Assisted Suicide: Not for Adults Only?

by Rita L. Marker

Table of Contents

INTRODUCTION

THE NETHERLANDS

Support from Down Under
Dutch Amend Proposal
Dutch Guidelines

 

PROMOTION IN THE UNITED STATES

Ohio Pediatrics Ethics Survey
Princeton University and Pediatric Euthanasia
Getting Students to Think
Wisconsin
Iowa Model Law

 

SUICIDE KITS FOR YOUR CHILDREN

“Peaceful Pill”
Death on Demand for Anyone of Any Age

CONCLUSION

ENDNOTES

INTRODUCTION

Could children and teens ever be eligible for euthanasia or assisted suicide? (1)

To even ask such a question can brand the questioner as a hysterical opponent of assisted suicide who is using emotionally charged fear tactics.

Assisted suicide supporters have worked mightily and successfully to persuade the public that a typical death would be an elderly person who, on her deathbed, freely chooses to die sooner, rather than later. This image has been so cemented in the public consciousness that even many opponents of assisted suicide are affronted by any suggestion that it would be available to young people.

This was readily apparent during a 1997 campaign to repeal Oregon’s “Death with Dignity Act.” (2) In 1994, Oregon became the only place in the entire world where a law specifically permitted assisted suicide. Its implementation was held up in the courts and, prior to its going into effect, voters were faced with an attempt to repeal it. As in any political campaign, television commercials were produced to sway voters. One such commercial, intended to persuade voters to overturn the law, depicted a young man of about 19 or 20 named Billy. He appeared frightened and desperate on receiving the diagnosis of his condition and opted for the lethal dose. A voice-over explained that Billy’s death from the drugs, far from being peaceful, could be lingering and painful.

The Billy ad was rejected by six television stations, including all three network affiliates in Portland. It was called “distasteful,” “over-the-edge,” “disgusting,” and “unbelievable” by both sides. Although some of the rejection of the commercial’s message centered around claims about lingering death, most people were turned off by Billy’s youth. No one could believe that someone who looked like a college freshman would qualify for doctor-assisted suicide.

The ad went too far, but not because it was inaccurate or misleading. It wasn’t. It went too far because it violated a major tenet in the art of argument and persuasion: “If a listener thinks that you are speaking falsely about any fact, she will be less likely to believe other facts that you assert or inferences that you suggest should be drawn.” (3)

That is, it is not only important to tell the truth, it is also important to tell the believable truth.

Until now, facts about euthanasia and children have been clearly in the realm of unbelievable truth.

But, in the last few years, developments in the Netherlands and in Australia have opened the door, ever so slightly, so that the implications of assisted suicide for youngsters can begin to be discussed.

THE NETHERLANDS

Euthanasia and, to a lesser degree, assisted suicide have been widely and openly practiced in the Netherlands for years, yet they remained technically illegal until a law permitting them went into effect in 2002.

In mid-August of 1999, the Dutch government published a proposal to formally legalize them.

 

 

According to the proposal, euthanasia and assisted suicide would be legal if:

The patient makes a voluntary request;
The patient is suffering irremediable and unbearable pain (Note: Dutch court decisions have found that either “psychic” (emotional) or physical pain can be used to meet the criteria of “unbearable suffering.” Terminal illness has never been a requirement for euthanasia in the Netherlands.)
All medical options must be exhausted;
A second medical opinion must be sought;
The euthanasia death must be “carefully carried out”; and
Physicians must report each case.(4)

These provisions would have received little attention — other than a report that technical legalization of a current practice was set to take place — if another aspect of the proposal had not been noticed. The draft legislation also provided for legalization of euthanasia for children. Like a match to tinder, world attention was ignited on that aspect of the plan:

“The most eye-catching aspect of the bill, and one that has focused international attention on the Netherlands, is that it would give children between the ages of 12 and 16 the right to request euthanasia and — with the doctor’s consent — have their wishes prevail even if their parents object. Those 16 and above would be treated as adults.” (5)

In the public eye, this provision was astounding. True, it had been common, but largely ignored, knowledge for years that disabled newborns were being euthanized in Holland. In fact, the Dutch Pediatric Association had issued guidelines in 1994 under which babies who were not terminally ill but who were mentally retarded or faced the prospect of living with chronic illness could be eligible for the treatment of death. According to Dr. Pieter Sauer, a co-author of the Association instructions, the rules let the doctor decide what is in the “best interests” of the baby.(6)

But this was different. This wasn’t a doctor’s decision. It wasn’t a parent’s decision. It would give children and young teens the legal right to request that their lives be ended with a lethal overdose of drugs.

Support from Down Under

Few advocates of euthanasia were willing to publicly support the Dutch proposal as it related to children. A notable exception, however, was Dr. Philip Nitschke, an Australian euthanasia campaigner and activist. Known as the Australian “Dr. Death,” Nitschke legally practiced euthanasia in Australia during the few months in which the now defunct “Rights of the Terminally Ill Act” of the Northern Territory was in effect. He now conducts “how to commit suicide” programs in Australia and New Zealand and is often a featured speaker at right-to-die conferences in the United States.

Nitschke said he believed that Australia should move down a track similar to that of the Netherlands since he couldn’t see any principled reason to preclude young children from receiving assisted suicide or euthanasia. According to Nitschke, a child has the maturity to make such a life and death decision. “I think the Dutch government has taken a very courageous step,” he said. (7)

There is a certain irony to Nitschke’s stance, given his explanation of an event that took place when he was in his teens.

