Euthanasia and Assisted Suicide
Rita L. Marker and Kathi Hamlon
One of the most important public policy debates today surrounds the issues of euthanasia and assisted suicide. The outcome of that debate will profoundly affect family relationships, interaction between doctors and patients, and concepts of basic ethical behavior. With so much at stake, more is needed than a duel of one-liners, slogans and sound bites.
The following answers to frequently asked questions are designed as starting points for considering the issues. For more detailed information see the documented, in-depth material available at this web site.
1. Where are euthanasia and assisted suicide permitted?
In 1995 Australia’s Northern Territory was the first jurisdiction to pass a euthanasia bill. It went into effect in 1996 but was overturned by the Australian Parliament in 1997.
As of early 2015, euthanasia and/or assisted suicide were permitted in Oregon, Washington, Vermont, The Netherlands, Belgium, Luxembourg and Colombia.
Although euthanasia and assisted suicide are illegal in Switzerland, assisted suicide is penalized only if it is carried out “from selfish motives.”
De facto legalization exists in Montana.
On February 6, 2015, the Canadian Supreme Court ruled that both assisted suicide and euthanasia are legal but suspended implementation of the decision for one year.
2. What is the difference between euthanasia and assisted suicide?
One way to distinguish them is to look at the last act – the act without which death would not occur.
Using this distinction, if a third party performs the last act that intentionally causes a patient’s death, euthanasia has occurred. For example, giving a patient a lethal injection or putting a plastic bag over her head to suffocate her would be considered euthanasia.
On the other hand, if the person who dies performs the last act, assisted suicide has taken place. Thus it would be assisted suicide if a person intentionally swallows an overdose of drugs that has been provided by a doctor for the purpose of causing death. It would also be assisted suicide if a patient pushes a switch to trigger a fatal injection after the doctor has inserted an intravenous needle bearing a lethal drug into the patient’s vein.
3. Doesn’t modern technology keep people alive who would have died in the past?
Modern medicine has definitely lengthened life spans. A century ago, high blood pressure, pneumonia, appendicitis, and diabetes likely meant death, often accompanied by excruciating pain. Women had shorter life expectancies than men since many died in childbirth. Antibiotics, immunizations, modern surgery and many of today’s routine therapies or medications were unknown then.
4. Should people be forced to stay alive?
No. Many people think that euthanasia or assisted suicide is needed so patients won’t be forced to remain alive by being “hooked up” to machines. But the law already permits patients or their surrogates to withhold or withdraw unwanted medical treatment even if that increases the likelihood that the patient will die. Thus, no one needs to be hooked up to machines against their will.
Neither the law nor medical ethics requires that “everything be done” to keep a person alive. Insistence, against the patient’s wishes, that death be postponed by every means available is contrary to law and practice. It is also cruel and inhumane.
There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. That’s when hospice, including in-home hospice care, can be of great help. That is the time when all efforts should be directed to making the patient’s remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to providing emotional and spiritual support for both the patient and the patient’s loved ones.
5. Does the government have the right to make people suffer?
Absolutely not. Likewise, the government should not have the right to give one group of people (e.g. doctors) the power to directly and intentionally end the lives of another group of people (e.g. their patients).
Activists often claim that laws against euthanasia and assisted suicide are government mandated suffering. But this claim would be similar to saying that laws against selling contaminated food are government mandated starvation.
Laws against euthanasia and assisted suicide are in place to prevent abuse and to protect people from unscrupulous doctors and others. They are not, and never have been, intended to make anyone suffer.
6. But shouldn’t people have the right to commit suicide?
Suicide is not illegal, and, tragically, people can and do intentionally end their own lives. Every 40 seconds a person dies by suicide somewhere in the world. In the United States alone, there were 41,149 reported suicides in 2013. At the same time there were 14,196 homicides, making the number of suicides almost three times greater than the number of homicides.
Euthanasia and assisted suicide, however, are not private acts. Rather, they involve at least one person facilitating the death of another. This is a matter of very public concern since it can lead to tremendous abuse, exploitation and erosion of care for the most vulnerable people among us.
Euthanasia and assisted suicide are not about giving rights to the person who dies but, instead, they are about changing public policy, giving doctors the power to prescribe or administer lethal drugs.
