Update 028: Volume 17, Number 2 (2003)

Hemlock is as Hemlock does:
Euthanasia group tries to change its image

“Charting a New Course… Building on a Solid Foundation,” the program for the Hemlock Society’s 13th Biennial National Conference read. The conference, held in San Diego last January, was to be the platform from which Hemlock leadership would try to sell a new strategy, image, and name to the group’s often critical rank and file.

According to Hemlock’s political consultant and acting legislative director, Phil Merrill, something had to be done because assisted-suicide advocates have not been able to replicate the Oregon victory in any other state. They needed to get expert help, so last year Hemlock hired “some of the best political talent in the business.” Those experts included Leon G, Billings, Inc., a Washington D.C. consulting firm specializing in federal policy, law, and regulations; Lake, Snell, Perry & Associates (LSPA), a national public opinion and political research firm; and The Raben Group, a Washington firm headed by Robert Raben, a former U.S. Justice Department assistant attorney general under Janet Reno who is experienced in “choice issues.”

LSPA and the Billings firm developed a series of questions to ask six focus groups consisting of 10 to 12 people each plus a moderator. The goal was to ascertain “why people react to our issue the way they do.” With the data from those focus groups, Merrill said, “we’ll have guidance for framing and promoting our issue that no one in the movement has ever had before.” [End of Life Choices, Summer 2002, p. 11]

A matter of semantics

It was during the Hemlock conference’s first session that Merrill, Raben, and others presented those research findings to conference attendees. The message was simple: People don’t like the word “suicide,” and Hemlock had to take on a kinder, gentler image. “People want to talk about this concept as ‘lessening suffering’ rather than ‘assistance in dying,’” Merrill explained.

Even more significant, he said, was that support for Hemlock’s agenda jumped 13 percentage points when the idea of patients’ being in control of their care and pain treatment at the end of life was presented to the focus groups.

A handout distributed to the conference audience spelled out Hemlock’s new direction. Deceptively titled “Empowering People to Preserve the Dignity of Life: A New Roadmap,” [hereafter cited as “Roadmap”] the sheet stated that the newly “reshaped and expanded” advocacy program will be carried out, not by Hemlock, but by its political arm, the Patients Rights Organization of the United States of America (PRO-USA). The new program consists of three key components: (1) promotion of a new advance directive, (2) consensus building endorsements of Hemlock’s new “Statement of Principles,” and (3) the advancement of state laws to expand patients’ rights.

Revamping advance directives

The new Hemlock spin on advance health care directives is slick: “The Patient’s Rights Organization believes that the people themselves should be in charge of how the tools of modern medicine are used to prolong life, to assuage pain and preserve dignity.” [Roadmap, p.1]

To that end, Hemlock is proposing a new measure for state legislatures to adopt: the “Patients’ Control & Comfort Act” (PCCA). While still in draft form, the measure will use benign language to cloak the act’s real intent. Essentially, it would decriminalize physician-assisted suicide for anyone who executes an “Advance Directive for Control of Suffering.” The language in this new directive would contain the following:

“In the event that I am diagnosed with a terminal illness, I want to be able to control my own medication to lessen suffering and preserve my dignity and be in control of my own pain and suffering, to the full extent allowed by law, administering the prescribed medications as I deem fit even to the point of hastening death. This directive must be witnessed by at least two persons one of whom is not an heir or executed before a notary public.” [“PCCA, Draft Highlights,” 1/9/03; emphasis added]

Like Oregon’s assisted-suicide law, the PCCA “relieves prescribing physicians of responsibility for the decisions their patient makes.” According to Merrill, the PCCA will have all the “safeguards” of the Oregon law. [P. Merrill, “Hemlock’s New Public Advocacy Strategy,” 13th National Hemlock Conference, 1/10/03; hereafter cited as Conference]

Hemlock leaders think the PCCA “will be very difficult for the federal government to block. The rights given a patient under the law are very close to those granted physicians under the double effect doctrine. Efforts to limit the rights granted by this bill would be forced to focus directly on the concept of patient control, the area in which we are strongest.” [Roadmap, “The Case to Hemlock Members for the Patients’ Control and Comfort Act,” p. 1]

While Hemlock has targeted senior citizen organizations (especially AARP) to promote its advance directive, the campaign thrust is much broader and includes “religious, legal, and medical groups.” They will be reaching out “to Americans through the mails, through their employers and through public service announcements letting them know what they must do to take control of their own end of life medical treatment.” [Roadmap, p. 2]

