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Update 2008-4
Special Edition
Washington
State: Seduced by Oregon's big lie
On November
4, 2008, Washington State
voters passed Initiative 1000 (the Washington Death with
Dignity Act) legalizing Oregon-style physician-assisted
suicide by a margin of 58 to 42 percent. It took over ten
years -- after right-to-die proponents failed to get 90
assisted-suicide bills passed in 23 states and were defeated
in costly initiative drives in Maine and Michigan -- for
another state to embrace assisted suicide after
Oregon enacted its Death with
Dignity Act in 1997.
Whether or not they realize it, Washington voters have
opted to place their state squarely on the crest of an
extremely slippery, ice-covered slope. But, they won't be
seeing any noticeable plunges down that slope in the near
future -- that is if the assisted-suicide advocacy group
Compassion & Choices (C&C) has its way. As the facilitator
of the majority of assisted-suicide deaths in Oregon and as
the group controlling what information, if any, is made
available to the public, C&C's plan is to get as many states
as possible to approve assisted-suicide for only
terminally-ill adults before there are any overt moves to
expand the practice to the chronically-ill, the
mentally-ill, those with a diminished quality of life, and
those simply tired of living. Widening the categories of
patients eligible for an induced death would make it very
difficult for C&C and other groups to sell assisted suicide
in states targeted for their "win" column.
But shortly after Washington's I-1000 passed, another
national assisted-suicide organization, Final Exit Network
(a C&C splinter group), jumped on the bandwagon and issued a
press release calling for the right-to-die movement's real
goal: death on demand for all, terminally ill or not.
According to the group's president, Ted Goodwin,
Final Exit Network and its
members supported passage of this landmark [Washington]
initiative by donating to the advocacy effort…. However,
the job is not finished….
Unfortunately, many
patients do not meet I-1000's strict criteria.
Individuals with neurological illnesses such as
Parkinson's disease, Multiple Sclerosis, Muscular
Dystrophy, Amyotrophic Lateral Sclerosis (Lou Gehrig's
disease) and Alzheimer's disease often lose the reason
and will to live long before their disease qualifies as
"terminal." For these individuals, neither I-1000 nor
the Oregon law go far enough. That is why Final Exit
Network pledges, until laws protect the right of
every adult to a peaceful, dignified death, Final
Exit Network will be there to support those who need
relief from their suffering today! [Final Exit Network
Press Release, 11/5/08. Emphasis added.]
The big lie
One
might ask, if Final Exit Network (FEN) had released its
death-on-demand comments before the Washington election,
would it have changed the outcome of the I-1000 vote?
Probably not, because C&C and the Death with Dignity
National Center, the two groups which orchestrated the "Yes
on I-1000" campaign, carefully honed their strategy and
talking points to undermine, among other things, any attempt
to get voters to see the reality of legalized assisted
suicide. There was a reason that these two groups chose
Washington as the state most likely to pass an
assisted-suicide law. Voters there were seen as easy marks
since they closely mirrored Oregon voters in being
independent minded, valuing total control, and being largely
un-churched.
The
majority of voters bought the "Yes" campaign's mantra that
10 years of legalized assisted suicide in Oregon proves that
the practice is transparent, safe, abuse free, and even
beneficial to overall health care -- despite proof to the
contrary.
They
ignored Oregon's largest newspaper, the Oregonian,
when its editorial board exhorted Washington voters to
reject I-1000 because, "Oregon's physician-assisted suicide
program has not been sufficiently transparent."
"Essentially," the board wrote, "a coterie of insiders run
the program, with a handful of doctors and others deciding
what the public may know." [Oregonian, 9/20/08]
They
ignored a recent Oregon Health & Science University study
that found that one in four Oregonians who request assisted
suicide may, in fact, be clinically depressed. The authors
of the study, published in the British Medical Journal,
concluded, "[T]he current practice of the Death with Dignity
Act may fail to protect some patients whose choices are
influenced by depression from receiving a prescription for a
lethal drug." [Ganzini et al., "Prevalence of depression and
anxiety in patients requesting physicians' aid in dying:
cross sectional survey," British Medical Journal,
10/8/08]
When
the Washington media reported on the study, the "Yes on
I-1000" camp immediately spun the findings to their
advantage:
The report proves that most
patients who request death with dignity are not
depressed, and the safeguards work so that those who are
must be referred for counseling. Every single one of the
many safeguards in the Death with Dignity Act is
working. [Yes on I-1000 Report, 10/7/08. Emphasis
added.]
