Update 025: Volume 16, Number 2 (2002)

Special Report: The Death that Backfired on the Right-to-Die Movement

Australian Nancy Crick, 70, was a lot of things to a lot of people. She was a mother, grandmother, and great-grandmother. She was a devoted friend to many in and around her home town on Queensland’s Gold Coast. But, since last February, she was first and foremost the right-to-die movement’s poster patient—and it was her case that advocates felt would finally bring down Australia’s laws prohibiting euthanasia and assisted suicide.

Nancy Crick died from an intentional drug overdose on May 22, 2002, in the presence of 21 supporters. The facts surrounding her life and death are anything but clear-cut. Her case has turned into a bizarre mix of fact and fiction, truth and lies. One thing, however, is clear: Her death has boomeranged into a colossal public relations and credibility disaster for the pro-euthanasia camp.

Crick’s Internet diary

Last February, Crick went on-line with a diary aimed at generating public support for euthanasia legalization. The strategy was two-fold.

First, Crick publicly attacked specific government officials who are opposed to euthanasia, particularly Queensland Premier Peter Beattie and Minister of Ageing Kevin Andrews. Beattie had just announced in February that there was no way the government would legalize assisted suicide or euthanasia, and Andrews had been responsible for the 1997 overturning of the short-lived Northern Territory law permitting euthanasia.

Secondly, Crick presented her own medical condition as justification for legalizing assisted death. Two years ago, she wrote, she “was diagnosed with bowel cancer and given 3 years to live.” “I made a promise to myself not to live through another winter,” she explained. “I intend to keep that promise. Whether it happens by natural causes or by my hand remains to be seen.” ["The Diary of Nancy Crick," nancycrick.com, 2/6/02. Hereafter cited as Diary.]

While the diary bore Crick’s name, it was, in fact, a group effort. Australia’s “Dr. Death,” Dr. Philip Nitschke, and his newly formed pro-euthanasia organization, Exit Australia, provided the computer and the web site software, as well as “Internet helpers” to actually post the diary entries. Nitschke was particularly helpful and supportive, Crick said, as was John Edge, also from Exit Australia, who served as her media front man and secretary. She was also receiving assistance from the Voluntary Euthanasia Society of Queensland. [Diary, 2/25/02, 3/26/02, and 4/23/02]

From Crick’s perspective, the diary web site accomplished its goals. “The diary has given me a chance to explain to everyone why I think we’ve got to make changes to the law,” she wrote. “I’ve been overwhelmed that my diary has been such a huge success and I’ve had letters of support from all round the world.” [Diary, 5/21/02] An earlier entry, however, revealed just how much the attention, notoriety, and the sense of purpose meant to Crick personally: “To all my Internet friends enquiring about my health all I can say is, going on the Internet has put the spark back in my life.” [Diary, 2/13/02]

Among her “Internet friends,” were noted euthanasia VIPs: Dr. Richard MacDonald, president of the World Federation of Right to Die Societies; Flemming Schollaart, head of the Danish Right to Die Society; Michael Irwin, president of the British Voluntary Euthanasia Society; and Derek Humphry, co-founder of the Hemlock Society, head of ERGO!, and author of the how-to-kill-yourself manual, Final Exit. [Diary, 2/16/02]

“Derek Humphry, the British/American author of the book ‘Final Exit’ got to hear about my internet site and sent me a message of support,” she proudly wrote. “This was followed on Monday by a mailed autographed copy of the book from none other than the author himself.” [Diary 4/16/02] In a later entry, Crick thanked Humphry “for writing such a useful book for people like me.” She said the “book told me what drugs I needed and how to peacefully end my life.” [Diary, 4/27/02]

Bowel cancer

Throughout the diary, Crick described her diminished life with bowel cancer. “I have bowel cancer and it is bloody painful.” [Diary, 2/20/02]

She had undergone three surgeries after she was diagnosed with cancer. “I was recently asked how much had my life style changed since the discovery of bowel cancer,” she wrote. “Things changed dramatically after the first bowel operation,” she explained, “no more window shopping, no swimming with my mates, no bingo, no longer free and easy, [sic] I became ever increasingly bonded to my toilet in a ‘Till death do us part’ relationship.” [Diary, 2/16/02]

The fear of being dependent and a burden—like so many of the assisted suicide victims in Oregon—was Crick’s underlying motivation for death. “Bowel cancer is a filthy disease made worse by constant vomiting and diarrhoea,” she wrote. “For now I can cope with the problem, however I know that at sometime in the near future I shall not be able to attend to matters of hygiene. The thought of some one else having to do this for me would take away my dignity and my self respect…. I will not allow this to happen.” [Diary, 3/14/02] Crick’s son, Wayne Crick, told reporters after her death that his mother had told him and his younger brother, Daryle, that she was determined to end her life to stop her suffering and to make sure that she did not become a burden on her family. [news.com.au, 5/24/02]

