Euthanasia, Assisted Suicide & Health Care Decisions

Euthanasia, Assisted Suicide & Health Care Decisions:

Protecting Yourself & Your Family
by Rita L. Marker
INTRODUCTION
The words euthanasia and assisted suicide are often used interchangeably. However,
they are different and, in the law, they are treated differently. In this report, euthanasia is
defined as intentionally, knowingly and directly acting to cause the death of another person
(e.g., giving a lethal injection). Assisted suicide is defined as intentionally, knowingly and
directly providing the means of death to another person so that the person can use that means
to commit suicide (e.g., providing a prescription for a lethal dose of drugs).
Part I of this report discusses the reasons used by activists to promote changes in the law; the
contradictions that the actual proposals have with those reasons; and the logical progression
that occurs when euthanasia and assisted suicide are transformed into medical treatments. It
explores the failure of so-called safeguards and outlines the impact that euthanasia and
assisted suicide have on families and society in general.
Withholding and withdrawing medical treatment and care are not legally considered
euthanasia or assisted suicide. Withholding or withdrawing food and fluids is considered
acceptable removal of a medical treatment.
Part II of this report includes information about practical ways to protect oneself and loved
ones during any time of incapacity and a discussion of some of the policies that have led to
patients being denied care that they or their decision-makers have requested. It concludes
with an examination of the ethical distinction between treatment and care.
EUTHANASIA & ASSISTED SUICIDE: MOVING THE BOUNDARIES
In 2002, the International Task Force report, Assisted Suicide: Not for Adults Only?
Discussed euthanasia and assisted suicide for children and teens. At that time, such concerns
were largely considered outside the realm of possibility.
Then, as now, assisted-suicide advocates claimed that they were only trying to offer
compassionate options for competent, terminally ill adults who were suffering unbearably.
By and large, their claims went unchallenged.
A crack in that carefully honed image appeared in 2004 when the Groningen Protocol
elicited worldwide outrage. The primary purpose of that protocol formulated by doctors at
the Groningen Academic Hospital in the Netherlands was to legally and professionally
protect Dutch doctors who kill severely disabled newborns. (2)
While euthanasia for infants (infanticide) was not new, widespread discussion of it was.
Dutch doctors were now explaining that it was a necessary part of pediatric care.
Also in 2004, Hollands most prestigious medical society (KNMG) urged the Health Ministry
to set up a board to review euthanasia for people who had no free will, including children
and individuals with mental retardation or severe brain damage following accidents. (3)

At first, it seemed that these revelations would be harmful to the euthanasia movement, but
the opposite was true.
Why?
Awareness of infanticide and euthanasia deaths of other incompetent patients moved the
boundaries.
Prior to the widespread realization that involuntary euthanasia was taking place, advocacy of
assisted suicide for those who request it seemed to be on one end of the spectrum. Opposition
to it was on the other end.
Now, the practice of involuntary euthanasia took its place as one extreme, opposition to it as
the other extreme, and assisted suicide for terminally ill competent adults appeared to be in
the moderate middle a very advantageous political position and expansion of the
practice to others had entered the realm of respectable debate.
This repositioning has become a tool in the assisted-suicide arsenal. In May 2006, an assistedsuicide bill, patterned after Oregons law permitting assisted suicide, failed to gain approval
in the British Parliament. The bills supporters immediately declared that they would
reintroduce it during the next parliamentary session.
Within two weeks, Professor Len Doyal a former member of the British Medical
Associations ethics committee who is considered one of Englands leading experts on
medical ethics called for doctors to be able to end the lives of some patients swiftly,
humanely and without guilt, even without the patients consent. (4) Doyals proposal was
widely reported and, undoubtedly, when the next assisted-suicide bill is introduced in
England, a measure that would permit assisted suicide only for consenting adults will appear
less radical than it might have seemed prior to Doyals suggestion.
Currently, euthanasia is a medical treatment in the Netherlands and Belgium. Assisted suicide
is a medical treatment in the Netherlands, Belgium and Oregon. Their advocates erroneously
portray both practices as personal, private acts. However, legalization is not about the private
and the personal. It is about public policy, and it affects ethics, medicine, law, families and
children.
A FAMILY AFFAIR
In December 2005, ABC News World News Tonight reported, Anita and Frank go often
to the burial place of their daughter Chanou. Chanou died when, with her parents consent,
doctors gave her a lethal dose of morphine. Im convinced that if we meet again
somewhere in heaven, her father said, shell tell us we reached the most perfect
solution.'(5)
The report about the six-month-old Dutch childs death was introduced as a report on the
debate over euthanizing infants. A Dutch legislator who agrees that doctors who
intentionally end their tiny patients lives should not be prosecuted said, Im certainly prolife. But Im also a human being. I think when there is extreme, unbearable suffering, then
there can be extreme relief. (6)
Gone was the previous years outrage over the Groningen Protocols. Infanticide had entered
the realm of respectable debate in the mainstream media. The message given to viewers was
that loving parents, compassionate doctors and caring legislators favor infanticide. It left the

