Death trumps choice
Debra J. Saunders Thursday, January 6, 2005
WHAT IF you knew that legalizing assisted suicide meant that sick and disabled people, who don't ask to die, nonetheless would be killed? That's the central question that Sacramento lawmakers will have to address as they consider a bill to legalize assisted suicide to be introduced by Assembly member Patty Berg, D-Eureka.
Simple fact: After The Netherlands essentially decriminalized the practice of assisted suicide and euthanasia, a government report conducted by Jan Remmelink found that 1,000 patients were killed without requesting to die in 1990, and 900 in 1995. More recently, the British medical journal, The Lancet, estimated that in 2001, among some 140,000 Dutch deaths, doctors euthanized some 3,000 patients, assisted in the suicide of about 140 patients -- but ended "life without patient's explicit request" for some 840 patients.
That's progress, I guess -- only 840 killed without asking for it. Why the change? "In 2001," The Lancet wrote, "physicians more frequently reported having become more restrictive about euthanasia and less frequently permissive. "
In 1997, The Lancet found that 8 percent of infant deaths in the Netherlands were physician induced.
Professor Raphael Cohen-Almagor of the University of Haifa wrote a paper for Issues in Law & Medicine in 2003, based on his interviews with Dutch doctors about the Remmelink data. He concluded, "Most of the interviewed Dutch authorities in the field of medical ethics are quite complacent about involuntary and nonvoluntary euthanasia, recruiting an array of justifications to show that there is no real cause for alarm even when patients' lives are terminated without their consent."
A noncomplacent doctor, Frank Koerselman, told Cohen-Almagor about an 85- year-old patient with pneumonia and depression. The man's family didn't want Dutch doctors to treat him. The patient's doctor was ready to take the easy way out. Koerselman said that he had to order security guards to remove the family so that he could question the patient in private. Then the patient opted for treatment, got it and was discharged from the hospital in very good condition, physically and mentally.
If he had not intervened as he did, Koerselman told Cohen-Almagor, the man would have died, and everyone would "say that I acted humanely and (I) would receive a nice bottle of wine from the family who physically wanted to prevent me from treating him."
Similar stories from Oregon, however, are anecdotal only. It should be noted that Oregon practices haven't been studied as the Dutch system has, and Oregon prohibits euthanasia.
Another difference: The Dutch medical system isn't plagued by the pressure to produce a profit. Pressures to cut costs are enormous in America, as politicians promise cheaper health care to assuage workers angry that their wage packages are eaten up by soaring medical costs.
People, who mean well, say, "Why not let people choose death to save society a little money?" The answer: Already some patients can't get the care they want -- even the care they paid for -- because of the bottom line. Already some suffer because some health-care administrator has decided their quality of life is so deficient they might as well die.
Let me be clear. Patients have a right to refuse care. They can say no to therapies, drugs, feeding tubes and being hooked up to life-extending machines. They should have the pain medication they need, even if it eventually kills them.
But assisted suicide changes the role of doctor from healers and protector of the sick and the disabled. Here is a noble profession that shields people who can't walk and live without assistance. Here is a calling dedicated to caring for people who are vulnerable, who may waste away, with all those messy smells and cosmetic changes that disease can bring. Still, the sick and disabled should know they will find comfort and relief from their doctors, not wrinkled noses and sneers.
Yet self-styled do-gooders want to turn these healers into professionals who kill the sick and disabled, because incontinence is undignified or because death is imminent anyway. But it's OK, people who call themselves compassionate argue, because they're doing it for the patient's own good.
Is it any wonder that some Dutch doctors took the role further and chose to kill the disabled for their own good, whether they asked to die or not? This is where the whole argument that assisted suicide is about choice evaporates. If assisted suicide offers choice for those who want it, but not for those who do not, then proposed legislation is not about promoting choice, but about promoting death.
E-mail: dsaunders@sfchronicle.com. Note: My husband, Wesley J. Smith, is a consultant to the International Task Force on Euthanasia and Assisted Suicide.
URL: http://sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2005/01/06/EDGOQAL6VE1.DTL
FYI: I didn't know Debra Saunders was married to Wesley Smith. See above post.