Orchestrated death campaign

There is no doubt that Crick’s death campaign was planned and orchestrated primarily by Dr. Philip Nitschke, John Edge, and others from Exit Australia. As reported in the last Update [2002, # 1, p. 7], Nitschke et al. organized a euthanasia rally in March to show support for Crick’s death wish. When she arrived at the rally, the crowd of 300 greeted her with a standing ovation. The media were in attendance, and dutifully reported on the rally. Crick was now a true celebrity.

Nitschke and Edge actively sought the media’s attention. They said TV stations from as far away at Japan and the U.S. wanted to film her death. [Gold Coast Bulletin, 3/26/02; news.com.au, 3/26/02]

Since aiding and abetting a suicide is punishable up to life in prison in Queensland, the folks at Exit Australia came up with a scheme to thwart attempts to prosecute anyone present when Crick died. Approximately 500 copies of her house key were made. Individual keys were sold for $20 (Australian). Anyone who purchased a key could claim that they were present when she died. Nitschke reasoned that the sheer number of claimants would make any investigation impossible. The money generated from the key sales would go directly into Exit’s coffers for future euthanasia promotions. [Diary, 3/7/02; Courier Mail (Brisbane), 3/27/02; Herald Sun, 5/25/02]

Concerned that his mother was being used by the euthanasia movement, Wayne recounted, “I said to her one day: ‘Mum, they are using you,’ and she said: ‘Yes, I know, but I’m using them.” [Courier Mail, 5/29/02]

An unexpected about-face?

Early on, Crick had picked April 10 for her “self-deliverance”—the day she would end her life by drug overdose. Then suddenly, in late March, she seemed to change her mind. She decided to give palliative care a chance to improve her condition. She entered the palliative care ward at St. Vincents Hospital in Robina. She did so, however, with some misgivings. She was worried about the appearance of changing her mind, that it would look like she was backing down from her original promise. But Dr. Nitschke encouraged her to enter the hospital program, which she did on April 3. “I’d hate to think she was ending her life without exploring and finding out what was possible,” he told the press. [Ananova, 3/27/02]

According to her diary, Crick felt that her pain treatment was going well. She was put on a morphine pump and given “pain patches,” and concluded that “one thing is certain, it’s a lot more comfortable with the patches and morphine pump than it was before I went into the hospital.” [Diary, 4/11/02] But the doctors at St. Vincent’s wanted her to have surgery because they thought that her real problem was that her bowel, in her words, “is all stuck together.” She refused the surgery. [Diary 4/9/02]

During her hospital stay, Crick received cards and letters from all over the world. Some were supportive, others were not. Reportedly, she received cards from staunch euthanasia advocates accusing her of wavering and reneging on her death promise. Crick discussed one such message in her diary; it was “from a V.E. [voluntary euthanasia] supporter stating that because I didn’t end my life on April 10th, I am no longer a heroine of the V.E. cause.” [Diary, 4/27/02]

Real motive revealed

Another entry after she returned home from the hospital reveals that Dr. Nitschke had an ulterior motive—other than Crick’s well-being—for encouraging her to enter the palliative care program with as much fanfare as possible. “Philip pointed out,” she wrote, “that most politicians, including the Federal Minister for Ageing Kevin Andrews and the Premier of Queensland Peter Beattie, rejected the need for V.E. Legislation claiming it was unnecessary, due to the continual improvements being made in palliative care. Had I ended my life without having explored this opportunity, I would have allowed politicians to claim I had chosen to end my life unnecessarily.” [Diary, 4/27/02; emphasis added.]

Back in favor

By early May, it was apparent that Crick was back on the death trail. “There’s been a lot of interest in things since I told everyone that I hadn’t changed my mind and still am going ahead with my plans,” she wrote, “even though I got real good help from the palliative care people in St. Vincent’s hospital. Still, fact is, I’ve tried real hard and now I think people should just let me do things my way.” [Diary, 5/2/02]

By mid-May, she was becoming annoyed by all the speculation, particularly in the media, as to when and how she would end it all. “It’s my business and private for me and my friends,” she said. “There’s still a few things left to do. I’m going to speak at the Gold Coast supporters group on the 29th [of May].” [Diary, 5/16/02]

She took her speaking engagements seriously—and looked forward to them. She could promote euthanasia and be affirmed at the same time. Yet, oddly, Crick never made that speaking engagement on May 29. Instead, on May 22, she opted to end her life.

