance, articles and book chapters by renowned pain specialist and head of palliative care at Memorial Sloane Kettering, Dr Kathleen Foley, and Dr Herbert Hendin, a New York psychiatrist specializing in suicide prevention, is likewise totally ignored.

And although Canadian psychiatrist Dr Harvey Max Chochinov’s research is referenced, his ground-breaking work in the psychiatry of dying people, what helps them and what they want, is not discussed.



Through the lens of individual autonomy

The authors make an assumption that individual autonomy, implemented through “informed choice”, is always the prevailing value and construct their case for euthanasia and PAS from there. They do not consider that for many people some other value might prevail – for example, respect for human life which requires that we don’t kill each other, except when unavoidable to save life -- and what line of argument and decision outcomes that would result in.

In short, the authors have adopted a basic assumption, from which, as they state, everything else they accept and recommend flows, without adequately justifying doing so and not even mentioning the possible alternatives.

The essential difference between the pro and anti euthanasia positions is that the former gives priority to individual autonomy over respect for life, the latter does the opposite. We should keep in mind, here, that we are not just talking about the value of respect for each individual human life, important as that is, but also, respect for human life in general. The authors refer to the Charter as the primary source of our shared values: Apart from any other claims on behalf of the value of respect for life, it is one of the values enshrined in the Charter.

There is a strong emphasis in the Report on the burden and healthcare costs of an aging population and the Report gives the impression that euthanasia and PAS will help to resolve this “problem”. The authors note that euthanizing people “in advanced stages of dementia” will be an issue to be addressed in the future. In other words, they don’t reject the possibility that this might be acceptable.

The Report doesn’t mention survey results, such as those from an Environics poll, which last year (2010) asked over 2000 Canadians what the government priority should be - legalizing euthanasia or improving end-of-life care, or both. Seventy-one percent said improving end-of-life care and 19 percent said legalizing euthanasia, and 5 percent said both (the remainder were Did not know/Neither).



What about elder abuse?

Because the Report seems to have a special focus on aging, I note that the Environics polls also showed Canadians are very concerned about elder abuse if euthanasia or PAS is legalized. The 2011 poll expressly asked about "elder abuse" and 76 percent of respondents said they were concerned about it, if euthanasia were legalized. The 2010 poll did not expressly ask about "elder abuse", but did ask a question where 78 percent of respondents said they were concerned that elderly persons (disabled and sick persons too) would be euthanized without consent. To another 2010 question, 63 percent said they were concerned elderly persons could be pressured to accept euthanasia in order to reduce health care costs.

The authors recognize their position involves an inconsistency in that they champion individual autonomy as the prevailing value, but clearly will place limits on its exercise and not recognize the validity of the choice to die of all autonomous, competent adults.

But, if individual autonomy trumps all other considerations, then why is there a need for any other justification for euthanasia? Simply wanting to be dead and consenting to it should be sufficient: “Over 70 and tired of life”, as proposed in The Netherlands, would suffice. And why, even, does the person need to be “over 70”? What about the broken hearted 18-year-old whose first love has abandoned her; why can’t she exercise her autonomy to have assistance committing suicide?

And if there’s a right to commit suicide, then there is a duty not to interfere with people exercising that right. How then can we justify treating people brought to an emergency room who have attempted suicide?

The usual “confusions” used to promote the case for euthanasia are all present in the Report: equating all acts and omissions; arguing there is no difference between killing and allowing to die; conflating intention and motive in relation to desired and unwanted consequences of pain relief treatment; and so on. The opposite arguments are not presented. And the fact that courts and others rely on these distinctions daily in making legal and ethical decisions is ignored.

The section on dignity, which the authors recognize is a prominent concept in the euthanasia debate, is especially biased to the pro-euthanasia arguments and inadequate. In particular, a 2008 major and very comprehensive research report on the concept by the US President’s Commission on Bioethics is not even mentioned.

The above criticisms are not comprehensive, many more could be articulated. Fortunately, in my view, there is a wealth of grounds on which the Report can be easily dismissed.


Margaret Somerville is founding director of the Centre for Medicine, Ethics and Law at McGill University.