7. Shouldn’t there be softer terms to describe doctor-prescribed suicide and doctor-administered euthanasia?
While changes in laws have transformed euthanasia and/or assisted suicide from crimes into “medical treatments” in some jurisdictions, the reality has not changed – patients are dying from lethal doses of drugs that are prescribed or administered by doctors. Ending one’s own life is suicide. Ending the life of another person is homicide.
Euthanasia and assisted suicide activists often use euphemisms like “deliverance,” “death with dignity,” “aid-in-dying” and “gentle landing.” If a change in public policy has to be promoted with euphemisms, doesn’t this make it clear that the use of accurate, descriptive language makes the chilling reality too obvious?
8. Isn’t euthanasia or assisted suicide only available to people who are dying and in great pain?
No. There is not a requirement in any place where euthanasia and/or assisted suicide are legal that the patient be in pain in order to qualify for death.
For example, in Oregon, the official reports indicate that the reason more than 90% of those who die from doctor prescribed suicide do so because they are concerned about loss of autonomy and loss of ability to engage in activities making life enjoyable. Pain concerns are one of the least cited reasons for assisted-suicide requests.
In The Netherlands, mentally ill patients are given lethal injections. In Belgium, an elderly couple announced plans to be euthanized even though neither had a terminal illness. Instead, they feared loneliness if one died from natural causes.
9. Wouldn’t euthanasia and assisted suicide only be at a patient’s request?
No. As one of their major goals, euthanasia proponents seek to have euthanasia and assisted suicide considered “medical treatments.” If one accepts the notion that those practices are good medical treatments, then it would not only be inappropriate, but discriminatory, to deny such good treatments to a patients solely because they are too young or mentally incapacitated to request it.
In Oregon, patients who are mentally incapacitated have been deemed capable of requesting doctor-prescribed suicide. For example, it has been noted that “a psychological disorder – senility, for example – does not necessarily disqualify a person” from requesting and receiving the lethal prescription.
In United States jurisdictions where doctor-prescribed suicide is considered a medical treatment, the law states that patients cannot be coerced into requesting death. However, they do not prohibit anyone from advising, suggesting or encouraging a patient to request the lethal dose.
In fact, the supreme court of one state has ruled that a law that bans advising or encouraging another’s suicide violates free speech rights.
10. Could euthanasia or assisted suicide be used as a means of health care cost containment?
“Choice” is an appealing word, but inequity in health care is a harsh reality.
In states that permit doctor-prescribed suicide, doctors are to inform patients about all treatment options. But discussing all options does not mean that the patient will have the ability to access those options.
Patients may find that their insurance will not cover the “feasible alternatives” their doctors informed them about but, instead, will pay for doctor-prescribed suicide.
That has already happened in Oregon where the Oregon Health Plan (OHP) notified patients that medications prescribed to extend their lives or improve their comfort level would not be covered, but that the OHP would pay for a lethal drug prescription.
Referring to payment for assisted suicide, the Oregon Department of Human Services explains, “Individual insurers determine whether the procedure is covered under their policies, just as they do any other medical procedure.”
If doctor-prescribed suicide becomes just another “end-of-life option,” and a cheap option at that, the standard of care and provision of health care changes. There is less and less focus on extending life and eliminating pain, and more and more focus on the “efficient and inexpensive treatment option” of death.
The last to receive health care could be the first to receive doctor-prescribed suicide.
11. Don’t the years of experience in Oregon prove that those who oppose doctor-prescribed suicide are being alarmists when they warn about abuses and problems?
Those who promote doctor-prescribed suicide point to Oregon’s experience with assisted suicide under that state’s “Death with Dignity Law.” They claim that years of official reports from that state prove that abuses and problems do not occur. However, when a British House of Lords committee traveled to Oregon seeking information about Oregon’s law, they found that claims about the Oregon experience are problematic, at best.
They found that safeguards in the law are disregarded and no one has been disciplined. In addition, the state does not have the legal authority or the resources to investigate any suspected problems. There is no assessment of patients after the prescription is written since the state’s job is only to make sure that all the steps happened up to the point the prescription was written. One official said that after writing the prescription, the physician may not keep track of that patient since “the law itself only provides for writing the prescription, not what happens afterwards.”
It is the prescribing physician who fills out the information for official reports, including whether there were any problems, abuses, etc. at the time the drugs were taken. But, even the state’s official reports indicate that the prescribing physician is very rarely present when the lethal drugs are taken so the reported information is likely “second hand.”