Apparently, voters believed that spin job even though most
of it was untrue. Neither the Oregon law nor Washington's
I-1000 requires that depressed patients be referred
for counseling. In fact, of the 49 assisted-suicide patients
who died in Oregon last year, NOT ONE was referred for a
psychological evaluation or counseling.
Given
the study's finding that one in four assisted-suicide
patients is likely to be clinically depressed, not having
even one out of 49 such patients with symptoms of depression
is highly questionable. According to psychiatrist Linda
Ganzini, lead author of the study, "What it means is that
primary care physicians probably need to use more rigorous
or well-validated instruments rather than just their gut
impression about whether the patient is depressed." [Oregon
Public Radio, 10/7/08]
The campaigns
As previously reported in the
Update, assisted-suicide advocacy groups Compassion &
Choices and the Death with Dignity National Center spent
most of last year preparing for the I-1000 campaign. They
raised almost $250,000 as seed money in anticipation of
launching their initiative in January 2008; they conducted
extensive research, testing the best arguments to use to
convince Washingtonians that they needed to legalize
assisted suicide; and they did all this before the ink was
dry on the final version of the initiative.
The
opposition, on the other hand, was slow off the mark,
perhaps because they hoped that the initiative wouldn't get
the needed signatures to qualify it for the November ballot.
When it did qualify in July, the "No on I-1000" group had to
ramp up its efforts quickly.
But
the "No" campaign couldn't compete with the large sums of
money that initiative proponents were able to generate from
assisted-suicide advocates and groups across the U.S. as
well as from Australia and Britain. As of November 1, the
"Yes on I-1000" committee reported receipts in the amount of
$4,856,732. Over the same period, the "No on I-1000"
committee received only $1,510,442. (For more on campaign
contributions, see: funding)
Despite the lack of funds, the "No" campaign was able to
produce two very effective TV ads. The first one featured
actor Martin Sheen warning voters about the dangers
legalized assisted suicide poses for poor and vulnerable
patients. The second ad featured Barbara Wagner, an Oregon
cancer patient whose health insurer, the Oregon Health Plan,
had denied her payment for a cancer treatment drug
prescribed by her doctor, but offered instead to pay for her
assisted suicide. Unfortunately, the ads were aired during
the latter part of the campaign and, in some cases, after
many voters had mailed in their ballots.
Implementing
a bad law
Washington's new
assisted-suicide law is scheduled to take effect on March 4,
2009. "We're going to be gathering information over the next
few weeks and expect to start the rulemaking process by the
end of the month [November]," explained a spokesperson from
the Washington Department of Health, the agency charged with
compiling annual statistical reports on assisted-suicide
deaths. [The Olympian, 11/7/08] Compassion & Choices
of Washington plans to take an aggressive, combative role in
that "rulemaking" process. According to the group's web
site,
Now the next battle begins.
As the established leaders in end-of-life care in
Washington State, Compassion & Choices of Washington
(C&C) will be the protector and guardian of Initiative
1000. Our opponents will spare no expense in
attacking I-1000, just as they did in Oregon. We need to
prepare for a long and potentially costly fight to
ensure that the law implemented is the same law that
voters endorsed on November 4…. [C & C web site]
Indeed, there may be battles on the horizon. Even the
Tacoma News Tribune, one of the many Washington papers
that endorsed I-1000, is calling for changes in the new law:
The News Tribune
editorial board endorsed I-1000, but we believe it needs
stronger public disclosure and mental evaluation
requirements. The Legislature should closely monitor
implementation of I-1000 and make any needed changes. [News
Tribune, 11/7/08]
The
"No on I-1000" camp is also considering "every option on the
table," including a legal challenge. [AP, 11/7/08]
Oregon's suicidal approach
to health care
Rita L. Marker
Oregon
seems to have found a surefire way to lower health care
costs: Tell the patient you'll pay for drugs that will end
her life, but not those that would extend her life. Here's
how it works:
In May
2008, 64-year-old retired school bus driver Barbara Wagner
received bad news from her doctor. She found out that her
cancer, which had been in remission for two years, had
returned. Then, she got some good news. Her doctor gave her
a prescription that would likely slow the cancer's growth
and extend her life. She was relieved by the news and also
by the fact that she had health care coverage through the
Oregon Health Plan.
It
didn't take long for her hopes to be dashed.
Barbara Wagner was notified by letter that the Oregon Health
Plan wouldn't cover her prescription. But the letter didn't
leave it at that. It also notified her that, although it
wouldn't cover her prescription, it would cover her assisted
suicide.