Champagne, tea, sandwiches, death, and a round of applause

Crick, a former barmaid and always the consummate hostess, made sure all of her 21 guests were comfortable. When all had been served the champagne, tea, and sandwishes she had provided, she initiated her pre-planned death ritual. First came the anti-nausea drug to prevent her vomiting what was to follow. Then came the vile-tasting barbiturate overdose, then the Baileys Cream liqueur to enhance the death-producing overdose. She topped off the procedure with three drags on a cigarette—all the while her guests clapped and cheered in approval. It took her 20 minutes to die. [Herald Sun, 5/24/02; The Age, 5/23/02]

Among the 21 onlookers were eight relatives. Most of the remaining attendees were elderly “friends” who Dr. Nitschke had arranged to be present. He told the press that paying for the group of elderly people to fly in from varying parts of Australia had almost bankrupted Exit Australia. [The Age, 5/29/02]

Police were not notified about Crick’s death for 11 hours. Pending an on-going investigation, all present could face assisted-suicide charges. Nitschke, however, deliberately was absent from the death scene. He had flown to Darwin in the Northern Territory hours before her death to avoid any apparent connection. [Herald Sun, 5/24/02]

But his absence did not prevent him from seizing the moral high ground and spinning her death for the media. “She really went through hell in the last few months,” he told reporters. He called her a martyr for the euthanasia cause and declared that her death was just the beginning of mass civil disobedience strategies aimed at changing the country’s euthanasia laws. “This is the first time strategies of mass civil disobedience have been used in the voluntary euthanasia movement,” he said proudly. At least three more patients are considering suicide, and he’s advising 100 more, Nitschke announced. [The Straits Times, 5/24/02; Sydney Morning Herald, 5/23/02, 5/24/02; Herald Sun, 5/24/02]

The autopsy that shocked a nation

The news shot across Australia like a bolt of lightning: Crick did not have cancer when she died! The woman advertized as suffering from the agony of terminal bowel cancer, who right-to-diers used to promote their euthanasia cause, was actually cancer-free.

According to the Brisbane pathologist who performed the autopsy, there was evidence that she had cancer prior to her first surgery several years ago, but he could find no visual trace of the cancer anywhere in her body now. What she did have was a “twisted bowel” and some minor illnesses which caused her discomfort. [Herald Sun, 5/25/02; Ananova, 5/24/02; Courier Mail, 5/25/02]

Her family was shocked by the news. Her son, Wayne, declared, “If the reports are correct and my mother is found not to have cancer, she was not aware of that.” [The Age, 5/26/02]

As expected, euthanasia advocates shifted quickly into damage control mode. “All the evidence points to the fact that she died because she considered herself terminally ill and that’s the end of the story,” said Exit Australia’s John Edge, who was present when she died. “The Voluntary Euthanasia Society holds the view that the issue is whether a person is hopelessly ill, not terminally ill,” he added. Nitschke also dismissed any public concern, saying that it was irrelevent whether or not Crick had cancer. “She got the best palliative care that Australia could offer,” he argued, “and she still found the quality of life such that she would prefer death.” He further insisted, “The only definite way cancer could have been established was through surgery, and she flatly refused to have it.” For him, her chronic pain was enough to justify her assisted suicide. [The Courier Mail, 5/29/02; Agence France Presse, 5/25/02, Herald Sun, 5/27/02, 5/25/02; news.com.au, 5/27/02]

But bowel cancer specialist Dr. John Zalcberg, oncology director for the Peter MacCallum Cancer Institute, refuted Nitschke’s claim that the only way to know whether Crick had cancer was through surgery. “If a patient has advanced bowel cancer it would have been possible to know without surgery,” he explained. “[A] twisted bowel does not mean you’re dying of cancer and usually it can be surgically or conservatively treated.” he said. [Sunday Herald Sun, 5/26/02]

The next shock wave hits

A second shock wave soon followed: Both Crick and Dr. Nitschke knew she was cancer-free, and told no one—not even her immediate family! Two months prior to Crick’s death, Gold Coast Hospital’s palliative care director, Dr. Barbara Craig, met with both Crick and Nitschke and informed them that Crick did not have cancer. Dr. Craig subsequently wrote a referral letter stating that Crick was not terminally ill. That assessment was confirmed by Dr. Robert Hitchins, the director of palliative care at St. Vincent’s, where Crick went for 10 days in April. He personally told her that she was cancer-free.

