Going Dutch?

A Breakthrough in Oregon will start a domino effect of law reform on assisted dying throughout America" writes Derek Humphry, co-founder of the Hemlock Society, in a fund-raising letter on behalf of the Oregon initiative known as Measure 16. If Oregon voters pass the initiative, it will mean that doctors, for the first time in American history, will be allowed to knowingly prescribe fatal overdoses of drugs.

Measure 16 is a case study in cynicism and subterfuge. The backers of the initiative assumed that Oregonians would reject any measure that appeared to be an outright legalization of euthanasia. So they wrote the proposal in minimalist terms, hoping to fool voters into believing that the measure would "only" permit physician-assisted suicide. But as Humphry's letter makes clear, the authors of the initiative intend it to be the rock that starts the avalanche down euthanasia's slippery slope, an avalanche designed to obliterate 2,500 years of public policy prohibiting doctor-induced death.

This is not an irrational approach for euthanasia advocates. Legalization proposals have been put forth before and repeatedly rejected by state legislatures and voters. This year in Michigan, Jack Kevorkian's supporters were unable to gather enough signatures to qualify a euthanasia initiative for the ballot, despite a well-publicized petition drive. Indeed, experience has shown that opposition to legalizing euthanasia grows the more people learn about the topic.

And that is precisely the problem for opponents of the Oregon initiative. Coverage of the O. J. Simpson murder trial will be at its height in October, when most voters would normally begin to focus on the campaign. That may make it difficult for the truth about euthanasia to get through. So now may be the best time to analyze what passage of Measure 16 would mean, not only for Oregon but for the rest of us "dominoes."

Slide into Euthanasia

The Social and moral consequences of legalizing doctor-induced death are already apparent in Holland, a nation touted by euthanasia advocates as leading the world to its bio-ethical future. Holland's slide into euthanasia can be traced back to 1973, when a Dutch judge refused to punish a doctor who had been convicted of killing her ailing mother by lethal injection. The judge ruled that the defendant physician had stayed within certain informal policy "barriers" against patient abuse, and so no legal sanction (aside from one week of probation) should apply.

That case and others like it led to the current state of Dutch law, which technically prohibits doctor-induced death but permits it to go unpunished if physicians stay within legislative guidelines. Under these guidelines, only patients who are experiencing unbearable pain and who repeatedly and voluntarily request death are supposed to be killed. In practice, Dutch physicians routinely ignore the rules. Here is just a sample of what is happening in the Netherlands, a mere 21 years after euthanasia made its first legal breakthrough:

- According to the Remmelink Report, an official Dutch government survey of euthanasia practices, more than one thousand patients are involuntarily euthanized each year. In other words, doctors kill an average of three patients a day without permission of the patients or their families.

- Some patients who are not terminally ill are euthanized. Indeed, they do not have to be physically ill to receive "deliverance," the favorite euphemism among euthanasia advocates. The Dutch Supreme Court recently ruled that a psychiatrist acted properly when he "assisted" a physically healthy but depressed patient to die. (The woman's two children had died and her marriage had dissolved.)

- Babies born mentally retarded or with birth defects are being killed in their cribs by pediatricians. So common is this infant euthanasia that the Dutch Pediatric Association is drawing up guidelines for its practice.

- The Dutch Patients' Association, a disability-rights group, has found it necessary to distribute a wallet card to members instructing doctors that "no treatment be administered with the intention to terminate life."

It is tempting to dismiss these problems as foreign to the U.S. experience. But a quiet revolution in ethics is being led by this nation's medical establishment, pushing us step by step along the path blazed by Holland. A May 26, 1994, editorial in the prestigious New England Journal of Medicine opined that the time has come to restrict the right of profoundly disabled people to receive life-sustaining medical treatment. According to the editorial, restrictions could come in three forms: expanding the legal definition of death to include permanent unconsciousness; legally limiting the health care a severely brain-damaged person would be entitled to receive; or creating a legal presumption that those with severe disabilities would rather die than live (reversing the current presumption in favor of life).

No matter how restricted these new guidelines were, you can bet they would soon be extended. In fact, conscious brain-damaged people are already being hustled into the grave. In 1993, for example, a Vermont court approved the withholding of food and fluids from a brain-damaged man named Ronald Comeau because of "quality of life" considerations. (See "The Right to Die, the Power to Kill," NR, April 4, 1994.) Mr. Comeau's case had a happy ending. But Michael Martin, another brain-damaged man, may not be as fortunate. (See "Better Dead than Fed?" NR, June 27, 1994.) Mr. Martin is slated to die by dehydration and starvation with the approval of a Michigan probate court despite strong evidence that he has communicated a desire to live. The court ruled he isn't competent to choose life over death, so a pre-injury statement to his wife that he would not want to live in a dependent condition allows the state to approve his killing. (A request for a hearing is currently pending before the Michigan Supreme Court.)

Eroding Guidelines

The decisions to starve Ronald Comeau and Michael Martin were unethical under guidelines created by the AMA Council on Ethics and the Law in 1986 and reiterated in 1992. The guidelines said it was ethical to withhold food and fluids only from patients who were "terminally ill" or "beyond doubt" permanently unconscious. Mr. Martin and Mr. Comeau are neither, proving that the protective limitations established by the AMA can be ignored, just as the euthanasia guidelines in Holland are. Moreover, in response to such cases, the AMA has loosened the guidelines. A recently published opinion by the Council on Ethics and the Law deems it ethical to withhold food and fluids from conscious brain-damaged patients like Mr. Martin and Mr. Comeau.

Despite the ostensible concern for the welfare of patients, legalizing. assisted suicide and euthanasia would be likely to increase the misery and suffering of the very people that doctor-induced death is supposed to help. This is the conclusion reached by the 25-member New York State Task Force on Life and the Law, a permanent commission created by Governor Mario Coumo in 1985. In 1994, after an intensive and lengthy investigation, the task force published a report entitled, When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context."

The task force found that the medical community is not doing a very good job of caring for severely ill and chronically suffering people. The task force reported, for example, that up to 60 per cent of cancer patients do not receive adequate medication for pain. Moreover, terminally ill patients who become clinically depressed and suicidal often do not receive adequate mental-health intervention or anti-depressants. If doctors do such a poor job of relieving pain and depression now, when doctor-induced death is illegal, what kind job will they do should killing a patient be considered just another "treatment option"?

The task force also found that worries about a slippery slope are justified. It concluded that "clinical safeguards would not be realized" and that euthanasia policies that "hinge on notions of pain and suffering" would be "uncontainable." The task force's conclusions were unequivocal and unanimous: The dangers of legalizing assisted suicide and euthanasia "would far outweigh any possible benefits." Furthermore, "the risks would be most severe for those who are elderly, poor, socially disadvantaged, or without good access to good medical care."

As the task force and others who have studied the issue have concluded, there is little to gain by legalizing doctor-induced death and much to lose. Now it's up to Oregon voters to stop the avalanche, by voting no on Measure 16. To do otherwise will unleash forces that will bring about devastating consequences not only in this country but eventually throughout the world. After all, if we can export rock 'n' roll, we can export Dr. Kevorkian.