By Jennifer Popik, JD, Robert Powell Center for Medical Ethics
A new journal article from Bioethics, “On the Moral Acceptability of Physician‐Assisted Dying for Non‐Autonomous Psychiatric Patients,” author Jukka Varelius openly makes the case that assisting suicide should be expanded to those who suffer from any kind of mental distress – even those who never request it,
Given that the distress a psychiatric patient undergoes can be very severe and that there may not always be adequate means of alleviating it (short of ending the patient’s life), the idea that psychiatric-assisted dying could sometimes be morally acceptable does merit attention. Yet it would seem that the suffering experienced by psychiatric patients who lack autonomy can be as bad as the distress that autonomous, or rational, psychiatric patients undergo, if not worse. Accordingly, it can be asked why physician-assisted dying should be limited to the cases of autonomous or rational patients, if it is endorsed in psychiatry. [internal citations omitted]
While this argument might seem shocking, particularly to those lives that have been touched by suicide and mental illness, it is what our near neighbors in Canada have just legalized, and it is exactly what the endgame is for the nation’s leading euthanasia promotion organization, Compassion and Choices (C&C).
C &C, formerly the Hemlock Society, is responsible for the promotion of dangerous laws to permit state sanctioned suicide. Upon the heels of a major euthanasia victory in California, it will no doubt use the newly enacted assisting suicide law to motivate death advocates and influence legislators.
While over 25 states did not advance legislation this year, we can be sure stronger efforts will be made in the next legislative session.
As part of a calculated effort believing that Americans are not yet ready for widespread euthanasia, C&C currently promotes carving out state laws that allow doctors to write lethal prescriptions to patients who request one so long as some illusory “safeguards” are followed. This kind of assisting suicide is legal in 4 states, California, Oregon, Washington and Vermont.* In the two states living under this law the longest, Oregon and Washington, provide evidence that safeguards are not working is mounting.
There are state-issued reports that provide evidence of non-terminally ill persons receiving lethal prescriptions. Further, there is nothing in existing law in any state that requires doctors to refer patients for evaluation by a psychologist or psychiatrist to screen for depression or mental illness. There is also no such requirement in any current proposal in any state.
The doctors can make a referral, but nearly never do. In fact, according to the Oregon’s official state reports, in 17 years of legalized doctor-prescribe suicide, a mere 5.5% of death candidates have been referred for psychological evaluation.
In short, there is evidence that no so-called “safeguards” work. What is worse, this is exactly what C&C President Barbara Coombs Lee wants. She would prefer to expand the list of those who can receive lethal drugs to any kind of discomfort a person might believe she or he is suffering from.
In the USA Today article, “Half of U.S. states consider right-to-die legislation,” Coombs Lee told reporter Malak Monir, “It’s not as simple as pain. Everyone gets to identify their own definition of suffering.” (emphasis added)
In another telling remark, Coombs Lee congratulated our close neighbors in Canada on its astounding Supreme Court decision that allows euthanasia for virtually any reason, and possibly for people whose wishes are unknown. In a press release she wrote, “We are heartened, as availability of aid in dying in Canada will have an impact here, especially in border states like New York and Maine.”
The situation in Canada is bleak. On February 6, 2015, the Supreme Court of Canada unanimously found a constitutional right to “termination of life” for anyone who has an “irremediable medical condition” and wants to die.
Unlike doctor-prescribed suicide laws in California, Oregon, Washington, and Vermont that theoretically are limited to those with terminal illness, the sweeping ruling allows killing any Canadian who “has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”
So while you might not live in either Canada, or in one of the states where doctor-prescribed suicide is legal, if more states join the ranks of California, Oregon, Washington, and Vermont, — and above all if 2016 sees the election of a president and Senate likely to use the next Supreme Court vacancy to nominate and confirm a Justice sympathetic to euthanasia–there is the real risk that in the future the U.S. Supreme Court might well follow Canada’s in holding there is a federal Constitutional right to assist suicide.
Presidential candidate Hillary Clinton has called assisting suicide “an appropriate right to have.”
If the Court were to follow Canada’s example, such a ruling might not, even nominally, apply the right only to the “terminally ill.” Instead it could include anyone who “has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual.”**
Indeed, as in Canada and as argued in the journal Bioethics, the same opinion might suggest that “surrogates” can direct the killing of children with disabilities, those with mental illness, or older people with Alzheimer’s who have never asked to die but are deemed incompetent to decide for themselves.
No one should suppose that the death advocates will stop with voluntary or even non-voluntary euthanasia. Involuntary euthanasia is an ultimate goal. In a book published in 1998, Derek Humphry, the founder of the Hemlock Society (a predecessor of Compassion and Choices), wrote supportively of the use of assisting suicide as “one measure of cost containment.”
“[T]he elderly,” he wrote, are “putting a strain on the health care system that will only increase and cannot be sustained.” Speaking of people with disabilities, Humphry wrote, “People with chronic conditions account for a disproportionately large share of health care use, both services and supplies.”
He wrote of recognizing a “duty to die” and invoked the precedent of hospital ethics committees that, then as now, routinely deny life-saving medical treatment, and even assisted feeding, against the will of patients and their surrogates. Other death advocates have made similar predictions of the need to require that the burdensome with a low quality of life be given lethal prescriptions against their will.
It would be foolish to understate the magnitude of the impact of California’s decision. But it may be hoped that the gravity of this defeat will shock and energize those who recognize that you don’t solve problems by killing those to whom the problems happen.
Instead it may cause us to redouble our efforts to block further expansion of the culture of death and, above all, to prevent the election of a president and senators who will use every available opportunity to entrench it irreversibly.
*Assisting suicide may have some legal immunity in the state of Montana, due to a state Supreme Court decision.
** “Irremediable,” the Canadian Supreme Court stressed, “does not require the patient to undertake treatments that are not acceptable to the individual.” Thus, as in the Netherlands, a depressed patient who rejects treatment for the depression has a “right” to be killed.