Euthanasia and assisted suicide - contagion and corruption of compassion.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Arthur Goldberg and Shimon Cowan have written an excellent analysis of euthanasia and assisted suicide laws from the point of view of Jewish scholars. The article: The contagion of euthanasia and the Corruption of Compassion was published in Public Discourse on September 11.

Goldberg and Cowan write about the issue based on several topic areas. They start their article by referring to the quick expansion of euthanasia "MAiD" in Canada.

In Canada, “natural death” must be “reasonably foreseeable” before a doctor may euthanize a patient. In spite of such statutory language, in A.B. v. Canada, a case decided this June, the Court judged that the anticipated natural death need not be “imminent”; it need not even be “connected to a particular terminal disease or condition.” Rather, Justice Paul Perell concluded, “what is a ‘reasonably foreseeable death’ is a person’s specific medical question to be made without necessarily making, but not precluding, a prognosis of the remaining lifespan.” Physician-assisted suicide may go forward as long as a medical professional considers “all of a particular person’s medical circumstances.” One wonders in what sort of case death would not be reasonably foreseeable, under this loose standard. 

The foundation for this decision was an earlier Canadian Supreme Court case, Carter v. Canada. It overturned the law that criminalized both the assisting of another’s suicide and the consenting to one’s own death, on the grounds that the law “unjustifiably infringed” upon the rights and freedoms of “competent adult persons.”

Goldberg and Cowan then write about the Contagion of euthanasia:

One vector for the contagion of euthanasia is the vagueness of the terms in which the conditions for termination of life are expressed. Alex Schadenberg, International Chair of the Euthanasia Prevention Coalition, provides a couple examples.  A.B. v. Canada, the case cited above, arose because the petitioner’s doctor was unwilling to execute a woman with excruciating osteoarthritis, fearing that if he did so, he might be charged with murder. If the requirement that death be “reasonably foreseeable” is supposed to rule anything out, it probably should rule out killing someone with painful, non-terminal arthritis—yet the court found some way to justify the killing. Schadenberg also points to a case of a young man in a Vancouver nursing home who was diagnosed with a neurological disease and struggled to “find a cure with massive doses of vitamins.” Nowhere near dying, this man was nevertheless killed by a Vancouver physician. 

The spread of the contagion is facilitated by financial motives also. Insurance companies, trying to save money, often seek to replace sanctity of life with so-called quality of life. Dr. Brian Callister, an associate professor at the University of Nevada School of Medicine and former head of the State’s Medical Association, attempted to transfer two patients to hospitals in other states, so they could receive potentially life-saving treatments unavailable in Nevada. His patients were denied insurance for their transfer and treatment. The insurers asked: “Have you considered suicide?” Speaking from personal experience, Dr. Callister says, “Assisted suicide changes the way we care for patients. It creates a dangerous segue to perverse incentives for insurance companies and there’s no going back from that.” 

But Dr. Callister’s experience is not isolated. Stephanie Packer, a vibrant mother of four from California, suffers with scholoderma, a terminal condition. She was advised by her insurance company to seek a prescription from her doctor for a lethal medicine that would only cost her a $1.20 co-pay, instead of granting her the financial assistance she sought for life-affirming treatments at UCLA.

Goldberg and Cowan then examine the question of the Psychological Contagion of Suicide:

On his Fox News show, Tucker Carlson highlighted the negative effect of 13 Reasons Why, a Netflix show, on two teenage girls in California. According to their parents, the girls committed suicides after “bringing” on episodes of the show. They blamed their children’s deaths on the show’s glamorization of suicide, its presentation of suicide as a response to the stresses of teenage life. 

It is perhaps no accident that Oregon, the first state to legalize assisted suicide, has a general suicide rate some 40 percent higher than the American national average. Whether legal “assisted suicide” fueled the State’s culture of suicide, or was fueled by an otherwise existing culture of suicide, the Oregon experience at least suggests that suicide as a culturally accepted “value” and legislation permitting “assisted suicide” go together.

The authors then examine the issue of conscience rights. They wrote:

Permitting euthanasia does not just harm those who are killed. It also harms those who are forced to kill, or else suffer legal consequences or be forced from a profession. Legislation implemented in Ontario—and similar legislation proposed in Victoria, Australia—forces physicians who oppose personal involvement in euthanasia or “assisted suicide” to “effectively refer” their patients to another physician who will kill. “Effective referral” is defined as a referral to carry out the purposes of the Act. That means a specific referral either “to someone who will do it or someone who will arrange it. Either way,” EPC Chair Alex Schadenberg explains, “it’s a referral for the purpose of death.” It thus denies conscience rights to medical professionals who do not understand killing their patients to be part of their craft. 

In the view of Larry Worthen, executive director of the Christian Medical and Dental Association of Canada, when doctors are told they must send their patient to an executioner, “we are being forced to violate our deeply held religious beliefs. Effective referral and participating in assisted death are morally and ethically the same thing. This forces people of conscience and faith to act against their moral convictions and threatens the very core of why they became physicians, which is to help to heal people.” 

Dr. Mark D’Souza, a palliative care physician and board director of Concerned Ontario Doctors, indicates that as a “conscientious objector,” he objects to killing a patient. As a result, he and several other doctors he knows will no longer accept patients needing palliative care. The palliative care system in the community in which he practices (Scarborough) is grossly under serviced. The effect of these retirements is to worsen available care for patients in severe pain. In addition to contradicting the very concept of palliative care, the availability of euthanasia also tends to undermine its practice; where euthanasia is available, funding for palliative care falls correspondingly.

The authors then examine the question of compassion:

Euthanasia therefore abandons people at their most vulnerable. Rather than providing compassion and support for people in their suffering, euthanasia presents a callous and insensitive “alternative.” As Viktor Frankl points out, the essential human dimension is neither body nor mind, but rather a soul or conscience with both mind and body as its vehicles and challenges. The task of soul or conscience is to respond purposefully and ethically to the predicaments of mind and body. 

We can see a shining example of true compassion in the case of an Oregon resident, Jeanette Hall. After receiving a terminal diagnosis of cancer, she requested lethal drugs, thinking it appropriate to “do what our law allowed”—a law for which she voted. Her doctor, however, encouraged her not to give up, even though medical diagnosis gave her six months to live. A decade later she is still surviving.

The authors finally deal with the the inalienable rights and obligations we have towards persons. They conclude their article by stating:

In a previous Public Discourse essay, we spoke about the conditions required to achieve restoration of the political-moral center. One essential ingredient is to overcome a culture of sanctioned killing, to re-anchor our contemporary culture towards the protection of life, rather than its disposal. To do this we must crystallize into our collective consciousness the principles of the Noahide Code, the moral root of our great religious traditions and our civilization.

Thank you Arthur Goldberg and Shimon Cowen for researching issues related to euthanasia and assisted suicide from a Jewish point of view.