“Statement of Principles”

In conjunction with the advance directive campaign, a consensus-building campaign will be launched and professionally orchestrated. According to public policy expert Robert Raben, of the Raben Group, organizations and individuals will be approached to endorse PRO-USA’s Freedom to Preserve the Dignity of Your Life, Statement of Principles. The statement, which is still in development, will be a composite of principles from Hemlock’s “mission to empower people at the end of life. The principles endorse the idea of people executing living wills and governments passing laws to empower dying patients.” [Roadmap, p. 2]

The strategy, once again, is to use benign, vague language to describe generalized principles with which most people and organizations would agree. In other words, create a stealth-like document, the real meaning and purpose of which most endorsers would never suspect.

This is how Hemlock intends to build a consensus in favor of assisted suicide, Raben told conference attendees. Once Hemlock gets endorsers to sign on the dotted line, the names of all those individuals and organizations will be presented to lawmakers on every level nationwide to show overwhelming, concrete support for assisted dying. [R. Raben, Conference, 1/10/03]

Hemlock by any other name is still Hemlock

For Hemlock members at the conference, the most controversial—and, for many, disturbing—aspect of the new advocacy strategy was being told that the organization’s name had to be changed. “Hemlock is a poison,” said Fred Richardson, then chairman of Hemlock’s board. All the expert strategists agreed that the name is disliked by politicians and administrators because of its association with Socrates, the Greek philosopher who committed suicide by ingesting hemlock. Board Vice Chairman Paul Spiers agreed. “We need to have a name that tells people they can support us without trying to make excuses about it at a cocktail party the next day,” he said. [Panel, “Tactics & Strategies for Political Advocacy,” Conference, 1/10/03]

But not all members are happy about a name change. Derek Humphry, who along with Ann Humphry founded Hemlock and gave it it’s name, is less than enthusiastic. “If it helps to pursue a political path, then I’m not against it,” he explained. [SignOnSanDiego.com, 1/16/03]

But a message sent over Humphry’s ERGO right-to-die email list indicates that he may actually oppose the name change. “Defenders say Hemlock is a perfectly acceptable name…. Even chairman Richardson admits that a more euphemistic name might earn the criticisms that it is a ‘wolf in sheep’s clothing.’ Humphry and others will campaign for the original name to be retained.” [ERGO right-to-die list, 1/10/03] Hemlock’s board will vote on a new name at its June meeting.

Actions, not words

No matter how well Hemlock camouflages itself, one need only look at what the organization does, at the projects it funds, to recognize it.

One such project is Caring Friends, referred to in the conference program as “Hemlock’s Crown Jewel.” Started in November 1998, the Caring Friends Program was created to help Hemlock members kill themselves. The first training session, held in San Diego, produced 28 volunteers whose job was to support members who were “hopelessly ill, mentally competent” and “help them examine the full range of their healthcare options for the final chapters of their lives.” Volunteers also “inform the member—once the decision for hastened death has been freely made—of methods that are legal and available to him or her.” [www.hemlock.org]

In four years, the number of volunteers has grown to over 100 nationwide. According to Dr. Richard MacDonald, Hemlock’s medical director, Caring Friends has “helped” in more than 120 deaths, and he personally was present for over 85 of them.

When asked about the best death-producing method, MacDonald said a plastic bag with helium is the “principal technique used in Caring Friends.” [“Hemlock’s Crown Jewel: Caring Friends after 4 Years,” Conference, 1/11/03] (More on Hemlock’s Caring Friends)

In addition to Caring Friends, Hemlock funds the development of ghoulish “NuTech” death methods, such as Dr. Philip Nitschke’s “COGen” machine, which delivers deadly carbon monoxide through a nasal tube. (Also see “Australia’s Dr. Death” below. More on Nitschke.)

Oregon: Record number of assisted-suicide deaths

According to the latest official report, in 2002, the fifth year under Oregon’s permissive physician-assisted suicide (PAS) law, doctors wrote 58 prescriptions for lethal drugs that 38 patients used to commit suicide—a record high in both categories.

While the number of lethal prescriptions written in 2002 increased by 32% over last year’s figure (44), the number of doctors (33) who reported writing those prescriptions remained the same. Of the 58 patients who received lethal drugs, 36 died by ingesting those drugs, 16 died from their illnesses, and 6 were still alive on 12/31/02. Two patients, who had received their lethal drugs in 2001, died in 2002 after taking the drugs. The record number of assisted-suicide deaths in 2002 (38), represents an increase of 81% over those documented in 2001. The total number of reported PAS deaths since the law was enacted in 1997 is 129, with a total of 198 lethal prescriptions issued by doctors.