According to news accounts, Nitschke had a somewhat troubled childhood. As a young teen, he was deeply unhappy and, at the age of 15, he took out his frustrations by killing a neighbor’s dog. He devised a plan in which he faked going to church on Sunday, then doubled back to the neighbor’s house to strangle the dog. When the dog didn’t die, he slit its throat with a knife.(8)

The story has caused embarrassment to Nitschke over the years. But he has explained it by chalking it up to his immaturity. “I was very young; I just didn’t have the world experience to be able to make good judgments,” he told the Sydney Morning Herald.(9) “It was the ill-considered action of a child, ” he says now. (10)

Thus, according to Nitschke’s logic, a 15-year-old who kills a neighbor’s dog is exhibiting the actions of a child who is too immature to make good judgments. But a child who decides to kill himself is sufficiently mature to do so.

Dutch Amend Proposal

The Dutch proposal regarding children did get support from other right-to-die activists, but they limited expressions of support to Internet mailing lists and inter-organizational discussions. “It has long been my view that any age cut-off point is unfair and discriminatory, when legalizing voluntary euthanasia,” said one nurse.(11)

However, the sentiments of those who approved the planned Dutch action did not prevail. It took less than six weeks for Holland to bow to international disapproval. In early October, the Dutch government changed is proposal, deleting the provision that would permit children between 12 and 16 to legally demand euthanasia without parental approval.(12)

Once again, kids and euthanasia dipped below the radar screen. Few people realized that, although euthanasia on demand for children was no longer in the bill, a similar provision had been substituted.

Under the amended version, twelve to fifteen-year-olds would still be able to request euthanasia, but their parents would need to consent to their deaths. Older teens (those who are 16 or 17-years old) would be able to demand euthanasia and, although their parents would need to be involved in any discussions, the teen would make the very final decision.(13) As with adults, children and teens would not need to be terminally ill. The subjective experience of undefined unbearable suffering (of either a physical or psychic nature) is the criteria qualifying one for Dutch death.(14)

Furthermore, it appears likely that the requisite parental approval or consultation will be observed where convenient but ignored if those in authority decide that such requirements are too burdensome. In effect, this would maintain a situation that has existed for well over a decade. That is, non-compliance will make such deaths illegal but they will not be prosecuted.

Dutch Guidelines

The practice of pediatric euthanasia and assisted suicide in the Netherlands is not new.

In l987, when the Dutch government drafted guidelines for the practice of euthanasia while retaining laws against it, the guidelines initially included requirements that family members should be included in mercy-killing decisions. However, the Dutch Health Council (an official government body charged with advising the government, the medical profession and health care institutions) advised the Cabinet to drop family participation requirements. The Council said that not only adults, but even children under 16, should be able to request euthanasia without family involvement. In asking for the change, the Council said that suffering is “not more bearable and recoverable because the patient has yet to reach the age of 16.” (15)

That same year, articles began to appear describing the practice of providing lethal doses of drugs to children that they could take when they felt so inclined. One such article described the practice of a Dr. Voute, the leading Dutch specialist in pediatric oncology, who acknowledged that he had supplied drugs to children for assisted suicide on an average of six times each year. He explained that this was done without the parents’ knowledge.(16)

One of the few mentions of the practice occurred in 1988 when, in a letter to the editor of the Journal of the American Medical Association, a Dutch physician wrote that some doctors provide “self-help programs” for adolescents to end their lives.(17)

But such coverage of euthanasia for teens and pre-teens was sparse to say the least. Furthermore, in the 1980s, euthanasia received scant mention in the major media. Few people were interested or concerned about it.

Throughout the 1990s, little reference was made to children being given the right to request euthanasia although there were numerous references in the popular press to mercy killings involving disabled babies in the Netherlands.

In July 1992, the Dutch Pediatric Association announced that it was issuing formal guidelines for killing severely handicapped newborns. According to Dr. Zier Versluys, chairman of the association’s Working Group on Neonatal Ethics, “Both for the parents and the children, an early death is better than life.” Versluys indicated that euthanasia is an integral part of good pediatric practice.(18)

Three of the eight centers of neonatology surveyed by the Dutch Pediatric Society were performing euthanasia on handicapped newborns when “bringing about a speedy death” was considered “the most merciful treatment.” (19) Infants who were deemed eligible for death included not only those who were terminally ill but children who were mentally retarded or faced the prospect of living with a chronic illness. The treatment of death was carried out after the doctor decided that it was in the “best interests” of the baby.(20)

As in the case of children who requested euthanasia, mercy-killing deaths of infants in Holland omitted the need for parental approval. According to Evert van Leeuwen, a medical ethicist at Amsterdam’s Free University, parents may give input but, in the end, the child’s doctor has the final authority to determine whether the child is killed, even if it is against the wishes of the parents. “We call that medical treatment,” van Leeuwen said.(21)

So why, if such practices have been on-going, was there such strong reaction to the 1999 proposal?

The answer may be two-fold. First, the news of the proposal hit front pages and was covered on nightly network news. Second, in the wake of Jack Kevorkian and ballot proposals in various states, more and more people had heard of and had paid at least some attention to euthanasia and assisted suicide.

Does this mean, then, that discussion of euthanasia and children is something which truly resonates with the American public? Has it entered the realm of the “believable” as it pertains to what could possibly happen here?

Absolutely not.

No matter how horrified people may be when they hear of the situation in the Netherlands, such horror is inevitably followed by comments like, “The United States is not the Netherlands” and “No one would ever propose euthanasia for children here.”

In fact, such proposals have been made in the United States on a number of occasions.

PROMOTION IN THE UNITED STATES

The initial proposal for legalization of euthanasia in the United States was, in fact, aimed at permitting involuntary euthanasia for children, as well as adults.

