By Jennifer Popik, JD, Robert Powell Center for Medical Ethics
In Switzerland, the numbers of people traveling from abroad to die are growing dramatically. Even more disturbing is the fact that the reasons they cite in seeking suicide are growing beyond inevitably terminal illness to include traditionally manageable conditions. In a New Scientist magazine article, “Non-fatal diseases increasingly drive assisted suicide,” Penny Sarchet reports
“An ongoing study of assisted suicide in the Zurich area has found that the number of foreign people coming to the country for the purpose is rising. For example, 123 people came in 2008 and 172 in 2012. In total 611 people came over that period from 31 countries, with most coming from Germany or the UK, with 44 per cent and 21 per cent of the total respectively.”
Assisting suicide is legal in only a handful of jurisdictions both in the U.S. and abroad. Assisting suicide in Switzerland is technically illegal, but the law on the matter punishes only those with selfish motives–which has turned out to be nearly impossible to prove in Swiss courts. This has, in practice, led to a system where anyone can assist in a suicide with essentially no restriction on whose suicides they facilitate.
According to the Swiss government, “Assisted suicide is resorted to when life no longer appears worth living for the person concerned, in particular due to a serious physical illness.” This sort of standard-less direction from the government has made Switzerland attractive to outside groups who promote suicide. Over the past decades, so-called “suicide tourism” had become a booming business in Switzerland, where an organization called “Dignitas” and other groups arrange trips for potential suicide victims.
The number of those with non-fatal neurological disorders, arthritis, osteoporosis, and mental illness who are “helped” to kill themselves has spiked. Sarchet reports,
“Neurological diseases, only some of which are fatal, were given as the reason for 47 per cent of assisted suicides for the years 2008 to 2012, up from 12 per cent in a similar study of the same region between 1990 and 2000. Rheumatic or connective tissue diseases, generally considered non-fatal, such as rheumatoid arthritis and osteoporosis, accounted for 25 per cent of cases in the new study. Between 1990 and 2000, they were cited in only 10 per cent of cases. There was also a tiny rise in the number of people coming to Switzerland because of mental health problems – 3.4 per cent in the latest study, up from 2.7 per cent. Cancer, on the other hand, was cited in 37 per cent of cases between 2008 and 2012, a decrease of 10 per cent.
The New Scientist article quotes UK suicide advocate Michael Charouneau claiming, “We know that many of those who travel do so earlier than they would wish, whilst they are still physically well enough to make the journey.”
He then uses this to argue that Britain’s protective law should be repealed so the suicidal will know they can be assisted to kill themselves at home!
The United States is not immune to such trends. In one place where doctor—prescribed suicide is legal — Washington State — there was a 43 percent rise in doctor-prescribed suicides in 2013. In a trend similar to that in Switzerland, other concerns–not pain from a terminal illness–are motivating the requests for suicide. Loss of autonomy and “dignity” rank highest, according to the official state government report.
Washington State’s annual report covering 2013 states that 91 percent reported to their health care provider concerns about loss of autonomy, 79 percent reported to their health care provider concerns about loss of dignity, and 89 percent reported to their health care provider concerns about loss of the ability to participate in activities that make life enjoyable. In contrast, only 36% expressed concern over inadequate pain control or concern about it in the future.
While suicide advocates such as Compassion and Choices deride fears of a “slippery slope,” in fact once they achieve a foothold under the banner of limiting assisting suicide to those with “terminal illness,” and surrounding it with “safeguards,” experience shows they quickly move on to expand the grounds and eliminate the “safeguards.”
For one example, after trumpeting “safeguards” in Oregon and Washington laws, in Vermont Compassion and Choices successfully promoted a bill that ultimately has virtually none. For another example, after a Montana court decision held that “consent” is a defense to the crime of homicide, Compassion and Choices issued a factsheet for legislators that said
“The Legislature should affirm the Court’s guidelines, and not place obstacles in patients’ way. The Legislature should affirm that physician participation is voluntary, and enact protections from civil liability and professional sanctions for physicians who practice within the court’s guidelines.”
But the Montana court, while setting a few vague boundaries, never actually issued guidelines. Compassion and Choices does not really advocate for guidelines, so much as employ them to give voters and legislators a false sense of security that people will not be abused under these laws.
In seeking to head off the organized, well-funded lobby that advocates legalization of assisting suicide, it is crucial to expose the inaccuracy of the claim that “safeguards” can effectively prevent abuse. Moreover, it is important to educate others that seemingly narrow laws will inevitably expand both here and abroad.
Currently, doctor-prescribed suicide is legal in Oregon, Washington, and Vermont –and may have some legal protection in the state of Montana, due to a court decision. Also, an appeal is pending of a Second District court decision in New Mexico that struck that state’s decades-old law protecting against assisting suicide. Most recently, New Jersey was in the crosshairs, with a law like Washington’s that died in the Assembly this term. Maryland and Nevada may also be prime targets in 2015.
More information on doctor-prescribed suicide can be found here.