Euthanasia Apologists Mount Campaign to Whitewash Oregon Law

By Burke J. Balch, J.D., Director
NRLC Department of Medical Ethics

A New Year's Day article appearing in the Washington Post provides an insightful glance into the themes pro-death forces are using to deflect mounting criticism of Oregon's unique-in-the- nation law that legalizes lethal prescriptions to assist suicide.

The nearly three-page long article praising Oregon's law, written by the Post's Susan Okie, is set against the backdrop of a fierce legal battle being fought in the courts. In a November 6 letter sent to the Drug Enforcement Agency, Attorney General John Ashcroft effectively reversed a 1998 decision by then-Attorney General Janet Reno that prohibited the DEA from enforcing federal drug control laws against doctors who prescribed lethal dosages under cover of Oregon's assisted suicide law.

The state of Oregon, along with the pro-euthanasia organization Compassion in Dying, immediately appealed to U.S. District Judge Robert Jones. On November 20, Jones allowed Oregon's law to remain in effect while he reviews legal briefs from all parties and sorts out the legal issues. NRLC and Oregon RTL filed a " friend-of-the-court brief" which defended Ashcroft's legal reasoning.

According to public opinion polls, sympathy for legalizing assisted suicide is strongest if a patient is suffering untreatable pain. However, modern medicine's ability to control pain is so effective that current pain was not given as a reason by any of those who received legal lethal prescriptions in 2000, the most recent year for which official reports in Oregon are available.

So physician-assisted suicide is now being sold, even more than ever, as a way of asserting control--as an exercise of "autonomy."

"Among people in Oregon who have used the law to end their lives, it appears the most common motive was a desire for autonomy," according to the Post. "Knowing that assisted suicide is an option... seems to comfort some sick people by offering a measure of personal choice ...."

Okie used Richard Holmes, who has received but not yet taken a lethal prescription to make her argument. Holmes' told the Post, " I've lived my life the way I want to. I should die the way I want to." Indeed, Holmes believes this should be the law "in every state in the whole country."

The idea that doctor-aided suicide should be available, not to escape intractable pain, but simply as a matter of personal choice, is prevalent in the Netherlands, the European country where it has been practiced under court protection for nearly two decades. Recently, a doctor there was given no penalty even though convicted of giving a lethal injection to a retired legislator. The legislator had no illness but simply expressed himself "tired" of living. There is considerable agitation among the Dutch to explicitly legalize assisting suicide in such cases.

Of course, to the extent heightened autonomy is claimed as a proper motive for the Oregon law, there is no logical basis for limiting the legalization of euthanasia to those who are terminally ill. It should equally be made available to the college student, legally an adult, who wants to exercise her autonomy by killing herself because she has been dumped by her boyfriend.

Arguing that the Oregon law has not led to predicted abuses, Okie writes, "[T]here is no evidence the law has been use to coerce elderly, poor or depressed patients...." In fact, the official reports show that those seeking lethal prescriptions have increasingly expressed concern about becoming a burden to family, friends, or caregivers.

In 1998, 12% described that motivation; in 1999, the proportion had risen to 26%; and in 2000, a whopping 63% said they were motivated at least in part by fear of being a burden.

This finding is consistent with the stated objectives of the founder of the pro-euthanasia Hemlock Society, Derek Humphry. In a 1998 book Humphry wrote supportively of the use of assisted suicide as "one measure of cost containment."

"[T]he elderly," Humphry said, are "putting a strain on the health care system that will only increase and cannot be sustained."

Referring to people with disabilities, he wrote, "People with chronic conditions account for a disproportionately large share of health care use, both services and supplies." In light of all this, he asked, "Is there a duty to diea responsibility within the family unit--that should remain voluntary but expected nevertheless?"

Apparently a good number of those Oregonians seeking lethal prescriptions are in fact motivated to do their "duty."

A major thrust of Okie's effort to justify the Oregon law is her claim that the legalization of assisting suicide in that state has "prompted doctors in the state to improve their care of the dying."

The article cites a 1999 survey showing "more than three-quarters of Oregon physicians who had cared for at least one dying patient in the previous year reported that they had made efforts to improve their knowledge of pain treatment for such patients." Adds Okie, "Sixty-nine percent said they had sought to improve their recognition of psychiatric illnesses such as depression and 30 percent said they had increased their hospice referrals."

Of course, many have remarked since September 11 that the terrorist attack on our nation has caused Americans to unite, to reduce partisan bickering, and to focus on things that are truly important, like family. Yet no one suggests that these important positive consequences should lead us to legalize or welcome terrorist attacks.

If promotion and legalization of euthanasia in Oregon has, in fact, played a role in motivating doctors to improve positive alternatives to suicide, that hardly is an argument for keeping assisting suicide legal there or spreading the policy to other states.

Ironically, the article fails to draw any connection between this improved care and another point it trumpets as a vindication of the Oregon law. The Post notes that there have been 70 officially reported deaths under the statute, and adds, " the law has not had the dire consequences that some opponents predicted. ... [It has not] caused significant migration of terminally ill people to Oregon."

Yet even the article unwittingly provides evidence that a lower- than-feared number of deaths may be largely attributable to the provision of positive alternatives.

The Post notes that according to one survey, "In 68 of 142 cases...., the request for a [lethal] prescription prompted the doctor to take other measures such as improving pain treatment, referring the patient to a hospice or prescribing antidepressants. Almost half of those who receive such interventions changed their minds."

Our objective should not be to promote assisted suicide but rather to provide pain treatment, antidepressants, and other positive interventions to 100% of the suicidal, not 48%and aggressively to improve those interventions until no one, whether for fear of being a burden or other reasons, feels a " need" to commit suicide.