“Now that Dr. Lejeune is Dead,who will Protect Me?” The Case for a Comprehensive Strategic Plan to Stop Assisted Suicide

Peeters Marie A. M.D. , “Quo Vadis? Professor Lejeune's Legacy, The Linacre Quarterly, Nov. 95, 86.

The former abortion doctor, Bernard Nathanson, objects to the image of slope, preferring instead “a spiralling staircase descending into unfathomable depths of evil. At every step one has the opportunity to rest, to survey the moral landscape critically, to look back, to contemplate with great care the next step, and even to climb back up if the occasion warrants.”, Nathanson, “Beyond Meaning”, First Things, June/July 1995, 48,50 (a review of John J. Michaldzyk, ed., Medicine, Ethics, and the Third Reich).

The U.S. Supreme Court heard oral argument on these cases on January 8, 1997 and as of this writing, has not yet issued its decision.

Many supporters of birth control and abortion sought to achieve population control. Now that the birth rate is low, and in many countries is below replacement rate, they may want to achieve “population balance” by increasing the death rate.

It would seem that the majority of victims of assisted suicide in the United States are older women. Nancy Osgood and Susan Eisenhandler, “Gender and Assisted and Acquiescent Suicide: A Suicidologist's Perspective”, Issues in Law & Med., 9 No. 4 (1994), 361. There are many reasons why this is so. Dr. Hendin, professor of psychiatry and executive director of the American Suicide Foundation, notes one of them. He observes from his own clinical experience that “in most (suicide) pacts (between elderly husband and wife) a man who wishes to end his life coerces a woman into joining him to prove her love.” Herbert Hendin M.D. , “Seduced by Death: Doctors, Patients, and the Dutch Cure”, Issues in Law & Med., 10, No. 2 (1994), 123, 133.

While the absolute numbers of elderly poor grow, we are told that the number of poor children, as a percentage of the entire population, is growing faster than the percentage of elderly poor.

The existence of retirement homes and communities would seem to cut both ways on this problem. On the one hand, members of retirement communities are less isolated from members of their generation; on the other hand, they are more isolated from members of other generations. In which community would deeds by doctors like Kevorkian more likely go unnoticed and engage in mischief? Could a Jim Jones-like figure persuade a retirement community to engage in mass suicide?

Cremation is important to the problem because it reduces or eliminates evidence of foul play.

Bernardin Joseph Cardinal , “Renewing the Covenant with Patients and Society”, The Linacre Quarterly, Feb. 1996, 3,5 (address delivered to the AMA House of Delegates, Washington, D.C., Dec. 5, 1995).

Hendin, 167. Dr. Hendin discusses the 1993 acquittal in Assen, the Netherlands, of a psychiatrist who had assisted in the suicide of a patient, a physically healthy 50-year old woman, recently divorced, whose sons had just died. He states that it is characteristic of suicidal people to wish “to control and to make demands on life that life cannot fulfill.” The Linacre Quarterly, 129.

“Determining the time, place, and circumstances of death is the most dramatic of such demands.” The Linacre Quarterly, 126.

He observes that “The acceptance of euthanasia for psychiatric patients who are suicidal is simply bad psychiatry…Seriously suicidal patients want suicide. In a society that makes euthanasia accessible for them they will be harder to treat, not easier.” The Linacre Quarterly, 164.

“Many Uninsured Struggle to Get Adequate Care, Study Concludes; Finding Contradicts Popular Belief that Needs are Met”, The Washington Post, Oct. 23, 1996, sec. A, p. 2 (reported in JAMA).

We refer to citizens. The welfare and immigration laws enacted in 1996 force us to focus on the problem of providing care for legal permanent residents.

See, e.g., George Anders, Health Against Wealth: HMOs and the Breakdown of Medical Trust (Boston: Houghton Mifflin, 1996); Burke J. Balch , “Managed Care: Will It ‘Manage’ Your Death?”, Nat'l Right to Life News, Aug. 5, 1994, 9. The trade association for HMOs issued a policy in December, 1996, in response to these concerns.