As early as the first official report, the state acknowledged that it has no way of knowing if the information included in the annual reports is accurate or complete but that it is assumed that the reporting doctors are being their usual careful accurate selves.
Therefore, any claim that, in Oregon, doctor-prescribed suicide is problem free is extremely questionable.
12. Doesn’t doctor-prescribed suicide make certain that patients can take a pill and slip peacefully away, surrounded by their loved ones?
No. It is inaccurate to state that the patient takes “a pill.” In fact, a massive dose of drugs must be consumed.
According to Oregon’s 2015 official report, deaths under the Death with Dignity Act occurred after 60% of patients took Secobarbital (Seconal) and 39% took Pentobarbital (Nembutal). Both are barbiturates (sedatives). The usual therapeutic dosage for each is 100 to 200 mg. (Pentobarbital has become extremely difficult to obtain since manufacturers are refusing to supply it because it is used for lethal injections in capital punishment.)
However, the usual doctor-prescribed suicide dose for each is 9000 to 10,000 mg. That is 90 to 100 times the usual therapeutic dose!
Advocates describe deaths under the Oregon law as peacefully slipping away. If it were not for occasional news reports and inadvertent disclosures, assisted-suicide in Oregon would seem problem free. However, there are troubling accounts. For example:
After Patrick Matheny received his lethal dose of drugs from the Oregon Health Sciences University via Federal Express, he delayed taking them for four months. On the day of his death, he experienced difficulty. His brother-in-law, Joe Hayes, said he had to “help” Matheny die. According to Hayes, “It doesn’t go smoothly for everyone. For Pat, it was a huge problem. It would not have worked without help.”
Another assisted suicide that went awry was disclosed by attorney Cynthia Barrett, an assisted suicide supporter during a class at Portland Community College titled, “Physician Assisted Suicide: Counseling Patients/Clients.” According to Barrett, “The man was at home. There was no doctor there,” she said.”After he took it [the drug overdose], he began to have some physical symptoms. The symptoms were hard for his wife to handle. Well, she [the wife] called 911. The guy ended up being taken by 911 to a local Portland hospital. Revived. In the middle of it. And taken to a local nursing facility. I don’t know if he went back home. He died shortly – some period of time after that time.”
Similar reports have come from The Netherlands:
Although euthanasia and assisted suicide remained technically illegal in The Netherlands until 2001, for many years the Royal Dutch Association of Pharmacy had provided prescribing guidelines to prevent problems and to increase the efficiency of euthanasia and assisted suicide. Yet there are still a number of complications and problems reported with such deaths.
Even Dutch euthanasia activists acknowledge these difficulties, stating in their own euthanasia society publication that, in one out of five cases of euthanasia or medically-assisted suicide, there are problems or complications. 
13. Since euthanasia and assisted suicide take place anyway, isn’t it better to legalize them so they’ll be practiced under careful guidelines and doctors will have to report these activities?
That sounds good, but it doesn’t work. It assumes that those who are currently breaking the law would adhere to guidelines.
But it is helpful to apply that argument to other situations.
For example, we know that employees sometimes embezzle from their companies. Would we favor a law that permits them to do so under certain guidelines?
In fact, those who are breaking the law now would likely ignore guidelines, and those who are abiding by the law now would begin to carry out the previously prohibited activity.
14. Isn’t euthanasia or assisted suicide sometimes the only way to relieve excruciating pain?
Quite the contrary. Euthanasia and assisted suicide activists exploit the natural fear people have of suffering and dying by claiming that, without euthanasia or assisted suicide, people will be forced to endure unbearable pain.
However, virtually all pain can be eliminated or – in those rare cases where it can’t be totally eliminated – it can be reduced significantly if proper treatment is provided.
It is a national and international scandal that so many people do not get adequate pain control because physicians are not properly trained in pain control. But giving doctors the power to end their patients’ lives is not the answer to that scandal. The solution is to mandate better education of health care professionals on these crucial issues, to expand access to health care, and to inform patients about their rights as consumers.
In 2002, the Patients Rights Council published an important book, Power over Pain: How to Get the Pain Control You Need, which is an incredibly valuable tool for people to use in obtaining pain relief.
Everyone – whether a person with a life-threatening illness or a chronic condition – has the right to pain relief. With modern advances in pain control, no patient should ever be in excruciating pain. Unfortunately, many doctors have never had a course in pain management so they’re unaware of what to do.
