My key reasons for opposing assisted dying (euthanasia and assisted suicide) Part II:

Patients overwhelmingly refuse the option of assisted death.

Gordon Friesen

By Gordon Friesen
President, Euthanasia Prevention Coalition

In an earlier post on this blog I began a list of key reasons to oppose euthanasia and assisted suicide (Part 1). I started with the social importance of maintaining a categorical prohibition of homicide.

Our adversaries predictably respond to such arguments with their own primary claim: that an exception must nevertheless be made because the people directly concerned truly wish to die.

I believe we may ourselves emphatically reply to this claim with one word: NO. 

That leads us to my Key reason #2: People eligible for Assisted Death (meaning euthanasia in Canada and assisted suicide in US) do NOT typically wish to die, nor will they typically consent to die in that fashion.

To be more precise and according to present clinical observations: at least NINETY PERCENT of all patients eligible for assisted death DO NOT WILLINGLY SUBMIT to that procedure REGARDLESS OF MEDICAL CIRCUMSTANCES.

(N.B. Such a bold claim of fact obviously demands clear proof, and I am pleased to present that proof in the concluding section of this commentary. To preserve a fluid narrative, however, I will first jump to the practical significance of these facts, in argument and in practice.)

What does it mean for euthanasia that (statistically speaking) people don't want to die that way?

Prior to widespread legalization of assisted death, all debate was wrapped in theory and conjecture. But as hinted above, that is no longer true. From a scientific perspective we must now concede that the hypothetical identification of a natural death-wish among certain patient populations has been rigorously tested, by an extended period of experimental legalization which has conclusively refuted that hypothesis.

Considered from a majority perspective therefore: the science (as they say) would unambiguously counsel us to stop this failed experiment and repeal all euthanasia-enabling legislation at once.

None of this, to be sure, should be taken to imply that the euthanasia phenomenon is actually too small to be of consequence. Not at all. Over 15,000 people died of euthanasia in Canada in 2023. That is an astounding number of medical homicides. And yet there is an equally important difference between the absolute size of a number and its proportional meaning in context.

It is only suggested here, that a proportional request rate of 1 in 10 eligible patients (even if entirely voluntary) cannot possibly justify the prioritization of assisted death which we observe today. Indeed, there is something deeply sinister (with far reaching political implications) about imposing this utilitarian medical agenda under a justification by personal choice, but against the clearly demonstrated collective will of those concerned.

(Our adversaries, of course, will surely retort that minority desire, also, deserves expression and respect.)

The proper place (if any) for a minority accommodation of assisted death.

In the modern policy lexicon we find a very interesting concept of "centering" which speaks to the wisdom of appropriately prioritizing minority interests in the public sphere. The centering of a marginal suicidal patient death-wish, however, has nothing in common with such positive examples of minority empowerment as the centering of disabled accessibility requirements in public buildings. Nor can the majority cost of this policy be discounted as a mere passing irritation, born of novelty. The Majority of patients interest and safety are severely compromised by the practices of euthanasia and assisted suicide. There is no legitimate minority claim, therefore, for the centering of assisted death.

Unfortunately, however, the often irrational theater of political compromise (particularly in the face of of actual legalization) has made the frank rejection of assisted suicide, and euthanasia, impossible in many jurisdictions at this time.

It thus becomes imperative to insist on a coherent political understanding of the simple quantitative facts presented here. Typical patients, of the vast non-suicidal majority, should always be served (by default) in Assisted Death-free institutions, by physicians and nurses who can be trusted never to suggest or to collaborate with assisted death in any form.

Only outside of this secure clinical environment might any minority accommodation ever be contemplated, and always limited to a scale which is proportional to real observed demand

The facts and nothing but the facts: demonstrating the marginal presence of patient death-wish

Euthanasia has been practised in the Netherlands and Belgium for over 20 years. It has been practised in the Canadian Province of Quebec for 9 years, and in the whole of that country for a little more than 8 years. We therefore possess an excellent body of data to inform us of the real popular response to assisted death.

We are not talking, here, about democratic support for the hypothetical freedom to choose. We are rather talking about the real instance of choices actually made. For it is to that measure that real policy should coherently respond.

A quick indication of the popularity of assisted death (in any given jurisdiction) may be found in the rate of AD to total deaths. By this measure, the Netherlands and Canada are the most prolific countries in the world having rates of 5.3% and 4.6% respectively. This means that roughly 95% of people (one way or the other) still die a natural death. However, we can't say that all of those people have refused euthanasia, because there are accidental and sudden deaths where that choice is not possible.

In the interests of fairness, therefore, let us examine that category in which the choice of euthanasia is most popular of all, which unsurprisingly concerns the terrifying prospect of terminal cancer. Indeed, on average, for our two countries, cancer causes only 28% of all deaths but results in no less than 60% of all euthanasia. Most interesting, however, is the observation that among all patients in this extreme category, in those two countries possessing the highest acceptance of euthanasia (and where all terminal cancer patients are systematically informed of that option) only 1 in 10 will choose, or consent, to die in that manner.[i]

Hence we are rigorously correct in concluding that the highest participation rate ever recorded, in any medical circumstance, in any jurisdiction --after nearly a quarter century of trial-- is no more than 10%.

