Chapter XXVIII: American assisted suicide.

Author:Fenigsen, Richard
Position:Other People's Lives: Reflections on Medicine, Ethics, and Euthanasia

A Family Conversation in Sarasota (491) I have always liked best the West Coast of Florida, with its wonderful abundance of birds, egrets, sandpiper and plunging brown pelicans. Gina's first cousin Irving and his wife Mary used to spend the winters in their condominium on Lido Key. When we met them at a restaurant there, Mary inquired about our previous visits to Florida. "Last year we were in Palm Beach on business," said Gina. "Tell her how you appeared in the court room with a terrible flu."

Richard: Dr. MacIver sued the State of Florida, (492) he wanted to be allowed to help a patient to commit suicide but Florida's law prohibits such acts. I testified in the case.

Mary: And are you for or against assisted suicide?

R: I fight it.

M: Why?

R: Are you for?

M: Once we had dinner with a nice elderly couple who later committed suicide. He was a retired doctor and she was quite senile or had Alzheimer's disease and was totally dependent on him. They were members of some kind of society.

R: Hemlock.

M: Yes, and them being so old and frail and as they wanted to die. I don't see why not. They invited their children and friends, had a farewell dinner, and then he gave her the pills and later took the pills himself; and they both died. To go together, that was what they wanted.

R: They acted on delusion.

M: What do you mean?

R: They were together as long as they lived. There is no togetherness after death.

Irving: You may be right, in a sense.

M: But did you hear of that woman in New York who gave pills to her mother and so helped her to die? She would never have got in trouble had she not told the story. But she published a book about it and Morgenthau ...

Gina: Which Morgenthau?

R: The district attorney.

M: Yes. He arrested her. She had to take the oath and tell how sick her mother had been, and that the mother herself had badly wanted to die. The daughter got away with it but only after this whole ordeal.

R: The ordeal? Do you think one should be able to dispatch the mother, period, no questions asked?

M: No, but you know ...

R: And I wonder when the idea of writing a book entered the lady's mind. If this occurred to her before the act, she couldn't help minding the future book while she pondered and prepared the mother's suicide.

M: That is a nasty thing to say!

R: Perhaps. But the problem deserves attention. I mean, what are the real motives of family members who hasten death of a loved one? It is generally assumed that their motives can only be noble: empathy, love, desire to free the loved person from suffering. Is it always so? It is amazing that those noble explanations are unqualifiedly accepted. After all, human lives are at stake; shouldn't we be more inquisitive?

M: Maybe. Still I think people should be free to choose their own death, and if they are unable to do it themselves they should be helped. You haven't yet told me why you are against it.

R: No, I haven't. Remember, the law in this state prohibits helping another person to commit suicide. So I am under no obligation to justify my position. The burden of the proof is on those who want to change the status quo. But I'll try to explain my reasons. I could not expect much of your attention in the restaurant, over excellent food, with all that talk and music around us. Let's now go for a walk, and postpone the rest of the discussion till our next meeting.

We haven't resumed that conversation, and now we shall not be able to do so: of the four persons, two are no longer living.

The Assisted Suicide Story. Physician's assistance with suicide is all we hear nowadays, and the impression is created that this is and always has been the aim of the American "right-to-die" movement. It doesn't take a very long memory to know that physician-assisted suicide is a recent invention. Historically, the American movement has always promoted active euthanasia, lethal injections administered by physicians, with (or, sometimes, without) consent of the patient. In 1938 the American Euthanasia Society submitted a bill to the New York legislature that would permit voluntary active euthanasia. (493) The American promoters of euthanasia in the nineteen forties, Dr. Foster Kennedy, (494) W.G. Lennox, (495) and Dr. Abraham Wolbarst, (496) Rev Joseph Fletcher, (497) the champions of euthanasia in the 1970's, (498) and the Hemlock Society up to 1994 (499)--all of them proposed euthanasia by lethal injection and nothing else.

But it turned out that American society was not ready to accept lethal injection administered by physicians. The measures proposing legalization of active euthanasia could not be put on the ballot in California in 1988, nor in Oregon in 1990, because the activists were unable to collect the required number of signatures.

In 1991, a bill that would legalize voluntary active euthanasia was put on the ballot in Washington state. That fall, the situation seemed to portend a victory for the supporters of the bill. The state's Medical Association took an equivocal position. The pre-referendum polls indicated that the majority of respondents favored the bill.

When November 5th came, the day of the ballot, the voters rejected the euthanasia bill by a majority of fifty-four percent. (500) Analyzing the result, some observers pointed out that new medical killings revealed by Dr. Kevorkian had deterred voters. Moreover, the newly published Dutch governmental survey of euthanasia, which showed that involuntary euthanasia was practiced on a large scale, was promptly faxed from Holland, presented at a press conference in Seattle, and may have influenced the vote. But first and foremost the ballot's result was due to the highly informative educational campaign led by a group of talented and dedicated activists, Mrs. Mary-Jo Kahler, Miss Eileen Brown, R.N., Dr. Robert Bernhoft, and Dr. Dorsett Smith.

The next year, 1992, a bill to legalize active euthanasia was rejected by the voters of California. (501)

The new Board of the Hemlock Society learned a lesson from these experiences. It was decided to suspend the campaign to legalize active euthanasia. Instead, the Society would now aim at the legalization of physician-assisted suicide.

Physician-Assisted Suicide: Is It Arty Better than Active Euthanasia? Physician-assisted suicide is more easily accepted by the public because it is believed to be an arrangement in which the patient remains in full control. This is of course an illusion. The overwhelming influence of the doctor, the sick person's swinging moods, the attitude of the family, the propaganda that is infecting a person's language and thinking--all these factors are part of a patient's suicidal decision.

It is the doctor who informs the patient on the diagnosis and prognosis, and, unfortunately, in this country some doctors do it in a callous or brutal way that may destroy the patient's will to live. (502) But also soft-spoken doctors who believe that suicide can be a rational solution, and discuss it in all seriousness, may induce the patient to put an end to his life. The patient thinks he can discuss it "safely"--after all, he's talking to his doctor! Some doctors impermissibly encourage dreams of delights that await the patient in the other world. Holland's leading practitioner of euthanasia, Dr. Pieter Admiraal, told the interviewer that before injecting the patient with drugs that paralyze the heartbeat and the respiration, he wished him "a very good journey to an unknown you've never seen." (503) The American pioneer of assisted suicide, Dr. Timothy Quill, tells in his report how his patient announced her intention to meet him after her suicide at her favorite spot on the shore of Lake Geneva, and they would...

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