Euthanasia / Assisted Suicide - Archive

Support for Physician-Assisted Suicide Requires a Blind Eye to Past, Present, and Future Abuses

I’ve known bioethicist Art Caplan for over 25 years. During that time span we have corresponded back and forth many, many times. He held positions that differ from National Right to Life’s from mildly different to radically, whole-heartedly different.

Why do I mention this? For two reasons. Caplan is, as he is often described, the “go-to” bioethicist whenever the media is looking for an “objective” perspective on just about every imaginable issue that falls under the (self-appointed) purview of bioethicists.

And second, because Caplan is seemingly omnipresent–on network and cable television, on op-ed pages, in news stories, and more specialized academic publications–his views carry weight.

There was never any doubt that Caplan would eventually go public with what clearly (to anyone reading his comments) was his private opinion: that whatever reasons there were previously to oppose legalizing physician-assisted suicide, experience had taught us (or at least Caplan) that legalizing assisted suicide would not unleash an anti-life genii which would wreak widespread havoc.

We’ve reposted elsewhere a terrific response from Nancy Valko which offers a fine-grained critique of the bottomless well of dubious assumptions Caplan relies on. She honed in on the very shaky unpinning of Caplan’s argument in “More States Approve Physician-Assisted Dying. Is This Risky?“: that there is no slippery slope. Or, to more accurate, there hasn’t been in the United States and won’t be in the future.

No one, including Caplan, could miss that the euthanasia/assisted suicide train had long since left the only-when-the-patient-is-terminal-and-in-pain station. It is running wildly off track.

So what is Caplan’s answer to his own recitation of the grim facts–people are not terminally ill, they want to die because they can’t stop grieving for their lost spouse, they seek assisted suicide because they are going blind or deaf, for starters? Two answers.

First, before introducing these abuses (and others) Caplan says, “We have seen a little bit of that behavior take place in Belgium and Holland,” meaning zipping down the slippery slope.

A “little bit”? Wow!

Second, none of that stuff could happen here in the United States. Physician-assisted suicide is working swimmingly in Oregon and Washington state.

But it isn’t – indeed, there is no way to know if the “safeguards” are working because of the way the deaths are reported, or not reported. As NRLC’s Jennifer Popik, JD, has written:

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.

What is even more disturbing is that in Washington and Oregon, death certificates are not permitted to give suicide as the case of death. Moreover, in those states the health department must destroy the required underlying reporting paperwork after only one year. This makes both potential litigation, and identifying true numbers of suicides very difficult.

One other extremely important consideration. Caplan is persuaded that the lesson of Oregon and Washington is that only a relative handful of people will avail themselves of the deadly concoction. That “handful” will be in the thousands, now that California has legalized assisted suicide.

But note: the rationale for physician-assisted suicide has already morphed out of pain and terminal illness as requirements to just about any justification they can offer. Moreover, if the last 25 years has taught us anything, it is that the “right to die” in all its many iterations, cannot be limited to the competent or even to adults.

Again, to quote Popik (referring to a proposal defeated in Massachusetts which has since been reintroduced)

Even more shockingly, State courts have ruled time and again that if competent people have a right, the Equal Protection Clause of the United States Constitution’s Fourteenth Amendment requires that incompetent people be “given” the same “right.” Under the Massachusetts state constitution, this would also be the case. Consequently, a “surrogate” could direct doctor-prescribed death for those unable to make decisions for themselves, such as patients with an advance Alzheimer’s.

Caplan subscribes to a belief in a different kind of American Exceptionalism. That is, the forces that have sucked countless other categories of people into the assisted-suicide vortex in Europe will be powerless here. We are safe, safe, safe from the human condition.

But even if you don’t want to admit it (because it weakens your argument), you have to take into consideration what the primary driving force behind assisted suicide is saying. Here’s what Barbara Coombs Lee, executive director of Compassion and Choices, said in a story published in April in USA Today.

Both Oregon and Washington found that participants had three major concerns: loss of autonomy, diminishing ability to engage in the activities that make life enjoyable, and loss of dignity. Meanwhile, only about a third of patients in both states were concerned about inadequate pain control.

“It’s not as simple as pain,” Coombs Lee said. “Everyone gets to identify their own definition of suffering.”

It is sad to see an old sparring partner knock himself out with his own arguments.

But it is far sadder that Caplan’s support for what he calls “physician-assisted dying” will help pave the way in the United States for exactly what he insists cannot happen here.

[November 4, 2015, Dave Andrusko, ]