The pro-euthanasia literature abounds in stories such as these: “The letter told of a doctor of 68 who was admitted to the hospital with advanced cancer of the stomach. An operation revealed that the liver was also affected. Another operation followed for the removal of the stomach, and there was evidence of further complications. The patient was told of his condition and being a doctor, he fully understood. Despite increasing doses of drugs, he suffered constant pain. Ten days after the operation he collapsed with a clot in a lung artery. This was removed by another operation. When he sufficiently recovered he expressed his appreciation of the good intentions and skill of the doctor who had performed the operation. But he asked that, if he had a further collapse, no steps should be taken to prolong his life, for the pain of his cancer was now more than he should needlessly continue to endure. He wrote a note to this effect in his case records, and the staff of the hospital knew of his feelings. Two weeks later he collapsed with a heart attack, and despite his expressed wish, he was resuscitated. The same night his heart stopped again on four more occasions and each time it was restarted artificially. He lingered on for three more weeks, with violent vomiting and convulsions. A whole series of medical techniques was then employed to keep him alive. Preparations were made for using an artificial respirator but the heart stopped before this could be done.” Robert N. Wennberg, Terminal Choices (Grand Rapids, Michigan: Eeardmans, 1989) 112 (reported in the July 1974 issue of The Humanist, reprinting a letter from the February 17, 1968 issue of the British Medical Journal). These are the types of stories that filled Dutch Dr. van den Berg's book, according to Richard Fenigsen Fenigsen Dr. M.D., “Euthanasia in the Netherlands”, Issues in Law & Med. 6, No. 3, 1990, 229. Such accounts appear in the American press. E.g., “Ohio Justices Reject Extended-Life Suit, Washington Post, Oct. 13, 1996, sec. A, p. 10 (when Edward H. Winter was hospitalized with heart problems in 1988 he told his doctor he did not want to be resuscitated since his wife had deteriorated after such a procedure and he did not want any extraordinary lifesaving measures. After his heart slipped into a potentially fatal rhythm, a nurse revived him with a defibrillator, steadying his heartbeat. Two days later, he suffered a stroke that paralyzed his right side. He remained incapacitated until he died two years later at age 82.).

See n. 13.

Aside from prohibiting euthanasia, another method to fulfill this societal duty is the enactment of legislation to protect medical personnel exercising their conscience. Lynn D. Wardle , “Conscience Clauses Offer Little Protection”, Health Progress, July-Aug 1993, 79.

Both fears can occur in the same person in close order. Dr. Herbert Hendin wrote the following account of a doctor and her uncle in the Netherlands: “Dr. Johanna Groen-Prakken, a psychoanalyst and euthanasia advocate…told me of her concern that too many physicians were unaware of how patients’ moods can fluctuate in the course of their treatment. After a colostomy necessitated by colon cancer, her own uncle, a retired physician, had been acutely depressed, stopped eating, and asked her to assist in his suicide. She told him that he could always end his life but that he should get healthy first, and she arranged to have him discharged from the hospital to a more cheerful setting in a nursing home. When she visited him in the home a few days later, he was smoking a cigar and no longer talking of suicide. Two years later his cancer had metastasized. But now her uncle, no longer wanting an assisted suicide, feared involuntary euthanasia. He was afraid his family would give him pills to hasten his death in order to collect their inheritance. His relatives assured him that they all wanted him to live. In the course of his treatment, this man had gone from wanting an immediate death to fearing that he would be deprived of the chance to die naturally.” Hendin, 160–1.

Both fears can occur in the same person in close order. Dr. Herbert Hendin wrote the following account of a doctor and her uncle in the Netherlands: “Dr. Johanna Groen-Prakken, a psychoanalyst and euthanasia advocate…told me of her concern that too many physicians were unaware of how patients’ moods can fluctuate in the course of their treatment. After a colostomy necessitated by colon cancer, her own uncle, a retired physician, had been acutely depressed, stopped eating, and asked her to assist in his suicide. She told him that he could always end his life but that he should get healthy first, and she arranged to have him discharged from the hospital to a more cheerful setting in a nursing home. When she visited him in the home a few days later, he was smoking a cigar and no longer talking of suicide. Two years later his cancer had metastasized. But now her uncle, no longer wanting an assisted suicide, feared involuntary euthanasia. He was afraid his family would give him pills to hasten his death in order to collect their inheritance. His relatives assured him that they all wanted him to live. In the course of his treatment, this man had gone from wanting an immediate death to fearing that he would be deprived of the chance to die naturally.” Hendin, 161

Marie A. Peeters M.D. , “Quo Vadis? Professor Lejeune's Legacy”, 86.

Until there is general agreement among the states on euthanasia, people may take state laws and policies on euthanasia into consideration in deciding where to live and certainly where to retire and die.

Once it does it will be harder to turn the tide. For example, in the Casey abortion case, the Supreme Court mentioned again and again how people had relied on the Roe v. Wade decision to order their lives. It is a characteristic common to those who conspire to kill the innocent and have blood on their hands. The same occurred in the Netherlands: “There is…a particular feature inherent in the euthanasia debate [in the Netherlands] that favors the suppression of contrary statements. Impartial discussion on euthanasia is only possible so long as it is purely theoretical. As soon as the first patients die by euthanasia, an editor, or any public figure who had once endorsed euthanasia, finds himself at a point of no return: he can no more afford to be wrong, lest he be held morally responsible for wrongful killings.” Fenigsen, 234.