Other claims made over the course of Crick’s campaign were also found to be false. Crick was not dying of malnutrition, and she was not 27 kg. (60 lbs.) as she stated in her diary and as Nitschke told the press. Medical records showed her weight as 36 kg. (79 lbs.) in 2001 and 38 kg. (84 lbs.) just weeks before she died. [Diary, 5/17/02; Courier Mail, 5/29/02] Under pressure from the media, Nitschke also volunteered that Crick had claimed she had breast cancer as well, but that there was no medical record confirming that. [Herald Sun, 5/25/02] He admitted that, in hindsight, he should have revealed the truth about her condition to the public. However, he added, the fact that she was cancer-free when she died should not reflect badly on the euthanasia movement. He said that he and his group had done everything possible to keep her alive. [Sydney Morning Herald, 5/30/02; 5/29/02; news.com.au, 5/30/02]

Reaction

In an article entitled “The death knell for euthanasia,” columnist Miranda Devine wrote, “The truth of Nancy Crick’s state of health makes a mockery of right-to-die arguments.” “The revelation has blown up so comprehensively in the faces of euthanasia activists,” she said, “it couldn’t have been engineered better by right-to-lifers. But poor Crick has not died in vain, for she has unmasked the true motives of the right-to-die lobby.” [Sydney Morning Herald, 5/30/02]

While Crick’s suicide would have been an avoidable tragedy even if she had terminal cancer, Melbourne University professor of palliative care Dr. David Kissane called the euthanasia campaign an example of the slippery slope phenomenon where right-to-diers say “terminally ill,” but mean “hopelessly ill.” “The euthanasia movement denies the slippery slope argument, they say it won’t happen. But we’ve just seen, in real time, precisely that happen with Nancy Crick,” he said. [The Age, 5/30/02]

Dr. Nitschke—who earlier this year had used Crick’s case to get the Australian Medical Association’s attention and to garner an invitation to speak at the group’s annual conference on May 26—was met with stiff opposition from many of his colleagues. In fact, after he was grilled about the circumstances of Crick’s death, the AMA members voted 79 to 34 to defeat a proposal to adopt a neutral stand on euthanasia. They also reaffirmed that a doctor’s first duty is to do no harm and that euthanasia would “undermine the very fabric of medical practice.” Frustrated, Nitschke told reporters, “We have a very unacceptable status quo.” [Deliverance (Exit Australia’s newsletter), vols. 7&8, 2002; The Age, 5/27/02]

It is likely that the Queensland Medical Board will investigate Nitschke’s handling of Crick’s case. Dr. David van Gend of the anti-euthanasia group Trust said that doctors have the duty to diagnose correctly and to strive to prevent suicide. “The medical board must investigate whether Dr. Nitschke has breached that duty by combining his role primarily as an activist and secondly as a doctor.” [Sydney Morning Herald, 5/30/02]

Ashcroft Assisted-Suicide Directive Struck Down

In the first round of what promises to be a protracted court battle all the way to the U.S. Supreme Court, Oregon-based Federal District Judge Robert E. Jones has issued a permanent injunction barring the U.S. Drug Enforcement Agency (DEA) from taking action against Oregon doctors who prescribe lethal barbiturates, or any federally controlled substance, for assisted suicides. At issue is whether assisted suicide is medically “legitimate” under federal law.

U.S. Attorney General John Ashcroft has determined that it is not. After reviewing solid legal precedents and an analysis done by the Office of Legal Counsel, Ashcroft issued his determination in a memo to DEA head Asa Hutchinson last November. “I hereby determine that assisting suicide is not a ‘legitimate medical purpose’” under the federal Controlled Substances Act (CSA), Ashcroft wrote, and “that prescribing, dispensing, or administering federally controlled substances to assist suicide violates the CSA.” Physicians who engage in this activity risk losing their federally-issued prescribing licenses, he said. [Ashcroft, "Dispensing of Controlled Substances to Assist Suicide," 11/6/01. See also, Update, 2002, #1, p. 1.]

In a strongly worded, 30-page decision, Judge Jones held that it is up to individual states to determine “what constitutes a legitimate medical practice or purpose” in that state. Furthermore, he wrote, “State statutes, state medical boards, and state regulations control the practice of medicine. The CSA was never intended, and the USDOJ [U.S. Dept. of Justice] and the DEA were never authorized, to establish a national medical practice or act as a national medical board.” [State of Oregon v. John Ashcroft, Civil No. 01-1647-JO (D. Ore. 2002)]

But U.S Assistant Attorney General Robert McCallum said that the Justice Department “remains convinced that its interpretation of the Controlled Substances Act as prohibiting the use of federally controlled drugs to assist suicide is correct.” [Dept. of Justice Press Release, 4/17/02]