According to the reporting physicians, the three most common reasons patients gave for wanting assisted suicide were loss of autonomy, inability to participate in enjoyable activities, and loss of control over bodily functions—not pain. Complications from the lethal drugs included one patient who experienced some coughing and gagging, but died after 13 minutes; another who vomited and died after two hours; one with impaired digestion who took 14 hours to die; while two others took nine and 12 hours respectively to expire. [ODHS, Fifth Annual Report on Oregon’s Death with Dignity Act, 3/5/03. Hereafter cited as Fifth Report. See also, “Five Years of Legal Physician-Assisted Suicide in Oregon,” NEJM, 3/6/03, 961-964]

All statistics were compiled by the Oregon Dept. of Human Services (ODHS), the state agency in charge of issuing an annual statistical report on the induced-death practice. But, as was the case with the ODHS’ four previous reports, those figures are based on a highly flawed reporting system resulting in incomplete and skewed data.

Data retrieval

According to the PAS law (the Oregon Death with Dignity Act), the ODHS must “annually review a sample of the records” and “the information collected shall not be a public record and may not be made available for inspection by the public.” The only information the public receives is an “annual statistical report” with limited data. [Oregon Death with Dignity Act, 127.865 §3.11. Emphasis added.]

The only way the ODHS identifies PAS patients is if the physician or pharmacy reports the lethal prescription. The actual patients are never interviewed, nor are their qualifications for PAS verified by the ODHS. The patients’ families and caregivers are not consulted by the ODHS. If a PAS patient’s case is one of the “sample” cases reviewed, it is done after the patient is dead, with data provided by physician reports, physician interviews, and a periodic review of death certificates.


While the PAS law mandates that all doctors who participate in assisted–suicide deaths report each case to the state, the law does not penalize doctors who fail to do so and gives the ODHS no authority to enforce the reporting requirement. Consequently, there is no way to know the exact number of deaths and the actual circumstances prompting a patient to request assisted-suicide. ODHS acknowledged early on that it is “difficult, if not impossible, to detect accurately and comment on underreporting.” “We cannot determine whether physician-assisted suicide is being practiced outside the framework of the [law].” [Chin et al., “Legalized Physician-Assisted Suicide in Oregon—The First Year’s Experience,” NEJM, 2/18/99]

A similar admission is also in the latest report: “[O]ur numbers are based on a reporting system for terminally-ill patients who legally receive prescriptions for lethal medications, and do not include patients and physicians who may act outside the law.” [Fifth Report, p. 14]

Despite the obvious reporting flaws and incomplete data, supporters of the PAS law continue to claim that it has greatly benefited patients, their families, and caregivers. According to Barbara Coombs Lee, head of the suicide advocacy group Compassion in Dying, “For every Oregonian who hastened his death, 10 others began the qualification process, a hundred discussed the option with their doctors, and thousands found comfort just knowing they had a choice.” Referring to efforts to legalize PAS in other states, Oregon Death with Dignity director Scott Swenson explained, “We’ll rely on the impeccable record of the Oregon law to dispel myths about physician-assisted suicide….” [Oregon Death with Dignity and Compassion in Dying Press Release, 3/5/03]

But Diane Coleman, president of the disability rights group Not Dead Yet, takes a more realistic view of the ODHS’ PAS reports. “People may agree or disagree about the Oregon law, but let’s not pretend that the Oregon reports scientifically examine the ways that medical practice and family life are influenced by the legalization of assisted suicide.” [D. Coleman, Letter to the Editor, Oregonian, 3/14/03] (More on Oregon statistics.)

Oregon cuts care, but pays for assisted suicide

The current financial situation facing the Oregon Health Plan (OHP), the state’s Medicaid program for the poor, along with the availability of the inexpensive assisted-suicide option, creates a dangerous environment for patients unable to pay for needed and costly care. After one disabled man ended up unconscious and in critical condition because payment for his prescription anti-seizure medication was cut by the OHP, ODHS director Jean Thorne called the case “a tragic circumstance” and added “we’re going to see similar cases.” “I’m sure there are some tragedies that we don’t ever see,” she concluded. [KION TV News, 3/10/03; see Editor’s Note]

So far, the OHP has cut the prescription drug coverage for 8,500 Oregonians. On July 1, another 100,000 of the state’s working poor will also lose their coverage. Add to that the 500,000 people in Oregon already without health care coverage, and you have a state where a $45 to $75 lethal drug prescription may be the only realistic option some patients think they have.