On January 17, 1938, the New York Times reported the official formation of the Euthanasia Society of America.(22) Within a year, the organization was ready to offer a proposal that would legalize “the termination of human life by painless means for the purpose of avoiding unnecessary suffering.” According to Charles Nixdorff, the society’s treasurer, the measure was limited to voluntary euthanasia because public opinion was not yet ready to accept a broad scope encompassing infants and incompetents. However, the article noted that the society “hoped eventually to legalize the putting to death of non-volunteers beyond the help of medical science.”(23) Dr. Foster Kennedy, the euthanasia society’s president declared that euthanasia was “needed mainly for defectives.” He urged the “legalizing of euthanasia primarily in cases of born defectives who are doomed to remain defective, rather than for normal persons who have become miserable through incurable illness.” (24)

In a 1941 poll of twenty-five thousand New York State doctors, conducted by the Euthanasia Society, 27 percent of respondents favored euthanasia for severely disabled children. The poll did not differentiate between newborn and older children. (25)

The following year, Dr. Kennedy came up with a plan for child euthanasia. In an American Journal of Psychiatry article, he wrote: “I believe when the defective child shall have reached the age of five years — and on the application of his guardians — that the case should be considered under law by a competent medical board…” If careful board examination determined that the child was considered to have “no future or hope of one,” he continued, “then I believe it is a merciful and kindly thing to relieve that defective — often tortured and convulsed, grotesque and absurd, useless and foolish, and entirely undesirable — of the agony of living.”(26)

While Kennedy boldly stated the goal of the Euthanasia Society, the organization’s public stance increasingly revolved around the more acceptable concept of voluntary euthanasia for adults.(27)

Just as it is easy to dismiss what is happening in the Netherlands by saying, “We’re not Holland,” it would be simple to describe proposals of the 30s and 40s as aberrations of the past and declare, “That was a long time ago. No one would suggest such a thing today.” But such things indeed are being suggested. The prospect of mercy killing for children entered the realm of “respectable debate” in the 1980s and 1990s.

Ohio Pediatrics Ethics Survey

In 1993, 900 parents whose children were patients at several Cleveland area health facilities, including the Cleveland Clinic Foundation and MetroHealth Medical Center were asked to fill out a 30-question “Pediatrics Ethics Survey” that included lethal injections and mercy killing among the “options.”(28) Authors of the survey were Dr. Eric Singer of the Cleveland Clinic Foundation and Dr. Andrea Sperduto at MetroHealth Medical Center. The cover sheet explained the survey’s purpose:

This survey is being given to you because you are a parent. We would like your opinion on various issues pertaining to the health care of children. As you have probably been hearing on television, radio, reading in the newspaper, or even experienced, doctors have been using newer medicines and technologies to keep patients alive who may have died only a few years ago. Whereas this may be viewed as positive, it is also producing new problems for society: these advancements are very costly. A major issue of recent political campaigns has been who will pay for this increase in health care. The options have been to deny health care to those who can not afford it, or raise taxes and/or insurance premiums. Questions have been raised on how our limited amount of health care dollars should be spent.

If you are a parent of a healthy child, these questions may be the farthest thing from your mind. If you a [sic] parent of child who has been very ill or has died, you may wish that these issues would just disappear. If you elect to complete this survey, you will be asked some very troubling and disturbing questions. As a parent, a person who almost by definition has a personal interest in the welfare of children, we want to get your opinion on these issues. By completing this survey, you can help us to see how concerned parents may approach varying tragic situations.(29)

Following the initial eight questions that dealt with the standard demographics requested in most surveys (age, education, income, etc.), participants were given scenarios such as:

If your child was seriously injured in an accident and the medical team tells you that, at best, your child would be severely brain damaged (but not in a coma) and be completely dependent on others for the remainder of your child’s life, would you

__ want “everything” done

__ want a “DNR” order

__ want withdrawal of potentially life sustaining machines

__ want withdrawal of all support including nutrition

__ want a lethal injection of a sedative to be given (“mercy killing”) (30)

If your doctor told you that your newborn(67) child had apparent severe brain damage and only had a 10% chance of normal intelligence, would you

__ want “everything” done

__ want a “DNR” order

__ want withdrawal of potentially life sustaining machines

__ want withdrawal of all support including nutrition

__ want a lethal injection of a sedative to be given (“mercy killing”) (32)

In each of the five scenarios, the lethal injection option was given. The scenarios were followed by questions about how a sum of money could best be used. For example:

If $100,000 was available to a hospital, would you want this money spent on

__ general preventative health care (immunizations, education, safety programs) for the community

__ a child that you do not personally know who is in an irreversible coma.(33)

The survey concluded with the questions:

Do you support physician-supported suicide (voluntary death)?
Yes or No (34) and

Do you support “mercy killing” (non-voluntary death)?
Yes or No (35)

When asked why the lethal injection option was included, Dr. Eric Singer, senior author of the survey, said the questions would have been considered “biased and censored” if the mercy killing option hadn’t been offered.(36)

The Pediatrics Ethics Survey received no attention outside of the Cleveland area, yet its message to the 900 parents who were asked to participate was loud and clear: euthanasia for a child is an “option” that deserves consideration.

Far more attention was focused in 1999 on the issue of killing children when Australian philosopher, Peter Singer (no relation to Eric Singer), became a professor in bioethics at Princeton University.

Princeton University and Pediatric Euthanasia

In 1999, Peter Singer, a former professor at Australia’s Monash University, became the Ira W. DeCamp Professor of Bioethics at the Princeton University Center for Human Values. At Princeton, Singer is molding and shaping the views of future leaders in medicine, law, education and business.

