Euthanasia: Where Is It Today?

Many thought that the euthanasia movement would find a more fertile ground in most countries than abortion did. Many (including myself) thought that opposition to it would be much more difficult and that it would slowly become legal throughout the Western world. As of this writing, however, it is only legal in Oregon, The Netherlands, Belgium and Switzerland. Up-front attempts to legalize it in the United States have failed, with the exception of Oregon.

The first attempts were in the liberal Pacific coast states. The proposals were to legalize the direct killing of patients by their doctor. These attempts failed. Pro-euthanasia activists retrenched and came back with a softer proposal. Doctors would not directly kill but could write a prescription for a lethal dose. The patient would then voluntarily take the medicine. This is now legal in Oregon. A recent similar attempt in Michigan was soundly defeated by a 4 to 1 margin in a statewide referendum. Another also failed in Maine by a much smaller margin. All attempts to legalize euthanasia through the state courts have so far failed. Most importantly, two cases failed by 9 to 0 votes before the US Supreme Court. It ruled there was no right in the federal Constitution to euthanasia but said states could so legislate. Further, the entrance of disability rights groups opposing euthanasia has added major pro-life fire power.

So it seems that most frontal assaults on the protection of human life in the US have failed, at least to date. What we are facing now are more subtle movements in hospitals, nursing homes and now hospices to “get people dead” who are too old, infirm, dependent and expensive for the likes of government planners and the financial balance sheets of health care institutions and organizations.

Oregon
Oregon’’s law became operative in 1998. Under it, a licensed physician was allowed to write a prescription for a lethal dose of medication. The patient then was to voluntarily take this medicine and thus commit suicide. Promoters claimed the main reason why it was needed was to relieve pain—severe pain, unremitting pain, uncontrollable pain, etc.

By 2002, 58 such prescriptions were written with 38 suicide deaths. It is important to remember that the law does not require reporting, so it is quite possible that this represents only a fraction of the actual cases. Also, the law does not require reporting complications. Certainly in the absence of a requirement, a physician whose assisted — suicide patient had complications has no compelling reason to report something that would reflect negatively upon his or her own practice.

A major revelation in Oregon mirrored findings earlier in the Dutch situation. What were the reasons given by patients who wanted to end their lives? They were: losing autonomy (84%), decreasing ability to participate in activities they enjoyed (84%) and losing control of bodily functions (47%). Almost no one even mentioned pain.

Several unofficial reports have surfaced in print of situations where the lethal drug did not kill the patient. In one case, the patient had convulsions, vomited, and was disoriented and uncontrollable. The son-in-law put a pillow on her head and sat on it until she smothered. The district attorney investigating the case reported that what he did was not criminal. Since 10% to 20% of assisted suicides in Holland fail to kill the patient, the practice there has been to then give a single lethal injection. Will this be needed in Oregon? Further, if an able-bodied person has the right to “choose” to kill himself, then what of a patient with Lou Gehrig’’s disease, who is unable to perform this physical function? It would only be a matter of one court case to allow a family member to administer a lethal drug; i.e., to kill grandmother. This would break down the wall between passively watching her do it and actively doing it to her. At this time, a challenge to the law by the US Justice Department is in process. It carries the potential of negating this Oregon law.

The Dutch Situation
The situation in The Netherlands remains the classic example of the slippery slope toward euthanasia. Two decades ago, one judge refused to punish a doctor who had killed her ailing mother. That set a precedent. Then, one by one, judges recognized other reasons that allowed doctors to kill. Finally, the judge-made law was crystallized. It allowed a licensed physician to directly kill a patient under rigid conditions:

  • The request must come from the patient, and be entirely voluntary.
  • The patient’s request must be well considered and persistent.
  • The patient must be having intolerable physical or emotional pain with no prospect of improvement.
  • It must be performed by a physician.
  • The physician must consult other doctors.
  • It must be ”force majeur” (We’ve tried everything. This is a last resort).
  • Euthanasia must be reported on death certificates to proper authorities.

Reports in the media continually repeat these stringent requirements.

I have an office in The Netherlands and have spent many hours with Dutch pro-life physicians. They all tell me that every one of these requirements is routinely ignored. Particularly ignored is the ”requirement” that the patient’s request be voluntary.

There are three ways of killing patients in Holland. One is direct killing by an injection from the physician. The second, and much more common method, is performed in a hospital. They increase the dosage of morphine in an IV until the patient dies. A third is to withdraw food and water and allow the patient to die of starvation and dehydration.

Now for numbers. To date there have been two formal investigations by the Dutch government of its euthanasia program, one in 1990 and the other in 1995. The 1995 investigation reported the following reasons for death: ”direct euthanasia” 3,200; ”physician-assisted suicide” 542; ”ending life without request” 948; and ”opioids given to end life” 1,896. Dr. Herbert Hendin’s analysis concludes that these add up to 6,368 killed by ”active intervention by a physician.” (Issues in Law and Medicine, Vol. 17, No. 3, Spring 03, p.223-247)

But there is more; 60% of such deaths are not reported. In ”termination without request” there was no psychiatric consultation in 97% of the cases. Of the 6,368 deaths, there was no request to die from 48% of the patients.