To recapitulate

1. The demand for assisted death is a marginal phenomenon arising among a small minority of patients;

2. Considering the proportion of those eligible individuals actually requesting this death it can (and should) be vigorously argued that no practice of assisted death, whatsoever, is reasonably justified;

3. In the real world of political compromise (where assisted death has already been legalized) it must be our task to lobby for the limitation of that practice to a marginal accommodation only, commensurate with the small minority who really desire it.

Above all: we must use these facts to defend our collective interest in maintaining a medical "safe spaces" which is safe for the non-suicidal majority, and thus to reject policies which would threaten that safety by artificially centering objectively marginal suicidal desires.

[i] Note on Canadian and Dutch cancer euthanasia as a fraction of all cancer deaths:

• Canada total deaths: 330,380 total deaths (Link)
• Canada euthanasia deaths: 15,280 (Link)
• Canada total cancer deaths 86,700 Cancer fraction of all deaths .26 (Link)
• Canada euthanasia fraction of all deaths .046 Cancer deaths fraction of all euthanasia deaths .63 (Link) 
• Canada cancer euthanasia fraction of all deaths (.046 x .63) .029 
• Canada euthanasia fraction of all cancer deaths (.029/.26) .11
  

• Netherlands total deaths 170,100 (Link)
• Netherlands total cancer deaths (2022) 49,790 (Link)
• Netherlands (2023) total euthanasia deaths 9068; cancer euthanasia deaths 5105; (Netherlands euthanasia reports)
• Netherlands cancer fraction of total deaths: (49,790/ 170,100) .29
• Netherlands euthanasia fraction of total deaths: (9068/ 170,100) .053
• Netherlands cancer deaths fraction of total euthanasia deaths: (5105/ 9068) .56 
• Netherlands cancer euthanasia deaths fraction of all deaths (.56 x .053) .03
• Netherlands cancer euthanasia deaths fraction of all cancer deaths (.03/.29) .10
  

Right-to-die legislation must consider concerns of African Americans

This article was published by Bridge Michigan on September 25, 2024.

Terri Laws

By Terri Laws, associate professor of African and African American studies at the University of Michigan-Dearborn.

In the 1990s, Royal Oak’s Dr. Jack Kevorkian put a national spotlight on the debate over the right of terminally ill patients to die with the aid of a physician. As Democrats reclaim their majority in the state Legislature, Michigan may be at the epicenter of this conversation again.

Last fall, a group of Democrats introduced the Michigan Death With Dignity Act, which would legalize physician-assisted dying, also known as medical aid in dying. Patients with a terminal condition, expected to die within six months, would be able to request that a participating doctor write them a prescription for drugs that, when self-administered and ingested, would allow the patient to die on the date of their choosing.

Many Michiganders will see this legislation as reasonable and compassionate. To others, however, often people of color, this legislation is more complicated. Some fear doctors and insurance companies may deny them lifesaving treatments and steer them toward assisted suicide instead. Others are concerned that legalization will normalize this type of death as the “correct” way to approach the end of life, when their cultural beliefs and practices tell them otherwise. Central to these views are issues around equitable access to care — and of trust.

According to a 2022 Pew Research report, nearly a quarter of the US population say they have “not too much or no confidence in medical scientists to act in the best interests of the public.” For African Americans, this mistrust has deep origins in exploitative experimental medicine and undertreatment. The best-known example — of far too many — is the 40-year long Tuskegee Syphilis Study authorized and conducted by the United States Public Health Service. Black men in rural Alabama, diagnosed with syphilis, were recruited into the study and were left untreated so physicians could follow the progression of the disease and conduct an autopsy once they died. The “study” continued even after penicillin became standard treatment in the 1950s and through 15 articles published in medical journals. In light of these horrifying details, it should be easy to see how rational many African Americans’ distrust of the traditional health care system is.

The effort to pass MAiD in Michigan is part of a larger, well-organized right-to-die movement. Legalization advocates move from state to state lobbying elected officials with template bills, which include the promise of legislative safeguards. They also point to public polls that measure the popularity of attitudes that support the legislation. But attitudes are not practice. Safeguards only put people at ease when they trust the entity creating them and that the people within those entities will enforce them. Data from states that have adopted right-to-die legislation shows that people of color are largely steering clear of pursuing a deliberate death. For example, in racially and ethnically diverse California, the Bureau of the Census reports that 35% of persons in the state selected their racial identity as white alone, yet public health reporting shows 88% of MAiD requests come from whites. A similar pattern of use has emerged across the country where the practice is legal.

A lesser-known outcome of Tuskegee is that it ultimately became one of several research studies later recognized as so egregious that it contributed to Congressional hearings and legislation that, ultimately, led to the national commission that approved the research standards and ethical framework that the US, and much of the world, lives with today. Passage of the Medical Aid in Dying Act in Michigan must include trustworthy safeguards, including genuine opportunities for community conversations and input — both before and after enactment — and funding for public education.

It is worth noting that people of color are not the only ones with reservations about MAiD. Those with less education and the un- or under-insured, not to mention persons who have disabilities, have expressed concerns as well.

For advocates of MAiD, the right to ingest medication that may bring about a “good death” seems morally right, compassionate, just and a matter of autonomy. But if we are to legalize the right to die in Michigan in a way that does not exacerbate distrust and inequity, we need to acknowledge and address Michiganders’ differing historical attitudes, cultural perspectives and lived experiences around end of life care.