Assisted suicide and the slippery slope towards eugenics

With last week's vote on A2270, New Jersey's Assembly approved physician assisted suicide. Oregon, Washington and Vermont have also passed AS (Assisted Suicide) laws.

State courts in Montana and New Mexico have affirmed the rights to physician assisted suicide.

What's wrong with that, you might well ask. If a person is terminally ill and wishes to end his or her suffering, why should this not be permitted?

In fact, this issue is not as clear cut as some might wish you to believe. The effect of such legal permissions, as seen in other countries which have historically permitted doctor assisted suicide, is worth reviewing.

Before we look at how this issue has played out in Switzerland, the Netherlands and Belgium, let's first define our terms. Euthanasia is also called "mercy killing," and is defined as the act of putting to death painlessly or allowing to die, as by withholding extreme medical measures, a person (or animal) suffering from an incurable disease or condition. The law generally differentiates between active and passive euthanasia. As defined in Wikipedia, "Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life. Active euthanasia entails the use of lethal substances or forces, such as administering a lethal injection, to kill and is the most controversial means."

Assisted suicide, on the other hand is defined as follows: "Suicide facilitated by another person, especially a physician, who organizes the logistics of the suicide, as by providing the necessary quantities of a poison."

Switzerland became the first country to legalize assisted suicide in 1942. In the 1980s, the law was reinterpreted to allow the existence of organizations to provide aid in dying. There are now six organizations in Switzerland which, for a fee, will help you to die. According to a recent study in the Journal of Medical Ethics, about six hundred people a year - many of whom are foreigners - avail themselves of these services in Switzerland. Hence the term - "suicide tourism."

In 2002, Netherlands passed the Termination of Life on Request and Assisted Suicide Act, which legalized euthanasia and physician assisted suicide in specific cases, and for people twelve years old and up. In 2004, the Groningen Protocol came into effect, which allows doctors to euthanize infants, who are obviously not able to request or consent.

According to EPC-Europe, "In the Netherlands the number of deaths by euthanasia has increased by 64% between 2005 and 2010 ... In comparison, the Dutch population grew by less than two percent over the same period. Yet the Dutch are now discussing the extension of euthanasia to people with dementia despite huge concerns about proper consent." In addition, euthanasia is now being performed on psychiatric patients in the Netherlands, with 42 such cases reported in 2012.

We have seen the expansion of the concept of relieving a person's pain to apply to emotional and psychiatric problems. Recently, an 89-year-old retired art teacher took her life at Dignitas in Switzerland. In an interview given to the London Times, she stated that she couldn't adapt to modern life and found that other people were acting increasingly like "robots." She had no terminal illness.

Dignitas also recently accommodated the end-of-life wishes of an 85-year-old Italian woman, who was depressed that she was "losing her looks." Oriella Cazzanello had no terminal illness and, other than wounded vanity, had been in excellent health.

There is a slippery slope through which assisted suicide is becoming acceptable for those with emotional rather than terminal physical pain. This incurs uncomfortable recollections of the treatment of psychiatrically ill people in medieval times. Modern medicine seemed to go a great distance to reverse the perceptions and fate of those who were mentally ill, only to have a contemporary pathway carved out for their termination, via "choice."

Belgium's laws have also raised concern. In recent reports, at least 32% of the euthanasias in Belgium appear to have been done in the absence of a request. It is of concern that these "unrequested euthanasias" are not being investigated as possible murders. In addition, a great number of euthanasias are considered to be unreported. Many of the unreported assisted suicides are apparently being done by nurses. Belgium's law explicitly prohibits this.

Earlier this year, Belgium lifted the ban on child euthanasias and now allows children to request to be euthanized.

The intersection between adult guardianship and AS needs careful attention. Under the law in many venues, guardians may make end-of-life decisions for their wards. The potential for abuse here is undeniable. The guardian may sign a "do not resuscitate order" for her client, and may order an assisted suicide without the individual's knowledge or consent.

This scenario, as alarming as it may seem, is becoming quite common in guardianships throughout the US. In one publicized case, a guardian in Southern California, Melodie Scott, ordered that the physician for Elizabeth Fairbanks not provide her client with needed antibiotics when Fairbanks came down with pneumonia. Fairbanks succumbed to a treatable illness due to the decisions made by Melodie Scott, decisions which were in fact protested by Fairbanks' adult children. Fairbanks was under a mental health guardianship.

It was subsequently revealed that Fairbanks' bank accounts had nearly run dry. As guardian of person and estate, Melodie Scott was paid by Fairbanks' savings.

In another recent case in California, a probate attorney, J. David Horspool, put his father under a guardianship and promoted the appointment of one of his sisters, Margaret Updike, as the guardian. Updike decided not to have the batteries replaced in her father's pacemaker and to let him die of heart failure.

J. David Horspool's law office then reported that Raymond Horspool's Will had been "misplaced." Raymond Horspool's daughter, Barbara Howard, has sued for wrongful death. The case is winding its way through court.

In an Illinois guardianship case, Alice Gore's teeth were mined for their gold content prior to her demise

Margaret Dore, a Seattle based attorney and anti-AS activist, raised concerns about the New Jersey bill. In a recent article on her website, choiceisanillusion.com, Dore writes, "...there will be pressure to expand 'eligibility' to broader groups of people who are not close to death."

She cites the debate ongoing in the State of Washington, where there are now discussions recommending the extension of euthanasia to people who do not have the funds to support themselves. Dore also cites a recent Washington Post article, which states that there "appears to be a surge in hospices enrolling patients who aren't close to death."

With advancements in medicine, the spectre of suffering unbearably while one is in the process of dying is pretty much a thing of the past. The current state of palliative care has largely erased that concern. So the rallying cry for "Death with Dignity" must be carefully scrutinized. Particularly when those who may profit from the death of others are waving this banner.

The New Jersey Bill now goes to the Senate. A petition is being circulated asking New Jersey Governor Christie to veto the bill.

AS bills are pending legislative consideration in several other states. The UK, Canada, France and Germany are also considering legislation.