If a patient who is under a doctor’s care is in excruciating pain, there’s definitely a need to find a different doctor. But that doctor should be one who will control the pain, not one who will prescribe or administer lethal drugs.
There are board certified specialists in pain management who can not only help alleviate physical pain but who are also skilled in providing necessary support to deal with emotional suffering and depression that often accompany physical pain.
15. Isn’t opposition to euthanasia and assisted suicide just an attempt to impose religious beliefs on others?
No. Euthanasia and assisted suicide activists have attempted for a long time to make it seem that anyone opposed to their agenda is trying to impose his or her religion on others. But that’s not the case.
Nonetheless, stereotyping has been, and will continue to be, part and parcel of campaigns to promote doctor-prescribed suicide and doctor-administered euthanasia. Its purpose is to marginalize those who work to protect vulnerable patients.
People on both sides of the euthanasia and assisted suicide controversies claim membership in religious denominations. There are also individuals on both sides who claim no religious affiliation at all. But it’s even more important to realize that these are not religious issues, nor should this be a religious debate.
The debate over euthanasia and assisted suicide is about public policy and the law.
The fact that the religious convictions of some people parallel what has been long-standing public policy does not disqualify them from taking a stand on an issue.
For example, there are laws that prohibit sales clerks from stealing company profits. Although these laws coincide with religious beliefs, it would be absurd to suggest that such laws should be eliminated. And it would be equally ridiculous to say that a person who has religious opposition to it shouldn’t be able to support laws against stealing.
Similarly, the fact that the religious convictions of some euthanasia and assisted-suicide opponents parallel what has been long-standing public policy does not disqualify them from taking a stand on the issues.
16. Where does the main support for euthanasia and assisted suicide come from?
The most visible and vocal proponents of euthanasia and assisted suicide are organizations made up of committed activists who seek to change the laws. But, they are only able to pursue their agenda because of funding from a handful of extremely generous sources.
Far from reflecting any grassroots desire, the push for legalization of euthanasia and assisted suicide is a “top down” creation where the few seek to change the laws that affect everyone.
17. Since suicide isn’t against the law, why should it be illegal to help someone commit suicide?
Neither suicide nor attempted suicide is criminalized anywhere in the United States or in many other countries. This is not because of any “right” to suicide. When penalties against attempted suicide were removed, legal scholars made it clear that this was not done for the purpose of permitting suicide. Instead it was intended to prevent suicide. Penalties were removed so people could seek help in dealing with the problems they’re facing without risk of being prosecuted if it were discovered that they had attempted suicide.
 “Rights of the Terminally Ill Act,” Northern Territory of Australia (1996). See additional information on Australia.
 Oregon’s “Death with Dignity Act” (ORS 127.800-897) passed in November 1994 and went into effect in 1997. See additional information on Assisted Suicide in Oregon.
 Washington approved the Washington “Death with Dignity Act” on Nov. 4, 2008. See additional information on Washington.
 Vermont ‘s law permitting doctor-prescribed suicide went into effect on May 20, 2013. See additional information on Vermont.
 Although both euthanasia and assisted suicide had been widely practiced in the Netherlands for many years, they remained technically illegal until passage of a bill for the “Review of cases of termination of life on request and assistance with suicide” was approved in April 2001. See additional information on Holland.
 Belgium’s law was passed on May 16, 2002. See additional information on Belgium.
 In 1997, Colombia’s Supreme Court ruled that penalties for mercy killing should be removed but the decision was not to go into effect until guidelines were approved by the Colombian Congress. (Republic of Colombia Constitutional Court, Sentence # c-239/97, Ref. Expedient # D-1490, May 20, 1997.)
The guidelines were not approved until 18 years later, in April 2015. (Sabrina Martin, “At last Colombia approves euthanasia guidelines.” PanAm Post, April 23, 2015 and Simeon Tegal, “Colombia just legalized euthanasia,” Global Post, April 29, 2015.) See additional information on Colombia.
 Swiss law states, “Whoever, from selfish motives, induces another to commit suicide or assists him therein shall be punished, if the suicide was successful or attempted, by confinement in a penitentiary for not more than five years or by imprisonment.” [Article 115 of the Penal Code] [emphasis added]. See additional information on Switzerland.