We say “for now” because (1) the AMA was at one time opposed to abortion; (the Hippocratic Oath did not stop the AMA from supporting abortion and it will not stop the AMA from supporting assisted suicide if it believes the circumstances warrant it); and (2) while the AMA filed briefs in 1996 before the Supreme Court opposing assisted suicide, an association of medical students filed briefs supporting it.

Dr. Fenigsen says that the “pro-euthanasia movement [in the Netherlands] is supported by all major Dutch political parties and by the majority of Dutch Catholics [and] Protestants…” but he does not cite sources. Fenigsen, 243.

Bernardin, 9.

The Rev. Kevin D. , O'Rourke O.P. , “Making Mission Possible: A Response to Rev. Richard A. McCormick's Article on the Preservation of Catholic Hospitals”, Health Progress, July-Aug. 1995, 45, 60.

E.g., Adam Cardinal Maida, “A Spirituality for Families for the Third Millennium”, Columbia, Oct. 1996, 8, 9 (keynote address at the 114th Annual Supreme Council Meeting of the Knights of Columbus) (“Last month…I announce[d] that the archdiocese [of Detroit] will be working with many Catholic and non-Catholic agencies in the [Detroit] metropolitan area to offer counseling and financial assistance to people who might be contemplating an abortion or euthanasia…The response and support have been absolutely overwhelming…[A]pproximately 10 to 15 calls per day are looking for assistance, particularly in the area of euthanasia and pain management…There is a great need for education in this regard, especially as many of our Catholics have a rather naive impression that our tradition requires them to accept all pain without any palliative treatment.”); Catholic Health Association's Task Force on Pain Management, “Pain Management: Theological and Ethical Principles Governing the Use of Pain Relief for Dying Patients”, Health Progress, Jan-Feb. 1993, 30, 38 (“[K]ey strategies that will be instrumental in formulating effective responses [include:] Through community education programs, promote public education about pain, pain treatments, drug addiction, and ways to discuss pain with health care professionals for patients, their families, and the general public.”); Catholic Health Association “Care of the Dying: A Catholic Perspective, Part II, Social and Political Context - Catholic Providers Must Exemplify a Caring Community”, Health Progress, April 1993, 16, 19 (excerpts) (we must acknowledge the influence of the media and seize opportunities for public education on fundamental human and religious values; the first effort has to be directed toward educating members of the media) (our proposal does not focus on members of the media).

Much needs to be done. For example, Cardinal Bernardin cited the fact that one-fourth of American medical schools do not have formal courses in medical ethics. Bernardin, 8.

It might be useful to research how the Catholic Church in the Netherlands and Catholic medical and legal professionals responded over the last 20 years to euthanasia in that country - if only not to imitate their failure. In our research, the only statement referring to church bodies in the Netherlands we have found relates to a very successful (in numbers sold and influence) 1969 book by Dr. Jan Hendrik van den Berg, Medical Power and Medical Ethics, in which he rejected traditional medical ethics’ respect for life and pronounced a duty to terminate meaningless lives, including those of “defective” children. Fenigsen, 229–230. There were a number of formal statements applauding the work, including those of Protestant ministers, Protestant church authorities, and Catholic intellectuals. Bernardin, 230, nn. 8–10.

This language combines the language of traditional Catholic morality (informing consciences) with the modern social science language of modern media (opinion polls). If the byword in real estate is “location, location, location”, then it would seem our byword must be “educate, educate, educate.”

Rev. Richard M. Gula , “Character Witness: Walking the Talk on Euthanasia”, Health Progress, Jan-Feb. 1995, 35, 36. The late Cardinal Bernardin taught us much when he answered these questions with his words and his example. On these questions, permit us to repeat another example: “I remember a mother who had lost her six-year-old son. She told me that when her son was three and a half years old, he had been struck down by a paralysis of his legs which, little by little, invaded his whole body, and he became blind. Some months before he died, his mother was weeping at his side. Her little one said to her: ‘Don't cry, mummy. I still have a heart to love my Mummy.”’ Vanier Jean, Man and Woman He Made Them (New York: Paulist Press, 1985), 25.

One observer of the effort to defeat Oregon Ballot Measure 16 stated the importance of: 1) having a number of mainstream religious groups perceived by the public as early and strong opponents, 2) keeping the Democratic party at all levels at least as neutrals, 3) pressing the ethical dimension of the issue within religious communities and in the mainstream culture, and 4) focusing on states that are less libertarian than the Western states. Kenney J.P. , “The Suicide State”, First Things, April 1995, 16.