Wesley Smith: The Suicide Juggernaut

Wesley Smith

This article was written by Wesley Smith and published in the Weekly Standard (December 30, 2013 issue) 

Advocates of assisted suicide tell two—no, three—lies that act as the honey to help the hemlock go down. The first is that assisted suicide/euthanasia is a strictly medical act. Second, they falsely assure us that medicalized killing is only for the terminally ill. Finally, they promise that strict guidelines will be rigorously enforced to protect against abuse.

Recent legislative proposals and developments in the field demonstrate the mendacity of these assurances. For example, a new bill tabled in the Scottish parliament would legalize assisted suicide for “terminal” or “progressive and either terminal or life-shortening” conditions—undefined terms that could easily include chronic ailments such as diabetes, asymptomatic HIV infection, and multiple sclerosis.

Such loose categories are ubiquitous in international assisted suicide advocacy. But the Scottish bill goes a radical step further by creating a new profession—the “licensed suicide facilitator,” authorized by the state to help suicidal patients kill themselves once a doctor has issued a lethal prescription. 

Licensed facilitators would be authorized to provide “practical assistance” in the suicide and “reassurance” when a substance “dispensed or otherwise supplied for the suicide of the person is taken.” They would also be authorized to remove lethal drugs—presumably narcotics—from the home after their client died. 

Such a heavy responsibility, one would think, should require extensive education in mental health disciplines and medicine. Nope. The legislation leaves it up to regulators to decide what experience and training licensed suicide facilitators will require. 

But it’s a good bet that possessing a suicide-friendly ideology will be an important component. For example, the bill specifies that organizations could be licensed—a boon to pro-euthanasia groups, many of which already surreptitiously “counsel” or assist suicides. Not only that, but individuals as young as 16—also the minimum age to receive assistance in committing suicide—would be eligible for licensure. This means that if the bill becomes law, one teenager could be legally authorized to help another teenager commit suicide. 

As the Scots continue to wrestle with legalizing assisted suicide, experience in Belgium warns of the consequences of accepting killing as an answer to human suffering. Belgian law allows broad access to euthanasia and assisted suicide when “the patient is in a medically futile condition of constant unbearable physical or mental suffering” caused by an illness or injury, and which cannot be alleviated. That’s a very liberal license. But since 2002, some Belgian doctors have implemented the law as if it permitted death on demand. Consider these well-documented examples:

• the euthanasia of a transsexual repelled by the results of a sex change operation;  
• the euthanasia of a depressed anorexia patient who wanted to die after being sexually exploited by her psychiatrist;  
• the joint euthanasia of deaf twins, who asked to be killed together when both began losing their eyesight;  
• the joint euthanasia of elderly couples who preferred immediate death to eventual widowhood.  

Belgian doctors also combine voluntary euthanasia with organ harvesting. One medical journal published an article describing the harvesting of a lung from a mentally ill patient who was identified as a self-harmer. Joint euthanasia/organ harvests have become so normalized that Belgian doctors created a Power Point presentation urging colleagues to be on the lookout for suicidal patients with neuro-muscular diseases (such as MS) as potential donors, because unlike cancer patients, they have “high quality organs.” 

And now, the Belgian parliament seems likely to legalize child euthanasia: By an overwhelming 50-17, the senate just passed a bill allowing doctors to kill sick children. The justification? It’s happening anyway. “We all know it,” Dominique Biarent, head of intensive care at Queen Fabiola Children’s University Hospital in Brussels told Belga news agency. “Doctors need a framework.”

Let me translate: Belgium’s euthanasia guidelines are a mere veneer that can be violated without consequence. When violations finally come to public light, lawmakers simply amend the law to reflect actual practice.

That has certainly been the pattern for the last 40 years in the Netherlands, where the categories of killable people have expanded like a sinkhole. Now, psychiatrists want to get in on the killing. A 2012 article in a Dutch journal of psychiatry concluded that not only is euthanasia for mental illness legal in the Netherlands (absolutely true), but making euthanasia—the “midwife of death”—more available to those with mental illnesses would constitute “an emancipation of the psychiatric patient and psychiatry itself.”

On this side of the pond, Quebec is close to legalizing euthanasia. All major political parties in the provincial parliament support the plan, which would—unlike any other proposal I have seen—forbid assisted suicide and require doctors to kill qualified patients as medical treatment. It would accomplish this bit of prestidigitation by renaming euthanasia as “medical aid in dying” and mandating that doctors “administer such aid personally” when asked by a legally qualified patient. 

As under most legal schemes outside the United States, eligibility would not be limited to the terminally ill. If of “full age” and “capable of giving consent,” the suicidal patient would be able to have him or herself killed if suffering from “an incurable serious illness” in an “advanced state of irreversible decline” that causes “unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.” As in the Scottish proposal and the Belgian and Dutch laws, the definition is broad enough to drive a hearse through.

What’s more, all Quebec doctors would be legally required to euthanize qualified patients—or, if morally opposed, to refer patients to others willing to kill them. In other words, complicity in euthanasia may soon become a condition of practicing medicine in Quebec—Hippocratic Oath be damned.

The United States too has seen a lurch in assisted suicide policy. Americans still have qualms about the issue; voters in Massachusetts narrowly rejected a legalization referendum last year. Thus, as a political expedient, proposals here usually limit doctor-prescribed death to the terminally ill and include bureaucratic guidelines that supposedly will protect against abuse.

True to form, Vermont has a new assisted-suicide law that contained such provisions when lawmakers passed it in May. But the “safeguards” will sunset in 2016. After that, no state oversight of any kind is mandated. Instead, suicide-assisting doctors will make their own rules so long as the patient is “capable and does not have impaired judgment.” The doctor informs the suicidal patient of “feasible end-of-life services” and discloses the “risks” of taking a lethal overdose. 

To recap: Starting in 2016, doctors in Vermont will assist patient suicides under what amounts to an honor system, no questions asked. What could go wrong? 

Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and consults for the Patients Rights Council and the Center for Bioethics and Culture.