The Fight Against Assisted Suicide

On April 21, 2010 the Canadian Parliament delivered a stunning blow to all those in favor of what is euphemistically called “death with dignity.” Parliament Bill C-384, which would legalize assisted suicide, was overwhelmingly defeated by a vote of 228 to 59.

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition in Ontario, Canada, credited the outcome to the fact that “[assisted suicide opponents] remained completely focused on our strategy to defeat this bill…convincing one Member of Parliament at a time to oppose Bill C-384.” Their main argument was: “Legalized assisted death would result in collateral damage to vulnerable groups.”

In these individual meetings, the coalition educated each parliamentarian about “the increasing incidences of abuse among Canada’s elderly,” and the fact that “an effective suicide prevention strategy needed to include every Canadian,” according to Schadenberg.

Eventually, the Members of Parliament “began to share our goals of improving end-of-life care and protecting vulnerable Canadians by upholding the rights of people with disabilities,” he explained. Following the vote, “a group of 30 Members of Parliament formed the Parliamentary Committee on Palliative and Compassionate Care,” Schadenberg reported. The committee will produce “a report setting a positive course for Canada, rather than legalizing the killing of its vulnerable citizens.”

Schadenberg now hopes to “turn the tide on euthanasia and assisted suicide in Canada, creating a ‘Made in Canada’ solution to these issues.”

Not limiting his efforts to Canada, Schadenberg has also organized two meetings in Seattle, Washington aimed at “developing a focused leadership willing to work with groups from every political and social constituency” in order to “convince politicians from across the political and social spectrum to oppose euthanasia and assisted suicide,” according to information sent out by the Euthanasia Prevention Coalition.

But on May 25, 2010 an article in Ontario’s Globe and Mail News reported that following the defeat of Bill C-384, the French Canadian Province of Quebec has decided that it may follow British Columbia’s lead on enforcement of the Criminal Code concerning assisted suicide.

Following a case of assisted suicide in British Columbia, the province decided that since it has the responsibility of enforcing the federal statute barring assisted suicide, the provincial government “would lay charges in such cases under only certain strict conditions,” according to the Globe and Mail article.

AUSTRALIA GOES AFTER “DR . DEATH ”

In Belgium, where euthanasia has been legal since 2002, the number of reported deaths by euthanasia last year was 822. In the last four years, the number of deaths by euthanasia per year has almost doubled.

The statistics appeared in a May 2010 article in Flanders News that also notes that these are only estimates, and likely represent one-fourth of the actual total deaths by euthanasia in Belgium last year.

The Netherlands, the first country to allow euthanasia for terminally ill patients, is now asking its parliament to consider legalizing lethal injections for healthy elderly, the UK Telegraph reported in March. Presently, Dutch deaths by assisted suicide and euthanasia average about 3,500 per year, according to the Guardian.

The Dutch “Right to Die” campaign, active since 1973, is behind the eff ort to extend euthanasia beyond the terminally ill. The initiative would allow trained, non-medical staff to administer a lethal injection to healthy people over the age of 70 who “consider their lives complete” and want to die. These certified suicide assistants would be required to make sure that patients were not temporarily depressed, and had a “heartfelt and enduring desire” to die. It has received support by a majority of people responding to national opinion polls.

Luxembourg legalized euthanasia in March 2009, while Switz erland passed a law in the 1940s legalizing assisted suicide.

The Atlantic, in a March 2010 article, examined the Swiss organization Dignitas, founded by Ludwig Minelli, a lawyer and self-described humanitarian who helps people kill themselves. The numbers of those traveling from all over Europe to commit suicide in Switzerland have steadily increased, and the country has become the new destination for “suicide tourism,” a trend that some in the Swiss government would like to curtail.

Over the last 12 years, Minelli and his staff of 14 part-time workers have helped more than a thousand people kill themselves. He owns a series of “death houses” outside of Zurich where “the group has been serving cocktails of sodium pentobarbital, a highly lethal barbiturate, to clients from around the world.”

In Australia, on the other hand, euthanasia advocate and physician Philip Nitschke (Australia’s “Dr. Death”) has started holding yearly assisted suicide seminars in France, Great Britain, Ireland, Vancouver (British Columbia), Washington State, and San Francisco, California. There have been att empts to prevent his entry into some of these countries. Australian authorities have been trying to shut down his organization, Exit International, and to block access to his website, which provides technical advice on how to kill oneself, order forms for his “death” products, and information on how and where to purchase illegal barbiturates from other countries.