Singer’s appointment was met with shock and dismay by those who were aware of his views. He is an outspoken advocate of infanticide and euthanasia. In a 1983 article, Singer negatively compared the value of a handicapped newborn with that of a pig:

If we compare a severely defective human infant with a nonhuman animal, a dog or a pig, for example, we will often find the nonhuman to have superior capacities, both actual and potential, for rationality, self-consciousness, communication, and anything else that can plausibly be considered morally significant. Only the fact that the defective infant is a member of the species Homo sapiens leads it to be treated differently from the dog or pig. Species alone, however, is not morally relevant.(37)

The article had been the result of findings from an Australian government research grant titled “Life or Death Choices for Defective Newborns” for which Singer and fellow philosopher Helga Kuhse(38) were the chief investigators. Singer had previously worked for a brief time at The Hastings Center and support for the three-year Australian grant was bolstered by an official letter of recommendation submitted by a Hastings Center colleague who wrote, “He is clearly one of the most outstanding philosophers in the English-speaking world. He has been highly productive, has had a major impact, and has always written interesting and significant things. …[H]e has a very clear sense of the state of the argument, and where that argument is likely to go in the future.”(39)

Singer has honed his argument over the years. In 1997, the second edition of his Practical Ethics was published. In it, he based his espousal of pediatric euthanasia on a “replacement theory.” According to this theory, many parents opt to have a specific number of children and such offspring are intended to bring happiness to the family. Singer suggests that disposing of a disabled child and replacing it with a new one could result in greater happiness for all.

He used the scenario of a woman who has decided to have two children. The firstborn is a “normal child.” The second child has hemophilia. According to Singer:

The burden of caring for that child may make it impossible for her to cope with a third child; but if the disabled child were to die, she would have another. …

When the death of a disabled infant will lead to the birth of another infant with better prospects of a happy life, the total amount of happiness will be greater if the disabled infant is killed. The loss of a happy life for the first infant is outweighed by the gain of a happier life for the second. Therefore, if killing a haemophiliac infant has no adverse effect on others, it would, according to the total view, be right to kill him.

The total view treats infants as replaceable, in much the same way as it treats non-self-conscious animals.(40)

He went on to explain:

If disabled newborn infants were not regarded as having a right to life until, say, a week or a month after birth it would allow parents, in consultation with their doctors, to choose on the basis of far greater knowledge of the infant’s condition than is possible before birth….

[T]he main point is clear: killing a disabled infant is not morally equivalent to killing a person. Very often it is not wrong at all.(41)

But, outside of the realm of academia, Singer was far better known in Australia and in Europe than he was in the United States prior to his Princeton appointment. Some of his speaking engagements in Germany had been halted because of massive protests, leading Singer to describe himself as a latter-day Socrates who was being persecuted for merely questioning the received wisdom of the time.(42)

And, when Singer was invited to address a Swedish book fair in 1997, Simon Wiesenthal, the world’s leading Nazi hunter, wrote to the organisers saying, “a professor of morals who justifies the right to kill handicapped newborns…is in my opinion unacceptable for representation at your level.”(43)

Such opposition, however, did nothing to give pause to the powers that be at Princeton. The university president announced Singer’s appointment saying: “There is no question about Professor Singer’s eminence in the field of bioethics…. In strongly recommending and endorsing Professor Singer’s appointment at Princeton, our own faculty members have made it clear that while they may disagree with him on some issues, just as my colleagues in Economics may differ on issues of economic policy, they have deep respect for his scholarship and invariably find his work instructive.”(44)

Apparently the president of Princeton considers advocacy of infant killing to be in the same category as differing views on economic policy — just one more topic of academic debate.

Since taking up the post, Singer has comfortably settled into his position, brushing off any opposition and emerging unscathed from a brief firestorm over an article he wrote about the merits of bestiality. (45)

He has explained that any protests directed at him have had a good side because they make him better known and has given him the opportunity to talk about the things he wants to talk about. He noted that he is “getting students to think.” (46)

Getting Students to Think

Singer told Salon.com that there wasn’t much going on before he took over his post but that all that has changed with lively discussions and events such as those he co-sponsors with Professor Lee Silver.(47) Silver is a professor of molecular biology and public affairs in the Department of Molecular Biology and the Woodrow Wilson School of Public & International Affairs at Princeton University. Like Singer, he is a strong proponent of animal rights. Both professors equate the value of animals with that of humans and seem to view children as commodities that exist solely for the purpose of bringing happiness to their parents.(48)

While Singer vociferously condemns killing animals, his opposition to killing pales when it comes to humans. “I do think that it is sometimes appropriate to kill a human infant,” he told the Cape Cod Times. “For me, the relevant question is, what makes it so seriously wrong to take a life?” he asked. “Those of you who are not vegetarians are responsible for taking a life every time you eat. Species is no more relevant than race in making these judgments.”(49)

In his book, Practical Ethics, Singer wrote, “We cannot expect a child with Down syndrome to play the guitar, to develop an appreciation of science fiction, to learn a foreign language, to chat with us about the latest Woody Allen movie or to be a respectable athlete or basketball or tennis player.” (50)

He suggests that parents may wish to prevent becoming attached to the baby with Down Syndrome: “When this can be done at a very early stage of the voyage, we may still have a chance to make a fresh start. This means detaching ourselves from the infant who has been born, cutting ourselves free before the ties that have already begun to bind us to our child have become irresistible.”(51)

To emphasize the point, after discussing the practice of infanticide in early cultures, he states, “But in the case of infanticide, it is our culture that has something to learn from others, especially now that we, like them, are in a situation where we must limit family size.”(52)

Yes, Peter Singer is making students think. And if they follow his twisted logic they will be more than ready to think that requesting or approving euthanasia for their children and the children of others is merely an application of very practical ethics.

Wisconsin

With the exception of the Netherlands, it would appear from the preceding discussion that suggestions of euthanasia for children deals with involuntary euthanasia of infants and other very young children whose doctors or parents would decide that they are better off dead.

But there has been actual and model legislation in the United States that would have permitted elementary school children to demand death, with or without parental consent.

Wisconsin State Representative Lloyd Barbee of Milwaukee introduced such a law on October 22, 1975.(53) It was described as an Act “relating to establishing a right to die.” If passed, the measure would have made an exception in the state’s homicide law for killing upon request and it would have abolished the crime of assisting suicide.

