EUTHANASIA AS A SUBSTITUTE FOR HEALTH CARE RATIONING?

By Burke J. Balch, J.D., Director

NRLC Department of Medical Ethics

Considerable commentary has followed in the wake of the determination by Attorney General John Ashcroft that federally controlled drugs may not be used to assist suicide. Not yet in effect while under challenge in the courts, the determination would have its greatest impact in Oregon, the only state whose law currently authorizes physician-assisted suicide.

In an otherwise urbane, "on the one hand, on the other hand"-style article by George Mason University Law School Professor Nelson Lund criticizing Ashcroft,1 one chilling paragraph stands out:

"[E]ven a skeptic like me has to admit the very real possibility that Oregon's approach is not the worst imaginable," Lund wrote in the February edition of Commentary magazine. "If ... the political and economic pressures for health-care rationing become significantly more intense, we may see a much more widespread denial of medical care to very feeble patients, including the withholding of food and water."

Having set the reader up, Lund then adds, "If the alternative to a miserable death by dehydration turns out to be physician-assisted suicide or euthanasia, Oregon's approach may begin to look a lot less bad than it does today."

Lund's justification of assisted suicide is all the more jarring in the context of the rest of his article, which raises many important warning flags about assisting suicide. For instance, he deplores the fact that, "Whether it happens directly through law and regulation, or informally, very sick patients who are elderly or whose prospects for recovery are thought to be small are going to be prime targets for 'hastened death.' ... Once physician-assisted suicide is legalized, there will be strong temptations to pressure such patients to accelerate the inevitable ... especially effective with those who are clinically depressed."

Lund's scary prediction of pressure for assisted suicide as an " alternative" to starving and dehydrating people to death or as a " cost containment" measure is already well on its way to realization.

The most recent official annual report on Oregon's unique-in-the-nation law that has legalized physician-assisted suicide there found that 63% of those who killed themselves said they were motivated at least in part by fear of being a "burden."

In December 1997, Faye Girsh, executive director of the pro-euthanasia Hemlock Society USA, issued a statement endorsing killing individuals - - such as people with Alzheimer's disease and children with disabilities - - who are legally incapable of making the decision themselves.

"A judicial determination should be made," Girsh said, "when it is necessary to hasten the death of an individual whether it be a demented parent, a suffering, severely disabled spouse or a child." (Confronted with vigorous protests by disability rights activists, Girsh later tried to pull back, issuing a " clarification statement" calling this position simply "one suggestion about the question of ending suffering" not officially endorsed by the Hemlock Society.)

In December 1998, the founder of the Hemlock Society, Derek Humphry, wrote positively of the use of assisted suicide as "one measure of cost containment." "[T]he elderly," Humphry's book (ironically, entitled Freedom to Die) said, are "putting a strain on the health care system that will only increase and cannot be sustained."

Speaking of 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 die--a responsibility within the family unit - - that should remain voluntary but expected nevertheless?"

In the justly famous "Iron Curtain" speech in which Winston Churchill helped awaken the West to the danger of Soviet communist expansionism at the beginning of the Cold War, the former British Prime Minister referred to his unsuccessful efforts in the 1930s to warn a Britain enamored of appeasement of the rising danger of Hitler's Nazi regime. "Last time I saw it all coming and cried aloud to my own fellow-countrymen and to the world, but no one paid any attention. Up till the year 1933 or even 1935, Germany might have been saved from the awful fate which has overtaken her and we might all have been spared the miseries Hitler let loose upon mankind. There never was a war in all history easier to prevent than the one which has just desolated such great areas of the globe."

We have been warned of the consequences of legalizing euthanasia. We have been warned by the mouths of its foremost proponents; we have now been warned by the mouth of one of its reluctant facilitators. If we fail to act now to stop it before it spreads, then - - if in time to come we see our grandmothers, parents, and children, when "very feeble," taken away to be killed - - let us blame no one more than ourselves.

NOTE:

1. What Lund conceives to be the main point in his article is that Ashcroft's ruling is not in keeping with "federalism" because it renders more difficult something a state has chosen, as a matter of its own state law, to permit. In fact, of course, the issue is whether the federal government will endorse and facilitate assisting suicide by authorizing the use of federally controlled drugs to kill patients.