THE RENAMED HEMLOCK SOCIETY KEEPS BUSY

The Denver headquarters of Compassion & Choices, the renamed Hemlock Society founded by Derek Humphrey in 1980, has been very busy. After helping to win the assisted suicide voter initiatives in Oregon and Washington, the organization is now aiming its funding and legal skills toward bringing lawsuits against other states that have antiassisted suicide legislation.

Connecticut and Montana have been the latest targets for legal skirmishes, with other states—Idaho and Massachusetts—showing evidence that Compassion & Choices is whipping up local sentiment in advance of more court cases.

In Connecticut, the recent murdersuicide of an elderly couple in North Haven gave impetus to a lawsuit fi led in October 2009. Plaintiff s in Blick v. Connecticut are represented by local counsel and lawyers from Compassion & Choices.

Gary Blick, MD, an HIV/AIDS specialist in Norwalk, Connecticut, and Ronald M. Levine, MD, an internist in Greenwich, Connecticut, filed a legal challenge to the state’s assisted suicide statute, saying that the threat of punishment prevents them from prescribing lethal doses of medication for their patients.

This past April, the Office of Protection and Advocacy for Persons with Disabilities (OPA) filed a motion in Superior Court to intervene in the lawsuit in order to ensure that the interests of those with disabilities are represented in the case. In early June, a Superior Court judge dismissed the case, saying that the issues raised by the lawsuits should be handled not by judges, but by the legislature. Compassion & Choices said it is reviewing its options, including an appeal.

In the Montana lawsuit, Compassion & Choices has declared victory. But a recent analysis of the state Supreme Court ruling against Montana’s antiassisted suicide statute suggests that the supposed “legal protections” the ruling provides for physicians involved in assisted suicide cases may not be as ironclad as originally assumed.

A MONTANA COURT RULING

In December 2008, District Judge Dorothy McCarter ruled, in Baxter vs. Montana, that Montana’s constitutional protections of “individual privacy and human dignity” allow terminally ill people to kill themselves with a doctor’s assistance. Therefore, she believed that the state’s homicide laws unconstitutionally restricted terminally ill patients’ right to “dignifi ed” deaths. Kathryn Tucker, director of legal affairs for Compassion & Choices, filed on behalf of Robert Baxter of Billings and four physicians. Baxter, who suffered from leukemia, died of lymphoma on December 5, 2008—the day Judge McCarter issued her ruling.

Tucker said that the ruling provided fairly secure legal ground for doctors. She stated: “This ruling gives a lot of comfort to a physician who has a patient suffering in the final stage of a terminal illness…in writing that prescription.”

A year later, the Montana Supreme Court, which took up the case, ruled four to two that nothing in state law or the court’s precedent was against public policy, but it decided not to determine whether the Montana constitution guarantees the right to assisted suicide. The justices pointed to laws giving patients the right to make crucial health care decisions as a justifi cation for legalizing the assistance to commit suicide.

In one analysis of this Supreme Court ruling, Montana att orney Greg Jackson and Alliance Defense Fund legal counsel Matt Bowman stated that the court “did not declare assisted suicide a constitutional right, and it imposed no duty on physicians or hosthe pitals to assist suicides.”

The attorneys added that the court decision “didn’t even ‘legalize’ assisted suicide.” Jackson and Bowman emphasized that the ruling “merely allowed a possible (patient’s) consent defense” (i.e., that the patient had consented to be assisted in suicide) and this might be used as a legal defense “for persons charged with murder for assisted suicide.” But they added that it was “an open question whether most assisted suicides would even qualify for the defense.”

Furthermore, since Montana law already defines assisted suicide as murder, “the state legislature doesn’t have to make it ‘illegal.’ The legislature can merely specify that the public policy of Montana, with respect to the already illegal act of assisted suicide, precludes the consent defense.”

Unlike Kathryn Tucker’s statement that the ruling protects physicians who prescribe lethal drugs for patients, Jackson and Bowman warn that, following the decision by the high court on Baxter, “assisted suicide continues to carry both criminal and civil liability risks for any doctor, institution, or lay person involved” in Montana.