impression that opposing such a death would be cold, unfeeling and, perhaps, intentionally
cruel.
In Oregon, some assisted-suicide deaths have become family or social events.
Oregons law does not require family members to know that a loved one is planning to
commit suicide with a doctors help. (7) Thus, the first knowledge of those plans could come
when a family member finds the body. However, as two news features illustrate, some
Oregonians who die from assisted suicide make it a teachable moment for children or a party
event for friends and family.
According to the Mail Tribune (Medford, Oregon), on a sunny afternoon, Joan Lucas rode
around looking at houses, then she sat in a park eating an ice cream cone. A few hours later,
she committed suicide with a prescribed deadly drug overdose. Grandchildren were made
to understand that Grandma Joan would be going away soon. Those who were old enough to
understand were told what was happening. (8
Did these children learn from Grandma Joan that suicide is a good thing?
UCLAs student newspaper, the Daily Bruin, carried an article favoring assisted suicide. It
described how Karen Janoch who committed suicide under the Oregon law, sent invitations
for her suicide to about two dozen of her closest friends and family. The invitation read, You
are invited to attend the actual ending of my life. (9) At the same time Californias
legislature was considering an assisted-suicide bill that was virtually identical to Oregons
law, UCLA students learned that suicide can be the occasion for a party.
In Oregon, assisted suicide has gone from the appalling to the appealing, from the tragic to
the banal.
During the last half of 2005 and the first half of 2006, bills to legalize assisted suicide were
under consideration in various states and countries including, but not limited to, Canada,
Great Britain, California, Hawaii, Vermont, and Washington. All had met failure by the end
of June 2006. But plans to reintroduce them with some cosmetic changes are currently
underway. A brief examination of arguments used to promote them illustrates the small
world nature of assisted-suicide advocacy.
TWO PILLARS OF ADVOCACY
Wherever an assisted-suicide measure is proposed, proponents arguments and strategies are
similar. Invariably, promotion rests on two pillars: autonomy and the elimination of
suffering.
Autonomy
Autonomy (independence and the right of self-determination) is certainly valued in modern
society and patients do, and should, have the right to accept or reject medical treatment.
However, those who favor assisted suicide claim that autonomy extends to the right of a
patient to decide when, where, how and why to die as the following examples illustrate.
During debate over an assisted-suicide measure then pending before the British Parliament,
proponents emphasized personal choice. The bill, titled The Assisted Dying for the
Terminally Ill Bill, was introduced by Lord Joel Joffe. Dr. Margaret Branthwaite, a
physician, barrister and former head of Englands Voluntary Euthanasia Society (recently

