How to Sell Death

Americans have seen abortion repackaged as a “choice.” They are witnessing an ongoing attempt to redefine marriage to include same-sex arrangements. Now they are being told that physician-assisted suicide is not actually suicide.

In Connecticut’s capital this week, for the second year in a row, a legislative committee heard arguments for and against a bill that would allow a physician to prescribe—and a terminally-ill patient to self-administer—drugs that would end that patient’s life. More than 400 persons had submitted written testimony, which is archived on the website of the Connecticut General Assembly.

But is the legislation an “assisted suicide” bill or an “aid-in-dying” bill?

It depends on which side you listen to. And it’s about more than a personal preference for one term over another.

The bill, HB 5326, known officially as “An Act Concerning Compassionate Aid in Dying for Terminally Ill Patients,” takes pains to distinguish “aid in dying” from physician-assisted suicide. It states that a patient and his physician who follow the procedures set forth in the bill are not participating in a suicide and that the bill does not allow for euthanasia. It directs that on a death certificate a patient’s underlying terminal illness be listed as cause of death, not assisted suicide, and that public agency reports list “aid in dying” events, not “assisted suicides.”

Archbishop Leonard Blair wrote to Catholics in the Archdiocese of Hartford, urging them to oppose the bill. He did not plan to testify at the March 17 hearing. But, speaking with CWR after the annual St. Patrick’s Day Mass at St. Mary’s Church in New Haven March 16, Archbishop Blair said, “People are sometimes misled into thinking this is a compassionate way to deal with physical suffering, but the reality is this is not getting rid of the suffering, it’s getting rid of the patient. When you start to cross that line it is very open to grave abuses, not to mention the fact that we are not the masters of life. Modern medicine can do a lot to alleviate pain, and the Church doesn’t say that you should have to suffer without relief.”

Michael C. Culhane, executive director of the Connecticut Catholic Public Affairs Conference, the public policy office of the state’s Catholic bishops, summed up opposition to the bill during a hearing of the State Assembly’s Public Health Committee March 17. “The conference believes that the state has an obligation to the sick and suffering within our borders and accordingly the state should direct their efforts towards research and programs to enhance palliative and hospice care, not concentrating on ways and methods to promote physician-assisted suicide,” he told the 28-member panel.

But Andrew Schneider, executive director of the American Civil Liberties Union of Connecticut, said in his testimony, “We believe the liberties protected by the 14th Amendment include the liberty to make personal and intimate decisions not just about how to live but also about how to die.”

Only three states so far have legalized assisted suicide—Washington, Oregon, and Vermont. But supporters—primarily the former Hemlock Society, which itself has rebranded as “Compassion & Choices”—have had a difficult getting more momentum on the issue. “Over 100 legislative proposals in various states—and numerous referendums—have consistently failed to enact physician-assisted suicide laws,” the Connecticut Catholic Conference points out in a statement.

In Connecticut, the bill did not get out of committee last year. Massachusetts voters narrowly defeated a referendum on assisted suicide in 2012. And just this month, New Hampshire’s legislature overwhelmingly rejected such a measure.

But Compassion & Choices won’t let the effort die. The organization has designated Connecticut, Massachusetts, New Jersey, and California “campaign states.”

“I think they view the Northeast as low-hanging fruit, kind of a petri dish, to be able to pass something more easily here, then try to export it to the rest of the nation,” said Peter Wolfgang, executive director of the Family Institute of Connecticut.

“They got the Pacific Northwest, which is a bastion of libertarian kind of thinking, and now they want to get the liberal Northeast,” said Wesley J. Smith, who writes the Human Exceptionalism blog at National Review Online. “I trust they’ll fail again in Connecticut.”

Patrick R. Brannigan, executive director of the New Jersey Catholic Conference, said there was a “major effort” in the last session of the state legislature to pass an assisted suicide bill. It passed in the Assembly but was defeated in the Senate. The legislation reads very much like the Connecticut bill. Brannigan said Compassion & Choices is making a “strong effort” again this year, but he expects a similar outcome.