The problem with the above is that the definitions of these categories continue to be blurred. The practice of turning up the morphine dose in a hospitalized patient is common and often not reported. Dr. Gunning of Rotterdam is the dean of the Dutch pro-life movement. He is convinced and continues to report that more likely 20,000 are given ”aid in dying,” half involuntarily.

Two years ago the Dutch Parliament finally officially legalized euthanasia with the same tight restrictions as above. Based on my sources, nothing has changed.

According to a 1997 study in the British medical journal Lancet, almost 10% of Dutch infant deaths today result from lethal injections—this sometimes even over parental objections.

Belgium
One year ago Belgium passed a Dutch-style euthanasia law with similar ”strict” guidelines. It took Holland almost two decades to go down the slippery slope. However, it has taken Belgium only one year. The government reports only 203 confirmed euthanasia deaths. But at a recent meeting of hundreds of Belgian doctors, individual interviews revealed that almost all the physicians there estimated the total at 1,000 or more. Most of these deaths technically violate the new law, but nothing is being done to stop it. Further, at this meeting, pro-euthanasia forces publicly requested that minors be allowed to request euthanasia, as well as people with neurologic degenerative diseases, before they become too totally helpless. These forces also requested that doctors who oppose euthanasia should be required by law to refer patients to those who will kill.

Switzerland
The situation here is slowly being exposed and reported. Assisted suicide is legal. Various sources indicate there are about 500 such cases annually. Two organizations, EXIT and Dignitas, facilitate ”suicide tourism” from other countries. There have been no prosecutions.

America
Recently, a very insidious practice has begun to rear its ugly head in the US. One example will suffice. In May 2001, Daillyn Pavia, a mature registered nurse, was charged with the death of an 86-year-old woman who was under her care at St. Louis University Hospital. She pleaded guilty to voluntary manslaughter. Her punishment? A five-year probation from practicing medicine. This would seem to have been first-degree murder, but all she got was a slap on the wrist. This sends shivers down my spine, for this is exactly what was happening in the early years of the Dutch situation. It only requires an arrogant judge (of whom the US has far too many). It reflects many judges’ attitudes that there are lives not worth living and that to help this patient die is a beneficent act. The prejudiced judge in the Terri Schiavo case is a perfect example of judicial arrogance.

This is a frightening attitude of mind. If it continues and grows, we will have given this sled a strong push down the beginning of a familiar slippery slope. This can happen while euthanasia is still technically totally illegal, but becoming more and more tolerated by the simple fact that it is not punished.

Hospice
I helped to introduce hospice into the United States 25 years ago by sponsoring one of its originators from England on a speaking tour in the States. When it became evident that hospice was less expensive than a hospital, the government announced that it would pay for such care. With this, hospices spread rapidly through the US. These institutions have since become highly respected, almost sacred. Their purpose is to make a terminal patient comfortable and pain free. They treat not just the physical discomfort, but also expedite the healing of psychological, domestic and family problems, so the patient may die in peace. No extraordinary measures are taken to keep a patient alive who is in the process of dying. But also, nothing is to be done to kill the patient.

Our problem now is that, increasingly, we are hearing stories from many parts of the country that hospice personnel are in fact killing patients. The pattern repeats itself frequently. This man was admitted to a hospice quite aware, relatively pain free and certainly not dying. Three days later the family is notified that he died. There are stories of the nurse even telling the family that she was increasing the dose of morphine and within a few hours the patient would be dead.

Prosecutions or investigations of such stories are almost nonexistent. It would seem there is probably pressure from government and HMO agencies not to investigate, for a terminal illness can be costly, and a rapid death saves them considerable money. Sometimes the family is complicit. They may be glad that a burdensome relative is gone, and his estate can now be divided amongst them. Is this true of all hospices? Of course not! But there are apparently some bad apples that cooperate in this. Prudent advice at this point would be to very closely examine the hospice in your area before committing your loved one’’s care to that institution.

Conclusion
This fight has only begun because our population is growing older. The number of taxpayers at the bottom of the demographic pyramid is dwindling as our birthrate remains under replacement level. It is so low that, at present rates, in a few years we will have only two taxpayers to pay for social services and medical care of every one older person. Something will then have to give, as there simply will not be enough taxes available to take adequate care of the aging generation. One expeditious answer to this bind is to find new ways to ”empty hospital beds.”

One final thought. If and when your state or our nation does legalize euthanasia, please do not allow or make doctors do it. Hire an executioner. Once it is known that doctors no longer only cure, but that now they can also kill, you and I will lose that indispensable and absolutely necessary trust in our physician.

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