renamed Dignity in Dying (10)), called for passage of the Joffe bill in an article in the British
Medical Journal. As a matter of principle, she wrote, it reinforces current trends towards
greater respect for personal autonomy. (11)
The focus on autonomy was also reflected in remarks about a plan to introduce an assistedsuicide initiative in Washington. Booth Gardner, former governor of Washington, said he
plans to promote the initiative because it should be his decision when and how he dies. He
told the Seattle Post-Intelligencer, When I go, I want to decide. (12)
The rationale is that when, where, why and how one dies should be a matter of selfdetermination, a matter of independent choice, and a matter of personal autonomy.
Elimination of suffering
The second pillar of assisted-suicide advocacy is elimination of suffering. During each and
every attempt to permit euthanasia and assisted suicide, its advocates stress that ending
suffering justifies legalization of the practices.
California Assemblywoman Patty Berg, the co-sponsor of Californias euphemistically
named Compassionate Choices Act, (13) said the assisted-suicide measure was necessary
so that people would have the comfort of knowing they could escape unbearable suffering
if that were to occur. (14)
In an opinion piece supporting the failed 1998 assisted-suicide initiative in Michigan, a
spokesperson for those favoring the measure wrote that the patients targeted by the
proposal were those who were tortured by the unbearable suffering of a slow and agonizing
death. (15)
In the United Kingdom, Lord Joffe said his bill would enable those who are suffering
unbearably to get medical assistance to die. (16) Testimony before the British House of
Lords Select Committee studying the bill noted that, where assisted dying has been
legalized, it has done so as a response to patients who were suffering. (17)
The centerpiece of the 1994 Measure 16 campaign that resulted in Oregons assisted-suicide
law was a television commercial featuring Patti Rosen. Describing her daughter who had
cancer, Rosen said, The pain was so great that she couldnt bear to be touched. Measure
16 would have allowed my daughter to die with dignity. (18)
When an assisted-suicide proposal that later failed was being considered by the Hawaiian
legislature in 2002, a public relations consultant who was working on behalf of the bill, emailed a template for use in written or oral testimony. The template suggested inclusion of
the phrases agonizingly painful, pain was uncontrollable, and pain beyond my
understanding. (19)
During consideration of an assisted-suicide bill in Vermont, the states former governor
Philip Hoff said, The last thing I would want in this world is to be around and be in pain,
and have no quality of life, and be a burden to my family and others. (20) Dick Walters,
chairman of Death with Dignity Vermont, said the proposal would permit a person to
peacefully end suffering and hasten death. (21)
Thus, the rationale given by euthanasia and assisted-suicide proponents for legalization
always includes autonomy and/or elimination of suffering. However, the laws they propose
actually contradict this rationale.

CONTRADICTIONS
When proposed, laws such as those now in existence in Oregon and similar measures
introduced elsewhere include conditions or requirements limiting assisted suicide to certain
groups of qualified patients. A patient qualified to receive the treatment of assisted suicide
must be an adult who is capable of making decisions and must be diagnosed with a terminal
condition.
If one accepts the premise that assisted suicide is a good medical treatment that should be
permitted on the basis of personal autonomy or elimination of suffering, other questions must
be raised.
If the reason for permitting assisted suicide is autonomy, why should assisted suicide be
limited to the terminally ill?
Does ones autonomy depend upon a doctors diagnosis (or misdiagnosis) of a terminal
illness? If a person is not terminally ill, but is suffering whether physically, psychologically
or emotionally why isnt it up to that person to decide when, why and how to die? Does a
person only have autonomy if he or she has a particular condition or illness? Is autonomy a
basis for the law?
If assisted suicide is a good and acceptable medical treatment for the purpose of ending
suffering, why should it be limited to adults who are capable of decision-making?
Isnt it both discriminatory and cruel to deny that good and acceptable medical treatment to
a child or an incompetent adult? Why is a medical treatment that has been deemed appropriate
to end suffering available to an 18-year-old, but not to a 16-year-old or 17-year-old? Why is
a person only eligible to have his or her suffering ended if he or she has reached an arbitrary
age?
And, what of the adult who never was, or no longer is, capable of decision-making? Should
that person be denied medical treatment that ends suffering? Are euthanasia and assistedsuicide laws based on the need to eliminate suffering, or not?
Establishing arbitrary requirements that must be met prior to qualifying for the medical
treatment of euthanasia or assisted suicide does, without doubt, contradict the two pillars on
which justification for the practices is based.
The question then must be asked: Why are those arbitrary requirements included in Oregons
law and other similar proposals? The answer is simple. After a series of defeats, euthanasia
and assisted-suicide proponents learned that they had to propose laws that appeared palatable.
In April 2005, Lord Joffe, the British bills sponsor, acknowledged that his bill was intended
to be only the first step. During hearings regarding the measure, he said that this is the first
stage and went on to explain that one should go forward in incremental stages. I believe
that this bill should initially be limited. (22)
He repeated his remarks a year later when discussing hearings about his bill. I can assure
you that I would prefer that the [proposed] law did apply to patients who were younger and
who were not terminally ill but who were suffering unbearable, he said and added, I believe
that this bill should initially be limited. (23)
STEP-BY-STEP APPROACH