Last year, the U.S. Supreme Court ruled in favor of the Justice Department’s interpretation of the CSA in United States v. Oakland Cannabis Buyer’s Coop. Like in the Oregon case, voters had passed a law, only in this case it was the provision of medicinal marijuana that became legal in California, not assisted suicide. The Supreme Court sided with the Justice Department, and, in a unanimous decision, ruled that federal law regulating controlled substances applies to all the states and cannot be erased by state action. [San Francisco Chronicle, 5/16/01; NY Times, 5/15/01]

On 5/24/02, the Justice Department took the next step on the road to the U.S. Supreme Court and announced that an appeal of Judge Jones’ ruling would be filed with the Ninth Circuit Court of Appeals in San Francisco. [AP,5/24/02]

European High Court Upholds British Law in Diane Pretty Case

On April 29, 2002, the European Court of Human Rights upheld the rulings of both Britain’s High Court and the House of Lords rejecting Diane Pretty’s claim that Britain’s law prohibiting assisted suicide violated her basic human rights and her right to privacy. [See Update, 2002, #1, p. 7]

Pretty, 43, who had motor neuron disease (also known as ALS and Lou Gehrig’s disease), was paralyzed from the neck down and wanted to have her husband, Brian, assist her suicide. Under Britain’s 1961 Suicide Act, however, anyone who “aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide” could face up to 14 years in prison. Pretty waged her court battle all the way to Europe’s highest court in hopes of getting legal immunity from prosecution for her husband and to change British law.

Pretty’s case before the European court argued that the European Convention on Human Rights contains five separate articles that protected her right to die, her right to be free of “inhuman or degrading treatment,” her right to privacy, her freedom of conscience, and her right not to be discriminated against. Since British courts upheld the law prohibiting assisted suicide, those court rulings and the law were in violation of the Convention on Human Rights.

But the European court’s panel of seven judges did not agree, though they expressed sincere compassion for Pretty personally. They unanimously ruled that the British law does not violate any of the cited Human Rights articles. They held that the right to life does not include the right to die and, thus, the state is not required to allow or facilitate a person’s death. Moreover, the judges said that the law prohibiting assisted suicide protects the weak and vulnerable, is not discriminatory, and that the British government, itself, had not inflicted any ill treatment on Pretty. [Pretty v. The United Kingdom, No. 2346/02, European Court of Human Rights, 4/29/02]

Less than two weeks after the European court’s ruling, Pretty died. She had entered a hospice close to her home in central England when she began having breathing problems. According to her husband, the hospice doctors and nurses did manage to stabilize her for a few days, but she eventually slipped into a coma and died on May 11. He claimed that she was in pain. But her physician, Dr. Ryszard Bietzk, said her death was “perfectly normal, natural and peaceful.” [CBC News Online, 5/12/02; Reuters, 5/12/02; USA Today, 6/4/02]

Dutch Study on ALS Patients Disturbs Experts

A Dutch study on the occurrence of euthanasia and assisted suicide among patients with ALS (also called Lou Gehrig’s disease or motor neuron disease) found that one in five opts to die by either euthanasia or assisted suicide.

The study, published in the New England Journal of Medicine, reviewed the deaths of 203 ALS patients who died between 1994 and 1999. Researchers found that 17% chose euthanasia (doctor administered lethal drugs) and 3% died by physician-assisted suicide (doctor provided drugs, but patient took them). The choice of either induced death was not associated with any symptom or characteristic of the disease or the quality of the patient’s care. Those who chose euthanasia were significantly more disabled that those who died in other ways. Deaths by physician-assisted suicide usually occurred at an earlier stage of the disease than the euthanasia deaths. [Veldink et al., "Euthanasia and Physician-Assisted Suicide among Patients with Amyotrophic Lateral Sclerosis in the Netherlands," NEJM, 5/23/02, pp. 1638-1644]

In an accompanying editorial, Drs. Linda Ganzini and Susan Block, both considered psychiatric experts on physician-assisted suicide, found the study a cause for concern. “Judging from our clinical and research experience with patients with ALS and cancer,” they wrote, “the rates of physician-assisted deaths [in the Dutch study]—10 percent among patients with cancer and 20 percent among patients with ALS—are unacceptably high.” “High rates would suggest that the procedure is not just being used as a humane approach to eliminating intractable suffering at the request of the patient,” they explained. [Ganzini and Block, "Physician-Assisted Death—A Last Resort?" NEJM, 5/23/02, pp. 1663-1665]

Belgium Legalizes Euthanasia

The Belgian Parliament has followed the Netherlands’ lead and passed a bill legalizing euthanasia. The lower house of the parliament voted 86-51 in favor of the measure on 5/17/02 after two days of heated arguments. The Senate passed the bill last October.