 On December 31, 2009, the Montana Supreme Court declared that, if charged with prescribing drugs to end a patient’s life, physicians could use the patient’s consent as a defense to a charge of assisted suicide. The decision established de facto legalization. See additional information on Montana.
 World Health Organization, 2014 .
 American Foundation for Suicide Prevention, citing the Centers for Disease Control and Prevention (CDC).
 Federal Bureau of Investigation (FBI), “Crime Statistics for 2013”.
 The testimony was published in: House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, “Assisted Dying for the Terminally Ill Bill [HL]” Volume II: Evidence. Apr. 4, 2005. (Hereafter referred to as HL) Testimony of Dr. Katrina Hedberg, Pg. 257, Q. 555.
Available at: http://www.publications.parliament.uk/pa/ld200405/ldselect/ldasdy/86/86ii.pdf.
 Hedberg, HL, p. 266, Q. 615.
 Hedberg, HL, p. 259, Q. 566. (Emphasis added.)
 Hedberg, HL, p. 259, Q. 567. (Emphasis added.)
 Erin Barnett, “Dilemma of Assisted Suicide: When?” Oregonian, January 17, 1999 and Erin Barnett, “Man with ALS makes up his mind to die,” Oregonian, March 11, 1999.
 Catherine Hamilton, “The Oregon Report: What’s Hiding behind the Numbers?” Brainstorm, March 2000. Hamilton was present at the class which she audiotaped. The revelations made at the class were also discussed on Portland’s KXL Radio and in the Oregonian. [David Reinhard, “The pills don’t kill: The case, First of two parts, Oregonian, March 23, 2000 and David Reinhard, “The pills don’t kill: The case, Second of two parts,” Oregonian, March 26, 2000.
 Johanna H. Groenewoud, et al., “Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands,” 342 New England Journal of Medicine (February 24, 2000), pp. 553-555.
 Beatrijs Trip, “Summary of Interview with former professor of pharmacology and hospital doctor, Dr. Jan Glerum,” from “Relevant,” Volume 26, Number 3, July 2000, posted on World Federation of Right to Die Societies web site . Dr. Glerum is described in the summary as a pharmacist and hospital doctor who “was often involved with euthanasia and in the attempts of people to kill themselves.”
Reflections on Euthanasia and Assisted SuicideFr. Frank Pavone
National Director, Priests for Life
1. Do we have a "right to die?"
When people ask me about the "right to die," I respond, "Don't worry -- you won't miss out on it!"
A right is a moral claim. We do not have a claim on death; rather, death has a claim on us! Some see the "right to die" as parallel to the "right to life." In fact, however, they are opposite. The "right to life" is based on the fact that life is a gift that we do not possess as a piece of property (which we can purchase or sell or give away or destroy at will), but rather is an inviolable right. It cannot be taken away by another or by the person him/herself. The "right to die" is based, rather, on the idea of life as a "thing we possess" and may discard when it no longer meets our satisfaction. The "Right to die" philosophy says there is such a thing as a "life not worth living." For a Christian, however, life is worthy in and of itself, and not because it meets certain criteria that others or we might set.
2. What is "euthanasia?"
"Euthanasia," from the Greek words meaning "good death," is something we do or fail to do which causes, or is intended to cause, death, in order to remove a person from suffering. This is sometimes called "mercy killing."
3. What is "assisted suicide?"
This refers to an act by which one assists another in taking his or her own life. A physician, for example, who engages in "assisted suicide" would, upon the patient's request, provide the deadly drugs for the person to use.
4. What is the difference between "active" and "passive" euthanasia?
"Active" euthanasia refers to an action one takes to end a life, for example, a lethal injection. "Passive" euthanasia refers to an omission -- such as failing to intervene at a life-threatening crisis, or failing to provide nourishment.
It is important not to confuse "passive euthanasia" with the morally legitimate decision to withhold medical treatment that is not morally necessary. (The question of what is or is not morally necessary is handled below.) When we forego a treatment that we are not required to use, then even if death comes faster as a result, that withholding is not euthanasia in any form and should not be called by the name.
5. What kind of treatments and interventions, then, are morally obligatory, and which are not?
No matter how ill a patient is, we never have a right to put that person to death. Rather, we have a duty to care for and preserve life. But to what length are we required to go to preserve life? No religion or state holds that we are obliged to use every possible means to prolong life. The means we use have traditionally been classified as either "ordinary" or "extraordinary."
"Ordinary" means must always be used. This is any treatment or procedure which provides some benefit to the patient without excessive burden or hardship.