Following the first judge’s ruling, 28 state legislators filed a brief in opposition, insisting that the court should not legalize assisted suicide without regulations, oversight, or review by the legislature. “The District Court decision endangers our citizens…without so much as even contemplating the potential abuses and social harms that may result,” the legislators wrote. “That is truly an analysis that should be left for the legislature.”

Even the high court justices suggested, toward the end of their ruling, that “public debate [should] continue, and allow the citizens of this state to control their own destiny on the issue.”

On May 30, 2010, Sen. Greg Hinkle announced he was introducing “the Montana Patient Protection Act, which prohibits physician-homicide and physician- assisted suicide, in response to the Supreme Court decision, and based on Montana’s public policy to prevent elder abuse and to value all citizens.”

As reported in a February 13, 2005 New York Times article, “Social Isolation, Guns, and a ‘Culture of Suicide,’” the state of Montana struggles with an overall high rate of suicide, rural areas with limited access to health care, and communities of Native Americans facing particularly high rates of suicide. These statistics were noted in a December 19, 2008 column writt en by Bishop George Thomas in the Diocese of Helena newspaper, The Montana Catholic.

Bishop Thomas wrote: “The era of physician-assisted suicide has been foisted upon us in Montana.” Calling the ruling by Judge McCarter “disappointing,” he said her decision echoed “disturbing actions taken in the states of Oregon and Washington, introducing this blatant disregard for human life into our own state.” Bishop Thomas explained, “‘Death with dignity’ is an unfortunate euphemism for assisted suicide because it implies a death in the natural order is not dignified. Death is a natural process in every human life, culminating in the hope of eternal life.” “The timing of this court decision could not be more ironic,” as the Montana legislature had recently established a Suicide Prevention Office because of the state’s high suicide rate, “the highest per capita in the nation,” the bishop noted. He said that the stated goal was to reduce the death toll, but that “death with dignity” stood in direct contradiction to that effort. By “cheapening life in allowing people to end it when and how they choose, we send a message to others struggling with suicidal ideations,” he emphasized.

Bishop Thomas stated: “Legalizing assisted suicide is a social experiment that we will work to prevent,” adding that the Diocese of Helena “will work with the religious, medical, and mental health communities to provide compassionate care for the dying, and surround them with emotional and spiritual care and medical management of pain to ease their suff ering.” He concluded by saying: “This is, from our vantage, death with dignity.”

ASSISTED SUICIDE IN THE NORTHWEST

Bishop Thomas, the past auxiliary bishop of the Archdiocese of Seatt le, knows too well the environment created in both Washington and Oregon after passage of voter initiatives for assisted suicide. The death toll in both states following their respective Death with Dignity Acts continues to rise, with very few of these deaths preceded by psychological counseling.

The Washington State Department of Health reported in March 2010, after the first year of legalized assisted suicide, that lethal doses of medication were dispensed to 63 people between March 5, 2009 and December 31, 2009.

“Of the 63 individuals who received lethal doses of prescription medication last year, 47 are known to have died,” the department said in a March 4 press release. “Thirty-six died after ingesting the medication…. Most had terminal cancer and all were expected to die within six months.”

The department said that according to prescribing physicians, all the patients who received the lethal medications and died had expressed concern about loss of autonomy as a reason for requesting a prescription. Of the 63 receiving lethal doses of medication, only four were sent for psychiatric or psychological evaluations.

Under the Death with Dignity Act in Washington, the physician cannot list assisted suicide as the cause of death, but instead must report an underlying illness present at the time of death, thereby forcing physicians to falsify a death certifi cate. If the death certifi cate isn’t sent to the health department, there is no way of knowing if the deceased died from assisted suicide or not.

In Oregon, the annual report from the Department of Human Services regarding physician-assisted suicide for 2009 was released March 3, 2010. It reports that 95 prescriptions were written in 2009 by 55 doctors, resulting in 59 deaths in 2009. Between 1998 and 2009, there have been 460 reported assisted suicide deaths in Oregon.

None of the 59 patients was referred for psychiatric evaluation. Over the past three years in Oregon, only 1 percent of patients committ ing assisted suicide (or two patients out of 168) were referred for psychiatric evaluation. This is in marked contrast to the report by Oregon Health Sciences University researchers in 2008 that 25 percent of patients requesting assisted suicide were considered to be depressed.