According to a Belgian news report, the new euthanasia law is “more far-reaching than its Dutch counterpart.” “The patient must be in a medically hopeless condition of chronic and unbearable physical or psychological suffering.” [expatica.com, 5/17/02] The Belgian law establishes different procedures for terminally-ill patients and patients with incurable illnesses who still have many years to live. [CNN, 5/17/02]

Assisted suicide seduction
Wesley J. Smith

On April 29, 2002, the European Court of Human Rights in Strasbourg rejected the assisted-suicide petition of a paralyzed British woman who argued that not being able to die in “dignity” violated her human rights.

Does Britain violate the “right to life” guaranteed by the European Convention on Human Rights by outlawing assisted suicide? Does the law against assisted killing violate the convention’s guarantee of privacy, freedom of conscience, prohibition on discrimination and the right not to be treated in an inhumane and degrading way?

Thankfully, the EU court answered each of these questions with a resounding and unanimous “no.”

Diane Pretty was dying from motor neuron disease (often called Lou Gehrig’s disease in the United States). Last year, she asked a British court to prevent British law enforcement from punishing her husband, Brian, if he helped her to commit suicide.

When the trial court refused to preempt the anti-assisted suicide law for her, Pretty appealed to the House of Lords. When the Lords ruled against her, she turned to the European Union, which has now ruled along the same lines as the U.S. Supreme Court has with respect to the U.S. Constitution that no fundamental right to assisted suicide exists under the developing EU legal system.

In the many years I have opposed the euthanasia movement, I have seen numerous cases like Pretty’s. They wrench the heart but too often short-circuit the brain. Inevitably, the reporters and editorial writers cover these cases as the newest cultural breakthrough of modernity, all the while focusing on the suffering of the patient with laser-like intensity.

But while it is certainly true that human suffering is a legitimate part of the debate regarding assisted suicide, other compelling issues rarely get reported. This one-sided coverage hinders the populace from gaining a reasoned and informed opinion about whether physician-assisted killing would truly be a wise—or indeed, compassionate —public policy.

Compelling arguments against assisted suicide can be advanced that don’t often appear in local news coverage. First, hospices can prevent agonizing deaths without killing patients.

I was invited to Britain in December to discuss the Pretty case throughout the country and to appear in debates about the issue on the BBC. As usually occurs in the United States (for example, with Jack Kevorkian’s murder of motor neuron disease patient Thomas Youk), the media accepted at face value assertions that Pretty would die choking on her own saliva.

I was stunned that BBC and other reporters hadn’t bothered to contact hospice professionals and others who work with motor neuron patients to determine the facts.

The good news is that people with motor neuron disease do not die by choking if they receive proper medical care. Attesting to this are Dr. Cecily Saunders, the founder of the modern hospice movement; Dr. Nigel Sykes, the current medical director of St. Christopher’s—the hospice Saunders founded; and many hospice professionals in the United States, such as Dr. Ira Byock. These experts in end-of-life care have treated thousands of motor neuron disease patients over many years and none has died by choking.

In fact, motor neuron disease patients usually die peacefully in their sleep.

The same is true of other terminal diseases. Pain control has advanced to the point that even the agony of bone cancer can be substantially alleviated. Depression, often a cause for suicide desire in terminally ill patients, also can be treated effectively, often reversing the desire to die.

Hospice care provides the opportunity for patients to pass in quiet dignity and comfort in their own beds, while receiving intense hands-on assistance from professionals and community volunteers. No one should be allowed to die in agony. Thankfully, assisted suicide is unnecessary to achieve that worthy goal.

Another factor often overlooked in the media is that refusing unwanted medical treatment is not the same as assisted suicide.

At about the time that Diane Pretty was losing her cases, “Miss B,” another quadriplegic British woman, won the right in court to direct her doctors to turn off her respirator. She died soon thereafter.

The media labeled both cases “right to die,” swallowing whole the favorite political slogan of the euthanasia movement. But Miss B did not win a right to die. She won the right to refuse medical treatment — a right that has long been recognized in the United States.

Laws permitting patients to refuse unwanted medical treatment are moral and ethical in that they prevent patients from being forced to submit to unwanted bodily intrusions. This is not the same thing at all as euthanasia or assisted suicide.

In a treatment-refusal case, death comes from the underlying physical condition. In assisted suicide, death is caused artificially — usually by poisoning. In a refusal of treatment case, the patient may not die. Indeed, the most famous of such patients, Karen Ann Quinlan, lived for nearly 10 years after her respirator was removed.