Section 1 of the proposed law stated:

895.50 THE RIGHT TO DIE

  1. Except as otherwise provided in this section, any person may request any person 14 years of age or older to terminate the life of the requestor. Any such request may be either oral or written. Any person terminating the life of a requestor, pursuant to a valid request, shall not be civilly liable for his actions and shall not be considered in violation of ss. 940.01 to 940.09.
  2. Prior to requesting another person to terminate the requestor’s life, the requestor, if married, shall notify his spouse of his decision. Permission from the spouse shall not be a condition precedent to making a valid request to die.
  3. (a) A person under 7 years of age shall not be able to make a valid request to have his life terminated under sub. (1).
    (b) A person 7 years of age or older but under 18 years of age shall notify his parents or guardian, whichever is applicable, prior to requesting another person to terminate the requestor’s life. Permission from such parents or guardian shall not be a condition precedent to making a valid request to die.(54)

Barbee’s bill was over the edge by any standard, yet it was a serious proposal. Since its quiet demise in the Wisconsin Assembly’s judiciary committee, no bill with such blatant advocacy of euthanasia for children has found its way into the legislative hopper. In fact, it was over twenty years before another bill that would have permitted minors to request death by assisted suicide or euthanasia was introduced anywhere.

In 1997, the Illinois “Dignity in Dying Act” (which never made it out of committee), would have let physicians provide qualified adults and “emancipated minors” with the “medical means to end their life.” (55)

But a model law, permitting death on demand for very young children, was drafted in 1989 with the expectation that it would be used eventually by states throughout the country.

Iowa Model Law

In 1989, the University of Iowa College of Law — noted for drafting laws that subsequently receive serious consideration in legislatures — drafted a “Model Aid-in-Dying Act.” In the Act “aid-in-dying” is defined to include “administration of a qualified drug for the purpose of inducing death.” (56)

Under the Act, aid-in-dying could be demanded for terminally ill (57) children by their parents or by terminally ill children along with their parents:

§ 5-101 DEMAND FOR AID-IN-DYING FOR TERMINALLY ILL PATIENT

a. Aid-in-dying for a terminally ill patient may be demanded under this section:

3. On behalf of a terminally ill patient under the age of 6 by the patient’s custodial parents or, if only one parent has custody, by the custodial parent who has made reasonable efforts to consult with the noncustodial parent; or

4. Jointly by a patient who is a minor 6 years or older and the patient’s custodial parents
or, if only one parent has custody, jointly by the patient and the custodial parent after the custodial parent has made reasonable efforts to consult with the noncustodial parent.(58)

Such a demand, in which there is parental participation, would not be subject to review by others. However, if there is parental objection, the child 6 years old or older could still request and be granted death upon approval of a specially appointed Aid-in-Dying Board.(59) The comment to this sections states: “Thus, when one of the custodial parents disagrees with the child’s wish to receive aid-in-dying, that parent does not have an absolute veto over the child. Rather, the decision goes to the Board which in turn considers all of the competing interests involved.” (60)

Furthermore, first graders who are “technologically dependent” (61)could receive aid-in-dying even if parents object: “Aid-in-dying for a technologically dependent minor is available only if a request for aid-in-dying is approve by an Aid-in-Dying Board. This section recognizes that minors have the right to request aid-in-dying whether or not their parents agree.”(62)

The final section of the Act emphasized its applicability to children, stating: “Aid-in-Dying shall not be provided or refused on the basis of the patient’s age, gender, race….”(63)

Fortunately, the Aid-in-Dying Model Act was never implemented. However, it and other proposals which would make assisted suicide and euthanasia available to children and teens are waiting in the wings for a climate in which their acceptance would be possible. In the meantime, at least one of the drafters of that Iowa law school endeavor, Cheryl K. Smith, has been instrumental in making that day of acceptance a bit closer.

Within months of the publication of the Iowa Model Act, Smith became a staff lawyer for the Hemlock Society. She went on to serve for a time as the organization’s interim executive director. She has also co-authored booklets and articles that give step-by-step instructions on methods to commit suicide, including the use of a plastic bag combined with sedatives.(64)

Smith was a principal drafter(65) of the Oregon Death with Dignity Act, the law that has transformed assisted suicide into a medical treatment in Oregon. Commenting on the content of the Oregon law, Smith wrote that it is a “narrow aid-in-dying bill” that “reflects lessons learned from previous attempts to pass similar laws.”(66)

Smith and most euthanasia proponents had learned the lesson well — patience does pay off. An incremental approach succeeds in achieving goals. It just takes a bit longer.

However, some advocates of mercy killing are not so patient. Upset that, after winning in Oregon, they’d been losing ground, one contingent of the right-to-die lobby explored the notion of using shock and threats to push their agenda.

SUICIDE KITS FOR YOUR CHILDREN

Plans to throw down the gauntlet were outlined at a November 1999 conference sponsored by Arizonans for Death with Dignity, an affiliate of the Hemlock Society. Failure to gain approval for assisted suicide in Michigan, the impending defeat of a legislative bill in California, and losses in the courts were discussed. Then conference participants were implored to put all available resources into passage of an initiative to legalize assisted suicide that was scheduled to be on the November 2000 ballot in Maine.

Maine is our last hope,” said Faye Girsh, executive director of Hemlock USA. “Hemlock has made a major commitment — hundreds of thousands of dollars. We’ve hired the man who did the two Oregon campaigns. He’s been on the payroll since March.”(67)

But she said they were concerned because of past failures. “We’ve gone into every state with over 70% support” but the lead has eroded. She said that must be prevented in Maine. “When you hear from Mainers for Death with Dignity, remember, it is not just for Maine. It’s for Arizona, Hawaii, California, Colorado…” Rallying the troops, Girsh called the Maine initiative “the last chance to gain approval for law change in the traditional way.”(68)
Participants asked what could be done if they failed to win in Maine.