In California, there are no active efforts to legalize assisted suicide, but Compassion & Choices “has been seeding the media with sad end-of-life stories and appears to be nibbling around the edges with proposed legislation that would ensure those who receive a terminal diagnosis be counseled about their ‘options,’” said Carol Hogan, pastoral projects and communications director of the California Catholic Conference.

But even in a state that has been liberal on abortion and redefining marriage, assisted suicide bills saw defeat in California in 2005, 2006, and 2007.

“Confusing People”

Compassion & Choices launched a public relations campaign earlier this year, with a photo display in the lobby of the Legislative Office Building in Hartford. Several dozen Connecticut residents—many of them prominent individuals in medicine, academia, and religion—were featured, along with the slogan “My Life. My Death. My Choice,” and a brief quote about why they support “choice in dying.”

But apparently, according to Compassion & Choices, the choice of what language to use should be restricted.

“Compassion & Choices started using the terminology ‘aid in dying,’ a euphemism that obscures the distinction between palliative care and other actual aid in dying—which is both lawful and encouraged in Connecticut and everywhere else—and deliberate killing,” said Adam MacLeod, associate professor at Faulkner University’s Jones School of Law in Montgomery, Alabama.

He said that after he wrote an essay about assisted suicide for Public Discourse, a website published by the Witherspoon Institute, he received a letter from Kathryn L. Tucker, director of legal affairs for Compassion & Choices.

“It seemed to me to be part of a broader letter-writing campaign to scholars, activists, people who speak and write about this issue,” MacLeod said. “And it was essentially an attempt to browbeat me into using their terminology. In fact, she went so far as to include a letter from a professor at one of the top 25 law schools she had written to previously, and he said, ‘Oh yes, thank you for correcting me. I will now use the terminology aid in dying rather than the misleading terminology assisted suicide.’ It’s clear that they recognize that if you call it what it is—assisted suicide is suicide—it’s a losing issue. I think the only way they will succeed is if they succeed in confusing people about exactly what it is they’re asking to be legalized.”

Tucker wrote in her November 9, 2012 letter, which MacLeod shared with CWR, “Terminology is evolving because of an understanding in both the mental health field and in the legislation and case law of many states that a mentally competent, terminally ill patient bases a decision to end his or her life for fundamentally different reasons than a clinically depressed person uses to justify suicide.” She cited a number of differences between “suicide” and “death with dignity” (DWD), which would be accomplished by a patient taking a lethal medication. “The suicidal patient has no terminal illness but wants to die,” she wrote. “The DWD patient has a terminal illness and wants to live. Typical suicides bring shock and tragedy to families and friends; DWD deaths are peaceful and supported by loved ones. Typical suicides are secretive and often impulsive and violent. Death in DWD is planned; it changes only timing in a minor way, but adds control in a major and socially approved way. Suicide is an expression of despair and futility; Death with Dignity is a form of affirmation and empowerment.”

Tucker went on to say that in Oregon, Washington, and Montana, “assisting a suicide remains a crime” while the practice of aid in dying “refers to an accepted medical practice.”

Archbishop Blair commented on such efforts: “When we see someone standing on a bridge, ready to jump, our rightful human instinct is to try to prevent them. And to say ‘Who’s to judge? They might be suffering and we should let them jump,’ I don’t think any of us would do that. Similarly, people suffer not only physically but also mentally, emotionally even spiritually, but that doesn’t mean that taking their own life is the answer to these things at all.”

Troubling prospects

There are other aspects of the Connecticut bill that some find troubling. The legislation does not require that witnesses be present at the time of death, opening up the possibility for abuse.

“With this situation, the opportunity is created for an heir, or for another person who will benefit from the patient’s death, to administer the lethal dose to the patient without their consent,” said the Connecticut Catholic Conference.