Editor’s Note: In 1994, after voters passed the PAS law for the first time, it was Jean Thorne, then OHP director, who announced that the state would cover assisted-suicide costs for the poor under the category “comfort care.” [Dan Postrel, “State could cover assisted suicide,” Statesman-Journal, Dec. 1, 1994, p. A1]

Reports indicate Dutch doctors breaking
new euthanasia/assisted-suicide law

Not long after the Dutch TV program “Reporter” aired an investigative report on the prevalence of physician noncompliance with the country’s one-year-old euthanasia law, a report issued on 4/29/03 by the official euthanasia oversight boards confirmed the fact that often doctors are not reporting the induced deaths as required by law.

The law legalizing euthanasia and assisted suicide was supposed to result in higher numbers of reported cases because doctors would no longer fear possible prosecution. Instead, the figure for reported induced deaths decreased 8% last year and 15% over the last four years. While Reina de Valk, head of the euthanasia boards, estimates that the actual number of cases is double the reported figure, others believe that the number of euthanasia and assisted-suicide deaths could be in the tens of thousands each year.

According to doctors interviewed on the TV program, the law’s guidelines are too rigid and time-consuming. The patient must be suffering unbearably, have no hope of recovery, be of sound mind, and repeatedly request euthanasia or assisted suicide over time. A second opinion by an independent physician must be obtained regarding the patient’s condition and whether he or she qualifies for an induced death under the law. After the patient’s death, the law requires that the case be reported to one of five regional euthanasia boards for review. If there are any irregularities, then the case is referred to prosecutors.

The euthanasia boards’ report states that 12 doctors over the last four years have been cited for violating the euthanasia law, but none has been summoned by the public prosecutors.

Dr. Peter Huijgens, one doctor interviewed on the TV program, admitted that he has knowingly broken the law. Claiming that he simply carried out the family’s wishes, Huijgens said that the patient was too sick to request euthanasia herself, so he increased her morphine. “A comfortable death for the patient comes in first place,” he said, “but in fact, we broke the law.” No second opinion from an independent physician was sought. [AP, 2/28/03; Expatica.com, 4/29/03, 2/27/03]

“Suicide consultant” given suspended sentence
for violating Dutch law

Suicide consultant Willem Muns has been convicted of actively helping an 81-year-old woman in Groningen commit suicide. Muns is an advisor for De Einder, an organization that aids people who plan to commit suicide. Providing information or advice about suicide is permitted under Dutch law. Active assistance or instruction by non-physicians is not.

According to Dutch authorities, Muns gave instructions to the woman and four other people on how to commit suicide and a list of things to buy to cause her death. He served as the “director” as the others helped her overdose on pills and put a plastic bag over her head. The prosecutor told the court that Muns helped to fasten the bag around her head with elastic. Yet, Muns denied any active role in the woman’s death, saying that he did not give how-to instructions to the woman.

Despite the seriousness of Muns’ crime, he was given only a six-month suspended sentence. The lenient penalty is dependent on Muns’ “good behavior” for two years. It is not clear why charges were not filed against the four other suicide assisters. [Expatica.com, 5/10/03, 3-28-03]

“Tired of life” no grounds for euthanasia

The Dutch Supreme Court has ruled that doctors are not allowed to perform euthanasia or assist in the suicide of patients who are simply “tired of life.”

This ruling is the result of a case involving Dr. Philip Sutorius, a general practitioner who, in 1998, assisted the suicide of 86-year-old ex-senator Edward Brongersma. Brongersma was not physically ill or in pain. He claimed he was simply “tired of life” and his aging, “hopeless existence.” A lower court ruled that Sutorius was medically justified in helping his patient commit suicide because Brongersma was suffering unbearably and there was no hope for any improvement. [British Medical Journal, 11/11/00, p. 1174; BBC, 12/24/02]

In part as a public relations move, the Justice Ministry appealed the lower court ruling since it countered the government’s claim that its newly proposed law to legalize euthanasia would not permit the termination of life for those who were just tired of living. [See Update, 2000, #3.]