Proposals for euthanasia and assisted suicide have always emanated from advocacy groups,
not from any grassroots desire. Those groups learned that attempting to go too far, too fast,
leads to certain defeat.
After many failed attempts, most recently those in the early 90s in Washington and California
when ballot initiatives that would have permitted both euthanasia by lethal injection and
assisted suicide by lethal prescription were resoundingly defeated death with dignity
activists changed their strategy. They decided to take a step-by-step approach, proposing an
assisted-suicide-only bill which, when passed, would serve as a model for subsequent laws.
Only after several such laws were passed, would they begin to expand them. That was the
strategy that led to Oregons Measure 16, the Oregon Death with Dignity Act.
Those who were most involved in the successful Oregon strategy were not new to the scene.
Cheryl K. Smith, who wrote the first draft of Oregons law, had served as a special counsel
to the political action group Oregon Right to Die (ORD). Smith had been the National
Hemlock Societys legal advisor after her graduation from law school in 1989 and had been
a top aide to Hemlocks co-founder, Derek Humphry. While a student at the University of
Iowa College of Law, Smith helped draft a Model Aid-in-Dying Act that provided for
childrens lives to be terminated either at their own request or, if under 6 years of age, by
parental request. (24)
Barbara Coombs Lee was Measure 16s chief petitioner. At the time, she was a vice president
for a large Oregon managed care program. After the laws passage, she took over the
leadership of Compassion in Dying. (25) [Note: In early 2005, Compassion in Dying merged
with the Hemlock Society. The combined organization is now called Compassion and
Choices.]
Coombs Lees promotion of assisted suicide and euthanasia began prior to her involvement
with the Death with Dignity Act. As a legislative aide to Oregon Senator Frank Roberts in
1991, she worked on Senate Bill 114 that would have permitted euthanasia on request of a
patient and, if the patient was not competent, a designated representative would have been
authorized to request the patients death. (26)
Upon passage of the Oregon law in 1994, many assisted-suicide supporters were certain that
other states would immediately fall in line. However, that did not occur. Between 1994 and
mid-2006, assisted-suicide measures were introduced in state after state.(27) Each and every
proposal failed. All of the proposals were assisted-suicide-only bills and, with one exception,
(28) everyone was virtually identical to the Oregon law.
Among supporters of assisted suicide and euthanasia, though, the Oregon law is seen as the
model for success and is referred to in debates about assisted suicide throughout the world.
For that reason, a careful examination of the Oregon experience is vital to understanding the
problems with legalized assisted suicide.
OPPOSING EUTHANASIA & ASSISTED SUICIDE EFFORTS
It is important to be concerned about assisted suicide and euthanasia. But concern alone
doesnt protect anyone. Tragically, some people worry about the dangers and assume that
either there is nothing they can do or that they dont have the time to get involved in
effectively opposing those seeking death on demand.