“Peaceful Pill”

Dr. Philip Nitschke (the Australian physician who had commented so favorably on Dutch plans to legalize euthanasia for 12-year-olds), the conference’s keynote speaker, responded to the query.

He described his efforts to find what he calls the “holy grail” and what others call the “peaceful pill.” Frustrated over the overturning of Australia’s euthanasia law and over the lack of progress in other legalization efforts, Nitschke had been working on a new way to make lethal substances which would circumvent existing laws and would be easy to obtain and use.

He said that “people are working on devices” and on combining the use of the plastic bag with deadly gas. (He was referring to the “Self-Deliverance New Technology Conference” that had been held in Seattle the previous week which he, Girsh and 26 other death experts had attended. There, attendees had come together for an induced death “show and tell” session to see demonstrations of masks, tubing, and plastic bags that could be used in conjunction with substances available at hardware and novelty stores.)(69) He explained that “patients don’t say, ‘Look, doctor, I want to put my head n a plastic bag.’ What they really want is a tablet” — a single tablet or pill that can kill them.(70)

He said he had been researching substances that weren’t approved for patient use because they had been found to be harmful, even deadly. These, he claimed, could form the basis for the new pill. Then, the “ingredients,” along with directions on how to mix the substances together can be sold over the Internet. (Girsh described the pill as one that could be made and kept until needed. “Then,” she said, “get the pill out of your closet. Pop it. And you’re gone.”(71))

Nitschke said he was close to completing the project but was working on making the home synthesis easier.

When one participant asked if there would be problems with marketing the kit over the Internet since teens would have access to them, Nitschke said it was unlikely that a teen would spend the time necessary to mix it.

But he went on to say that the possibility of teen use should be used to force politicians to adopt laws permitting assisted suicide. “Tell the politicians, ‘You’re looking down the barrel of a very anarchic and out-of-control environment” (72) since, if it becomes necessary to provide this means of assisted suicide, teens will get it. There won’t be any way to control it.

The bottom line was: Pass the laws we want or we’ll sell suicide kits to your kids.

The concept was a big hit. Participants asked where to send funds to help in development of this kit. Nitschke provided the information and added that he’s been “very kindly helped by Derek Humphry.” (73)

Girsh announced, “The Hemlock Foundation will make a donation for that purpose” and Earl Wettstein, president of Arizonans for Death with Dignity, chimed in that his organization would publicize the need for funds.

Bizarre?

Yes.

But also deadly serious and probably not illegal. And as outrageous as the plan to force the issue by threatening Internet sales of suicide kits seemed, assisted suicide activists were ready to embrace it.

The Maine initiative did fail. And Nitschke has continued his research into an easy-to-get-and-market lethal substance. In 2001, he received $58,000 from the Hemlock Society for his “research.” (74)

Death on Demand for Anyone of Any Age

With the exception of his comments at the Arizona conference, Nitschke has not used the potential availability of his “peaceful pill” for teens as a threat. Instead, he has increased his advocacy for making it, and other means of assisted suicide, available to teens. He describes access by teens to the means for suicide as eminently reasonable.

In an interview with National Review, he said:

So all people qualify, not just those with the training, knowledge, or resources to find out how to “give away” their life. And someone needs to provide this knowledge, training, or recourse necessary to anyone who wants it, including the depressed, the elderly bereaved, [and] the troubled teen….

This would mean that the so-called “peaceful pill” should be available in the supermarket so that those old enough to understand death could obtain death peacefully at the time of their choosing.(75)

He emphasized that he did, indeed, believe that children and teens should have access to assisted suicide. “Why should they have to wait till they’re 18?” he asked.(76) And he told Australian radio that teenagers should be given access to the means of assisted suicide “in the same way I’d give it to every other lucid Australian.”(77)

By moving the boundaries in this manner, the Nitschke-Humphry-Girsh element of the euthanasia movement could make others in the movement seem reasonable by comparison. Other euthanasia advocates could then be seen as the “moderate middle” of the debate and seize the high ground to promote the “need” to legalize the practice under careful guidelines so abuses that would surely result from the sale of Internet suicide kits can be prevented.

CONCLUSION

As has been discussed, euthanasia advocacy over the years has not been limited to adults. Assisted suicide and euthanasia do pose a real threat to minors. But, to date, little attention has been paid to this aspect of the debate.

One writer, however, has recently cautioned that consideration of how young people would be affected should not be overlooked.Susan M. Wolf, an associate professor of law and medicine at the University of Minnesota, has warned that a discussion of the pediatric implications of euthanasia and assisted suicide is necessary for a full debate of the issues. She observes that conducting such a debate without examining the consequences for minors ignores too much. In particular she notes that, if permitted, it would be difficult to confine the practices to adults. She points to termination of treatment and abortion as areas that were initially applicable to adults only but have since been expanded to minors. (78)

But as discussed above, the public is not yet ready to consider the possibility, let alone the probability of death on demand for or by children and adolescents.

This does not mean that this aspect of the debate should be ignored. On the contrary. For all who already oppose euthanasia and assisted suicide, it should serve as a continuing reminder of what is really at stake. It shows the urgency of the need to work harder than ever to effectively oppose legalization of assisted suicide and euthanasia for all ages.


Rita L. Marker is an attorney and the executive director of the International Task Force on Euthanasia and Assisted Suicide.


Endnotes:

(1)  Because “euthanasia” and “assisted suicide” are often used interchangeably in the press and in public discussions, they are used similarly in this report.
It should be noted, however, that they are not the same. One way to distinguish them is to look at the last act – the act without which an intended death would not occur. For example, if an intravenous needle has been inserted into a patient’s vein so that a lethal drug dose will flow through upon the flip of a switch, triggering the switch is the last act. If the patient activates the switch, assisted suicide occurs. If the doctor activates the switch, euthanasia occurs.
Until 1994, right-to-die advocates sought to legalize both practices under the label “aid-in-dying.” The Oregon Death with Dignity Act marked the first time that an “assisted suicide only” bill was proposed. The measure passed, making Oregon the first place in the world to pass specific legislation permitting assisted suicide. The Netherlands and Belgium have passed laws permitting both euthanasia and assisted suicide.