In 2001, the Amsterdam appeals court ruled in favor of the prosecution, stating that Brongersma had not been suffering unbearably, and found Sutorius guilty. Yet, despite the conviction, the court declined to sentence him because, in the court’s view, he had acted out of compassion for his patient. [Radio Netherlands, 7/23/01] Sutorius appealed the guilty verdict to the Dutch Supreme Court.

While Dutch Health Minister Els Borst has said that “being tired of life” has nothing to do with medicine or the euthanasia law, she also has stated that she is not against suicide pills being made available for “people of advanced age who are done with life.” [NRC Handelsblad, 4/14/01.] (See English translation of Borst Interview)

Swiss group responsible for deaths
of non-terminally ill couple and others

British couple Robert and Jennifer Stokes are among the latest foreign victims to die with the help of Dignitas, a Swiss assisted-suicide group in Zurich responsible for creating what’s been termed “suicide tourism.”

Robert Stokes, 59, had epilepsy and bouts of depression; his wife Jennifer, 53, had diabetes, pain due to arthritis in her spine, and depression. Neither was terminally ill. “Both of them had things wrong with them, but they were certainly not terminally ill,” Mrs. Stokes’ sister said. “It may have all been carefully planned,” the shocked sister explained, “but we had no idea what they were going to do.” [BBC News, 4/15/03]

The Stokes were not the first Britons to use Dignitas’ death services. Thus far, five U.K. citizens have had their lives ended in a Zurich apartment rented by Dignitas director Ludwig Minelli expressly for that purpose. For only a £45 (US $72) registration fee and a £10 (US $16) annual fee, people—even those who are depressed or have other forms of mental illness—can fulfill their death wishes. Reportedly, more than 150 people have ended their lives with the group’s help. [Independent, 4/15/03]

According to Minelli, in addition to the apartment, Dignitas’s services include a Swiss doctor who, after seeing the patient only once, will supply the lethal drugs if it appears that the patient’s death wish is the result of a “rational” decision; a volunteer nurse who prepares the drugs; and two witnesses for each death. Local authorities are then notified. [See Update, 2003/1, & Update, 2002/3.]

But in the Stokes’ case, Edwin Loescher, a Zurich district attorney investigating their deaths, appears to be misinformed as to their physical conditions. “They were terminally ill,” he told reporters, “and both were wheelchair users.”

Loescher also expressed concern over the increasing numbers of Dignitas deaths. He said that between 3/31/03 and 4/5/03, five people had their lives ended. “Too many—it’s nearly unbearable,” he added. Among those were the Stokes (on 4/1/03), an unnamed British woman, a French patient, and a German. [Independent, 4/15/03; Guardian, 4/15/03; Daily Telegraph, 4/15/03]

Meanwhile, British police announced they would not prosecute the widow of Reginald Crew, 74, for aiding his 1/27/03 assisted suicide in Zurich—a crime in the U.K. They said it would not be in the public interest to pursue the matter. [BBC News, 4/9/03; for more on Crew, see Update, 2003/1: p.8]

Italy: Better pain relief needed for patients

Measures are being taken by Italian Health Minister Girolamo Sirchia to improve the provision of adequate pain relief for patients. In a letter to all Italy’s doctors and pharmacists, Sirchia wrote, “I’m sure everyone agrees that the principle of controlling pain, especially in the terminally ill, represents an inalienable ethical duty for doctors.”

According to Health Ministry data, the use of opioid drugs in Italy is the lowest in all of Europe. Moreover, Italy has an insufficient number of high-quality palliative care facilities.

Sirchia plans to improve palliative care through mandatory training for health care providers and by simplifying the process for opioid prescriptions, which would need parliamentary approval.

The first obligatory course in pain and symptom control for doctors, pharmacists, and nurses was held on May 25 in Rome, a day designated as the “Day of Relief.” [Reuters, 2/26/03]

Hungarian court rejects legal
maneuver to decriminalize euthanasia

Hungary’s constitutional court has rejected a bid to decriminalize euthanasia. In the 4/28/03 ruling, the court’s president, Janos Nemeth, said, “The current state of affairs is not unconstitutional,” and therefore the Hungarian Parliament is under no obligation to change any current laws banning euthanasia.

The case before the court stemmed back to a 1993 manslaughter conviction. Gyorgyi Binder was a distraught mother who intentionally drowned her daughter in their bathtub. The 11-year-old daughter had an incurable disease, and Binder said she took the child’s life to end her suffering.

