“Protective guidelines” serve mainly to give a wary society a false sense of security about assisted suicide

Assisted Suicide by Zoom

By Wesley J. Smith

Those who advocate the legalization of physician-assisted suicide always claim that doctor-prescribed death will involve a meticulous process of intimate conversations and hands-on examinations by qualified physicians. They promise that patients who request assisted suicide as a solution to illness or disability will receive a physical to determine the extent of the disease. If declared terminally ill, the patient must next be referred for a second opinion. Only then can the doctor dispense the lethal prescriptions.

But once it’s legal for doctors to prescribe poison, opinions about death and suicide quickly change. Assisted suicide boosters come to see “protections” as unjust “barriers” to attaining a “peaceful death.” This leads to cutting legal corners and breaking public policy promises.

The COVID-19 crisis has provided a pretext for further eroding supposedly ironclad guidelines. 

When the crisis first hit, assisted suicide advocates wrung their hands because people would be unable to access the medical examinations necessary to obtain doctor-prescribed death. Technology to the rescue! The American Clinicians Academy on Medical Aid in Dying—a newly formed association of doctors who assist suicides—recently published formal guidelines that permit doctors to assist suicides via the Internet. These guidelines state that examination should include a review of medical records and a video meeting via Zoom or Skype. The second opinion can simply be done by phone. This means that assisted suicides will be facilitated by doctors who never actually treated patients for their underlying illness, who may be ignorant of their family situations and personal histories, and who have never met their patients in the flesh.

Tele-assisted suicides have already been done. An article published in The Conversation quoted a doctor who quietly began doing streamed suicide consultations years before the COVID pandemic began.

“My patients love telemedicine,” Dr. Carol Parrot, a physician who lives on an island in Washington, told me during a Skype interview in 2018. “They love that they don’t have to get dressed. They don’t have to get into a car and drive 25 miles and meet a new doctor and sit in a waiting room.”

Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing. “I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.” 

Parrot told the interviewer that she “sometimes” consults the suicidal patient’s primary care physician. This means that she sometimes does not even bother to discuss the patient with the medical professional most familiar with the patient’s case.

The dichotomy between advocates’ easy promises and actual practice was apparent long before the COVID crisis. In Oregon, where assisted suicide has been legal since 1994, one of the so-called “protective guidelines” requires doctors to refer patients for psychological “counseling” if the prescribing physician suspects that the patient has a mental condition “causing impaired judgment.” Alas, this supposed protection has proved specious. Few physicians ever make these referrals, and when they do, the resulting consultation is often superficial.

Here’s an example. In 2008, an article in the Michigan Law Review—written by the late suicide expert, Herbert Hendin, and Kathleen Foley, perhaps the nation’s foremost palliative care doctor—described the assisted suicide of Joan Lucas. Lucas tried to kill herself after being diagnosed with Lou Gehrig’s disease, but failed. She next sought assisted suicide. The death doctor referred her to a psychologist only “to protect my ass.”

The consultation was hardly a professional interaction. From the article:

The doctor and the family found a cooperative psychologist who asked Joan to take the Minnesota Multiphasic Inventory, a standard psychological test. Because it was difficult for Joan to travel to the psychologist’s office, her children read the true-false questions to her at home. The family found the questions funny, and Joan’s daughter described the family as “cracking up” over them. Based on these test results, the psychologist concluded that whatever depression Joan had was directly related to her terminal illness, which he considered a completely normal response.

In other words, the psychologist never personally saw the patient and never considered suicide prevention. As Foley and Hendin wrote, “The psychologist’s report in Joan’s case is particularly disturbing because ‘on the basis of a single questionnaire administered by her family, he was willing to give an opinion that would facilitate ending Joan’s life.’”

Promises were broken in Oregon’s very first doctor-prescribed death in 1997. Assisted suicide boosters always depict such deaths as taking place in the context of long-term, caring relationships between doctor and patient. But according to Issues in Law and Medicine, when “Mrs. A” was diagnosed with cancer and asked for assisted suicide, her treating physician refused. So she simply went doctor shopping. A second doctor also declined and diagnosed her as depressed. She then contacted an assisted suicide advocacy organization that referred her to a new doctor—one known to be a proponent of physician-assisted suicide. This doctor gave Mrs. A the deadly prescription a mere two and a half weeks after first meeting her.

Even when patients do not qualify legally for doctor-assisted death based on the nature or extent of their illness, advocates for euthanasia and assisted suicide manage to find ways around the diagnostic impediment. Canada permits lethal injection euthanasia only if death is “reasonably foreseeable.” But what about people whose deaths are not foreseeable? No worries—they can receive a lethal jab too. An ethics opinion from the College of Physicians and Surgeons of British Columbia decided that patients who are not eligible under current law for euthanasia can become eligible by starving themselves until they are sufficiently weakened and death becomes “reasonably foreseeable.”

What can we learn from all of this? “Protective guidelines” serve mainly to give a wary society a false sense of security about assisted suicide. But once we accept suicide as an acceptable answer to suffering caused by illness or disability, our attitudes toward death become so warped that obtaining suicide for requesting patients quickly becomes the overriding priority. Over time, practices become progressively unregulated—and nobody much cares.

Because many state legislatures are not in session due to the COVID crisis, attempts to legalize assisted suicide in states like New York, Massachusetts, and Maryland are temporarily paused. But these proposals have not gone away. When the political battle resumes, we will again hear many blithe assurances of strong protections. But history demonstrates that “protections” matter little once it is legal for doctors to help patients kill themselves. 

Editor’s note. This appeared at First Things and is reposted with the author’s permission.