But in euthanasia and assisted suicide, poison invariably does its job—albeit sometimes with such disturbing side effects as vomiting, convulsions or extended coma.

The media seldom report that the slippery slope is real. When opponents of legalized assisted suicide worry about abuses, assisted suicide advocates invariably soothe the public’s nerves by assuring that guidelines will protect against abuse.

The situation in the Netherlands, which has permitted decriminalized euthanasia since 1973 and formally legalizing killing by doctors this year, demonstrates the utter falsity of this assurance.

During the past 30 years, the Dutch have slid quickly down the slippery slope. Doctors have gone from killing terminally ill people who ask to be killed, to chronically ill persons who ask to be killed, to infants born with defects who by definition cannot ask to be killed.

Doctors also are permitted to assist the suicides of depressed people, thanks to a Dutch Supreme Court ruling involving a psychiatrist who assisted a woman’s suicide because her two children had died. Several studies of the Dutch experience also prove that doctors kill approximately 1,000 people each year who have not asked to be euthanized. This practice is so common it has a name: termination without request or consent. Despite violating every guideline, it is rarely prosecuted and almost never punished.

Further demonstrating the seductive nature of killing as an answer to human suffering, the Dutch minister of health has now proposed that elderly people who are tired of life but who do not otherwise qualify for euthanasia be given access to suicide pills to take whenever they wish.

Perhaps most important, assisted suicide inevitably will be about money. Once fully established in the bedrock of medical practice, it would be less about “choice” than about profits in the health care system or cutting the costs of government-funded health care. (The drugs for an assisted suicide cost about $40.)

The money factor is not just a worry of opponents of assisted suicide, but also a concern of Derek Humphry, the patriarch of the modern assisted suicide movement. In his book “Freedom to Die,” Humphry and co-author Mary Clement write that cost containment may become the ultimate raison d’etre for physician-assisted suicide.

Our values often follow our pocketbooks. That being so, imagine a health care system in which the profit incentives favor killing as the best “treatment” for cancer, ALS, multiple sclerosis, spinal injury, Alzheimer’s disease and the many other medical conditions that eventually affect us all. Imagine the money to be made by for-profit HMOs if they are spared the expense of caring for such patients until the natural end of their lives.

And such issues as life insurance and inheritance have the potential to weight family decisions toward the assisted suicide option.

Legalizing physician-assisted suicide would return us to practices equivalent to those of ancient societies that exposed disabled infants on hills and left the elderly and infirm by the side of the road. Our sick and dying loved ones deserve better. We open the door to assisted suicide at our own peril.

Wesley J. Smith is an attorney for the International Task Force and the author of Culture of Death: The Assault on Medical Ethics in America (Encounter Books, 2000) and Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (Times Books, 1997). He is also the co-author, with Eric Chevlen, M.D., of Power over Pain: How to Get the Pain Control You Need (International Task Force, 2002). His article was carried by UPI on 5/2/02 and is reprinted here with the author’s permission.

Hawaiian Senate Resurrects Then Narrowly Defeats Assisted Suicide Bill

It had appeared that physician-assisted suicide was a dead issue in the final hours of the Senate session in Hawaii. “The Death with Dignity Act” (HB 2487), patterned after the Oregon law, had already passed in the House by a vote of 8 to 1 on February 23, 2002. But its chances were pretty slim in the Senate, or so everyone thought.

Then, in a surprise move during a late night session on April 30, the Senate voted 15-10 to pull the bill out of the Health & Human Services Committee where it had stalled. The committee chairman, Senator David Matsuura, had opposed the bill and, after holding a hearing on March 8, declined to release it.

At that point, any senator who supported the bill could have formally requested that it be pulled out of Matsuura’s committee 20 days after the hearing. No one did. Instead, with just two days left in the legislative session, the bill was yanked out of committee and put to a vote. Senate voted 13-12 to pass the measure for a final floor vote on Thursday, May 2. [Pacific Business News, 5/1/02; Star Bulletin, 5/1/02]

Many in the media were sure the bill would pass. The Los Angeles Times reported, “Hawaii is expected to become the second state to allow physician-assisted suicide.” [5/2/02] Even the Oregon TV station KPTV reported, “The state of Hawaii could join Oregon as the only states to allow physician-assisted suicide.” [KPTV 10 O'clock News, 5/2/02]

But, when the time came for the final vote to be taken, the Hawaiian “Death with Dignity Act” was defeated by a final vote of 14-11. Three senators had changed their votes from the 13-12 margin just two days before. [Star Bulletin, 5/2/02]

Several senators who had opposed the measure in both votes did so, not because they were against assisted suicide, but because of the strong-arm politics used to resurrect the bill at the last minute

“We’re being robbed of the opportunity to adequately participate, to inform ourselves and to ask intelligent question and get intelligent answers from both sides,” Sen. Jonathan Chun said.