"Extraordinary" means are optional. These are measures which do present an excessive burden.
The distinction here is not between "artificial" and "natural." Many artificial treatments will be "ordinary" means in the moral sense, as long as they provide some benefit without excessive burden. It depends, of course, on the specific case in point, with all its medical details. We cannot figure out ahead of time, in other words, whether or not we ourselves or a relative want some specific treatment to be used on us "when the time comes," because we do not know in advance what our medical situation will be at that time or what treatments will be available. When the time does come, however, we must consult on the medical and moral aspects of the situation. Remember, procedures providing benefit without unreasonable hardship are obligatory; others are not. You should consult your clergyman when the situations arise.
6. Shouldn't a person be able to say that his or her pain and suffering is too much to bear, and have the right to be free of that suffering?
Our duties toward others and ourselves certainly require reasonable efforts to alleviate suffering. At the same time, it is impossible to live without suffering, and therefore it makes no sense to talk about a "right" to be completely free of it. The pro-euthanasia movement maintains that our rights include determining the time and manner of our own death. First of all, given the fact that people die unexpectedly every day of both natural and accidental causes, this philosophy is patently absurd. If, however, one simply considers the so-called right to choose death when suffering is too great, then we have to ask the question of what kind of suffering qualifies.
Who is to say, in other words, that the suffering of a teenager who has just flunked his most important class in school, lost his girlfriend, and been kicked off the football team, isn't a suffering too great for him to bear? What if he thinks it is? Do we allow him to commit suicide -- because he has the right to determine the end of his life -- or do we call a crisis hotline? The question is critical, because either people do not have the right to end their lives in any circumstance, or else they do have that right, and the circumstances don't matter.
7. What about people who are unable to communicate?
What about them? That, indeed, is the question for the pro-euthanasia forces. People who cannot communicate are people, nevertheless. This gets to the heart of the problem. A person's inability to function does not make their lives less valuable. People do not become "vegetables." Children of God never lose the Divine image in which they were made.
A key distinction that needs to be made here is between a patient who is dying and one who is not.
When one is dying, we try with all reasonable means to sustain life, and as we have noted already, some interventions are necessary and some are not. But when one is not dying, then there isn't even a question of what "treatments" to provide. There is such a thing as a useless treatment, but there is no such thing as a useless life. This is where the confusion arises. A person who cannot walk, or cannot communicate, or is not conscious (as far as we can tell), still has a right to life and to reasonable measures to sustain life.
8. Must we always provide food and fluids to a patient?
When we come back from lunch, we do not say that we just had "our latest medical treatment." Food and drink are a normal aspect of taking care of life and health, not an extraordinary intervention. As aspects of normal care, therefore, they are morally obligatory.
In the case of a person who is not dying but whose physical or mental functioning is impaired, the question often arises as to whether we should "keep them alive" by feeding them. But there is no more of a doubt about keeping that person alive than about keeping alive anyone else who is not impaired! There is no underlying cause of death in this case. To fail to feed such a person is to introduce a new cause of death, namely, starvation. This is what the current case of Terri Schindler-Schiavo in Florida is about.
In the case of somebody who is dying, food and fluids are to be provided as well. There may come a point when death is imminent and when the body no longer assimilates what it is given, despite various efforts to feed the person by alternate means. At that stage, of course, it is normal to accept the inevitability of the person's death.
9. What are some of the common myths supporting euthanasia and assisted suicide?
a. It is a myth that most terminally ill people seek suicide. "According to available data, only a small percentage of terminally ill or severely ill patients attempt or commit suicide." (p.9)
b. It is a myth that single events cause people to end their lives. "Contrary to popular opinion, suicide is not usually a reaction to an acute problem or crisis in one’s life or even to a terminal illness… Instead, certain personal characteristics are associated with a higher risk of…suicide." (p.11)
c. It is a myth that requests for suicide represent a person’s true desires. "Like other suicidal individuals, patients who desire suicide or an early death during a terminal illness are usually suffering from a treatable mental illness, most commonly depression." (p.13)
d. It is a myth that terminal illness has to involve unmanageable pain. "Taken together, modern pain relief techniques can alleviate pain in all but extremely rare cases." (p.40)
(Quotes are from a May 1994 study by the New York State Task Force on Life and Law entitled , When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context.)
