Slouching Towards Gomorrah (31 page)

This sounds simpler and safer than it will be. Determinations of life expectancy for the terminally ill can be very wrong. When my first wife was diagnosed with cancer, the doctor told me she would live only six months to two years. She lived nine and a half years, and those were good years, for her, for me, for our children, and for her friends. Mistakes of that nature, and some of that magnitude, are certain to be made under any assisted suicide regime.

Mistakes do not express the full pathos, and evil, that will certainly attend assisted suicides. The patient who is a candidate for medical termination of his life will be in a greatly weakened physical condition, probably frightened or in despair, which means that his will and his capacity for independent thought will also be weakened. He will be flat on his back with his relatives and the authority figure of the doctor looking down at him. There can be few better subjects and settings for subtle or not-so-subtle psychological coercion. The patient will know, and probably will be informed, that prolonging his existence, which the physician says will be brief, places an enormous emotional and financial burden on his family. A great many people in this position are likely to accept premature death under coercion. That can hardly be called death with dignity.

Even when the patient requests aid in committing suicide, that will not always be instance of personal autonomy. Herbert Hendin, a professor of psychiatry, says that chronically ill and dependent people who ask help in committing suicide are not always exercising free choice. “The request can be a way of begging for support…. A patient requesting assisted suicide is often ambivalent. The request may cloak a cry for reassurance that one is loved and valued despite physical decline. If the family and the doctor don’t wish to listen, the patient may become trapped by the request and feel that he or she has no choice.“
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In fact, many hard-pressed or even not-so-hard-pressed families will prefer to be rid of the encumbrance, and the physician will almost always go along with them. What a wonderful way for an elderly, ill person, who has begged for reassurance, to depart this life and those he or she had hoped were loved ones.

Assisted suicide will certainly lead to euthanasia. “It has been reported that roughly one quarter of assisted suicides fail,” writes Doctor Edmund D. Pellegrino. That would spell disaster for any assisted suicide program. “For this law to be effective requires the next step, i.e., authorization of the physician ‘to administer the
coup de grace
if necessary.’ However, this is the very step the proponents of the law said would never come.“
²³

Quite aside from the practical necessity of euthanasia to complete botched suicides, public acceptance of assisted suicide will certainly lead to acceptance of the morally indistinguishable practice
of euthanasia. Then we will really be racing down a slippery slope. Because proponents of euthanasia routinely point to the experience of the Netherlands to demonstrate that the practice is humane and not subject to abuse, I offer the contrary views of those who have studied it.

Author Michael Fumento cites the Netherlands’ experience to oppose euthanasia, to show what it, probably inevitably, becomes.
²⁴
Until fairly recently, the Dutch law, like Oregon’s, forbade any medical killing unless a dying patient requested it. That has changed. The evolution was accomplished by Dutch courts and ratified by the legislature in 1995. In 1973, a doctor killed her terminally ill mother, was convicted, but given only a suspended sentence of one week in jail. The next step was to dispense with convictions and absolve doctors who killed patients with terminal illnesses. Then the Dutch High Court held that killing was permissible if the patient’s disability, although not fatal, was incurable. Thus, a doctor who killed a young girl with multiple sclerosis went free.

Next, the requirement that the patient request euthanasia was dropped. Doctors killed babies born with diseases such as spina bifida that were disabling but not fatal, as well as patients in persistive vegetative states. By 1990, about 11,800 deaths (9 percent of all deaths) were inflicted by doctors, about half of them without the patient’s consent. Some critics think that a socialized health care system lends itself to rationing resources by killing the sick.

The Dutch experience has also been studied by Carlos F. Gomez, a physician at the University of Virginia School of Medicine.
²⁵
He argues that what began as an exercise in patient autonomy has become something altogether different, that the Dutch experience shows that the practice cannot be regulated, and that if the practice is transplanted to the United States, our experience will be no better and perhaps a good deal worse.

Though the public theory is patient empowerment, the private practice has come to encompass a range of activities and of patients that the original proponents said would clearly be beyond acceptable limits. Gomez found, for example, that a 2-day-old child with Down’s syndrome and duodenal atresia was killed with the tacit consent of his parents. A 70-year-old man who had had a stroke was killed without being able to consent (or dissent)
because the doctor thought no one would want to live that way, although the patient was only five days into his potential recovery. Euthanasia now extends to incompetent and unconsenting patients. In a substantial number of cases, euthanasia is a unilateral decision by the physician.

Gomez calculates that euthanasia accounts for about 7 percent of all deaths in the Netherlands. If the United States had a similar rate, there would be about 140,000 cases annually. If Fumento’s 9 percent figure is correct, the United States number would be 180,000. And if it is correct that half of the Dutch euthanasias are unconsented, applying that proportion here would mean that the number of physician-inflicted unconsented deaths in this country would be between 70,000 and 90,000 annually. In fact, matters might be much worse. The Dutch practice is virtually unregulated despite the guidelines laid down by the courts. The cause of death is often misleadingly reported as something other than euthanasia—cardiac arrest, for example. We will probably never know the number of persons killed by doctors in the Netherlands or the number killed without their consent. The same ignorance will surely prevail if euthanasia comes to the United States.