In an analysis by Physicians for Compassionate Care Education Foundation (PCCEF) of Oregon, it was noted that: “One organization is responsible for 97 percent of the assisted suicide deaths this past year, Compassion & Choices, [who are] authors of Oregon’s physician- assisted suicide law and [claim themselves as] stewards.”

PCCEF reported that The Oregonian editorial board “correctly stated in 2008 that ‘a coterie of insiders run the [assisted suicide] program, with a handful of doctors and others deciding what the public may know.’”

ENTER HOLLYWOOD

Hollywood has predictably entered the fray with two fi lms from HBO. The films cast a fairly sympathetic light on the lives of Dr. Jack Kevorkian, the notorious “Dr. Death,” and Governor Booth Gardner, instigator of a successful voter initiative for assisted suicide in Washington State last year. There is a connection between these two men, beyond their interest in assisted suicide.

Kevorkian was most active in helping people to kill themselves in the early 1990s, when Booth Gardner’s home state of Washington att empted its fi rst assisted suicide initiative in 1991. It failed, partially owing to the public’s visceral reaction to the antics of Dr. Kevorkian, who left a trail of dead bodies, many dumped in Michigan hospital parking lots.

You Don’t Know Jack tells the story of Dr. Jack Kevorkian (played by Al Pacino), a medical pathologist, who became famous in the 1990s for his “death machine.” This was a device he invented allowing the user to selfinject a lethal dose of potassium chloride. His initial att empts led to a 1993 Michigan law that specifically prohibited him from continuing, a law he openly defied in an effort to force the issue into the courts. He spent a good part of eight years in and out of court and jail. In 1998, a tape showing his assistance in the death of a paralytic, Thomas Youk, which was broadcast on CBS television’s 60 Minutes, resulted in his being convicted and sentenced to 10-25 years in prison.

The Last Campaign of Governor Booth Gardner, nominated for an Academy Award for Best Documentary Short in 2009, was produced by Just Media and HBO. The film chronicles Gardner’s fight to pass an assisted suicide initiative in Washington State in 2009 while struggling with a debilitating disease. It also contains interviews of those trying to defeat his effort.

On the website showing clips of the HBO film, Gardner bluntly states his reason for this last campaign:

In case anybody is wondering why I worked my ass off to help pass (with an impressive margin, I might add) a Death with Dignity ballot measure in Washington State, well, here’s why—Oscar-nominated why. I hope that other states follow suit.

After a career of successful political battles, including his tenure as governor of Washington, Gardner appears vexed that he now faces something he can’t “win”—Parkinson’s disease, with which he was diagnosed shortly after leaving office. Gardner laments: “I automatically thought I would have control over the rest of my life. It never dawned on me that I didn’t have any control. But that’s a fact, and that’s wrong.” He tells an audience later: “I made all the tough decisions of my life by myself. I think I should have the right to make the last decision—when it’s time for me to go and how I go.”

REAL CHOICE

Dr. William Toffler, MD tried to separate the hype from the reality of Oregonians living under the assisted suicide law in a recent letter to Helena, Montana’s Queen City News. Toffler is professor of family medicine at the Oregon Health Sciences University, and founding member of Physicians for Compassionate Care Education Foundation (PCCEF).

He said: “The safeguards in Oregon’s law have proved to be a sieve. Although ‘only the patient’ is supposed to take the lethal dose, there are documented cases of family members administering it.”

“Family members,” Toffler said, “often have their own agendas, and also financial interests, that dovetail with a patient’s death.” But the true extent of these cases will never be known since the data comes from “second-and third-hand reports”—including “doctors who are not actually present for the deaths,” he explained.

“In short, what we do know about assisted suicide in Oregon is essentially shrouded in secrecy,” he emphasized. This “scant information” is provided by the “official” Oregon statistics report, which has documented that “the majority of patients who have died via Oregon’s law have been ‘well educated,’ with private health insurance.” Toffler added, “In other words, they were likely people with money.”

“Was it really their ‘choice’?” Toffler wondered. He then urged Montanans: “Preserve choice in Montana. Reject assisted suicide.”