(2) ORS 127.800 – 127.995.

(3) R. Waicukauski, J. Epps, P. Sandler, “Ethos and the Art of Argument,” Litigation, 1999, 26: 31 (emphasis added).

(4) “World in Brief,” Washington Post, August 11, 1999, A16 and Associated Press, “Dutch Government Legalizes Mercy Killing,” August 10, 1999.

(5) R. Moseley, “Dutch euthanasia plan lets kids make choice,” Chicago Tribune, August 26, 1999.

(6) J. Shapiro and D. Bowermester, “Death on Trial,” U.S. News & World Report, April 25, 1994, 36.

(7) “Children should have the right to die: euthanasia campaigner,” The Age, (Australia), August 11, 1999.

(8) “Profile: Philip Nitzschke,” Sydney Morning Herald, October 12, 1996 and Richard Yallop, “Truth and consequences,” The Australian, May 30, 2002.

(9) Id. Sydney Morning Herald.

(10) Supra note 8, The Australian.

(11) “Australia: Children should have RTD,” Right-to-die Internet mailing list, August 12, 1999.

(12) Wall Street Journal, October 6, 1999.

(13) “Questions and answers regarding euthanasia policy 2001: ‘Can anyone request euthanasia?’” Web site of the Dutch Ministry of Foreign Affairs: The Dutch euthanasia legislation, accessed April 24, 2001 (http://www.miknbuza…/Content.asp?Key=413173&Pad=400025,257588,257609,405188,41307), Press release from the Ministry of Justice, (http://www.minjust.nl:8080/c_actual/persber/pb0715.htm) and Text of Bill for Review procedures of termination of life on request and assistance with suicide (PDF format, accessed from Press Release on line). All accessed Apr. 24, 2001. The bill went into effect in April 2002.

(14) Id. “Questions and answers:. ‘Does unbearable suffering include psychological suffering?’”

(15) M. Nesirky, “Euthanasia of children proposed: Holland would forgo requiring parent OK,” Orange County Register, March 20, 1987.

(16) R. Fenigsen, “Euthanasia in the Netherlands,” Issues in Law & Medicine, 1990, 6:244, citing “Arts Geeft Jongeren Dodeliijke Pil Mee (Doctor Supplies Boys with Deadly Pills),” Brabants Dagblad, October 10, 1987.

(17) “It’s Almost Over — More Letters on Debbie,” Letter to the editor by G.B. Humphrey, M.D., Ph.D., University Hospital, Groningen, The Netherlands, Journal of the American Medical Association, August 12, 1988, 260:788.

(18) A. Katzman, “Dutch debate mercy killing of babies,” Contra Costa Times, July 30, 1992, 3B.

(19) M.A.M. de Wachter, “Euthanasia in the Netherlands,” Hastings Center Report, March-April, 1992, 24.

(20) J. Shapiro and D. Bowermester, “Death on Trial,” U.S. News & World Report, April 25, 1994, 36.

(21) M. O’Keefe, “The Dutch way of dying,” San Francisco Examiner, February 19, 1995, A-8.

(22) “Sanction is Sought for ‘Mercy Deaths,’” New York Times, January 17, 1938.

(23) “‘Mercy Death’ Law Proposed in State,” New York Times, January 27, 1939.

(24) “‘Mercy Death’ Law Ready for Albany,” New York Times, February 14, 1939.

(25) O. Ruth Russell, Freedom to Die: Moral and Legal Aspects of Euthanasia, (New York: Human Sciences Press, rev. ed., 1977), 89-90.

(26) F. Kennedy, “The Problem of Social Control of the Congenital Defective,” American Journal of Psychiatry(1942) 99:13-14.

(27) In 1975, the Euthanasia Society of America changed its name to the Society for the Right to Die. It operated under that name until 1991 when it became known as Choice in Dying. In 2000, Choice in Dying began “evolving into a new organization,” called “Partnership for Caring.” Officials of the newly named organization have never repudiated the society’s early calls for involuntary euthanasia or its stated corporate purpose: “To disseminate information to the public by all lawful means of the nature, purpose, and need of euthanasia, and to foster its general adoption. By the term ‘euthanasia’ is to be understood the lawful termination of human life by painless means for the purpose of avoiding unnecessary suffering and under adequate safeguards.” [Certificate of Incorporation for Euthanasia Society of America, Nov. 28, 1938, on file with author] In fact, the current Partnership for Caring web site notes that Partnership for Caring intends to continue the mission of Choice in Dying, including its vision from the 1930s. [http://www.partnershipforcaring.org/AboutUs/choice_content.html, last accessed Sept. 30, 2002.]

(28) Pediatrics Ethics Survey formulated by Dr. Eric Singer of the Cleveland Clinic Foundation and Dr. Andrea Sperduto of MetroHealth Medical Center, circulated in summer 1993 (on file with author).

(29) Id. cover sheet, (emphasis added).

(30) Id. question 10, (emphasis added).

(31) Id. question 13 (emphasis on “newborn” in original).

(32) Id. question 13, (emphasis added).

(33) Id. question 17.

(34) Id. question 28.

(35) Id. question 29.

(36) Telephone interview with author, February 10, 1994.

(37) P. Singer, “Sanctity of Life or Quality of Life?” Pediatrics (1983) 72: 129.

(38) Kuhse, like Singer, espouses the choice of death for newborns. At a 1990 symposium held at the University of Iowa College of Medicine she said that she had proposed a four-week period after birth during which newborns could be assessed for serious handicaps. Those who failed the assessment would be allowed to die or to be killed, whichever was more socially acceptable and painless. P. Steinfels, “Beliefs,” New York Times, November 10, 1990.