There is, however, much that can be done by everyone, no matter what ones age, occupation
or financial ability may be. The following are some concrete suggestions.
As already discussed, assisted-suicide laws have been and will continue to be proposed
throughout the country, using two prime avenues ballot initiatives and legislative proposals.
No matter which of those two avenues may be taken, effective advocacy of ones position
can include the following:
Be informed. Nothing destroys credibility more than having the facts wrong. Be able to cite
your source for any information.
Keep to the issue. There are many other hot button issues that one may feel passionate
about. But, when discussing assisted suicide, keep the focus on assisted suicide. Dont be
sidetracked to other issues. Dont be tempted to compare assisted suicide to other issues.
Write letters to the editor of your local newspaper. Keep the letters short and to the point.
(The Letters to the Editor section of any newspaper is one of the most-read sections, only
behind the sports page and advice columns.)
Always ask yourself three questions:
1. Who am I trying to reach? Know your audience. Is it a neighbor, family member,
legislator, large gathering or general reader of the local newspaper?
2. What am I trying to accomplish? Specifically, what is my one goal in saying or writing
this?
3. Will what I am planning to say or write reach the person or persons Im attempting to reach
and will it accomplish what Im trying to accomplish?
Recognize that your views are important. Your personal views, shared with clarity and
respect, can have a far greater impact on those you know than anything an outside expert
may say.
Become involved. Be active in neighborhood, community, professional, church and/or
political activities if possible. If you are already taking part in such activities, you will have
far greater influence when speaking about assisted suicide because you will have established
relationships. People will know you as a friend and colleague.
Dont take anyones viewpoint for granted. When the issue is assisted suicide, one cannot
predict anothers stance on the topic based on political or religious affiliations, nor can ones
view regarding assisted suicide be predicted based on a position related to other issues such
as abortion, capital punishment, etc.
Legislative proposals
If an assisted-suicide measure is proposed in the state legislature, the best thing to do is to
elect lawmakers who share your viewpoint about assisted suicide. This means finding out
where candidates stand on the issue. If you are pleased with the position taken by a candidate,
donate to the campaign or volunteer to work on the campaign, even if it is only to make a
few phone calls on the candidates behalf.
Then, continue to maintain contact with your elected officials after they get into office. If
you have established some type of relationship with your elected official or with his or her

staff, it is far more likely that your voice will be heard when a really important issue comes
up.
If an assisted-suicide measure is pending, dont wait until it is almost time for a vote to
contact your elected official. Generally, by the time a measure gets to a vote, minds are made
up. This is not to say that testifying at hearings about a measure is useless, but it is far easier
to change minds before that point.
Remember that short personal letters are far more effective than petitions or form letters.
Some suggestions:
Keep letters short (ideally one page long). A multi-page, single spaced letter filled with
underlining shouts, Ignore me. That type of letter may get a form letter in response, but its
only effect will be to alert office staff to ignore the next letter or message from the sender.
Be accurate. Make sure you can back up everything you write.
Say thank you. Occasionally send a letter thanking your elected official for a particular
position or vote that he/she has taken.
Be respectful but firm. Recognize that a lawmaker may, at first, favor a particular proposal
that you know is dangerous. His or her intent may be good. But that good intent will not
protect people from the sometimes deadly content of a measure. Gently point out the
problems in the bill. Be clear, concise, brief, and respectful.
Use correct terminology. Remember the definitions of euthanasia and assisted suicide
explained at the beginning of this report.
Note: The ITF is not a lobbying organization so it does not contact legislators seeking to
influence their votes. However, the ITF does analyze pending assisted-suicide bills. A
selected point from such an analysis can be used in a letter or message to a lawmaker.
Remember, you as someone who votes for the lawmaker will have far more influence on
an elected official than any outside organization or expert.
Voter initiative or referendum
If a proposal will be decided by a direct vote of the people, either through a referendum or
an initiative, the voters you, your friends, family, neighbors and colleagues will be
deciding whether the crime of assisted suicide will become a medical treatment in your
state.
There are many effective ways to help others understand the danger of such a proposal. The
following ideas are only a few such ways:
Before such a measure is actually scheduled for the ballot, begin to discuss assisted suicide
with others.
If you are a member of a church, professional or civic organization, become involved in the
program committee. If you have suggested other speakers who have been interesting, your
suggestion to schedule a speaker who will discuss assisted suicide is more likely to be
accepted. (You may even decide that you will offer to be the speaker for the topic.)
If you belong to an organization that frequently or occasionally adopts resolutions supporting
or opposing pending legislation, draft a simple resolution supporting your position on
assisted suicide. Line up support for it among others in the organization before proposing it.

If your resolution passes, make certain that your organization issues a press release
announcing the resolution.
Assisted suicide and euthanasia do, indeed, pose a great threat to families and to all of society.
But, with the exception of Oregon, the Netherlands and Belgium, attempts to legalize them
have been unsuccessful.
Unfortunately, there are other threats to vulnerable individuals. Those threats and the ways
to protect oneself and ones loved ones are addressed in Part II of this report.