Sen. Cal Kawamoto agreed, “The circumventing of this procedure, this takes the reputation of the Senate into the toilet. One’s word is no longer important here One’s integrity is no longer important here. I’m ashamed, totally ashamed of this body, and our Democratic Party, to allow these kinds of things to happen.” [Pacific Business News, 5/1/02]

Ohio House OKs Bill Against Assisted Suicide

The Ohio House of Representatives has passed a bill which would authorize the State Medical Board, the Board of Nursing, and the Respiratory Care Board to discipline health care providers who assist in suicides. The boards could deny, revoke, suspend, or restrict professional licenses as well as assess fines up to $500 for each violation. Assisted suicide is already illegal in the state.

In addition, the measure would create a bipartisan Compassionate Care Task Force to study the problems and difficulties associated with terminal illness and chronic pain. The task force would be comprised of lawmakers, professionals, and the public.

The bill (HB 474) passed the House by a vote of 83-7. It now goes to the Senate for consideration. If passed, assisted suicide would be officially “against the public policy of the state.”

Nothing in the bill would prohibit the provision of needed pain medication to patients even if it might hasten or increase the risk of death. [The Columbus Dispatch, 5/22/02; Dayton Daily News, 5/22/02]

California Senate Passes Bill to Study Policies on “Futile Care”

The California Senate has passed SB 1344, a bill which would require the state’s Health and Human Services Agency to form a working group to obtain copies of policies from all California health care institutions “that pertain to the denial of desired life-sustaining health care.” The work group would consist of members from the Medical Board of California, the State Department of Health Services, the Department of Managed Health Care, the Department of Insurance, and patient advocates appointed by the majority and minority leaders from each house.

Currently, in California and across the country, there are claims that health care providers and facilities are denying patients the care they or their surrogates have requested on the basis that the care is thought to be futile, inappropriate, medically ineffective, nonbeneficial, or contrary to accepted health care standards.

SB 1344 would mandate that the work group determine what each institution’s policy is, what are the definitions of the terms used in each policy, what procedures are available to resolve disputes, and the number of patients who have been denied wanted health care or treatment.

After gathering this and other information, the work group would be required to issue a report on its findings and make recommendations (1) for amending state law to “protect the right of patients to receive desired life-sustaining health care,” (2) for “civil penalties for the failure to comply with existing law,” and (3) for defining the term “futile care.”

The bill, introduced by Sen. Ray Haynes last February, passed the Senate on 5/28/02 by a vote of 39-0. It is currently under consideration in the Assembly.

News Notes:

A recent announcement about the upcoming World Federation of Right to Die Societies meeting in Brussels revealed the real goal of the euthanasia movement. The e-mailed announcement was written by the Dutch Voluntary Euthanasia Society and forwarded by Derek Humphry to everyone on the right-to-die electronic mailing list. After explaining how the conference will be organized, the message read, “This [is] in order to achieve the overall objective of having a free choice around the end of life for everybody anywhere in the world who wishes to have one, within the structures and cultures of their residence.” [Right-to-Die e-mail list, 5/10/02; emphasis added]

Looks like Jack Kevorkian will be calling prison “home” at least until May 2007, when he could be paroled for good behavior. The Michigan Supreme Court, his last hope in the state for a new trial, rejected his request. Kevorkian is currently serving a 10 to 25 year sentence for the second-degree murder of Thomas Youk in 1998. Youk had Lou Gehrig’s disease. Kevorkian video taped Youk’s death, which showed Kevorkian giving Youk a lethal injection. The video tape was later shown nationally on CBS’ 60 Minutes.

In a 6-1 ruling, the Michigan Supreme Court upheld last November’s Michigan Court of Appeals decision, which denied the death doctor a new trial. (See Update, 2002, #1, p.10) Michigan’s highest court ruled that Kevorkian and his lawyer, Mayer Morganroth, had not persuaded the justices “that the questions presented should be reviewed by this Court.”

According to Morganroth, it’s now on to the U.S. Supreme Court. “I don’t see the United States Supreme Court taking up these issues,” Assistant Prosecutor Anica Letica told the press.

It appears Kevorkian’s former lawyer, Geoffrey Fieger, agrees. “I may have to run for governor,” he said. “Someone is going to have to commute his sentence or pardon him.” [Oakland Press, 4/11/02; AP, 4/11/02]