After
Wagner's story appeared in the Eugene Register-Guard,
the Oregon Health Plan acknowledged that it routinely sends
similar letters to patients who have little chance of
surviving more than five years, informing them that the
health plan will pay for assisted suicide (euphemistically
categorized as "comfort care"), but not for treatment that
could help them live for months or years.
Certainly, spending $100 for deadly drugs is cost effective
because patients die sooner, avoiding any costly care. And,
ever since the Oregon Death with Dignity Act transformed the
crime of assisted suicide into a "medical treatment" more
than ten years ago, it has been perfectly legal. So Oregon
doctors prescribe the lethal drug overdoses and pharmacists
dispense them, sometimes with instructions to "take all of
this with a light snack and alcohol to cause death."
The road to
Seattle
Now,
an Oregon-style, assisted-suicide law has passed in
Washington State. After engineering passage of Oregon's
Death with Dignity Act, assisted-suicide advocacy groups
thought other states would rapidly adopt similar laws. But
they were wrong. Because their attempts to pass Oregon-style
laws in more than twenty states failed, the Portland-based
Death with Dignity National Center (DDNC), along with
Compassion & Choices (the former Hemlock Society), devised a
plan in 2005 called "Oregon plus One" to break the logjam.
It was based on the premise that, if just one more state
followed Oregon's lead, then other states would fall in
line.
The
plan was put into effect in early 2006. In its 2007 annual
report, the DDNC noted that it had spent a year "researching
and collecting data to determine that state which is most
likely to adopt a Death with Dignity law...Through these
efforts we have identified Washington as the state." (Note
that the assisted-suicide group chose Washington.
Washingtonians were not in on the selection.
After
choosing Washington as the target state, the DDNC reported,
"[W]e have never had such great odds of success as we have
in Washington in 2008. That is why we will be directing $1.5
million over the next year and a half to the efforts....Our
organization is providing leadership, political strategy,
and financial resources to this monumental effort."
The
political campaign was formally announced in late 2007 and,
in mid-July 2008, Initiative 1000 (called the "Washington
Death with Dignity Act," a measure virtually identical to
Oregon's law) qualified for the 2008 general election
ballot. Its advocates contended that Oregon's ten-year
experience demonstrates that a Death with Dignity law not
only works well, but is actually a benefit to patients. As
proof they point to Oregon's annual official reports, to the
law's "safeguards," and to studies in professional journals.
However, their claims were at best misleading. For example,
under Oregon's law doctors participating in assisted suicide
must file reports with the state. So the only physicians
providing data for official annual reports are those who
actually prescribe lethal drugs for patients. First, they
help the person commit suicide and, afterwards, they report
whether their actions complied with the law. Then, that
information is used to formulate the state's official annual
reports. However, according to American Medical News,
Oregon officials in charge of issuing the reports have
conceded that "there's no way to know if additional deaths
went unreported." (The official number of reported
assisted-suicide deaths in Oregon is 341.)
Indeed, the official summary accompanying one annual report
noted that there is no way to know if information provided
by the physicians is accurate or complete. But, it stated,
"[W]e, however, assume that doctors were being their usual
careful and accurate selves." The reporting agency also
acknowledged that it has no authority or funding to
investigate the accuracy of those self-reports.
It would be nifty if the Internal Revenue Service allowed
such unverified and unverifiable self-reporting.
The
Oregon law's safeguards are equally problematic. They
contain enough loopholes to drive a hearse through them. The
safeguards certainly do have the appearance of being
protective. They deal with requests for assisted suicide,
family notification, and counseling or psychological
evaluation. However, those safeguards are about as
protective as the emperor's new clothes:
-
• The oral requests,
which must be separated by fifteen days, do not need to
be witnessed. In fact, they don't even have to be made
in person. They could be made by phone - even left on
the physician's answering device. The written request
must be witnessed, but it could be mailed or faxed to
the doctor.
-
• The law states
that the physician is to "recommend that the patient
notify next of kin," but family notification is not
required. It is entirely possible that the first time
family members find out that a loved one was
contemplating suicide could be after the death has
occurred.
-
• Doctors can
facilitate the suicides of mentally-ill or depressed
patients without any prior counseling being provided. A
psychiatric evaluation is required only if the physician
believes that the mental illness or depression is
causing impaired judgment. According to Oregon's
latest official report, not one patient who died after
taking the lethal drugs was referred for counseling
prior to being given the prescription.