(39) Application for Renewed Support for 1984 project titled “Life or Death Choices for Defective Newborns,” Official Report of Assessor, File No. A181/15082 1 (on file with author).

(40) P. Singer, Practical Ethics, Second Edition, 1997, 186.

(41) Id. 190-191.

(42) D. Oderberg, “The Singer Controversy,” Quadrant, September 1993, 74, citing P. Singer, Journal of Applied Philosophy, 1992, 9:85-91.

(43) D. Oderberg, “Good riddance to a warped philosopher,” The Age (Australia), April 28, 1999.

(44) The President’s Page, “The Appointment of Professor Peter Singer,” Princeton Weekly Bulletin, December 7, 1998.

(45) In March 2001, Singer was briefly at the center of a storm when he wrote, in an essay for an internet magazine, that “sex with animals does not always involve cruelty” and that humans and non-humans can have “mutually satisfying” sexual relationships. [http://www.NERVE.com/Opinions/Singer/heavyPetting/main.asp, last accessed March 14, 2001]

(46) “Opinion Interview: Only Human,” New Scientist, January 8, 2000.

(47) Viktor Frolke, “Professor Death,” Salon.com, June 25, 2001. (http://www.salon.com/books/int/2001/06/25/singer.html) last accessed June 26, 2001.

(48) In 1998, Silver testified before Congress regarding the feasibility of using chimpanzees or gorillas as gestational surrogates for humans. But he said he hoped the technology would never be used because: “Aside from the psychological impact on the child, an equally important consideration is the diminishing number of great apes in the world today. If we require them to gestate our children instead of their own, we will only hasten their extinction.” [Lee M. Silver, Ph.D., "Statement Prepared for the Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations of the U.S.House of Representatives," May 17, 1988, p. 4. (On file with author.) (Emphasis added.)]

Eleven year later he predicted that, in a few years, parents would be able to pick their children’s traits “from a list of options the way car buyers order air conditioning and chrome-alloy wheels.” [Michael Lemonick, "Designer Babies," Time, January 11, 1999, p. 64.]

(49) “Ethicist: OK to kill disabled newborns,” Cape Cod Times, October 6, 2001.

(50) Supra note 40, 228.

(51)Id.

(52) Id. 229.

(53) State of Wisconsin, Assembly Bill 1207. Barbee served in the Wisconsin legislature from 1965 to 1977.

(54) Id. (emphasis added).

(55) Illinois HB 691, sponsored by Representative Scott in February 1997. Co-sponsors were Representatives Feigenholtz, Ronen, Burke, McKeon, Fritchey, Howard, Erwin, Stroger, and Art Turner.

(56) “Model Aid-in-Dying Act,” Iowa Law Review, (1989) 75:139. The Model Act is also available online at http://www.uiowa.edu/~sfklaw/euthan.html (last accessed Sept. 26, 2002.)

(57) Definitions of “terminal condition,” “terminally ill” and “terminal illness” have no time reference but, instead, refer to a condition that “will, in the opinion of two physicians, probably result in death.” Id. 142 (emphasis added).

(58) Id. 163 (emphasis added).

(59) Id. 165-166.

(60) Id. 167.

(61) “Technological dependence” is defined in a manner that could include anything from use of tube feeding, dialysis, a pacemaker or a shunt. Id. 140-141.

(62) Id. 170.

(63) Id. 214 (emphasis added).

(64) Chris Docker and Cheryl Smith, Departing Drugs, 1993; Chris Docker and Cheryl Smith, Beyond Final Exit, 1996; Richard MacDonald, Faye Girsh, Derek Humphry, Cheryl Smith, “Do’s and Don’t of Self-Deliverance,”Timeslines (Hemlock Newsletter), Winter 1998, pp. 5-6.

(65) M. O’Keefe, “Hemlock Society seeks a new image,” Oregonian, November 20, 1994 and T. Bates, “Write to Die,” Oregonian, December 18, 1994.

(66) C. Smith, “Safeguards for Physician-assisted Suicide: The Oregon Death with Dignity Act,” in S. McLean (ed.), Death, Dying and the Law (1996) 83.

(67) Transcript of tape of Girsh presentation, “State of the Nation & World,” at Arizonans for Death with Dignity conference, Radisson Resort, Scottsdale, Arizona, November 20, 1999 (on file with author).

(68) Id.

(69) C. Ostrom, “Assisted-Suicide Activists Split — Legislative Setbacks Spur Do-It-Yourselfers, Seattle Times, November 13, 1999.

(70) Transcript of tape of Nitschke presentation, “Patient Aid-in-Dying Clinics & status of a ‘Peaceful Pill,’” at Arizonans for Death with Dignity conference, Radisson Resort, Scottsdale, Arizona, November 20, 1999 (on file with author).

(71) Supra note 67.

(72) Supra note 70.

(73) Derek Humphry was a co-founder of the Hemlock Society and the author of the suicide manual, Final Exit. Now an official of the Euthanasia Research and Guidance Organization (ERGO) and of Americans for Death with Dignity, Humphry is currently promoting a video on how to commit suicide using a plastic bag.

(74) Brett Foley, “Euthanasia groups cool on suicide pill,” The Age (Australia), August 3, 2001.

(75) Kathryn Lopez, “Euthanasia Sets Sail,” National Review Online, June 5, 2001.

(76) Id.

(77) Sasha Baskett, “Suicide pill plans gain momentum,” Herald Sun (Australia), August 13, 2001.

(78) S. Wolf, “Facing Assisted Suicide and Euthanasia in Children and Adolescents,” in L. Emanuel, ed., Regulating How We Die: The Ethical, Medical, and Legal Issues Surrounding Physician-Assisted Suicide, 1998, 93.