Utilitarian Euthanasia and the Question of Dignity

Facebook can be useful. Browsing through its weekly birthday update, I learned that Nick Tonti-Filippini, a bioethicist who serves on various Australian government committees and teaches at a Catholic institute in Melbourne, turns 55 today. Some of those years must have gone slowly for him, as he is chronically ill. Fortunately, he has the training to analyse his difficulties with critical detachment. So his reflections on euthanasia, whose publication in the local media today coincides with the celebration, are worth passing on.

He begins with a description of his condition:

I am chronically ill with a progressive rheumatoid auto-immune disease that destroyed my kidneys and causes inflammation around the lungs, inner chest walls and heart, ischaemic heart disease and peripheral neuropathy. I have been dependent on dialysis for 20 years and I have undergone 15 angioplasties and the placement of eight stents to recover some blood flow after the failure of coronary bypass surgery.

Nonetheless, he says, euthanasia and assisted suicide are not the answer to his illness. In support of his contention he offers three arguments. First, Nick says, fear of being dependent can be a powerful motivation to seek euthanasia:

The fear of being a burden is a major risk to the survival of those who are chronically ill. If euthanasia were lawful, that sense of burden would be greatly increased, for there would be even greater moral pressure to relinquish one's hold on a burdensome life.

Second, the existence of a euthanasia option would undermine the development of better palliative care facilities. This notion is supported by many disability activists. They say that it spreads subtle and widespread expectation that death must be better than disability. "If the legalization of assisted suicide continues, I believe the rank and file will some day see nothing wrong with hastening the deaths of many people," writes disability expert Dr Carol J. Gill. "They will stand by and do nothing to stop it and will endorse the policies and institutions that advance it – not because they are evil people but because it will no longer be evil in our culture to do so. It will be compassionate, respectful, routine."

Third, Nick argues that no legislation will ever ensure that there can be no abuse. “Legislation that permits euthanasia could never be made safe for those of us who have serious chronic illnesses, because the essence of such legislation is to make respect for our lives contingent upon the strength of our will to survive.” The fact that euthanasia has been rejected in six countries over the past year (by my count), supports this. Committee after committee, in the UK, the UK, France and Australia has found that it is impossible to reconcile legalised euthanasia with the government’s responsibility to defend the disabled, aged and disadvantaged. Since Oregon legalized assisted suicide in 1994, other American states have it debated it again and again. Between January 1994 and March 2011, there had been 122 legislative proposals in 25 states. All bills that are not currently pending were either defeated or languish in committees.

Three solid arguments from a well-informed academic with personal experience. You’d think that his insights would be treated with respect.

They weren’t. Comments on his article were running about 5 to 1 in favour of legalised euthanasia, and nearly all of them were passionately, gut-wrenchingly, venomous.

Coming to grips with his arguments was not on his readers’ agenda. They just wanted to make their own choice. As "Dreamer" put it,

“I don't see it as anyone’s business but mine if I chose euthanasia. Religious ratbags and goodie-two-shoes included. Mind your own bloody business and keep your noses out of my affairs.”

Although Nick’s arguments were entirely secular, he was repeatedly slammed for being a Christian. In one all-too-typical comment, "Susan" noted:

“What a nerve to commit people to absolute agony in the name of your religion. And the slur against good people who want to end their terminal suffering is abhorrent. Why should the terminally ill be put up on your cross and made to suffer your torment? You have no right to choose the death or torture for others. If you want a death on a cross, well climb up yourself, but by God do not put others on it, especially the dying.”

The underlying philosophy was a rough-and-ready utilitarianism – that the value of life is the sum of its pleasures. As "Claudius" put it,

“Quality of life is more important than quantity of life, and euthanasia is a superior outcome to ineffective palliative care.”

And on and on and on.

No one expects internet comments to be balanced and thoughtful, but the vituperation in today’s comments was unsettling. They reveal four things about euthanasia and assisted suicide. First, that support for euthanasia is so visceral that it defies reasoned discussion. Second, that it is so me-centred that every argument about its community impact will hit a brick wall. Third, from a utilitarian point of view, Christianity is a abominable force for evil. Fourth, that the notion of meaningful suffering is incomprehensible.

All this suggests that clashes between traditional human dignity and the debased utilitarianism which characterises public debate in Australia are all but insoluble. Ultimately the problem is that the side which sees meaning in suffering is willing to reason it out. The other side isn’t.

Solving conundrums like this is why people like Nick Tonti-Filippini are needed in public life. Happy birthday, Nick. Many more of 'em.


Michael Cook is editor of MercatorNet.