Additionally troubling are omissions in both the Oregon and
Washington laws. For instance, doctor shopping is not
prohibited. If one physician refuses to prescribe assisted
suicide because, for example, the patient is not competent
to make an informed death request, that patient or a family
member can go from doctor to doctor until finding one who
will write the prescription.
Moreover, neither law has any type of protection for the
patient once the prescription is written. While the requests
for assisted suicide are to be made knowingly and
voluntarily, there is no provision that the patient must
knowingly and voluntarily take the lethal drugs. Dr. Katrina
Hedberg, the lead author of most of Oregon's official
reports, acknowledged that there is no assessment of
patients after the prescribing is completed. She said that
the "law itself only provides for writing the prescription,
not what happens afterwards."
Forcing
physicians to lie
The
new Washington law, in a major departure from Oregon's law,
adds a layer of unprecedented deception by forcing doctors
to lie about the cause of death. It requires that, when a
patient dies after taking the prescription for assisted
suicide, the physician "shall list the underlying terminal
disease as the cause of death." Washington State Medical
Association president, Brian Wicks, M.D., described the
requirement in a WSMA press release opposing the initiative:
[I]f a physician prescribes
a lethal overdose, when that physician completes the
death certificate, he or she is required -- actually
required -- to list the underlying disease (say lung
cancer) as the cause of death, even when the doctor
knows full well that the patient died due to the
suicidal overdose he or she prescribed. To my knowledge
there's no other situation in medicine in which the
death certificate is deliberately falsified -- and in
which this falsification is mandated by law.
Questionable data
Concerns about assisted suicide often are thrust aside by
citing studies to bolster the benign nature of legalized
assisted suicide. Such studies are often far from un-biased
as indicated by one that was released in late 2007, just as
the Washington campaign formally got underway. Published in
the Journal of Medical Ethics, and widely reported in
news articles across the country, it concluded that assisted
suicide in Oregon is abuse free, even for vulnerable people.
(The basis for that conclusion was an examination of
Oregon's official annual reports.) Its principle author was
Margaret Pabst Battin. Battin, a University of Utah
philosophy professor, is a longtime supporter of assisted
suicide and a member of DDNC's advisory board -- information
not disclosed in either the journal article or the initial
flurry of national media coverage.
Thus,
the "proof" for the benign nature of legal assisted suicide
-- found in official annual reports, safeguards and studies
-- is preposterous. Assisted-suicide advocates take great
umbrage when this is pointed out, as they do at any
suggestion of assisted suicide being used for cost
containment. Do assisted-suicide advocates intend this as a
cost-containment measure? Does it matter? Did their
intentions mean anything to Barbara Wagner? Or does it
really come down to recognizing that, even if its advocates
don't intend to follow such a path, the force of economic
gravity inevitably leads in this direction?
When
all is said and done, it is not the intent of
assisted-suicide supporters that matters. Instead, it is the
law's deadly content and the inevitable price that we will
all pay for health care cost containment -- Oregon style.
________________________
Rita
L. Marker is an attorney and the executive director of
The International Task Force on
Euthanasia and Assisted Suicide. An earlier version of
her article appeared in the September 14, 2008, on-line
edition of American Thinker.
Assisted suicide: The wind
in their sails
Wesley J. Smith
Between November 1994 and
November 2008, the assisted-suicide movement in this country
was moribund. After Oregon passed Measure 16 (the Death with
Dignity Act) in 1994 and saw it go into effect in
1997-despite widespread expectations, myriad state
legislative efforts, and two voter referenda (Michigan and
Maine) -- no other state swallowed the hemlock.
Frustrated advocates adopted an "Oregon-plus-one" strategy,
believing that if only a second state legalized assisted
suicide, it would put the winds back into their sails. That
theory is about to be tested. Boosted by a multi-million
dollar campaign budget that swamped the opposition -- most
coming from out of state, some even from out of the country
-- fronted by a popular former governor who also poured
hundreds of thousands of dollars of his own money into the
cause, and cheered on by a media all but unanimously in
favor of "death with dignity," Washington State became the
"plus one" on November 4, 2008 when Initiative 1000 cruised
to a 58-42 percent victory.
And
with that success, the sails of the ghost ship Euthanasia
rippled with the briskly rising breeze, and once again began
to plow through the waves toward other shores, far and near.
