This article was published by National Review online
on November 19, 2019
Wesley SmithBy Wesley J SmithMeasure 16 in Oregon did not start the fire, but it added fuel.
Proponents of assisted suicide are celebrating the 25th anniversary of Measure 16, the Oregon referendum that, for the first time in the modern era, formally legalized doctor-prescribed death. To open the door to more suicide in a culture that is now roiled by an acute suicide crisis — about 45,000 Americans kill themselves annually, up from about 30,000 in 1999 — seems a bizarre event to cheer. But nihilism strikes a beat. Suicide to prevent suffering is seen by euthanasia supporters as not only acceptable but optimal, perhaps the best way to die.
After the passage of the Oregon referendum, assisted-suicide enthusiasts predicted that it would lead quickly to widespread public embrace of doctor-hastened death. That hasn’t happened, and resistance remains stiff. Still, Measure 16 did mark the beginning of an avalanche down the slippery slope. The District of Columbia and nine U.S. states, including that culture-driving behemoth California, have legalized assisted suicide for the terminally ill. Belgium, Colombia, Luxembourg, the Netherlands, and our closest cultural cousin, Canada, now permit doctors to give lethal injections to patients who ask to die. Switzerland’s once sleepy law allowing assisted suicide, passed back in the 1940s, came to the fore in the ’90s with the establishment of suicide clinics at which people from around the world pay about $10,000 to be made dead. Victoria, Australia, has also legalized assisted suicide, while the German supreme court conjured a limited legalization, permitting the practice so long as the motive for assisting isn’t venal. Energetic legalization efforts are continuing in countries as disparate as New Zealand, India, the United Kingdom, and Italy.
That’s a lot of radical cultural change — which, I hasten to note, is not a synonym for progress — in a quarter century. But it seems to me that, now that doctors have greater ability than ever before to relieve suffering, the current vitality of the euthanasia movement is more a symptom of growing nihilism than a cause of it. But it is also a reinforcing symptom. This milestone anniversary of Measure 16 seems a reasonable time to assess the cultural consequences that have accrued from redefining suicide as a medical treatment.
It is important to understand that the so-called right to die isn’t about terminal illness. Nor is it a safety valve to be used only to prevent irremediable suffering. Those are just sales pitches to persuade a still-wary public to swallow the hemlock. Even in jurisdictions that (currently) restrict the writing of lethal prescriptions to those deemed to have six months or less to live — a notoriously difficult and imprecise prognosis — there is no requirement that the suicidal patient’s purported suffering be objectively irremediable.
Besides, once a country popularly embraces euthanasia, most limitations are quickly abandoned. Both Belgium and the Netherlands legalized lethal-injection euthanasia commencing in 2002 and proceeded quickly, from allowing doctors to lethally inject terminally people who request it, to allowing chronically ill people who request it, to allowing people with disabilities who request it, to allowing the mentally ill who request it.
The mentally ill? Really?
Alas, yes. There are many sad examples. In Belgium, a transgendered person profoundly depressed by the results of a sex-change surgery asked for, and received, euthanasia. In a truly awful case, a woman suffering from anorexia, who had been sexually abused by her psychiatrist, was euthanized by another psychiatrist
because she was in despair that the first doctor had not been subjected to professional discipline. A woman who had struggled with depression her whole life was euthanized by an oncologist
. The first her son knew of the plan was when the hospital called him to pick up his mother’s body. Meanwhile, in the Netherlands, psychiatrists are killing more of their mentally ill patients each year. In 2017, Dutch psychiatrists and other doctors lethally injected 83 mentally ill patients, up from 42 in 2013.
Sometimes such homicides are accompanied by organ harvesting. In other words, doctors remove organs from donors who would not be dead but for being killed by other doctors. These ghoulish procedures have even been discussed respectfully in medical journals dedicated to organ-transplant research. One such study discussed the successful transplant of lungs from four euthanized donors
who had not been terminally ill. Three had neuromuscular disabilities. One suffered from chronic self-harming.
Pause and think deeply about that for a moment. The “treatment” for self-harming was for a doctor to commit the ultimate harm, killing the patient.
Elderly people are euthanized because they are experiencing the usual afflictions of age, such as macular degeneration. There have even been joint euthanasia killings of married couples in Canada
, Belgium, and the Netherlands, and assisted suicides in Switzerland. In one Belgian example, neither spouse was seriously ill. Not only that, but the death doctor was procured by the couple’s son
— who told the Daily Mail that this was the best choice, since he would not have the ability to care for his parents if they ever became dependent. There is a word for that, and it isn’t “compassion.”
In Belgium and the Netherlands, euthanasia has spread to incompetent people with dementia if they expressed a desire to be killed in an advance medical directive. One such recent case from the Netherlands illustrates how profoundly euthanasia corrodes societal morality. An elderly woman was diagnosed with dementia. She said that she wanted to die when she became incapacitated — but also that she wanted to decide when that time had come. The woman’s doctor decided for her, drugging her coffee to make her sleep before being lethally injected, but the patient awakened and struggled against being killed. Rather than cease and desist, the doctor instructed attending family members to hold her down so she could finish dispatching the patient.