In fact, Gomez thinks the U.S euthanasia rate would be higher than that in the Netherlands. Given that the rapidly rising cost of health care cannot be sustained at its current rate, it would be dangerous to introduce a license to kill. Those most in danger would be those who now overpopulate the public hospitals and clinics because private institutions will not take care of them—patients with AIDS, minorities, the demented, and those just this side of dementia.

David C. Thomasma also compares the Dutch experience and the likely American experience of euthanasia.
²⁶
He points out that terminal care in the Netherlands is part of a comprehensive national health plan so that the terminally ill need not worry that their care will bankrupt their relatives. That is not so in the United States, where the expense of caring for the terminally ill or the merely aged falls in large measure on the family. The Dutch tend to die at home, while Americans tend to die in hospitals or nursing homes. Thus, in the Dutch case there are no financial or institutional urgencies, while in the American situation there are. These, and perhaps other factors, would press towards euthanasia
more urgently in the United States than in the Netherlands.

Thomasma does not rule out the relevance of the Nazi experience. The comparison is extravagant, but there are some similarities in the progression. Hitler signed into law permission for designated physicians to kill patients judged “incurably sick by medical examination. “This was billed as merciful. But the practice soon focussed on the retarded and mentally ill, then moved on to include the elimination of Jews, gypsies, and socialists. In the United States, while we will never adopt genocide, we are already discussing euthanizing the demented elderly. There is, moreover, a coming crisis in health care created by an increasingly elderly population. Persons over 85 years of age will increase fivefold in the next fifty years, from 3 million to 15 million. There will be fewer of middle age to bear the heavy costs. “The phenomenon of the elderly (seventy to eighty-five years of age) caring for the ‘old old’ (those over eighty-five) has already begun.“
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The proponents of euthanasia and assisted suicide offer a few case histories to show how free the choice is and how compassionate is the process. We have already seen that the claim of free choice is given the lie by the frequency in the Netherlands of unconsented euthanasia. There is no reason to think such killings will be less frequent here. But even where consent is in some sense given, the claim of autonomy is dubious. Hendin says that even the selected model cases proffered by proponents show the discrepancy between theory and practice.
²⁸
He watched a 1994 film shown on Dutch television in which a patient, Cees van Wendel, who had amyotrophic lateral sclerosis (Lou Gehrig’s disease), was put to death. He expressed a wish for euthanasia after his disease was diagnosed. Severe muscular weakness confined him to a wheelchair and his speech was barely audible. When this segment was shown on
Prime Time Live
, Sam Donaldson called it “a story of courage and love.” Hendin says it is that “[o]nly for the most gullible viewer.” The doctor is the primary figure. “The patient is nearly invisible.” In the doctor’s two house calls, it becomes apparent that Cees’s wife, Antoinette, wants her husband to die.

The wife appears repelled by her husband’s illness, never touches him during their conversation, and never permits Cees to answer any question the doctor asks. She “translates” for him, although Cees is intelligible, able to communicate verbally
although slowly, and able to type out messages on his computer. The doctor asks him if he wants euthanasia, but his wife replies. When Cees begins to cry, the doctor moves sympathetically towards him to touch his arm, but his wife tells the doctor to move away and says it is better to let him cry alone. During his weeping she continues to talk to the doctor. The doctor at no time asks to speak to Cees alone; neither does he ask if anything would make it easier for him to communicate or if additional help in his care would make him want to live. Cees keeps putting off the date of the euthanasia, and his wife becomes impatient. Finally, he is given the lethal injection.

Was this the affirmation of the autonomy of the patient that euthanasia supporters insist is their object? “From the beginning, the loneliness and isolation of the husband haunts the film. Only because he is treated from the start as an object does his death seem inevitable.“
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If this was selected as a model case, it must be true that many such deaths at the hands of doctors are even less stirring examples of patient autonomy.

The systematic killing of unborn children in huge numbers is part of a general disregard for human life that has been growing for some time. Abortion by itself did not cause that disregard, but it certainly deepens and legitimates the nihilism that is spreading in our culture and finds killing for convenience acceptable. We are crossing lines, at first slowly and now with rapidity: killing unborn children for convenience; removing tissue from live fetuses; contemplating creating embryos for destruction in research; considering taking organs from living anencephalic babies; experimenting with assisted suicide; and contemplating euthanasia. Abortion has coarsened us. If it is permissible to kill the unborn human for convenience, it is surely permissible to kill those thought to be soon to die for the same reason. And it is inevitable that many who are not in danger of imminent death will be killed to relieve their families of burdens. Convenience is becoming the theme of our culture. Humans tend to be inconvenient at both ends of their lives.

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