Soon, legislation will be introduced to legalize assisted
suicide in states throughout the country -- California,
Vermont, Arizona, Wisconsin, Hawaii, perhaps Ohio, and
others -- to make it Oregon-plus-two, -three, -four, and
-five.
The
victory will also be used to further the euthanasia cause
internationally. Every time a legal sovereignty says yes to
mercy killing, it grants permission for others to do the
same. Thus, expect I-1000's passage to boost the cause in
countries such as Australia, France, the United Kingdom, and
New Zealand -- to name just a few -- all of which have been
edging ever closer in recent years to joining the
Netherlands and Belgium in permitting euthanasia, and
Switzerland, which allows assisted suicide by lay
facilitators.
Beyond
the politics of the thing, the passage of I-1000 begs a far
more fundamental question: Why now, when for the first time
in human history the pain and discomforting symptoms of
serious illness can be substantially alleviated, do so many
find mercy killing and suicide so appealing? Think of it as
a symptom rather than a cause. The euthanasia movement
reflects a profound nihilism that has been spreading like a
cancer throughout the West for the past hundred years.
The
extent of our societal illness was described succinctly
several years ago by the Canadian journalist Andrew Coyne.
Writing in the wake of widespread public support for Robert
Latimer, a Saskatchewan farmer who murdered his
twelve-year-old daughter Tracy because she was disabled by
cerebral palsy, Coyne wrote: "A society that believes in
nothing can offer no argument even against death. A culture
that has lost its faith in life cannot comprehend why it
should be endured."
Ponder
three recent stories out of the United Kingdom, which seem
to validate Coyne's premise. The first story involved a
mentally ill woman named Kerrie Wooltorton, who had
repeatedly attempted to kill herself by swallowing
antifreeze. On her last attempt, she called an ambulance --
but when she was wheeled in to the ER, Wooltorton was
clutching a "living will" in which she declined to be saved.
That note morally paralyzed the medical team. Queries were
made, consultations held -- and the decision made to let her
die. The physician who could have saved her life later told
an inquest: "It's a horrible thing to have to do but I felt
I had no alternative but to go with her wishes."
Then,
there is "suicide tourism" -- think Jack Kevorkian on the
international stage -- in which hundreds of people have
flown from their own countries to Switzerland for assisted
suicides at the hands of a death facilitating organization.
One of the most recent cases involves a young man named
Daniel James who was taken to Switzerland by his parents
for an assisted suicide after the young man was paralyzed in
a rugby accident and became despondently suicidal. The
grieving parents are unapologetic and the case has become a
cause célèbre for legalizing assisted suicide in the
UK. After all, why should such things have to be done
overseas? The idea of suicide prevention seems not to come
up much in the discussion.
Meanwhile, the agenda is also being furthered by a woman
named Debbie Purdy. Purdy has progressive multiple sclerosis
and wants her husband to be able to take her to Switzerland
for assisted suicide so that she can choose to die without
legal consequence. Boosted by the James case, Purdy has
garnered much media support.
Thus,
the Times of London columnist Libby Purves wrote:
Debbie Purdy has an
incurable degenerative disease and all she wants is
permission to shorten the last painful months. Knowing
there is an escape route might be so comforting that you
never use it. Many terminally ill people willingly live
each day, particularly if they get palliative care and
comfort from the hospice movement rather than suffering
in a stressed, overlit general hospital. But the law on
Swiss-bound helpers must be clarified. Dignitas [a Swiss
assisted-suicide organization] will not be un-invented.
Of
course, James wasn't, and Purdy isn't, terminally ill. So we
see the slippery slope slip-sliding away even within Purves'
own column.
Doctors' letting Wooltorton die, James' parents taking him
to Switzerland to die, Purdy's lawsuit agreed upon by her
husband, and suicide-supportive columns like Purves' are
unquestionably intended to be kind; but they are not. With
such deaths emotively and sympathetically reported in the
media, and with every lawsuit that chinks away at the laws
intended to protect people with serious difficulties from
suicide, mercy killing becomes more easily envisioned, more
comfortably embraced.
By passing
I-1000, Washington voters added dry kindling to this
smoldering fire. If more of us don't man the hoses soon, we
risk being consumed by the flames.
________________________
Wesley J. Smith is an attorney
for the International Task Force on Euthanasia and Assisted
Suicide, a Senior Fellow in Human Rights and Bioethics at
the Discovery Institute, and a special consultant to the
Center for Bioethics and Culture. His article originally
appeared in the November 10, 2008 edition of First Things
and is reprinted here (with minor changes) with the author's
permission.
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