In general, said Wesley Smith, proponents “sell this as if it’s only intended for people in unbearable agony that can’t be relieved. That’s not how it’s practiced. That’s just a scare tactic to get people to say, ‘Well, in those few situations, if somebody is in unbearable pain that can’t be relieved, well…’ People kill themselves in Washington and Oregon with the help of a doctor because they’re worried about being a burden; they’re worried about losing their dignity. The state’s published statistics show that most assisted suicides are motivated by fear of not having a life worth living—and these are issues that are very important that need to be addressed by good palliative care, by good intervention, hands-on care for people who are terminally ill. But it’s important to emphasize that people almost never commit assisted suicide because of pain. That’s how they sell it. That’s not what it’s about. And by the way, it’s not about terminal illness either; that’s just to get a foot in the door. As we’ve seen in Europe, once a culture widely accepts the agenda, it becomes a fall off the moral cliff. So in Belgium euthanasia has just been legalized for children; they’ve coupled euthanasia with organ harvesting. They’re killing people in both Belgium and the Netherlands because of mental illness and severe depression, because of old age. Once a culture accepts the toxic premise that killing is an acceptable remedy for human suffering, it becomes increasingly difficult to limit the circumstances that justify doctor-facilitated death.”

Safeguards

Both proponents and opponents of the Connecticut legislation were able to point to polling on the issue. A March 6 Quinnipiac survey showed strong support among Connecticut voters—with 61 percent in favor of assisted suicide and 32 percent opposed.

But a Knights of Columbus-Marist poll, released the Thursday before the March 17 hearing, found that 55 percent of those surveyed believe a doctor “should not prescribe or provide life-ending drugs, but instead should manage the illness (27 percent) or be allowed to remove a respirator or other medical interventions so nature can take its course (28 percent).”

Marist polled 1,000 Connecticut residents March 6-9 and found that 65 percent of them “worry that if the law passes, those without better health insurance could have fewer end-of-life options. A similar number (64 percent) worry that the state of mind of a patient may be misjudged since the bill allows doctors who are not mental health professionals to determine the patient’s state of mind. Sixty-three percent worry that the doctor’s prediction of the course of the disease could be inaccurate, and the same number (63 percent) worry that the elderly could be at risk in nursing homes or health care facilities. Nearly 6 in 10 (58 percent) are concerned that patients who suffer from depression will be more likely to want to take their own lives.”

Adam MacLeod said the bill has “no provision that requires psychiatric evaluation or counseling. The bill says that if, “in the medical opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological condition or depression that is causing impaired judgment, either the attending or consulting physician shall refer the patient for counseling to determine whether the patient is competent to request aid in dying.”

But that is not a binding requirement, MacLeod said. “The attending or consulting shall refer the patient only if that physician forms the opinion that the patient is suffering from a condition that causes impaired judgment,” he said. “But attending and consulting physicians are not generally psychiatrists or psychologists, and there is growing evidence, from Oregon in particular, that they are not very good at spotting mental impairment and depression.”

“Second, even if a referral is made, the purpose of the referral is only to determine ‘whether the patient is competent to request’ physician-assisted suicide. But that is not enough to deal with the root of the problem.”

He said a number of studies have shown that “many patients who seek assisted suicide are in fact depressed. One study by the Royal College of Physicians found that of those patients who sought assisted suicide, 98-99 percent of them, when treated for depression, change their minds.”

The Marist poll found Connecticut residents divided over “whether patients may be pressured by their families or friends to end their lives (47 percent concerned) or whether it may become a cost-saving measure for health decisions (45 percent concerned). People in Connecticut also deeply divide as to whether the benefits of such a law outweigh the risks or the risks outweigh the benefits (46 percent to 45 percent, respectively).”

Crossing a line?

Wolfgang is confident that those opposing the bill can stop it again this year.

“We’d like to defeat this every year until Compassion & Choices’ out-of-state funders decide that Connecticut was not a good investment after all,” he said.

According to Brannigan, that’s important because of the message society would be sending if it put its stamp of approval on the practice, whether you call it assisted suicide or aid in dying.

“More military personal committed suicide than were killed in wars we were involved in last year,” he said. “What kind of message do we send our military personnel when [we say with legislation, if you have] pain and suffering go ahead and kill yourself?”

Added MacLeod: “The moment you cross that line into deliberate killing, you’ve involved the medical profession and the legal profession in deciding who gets legal protection of our laws against killing and who doesn’t. That’s a line we should never be willing to cross.”