This would seem to be a clear-cut case of murder. But judges exonerated the doctor, arguing that she had acted in her patient’s best interest. So an elderly woman, struggling to live, was killed, and a judge praised her killer for performing the lethal act.
“But Wesley,” some might be saying, “we would never allow Alzheimer’s patients to be killed in the United States!” Oh no? Nevada just passed
a first-of-a-kind law permitting dementia patients to order withdrawal of their food and water withheld when they become incapacitated.
Understand, this new statute does not refer to feeding tubes, which is a medical treatment that can be refused legally by advance directive in all 50 states. Nor is it about preventing forced feeding. Rather, the law requires caregivers to withhold spoon feeding, which is humane care, akin to keeping a patient warm or clean. In other words, Nevada has legalized killing dementia patients by starvation, even if the incompetent person willingly eats, perhaps even if the patient asks for food.
Euthanasia has spread to the treatment children. In the Netherlands, sick kids can be euthanized starting at age twelve. There are no age restrictions in Belgium, where government reports indicate that a nine-year-old was subjected to euthanasia in recent years. Euthanizing children remains illegal in Canada, but the government is currently debating whether to expand euthanasia eligibility, and many in the pediatric medical community support extending the license to children. Indeed, some pediatricians at a children’s hospital in Toronto have already volunteered to do the deed if pediatric euthanasia becomes legal.
Infanticide was, until recently, universally considered a heinous crime. Not any more. Neonatal euthanasia is tolerated by authorities in the Netherlands, where it remains technically illegal. Indeed, in medical journals, doctors have admitted that they have lethally injected babies who were born with terminal conditions or serious disabilities. There is even a published bureaucratic infanticide checklist, known as the Groningen Protocol, to help doctors decide which babies to euthanize. Revealingly, the protocol was written up, with scant criticism
, in The New England Journal of Medicine.
Support for infanticide is becoming respectable in the United States as well. Recall that Peter Singer, the world’s foremost apologist for infanticide, was given a prestigious chair in bioethics at Princeton University not despite his views but because of them. Meanwhile, support for post-viability abortion has become de rigueur among Democrats, with almost all the party’s presidential candidates opposing any limitations and rejecting laws that would require babies who survive attempted termination to be treated medically like other infants. Virginia’s governor, Ralph Northam, even strongly suggested that a baby who survived abortion “should be kept comfortable” while doctors and mother decided whether to withhold care and neglect the baby to death.
Advocates for assisted suicide claim that, whatever might be happening in other countries, there have been no “abuses” here. But that isn’t true. In 2008, two terminally ill Medicaid patients in Oregon were refused life-extending chemotherapy by bureaucrats but specifically assured that assisted suicide
would be covered. A similar case was reported in Nevada, where in 2017 a doctor complained that a private health-insurance company refused to pay for a patient’s transfer to California for life-saving care and that, adding injury to insult, the company asked the doctor to consider recommending assisted suicide
, for which benefits would be paid.
According to the Oregonian, a dementia and cancer patient named Kate Cheney may have been persuaded to die early by her daughter, who a psychologist said appeared to be the primary driving force behind the elderly woman’s request for assisted suicide.
Then there is Martin Freeland, who was dispensed a lethal prescription two years before succumbing naturally to cancer, meaning that surely he was legally ineligible for assisted suicide. Adding to the abuse, after Freeland became psychotic, to the point that he was put under a legal guardianship, his psychiatrist reported that the man’s guns were removed from his home but ensured that the lethal drugs remained available for use. Freeland eventually regained his competence and died naturally, having had the time to reconcile with his daughter — which would not have happened had he taken the prescribed poison when it was dispensed. He told his caregivers he was very glad not to have committed suicide.
Meanwhile, as doctor-prescribed death is promoted far and wide by friendly media, the United States in in the depth of a suicide crisis. Perhaps not coincidentally, Oregon’s suicide rate is 33 percent higher than the national average. Does this mean that there is a connection between assisted-suicide advocacy and increasing suicide rates? At least one study indicates
that there may be. There is no dispute that the suicide crisis is worsening. Ohio just announced that suicide deaths there have risen a stunning 45 percent in the past twelve years. Even so, the Ohio Nurses Association recently gave its support for legalizing assisted suicide. One would think that nurses could connect some damn dots!
Enough. Measure 16 did not start this fire. But it clearly quickened what was then merely an incipient cultural trend. The uncertainty 25 years later is not whether killing the sick, disabled, and elderly could happen. It already is happening. No, the real question is whether we are willing, with clear eyes, to accept the toxic cultural consequences that flow directly from eliminating suffering by eliminating sufferers.