10. How does "voluntary" euthanasia lead to non-voluntary" euthanasia?
"Right to die" proponents couch their arguments in terms of personal freedom and voluntary choice. But in fact, as soon as you say that people have a "right" to end their lives (voluntary euthanasia), you have automatically and immediately introduced non-voluntary euthanasia, that is, killing people without their having asked for it. The reason is simple: A person should not be deprived of a "right" simply because they are not able to ask for it. This is especially easy to understand when the "right" is freedom from suffering. Why should someone suffer just because he cannot vocalize his desire to die?
This also leads to involuntary euthanasia, the killing of people although they want to live. The reasoning that leads to this conclusion is that the patient is not in a position to properly evaluate what is best for him/her in the circumstances -- so we will step in and do what is best.
11. How are euthanasia and assisted suicide political issues?
The first purpose of government is to defend and protect the lives of the citizens, and both euthanasia and assisted suicide contradict that fundamental purpose. To move from the view that government has an essential duty to protect lives, to the view that it can choose to destroy (or permit the destruction) of life, is a "sea change" about which the US Catholic bishops have spoken in the following words:
"The losers in this ethical sea change will be those who are elderly, poor, disabled and politically marginalized. None of these pass the utility test; and yet, they at least have a presence. They at least have the possibility of organizing to be heard. Those who are unborn, infirm and terminally ill have no such advantage. They have no "utility," and worse, they have no voice. As we tinker with the beginning, the end and even the intimate cell structure of life, we tinker with our own identity as a free nation dedicated to the dignity of the human person. When American political life becomes an experiment on people rather than for and by them, it will no longer be worth conducting. We are arguably moving closer to that day" (1998, Living the Gospel of Life, n.4)
12. What does support for euthanasia and assisted suicide say about a candidate?
Support for any form of killing the innocent, including killing oneself, indicates that a candidate for public office believes in a different kind of government than that set up by our Founding Fathers.
Ultimately, there are only two forms of government. All of the varied governments throughout the history of the world fall into two categories. The first type acknowledges that our rights come from God and that government exists to secure those rights. The other type says that government is the source of those rights and therefore can alter, add to them, subtract from them or deny them completely.
The Declaration of Independence says that the United States is a government of the first type, acknowledging as "self-evident" that we are endowed with our basic rights, starting with the right to life, from our Creator, and that "to secure those rights, governments are instituted."
Let's make no mistake about it. One of the things we are going to decide in our national elections is which of those two types of government America will continue to be.
13. How do euthanasia and assisted suicide rank in importance among the various issues we have to consider in an election?
Euthanasia and assisted suicide are foundational issues because they attack a foundational right, the right to life. These issues, therefore, carry greater weight than issues which deal with the quality of life or with lesser rights.
The US Bishops, in Living the Gospel of Life, write, "Abortion and euthanasia have become preeminent threats to human dignity because they directly attack life itself, the most fundamental human good and the condition for all others. They are committed against those who are weakest and most defenseless, those who are genuinely 'the poorest of the poor'" (n. 5). … All direct attacks on innocent human life, such as abortion and euthanasia, strike at the house's foundation. These directly and immediately violate the human person's most fundamental right -- the right to life. Neglect of these issues is the equivalent of building our house on sand. Such attacks cannot help but lull the social conscience in ways ultimately destructive of other human rights" (n. 23)
The Holy Father says that when the right to life is denied by a state, the state itself disintegrates. He writes,
"In this way democracy, contradicting its own principles, effectively moves towards a form of totalitarianism. The State is no longer the "common home" where all can live together on the basis of principles of fundamental equality, but is transformed into a tyrant State, which arrogates to itself the right to dispose of the life of the weakest and most defenceless members, from the unborn child to the elderly, in the name of a public interest which is really nothing but the interest of one part. The appearance of the strictest respect for legality is maintained, at least when the laws permitting abortion and euthanasia are the result of a ballot in accordance with what are generally seen as the rules of democracy. Really, what we have here is only the tragic caricature of legality; the democratic ideal, which is only truly such when it acknowledges and safeguards the dignity of every human person, is betrayed in its very foundations: "How is it still possible to speak of the dignity of every human person when the killing of the weakest and most innocent is permitted? In the name of what justice is the most unjust of discriminations practised: some individuals are held to be deserving of defence and others are denied that dignity?" When this happens, the process leading to the breakdown of a genuinely human co-existence and the disintegration of the State itself has already begun.
"To claim the right to abortion, infanticide and euthanasia, and to recognize that right in law, means to attribute to human freedom a perverse and evil significance: that of an absolute power over others and against others. This is the death of true freedom" (Evangelium Vitae, 20).
14. How do advocates of euthanasia and assisted suicide manipulate language to make their position seem acceptable?
Advocates of euthanasia and assisted suicide advance their philosophy and legislative proposals by using terms such as "assist in dying," and "helping to die." This is carefully veiled language that, in a way very similar to the phrase "pro-choice," makes something which is very evil sound very good.
An example of its effectiveness is the following story.
I was stationed in a New York City parish some years ago when a ballot initiative regarding assisted suicide came up in another state. I asked the parishioners to contact any friends or relatives they had in that state, to inform them of how harmful the initiative was. A few days later, one of the parishioners told me she spoke to her daughter, who lived in the state in question, and that her daughter obtained a copy of the various initiatives that were to be voted on. She said that the one I spoke about wasn't listed.
I asked her to send me the list...And right there on the list was the ballot initiative I had spoken of. This woman and her daughter, even when they knew what they were looking for, couldn't find it, because the language was so carefully sugar-coated. The initiative spoke about giving "assistance in dying."
This kind of language blurs the critical moral distinction between giving assistance to a dying person and placing an act which brings about death.
Mother Teresa "assisted" many people "in dying" and "helped" many people "to die." She was present to them, assuring them that they would not die alone. She helped them find the courage to face death, the conviction that their dignity had not been lost, and the serenity borne of receiving love from people and from God. This is the legitimate meaning of death with dignity and of helping people to die. This, in fact, is the Gospel response to the dying members of the human family.
15. Is it acceptable to sign a "Living Will?"
Obviously, we cannot predict the future, or know in advance what form of sickness or disease we may be afflicted with in the years ahead. We do not know what treatments we will need or what will be available.
The making of a "Living Will" presupposes that we know what kind of medical treatments we will want to use or avoid in the future. It speaks about treatments before we even know the disease; it turns a future option into a present decision.
Not every medical treatment is always obligatory. But to figure out which treatments are obligatory, morally speaking, and which are only optional, one must know the medical facts of the case. These facts are then examined in the light of the moral principles involved. But to try to make that decision in advance is to act without all the necessary information. Moreover, to make that decision legally binding by means of a formal document is really putting the cart before the horse. It is not morally justified. Living Wills are both unnecessary and dangerous.
Living Wills are also unnecessary because they propose to give rights which patients and doctors already possess. People already have the right to make informed consent decisions telling their family and physicians how they want to be treated if and when they can no longer make decisions for themselves. Doctors are already free to withhold or withdraw useless procedures in terminal cases that provide no benefit to the patient. Some people fear that medical technology will be used to torture them in their final days. But it is more likely that the 'medical heroics' people fear are the very treatments that will make possible a more comfortable, less painful death.
Moreover, if the living will indicates one does not want "to be kept alive by medications" or "artificial means" what does that mean? An aspirin is "medication," is it not? Drinking through a straw is "artificial." People can construe meanings for these words which the signer of the document never intended.
16. What are the alternatives to a "Living Will?"
A safer route is to appoint a health care proxy who can speak for you in those cases where you may not be able to speak for yourself. This should be a person who shares your moral convictions, and who will be able to apply them to specific medical situations that may arise for you in the future.
Some are worried that they will have all kinds of treatment they don't want. But in the current climate, you are more at risk of the opposite, as more and more hospitals are refusing life-saving treatment to people who want it. Because of this, more and more people are signing documents, called the "Will to Live," that expressly indicate their desire for life-saving treatment, should the need arise.
17. What are some questions I should ask candidates regarding euthanasia and assisted suicide?
This issue, first of all, should be raised with candidates at all levels of government. Many of these battles are taking place at the state level.
Candidates should be asked questions like the following:
Do you believe that government should protect the lives of the sick, the dying, or the physically or mentally impaired, without judging the worth of those lives?
Do you believe that the state has the right to allow suicide, or the administration of lethal drugs?
Do you think that federally controlled drugs should be allowed for use in assisting a suicide?
Do you think that health care needs to be "rationed," or do you acknowledge that we have both the means and the duty to give all reasonable health care to citizens, without judging the merit of their lives based on their ability to function?