Initially, Binder was given a two-year suspended sentence, but a higher court overturned the ruling, reinstating Binder’s two-year prison term for manslaughter.

The controversy over this case intensified when the country’s president, Arpad Goncz, used his presidential clout to get her sentence once again suspended. The president’s action prompted constitutional jurist Albert Takacs and lawyer Ildiko Kmetty to bring the issue before the constitutional court in hopes of a court mandate against treating euthanasia deaths as crimes. The court did not comply.

“We have considered international examples [of euthanasia legalization],” Judge Nemeth said, naming Belgium, the Netherlands, and Oregon, but, in the end, the court found no merit to this constitutional challenge. The court also pointed out that, since 1997, Hungary has legally recognized patients’ rights to refuse unwanted, life-sustaining medical treatment. [AFP, 4/28/03, Budapest Business Journal, 4/29/03]

Australia’s Dr. Death thrives on controversy

“As he well knows, a little controversy makes for a big entrance,” a New Zealand reporter wrote about Dr. Philip Nitschke, Australia’s version of Jack Kevorkian. [M. Hewitson, New Zealand Herald, 4/5/03]

That was certainly the case last January when Nitschke arrived in San Diego for the national Hemlock Society conference. He was supposed to conduct a “hands on” demonstration of his latest death-producing, carbon monoxide device (the COGen) for conference attendees, but, as he boarded the plane at Sydney’s airport, Australian customs officials confiscated the gadget, along with his custom-made plastic “Exit Bags.” They informed him that a new law prohibiting the export of suicide items had taken effect. While the “hands on” demonstration had to be cancelled, the media—both U.S. and Australian, both TV and print—were at the conference to cover the customs controversy from Nitschke’s perspective. He reveled in the attention. (See Update, 2003/1.)

Nitschke has learned to spin controversy to his own end. When he was scheduled to speak in New Zealand last April, he relished telling reporters that he had foiled Australian customs officials by sending the component parts of his death device to Auckland by mail. He e-mailed his informational handbook and camouflaged the “Exit Bag” in his luggage by using it for dirty laundry. [NZ Herald, 4/5/03]

Most of the controversy surrounding Nitschke is of his own making. He recently outraged veterinarians in Australia and New Zealand by suggesting that those who want to end their lives should make friends with a vet. According to Nitschke, doctors in both countries cannot prescribe Nembutal, his euthanasia drug of choice, but vets can use it to euthanize animals. He told a New Zealand audience: “I often say to people at my clinics, ‘Do you have any vets who owe you favors?’ A woman who came to a clinic told me she had gone back to a vet and reminded him of a brief affair she had had with him years ago. The next time I saw her she looked very happy.”

He gave the same advice during an Australian TV interview. “I’m telling people to get friendly with a vet because vets are the only people that have access to the very best of drugs.” [The Advertiser, 4/14/03; The Australian, 4/15/03; Cybercast News, 4/16/03]

Nitschke often mocks governmental attempts to curtail his euthanasia and assisted-suicide promotion. Much to the amusement of his death clinic participants, Nitschke has added disclaimers to his handbook and Exit Bags for each attendee to sign. “I acknowledge that none of the information provided in this workshop… will be used in any way to advise, counsel or assist in the act of suicide…,” the handbook reads. On his Exit Bag order form, it says, “I will not use the Aussie Exit Bag in a manner that may harm, injure or cause death to myself or any other person.” [NZ Herald, 4/8/03]

But not all controversy surrounding this death doctor is to his liking. When he was 15 years-old, he killed his landlord’s dog by slitting the animal’s throat. He claims the dog was annoying him but adds that he really did it because the landlord was subjecting him to “low-level sexual abuse.” This incident, Nitschke says, is often brought up by those who oppose him and his cause. [Australian Magazine, 5/10/03; NZ Herald, 4/5/03]

He also is not happy about the Australian government’s plan to crack down on Internet websites that encourage “vulnerable individuals to take their own lives.” Nitschke has blasted the plan because he uses the Internet to communicate extensively with elderly and ill people who want to end their lives. [The Age, 4/8/03; Sydney Morning Herald, 4/8/03; CNSNews, 4/7/03] (More on Nitschke)

Most UK doctors oppose assisted suicide

According to a recent poll, almost 75% of British doctors surveyed would refuse to participate in an assisted suicide even if it were legal to do so. Of the 986 physicians surveyed, only 25% said they agreed with the practice, while the majority (56%) felt it would be impossible to establish safe limits for medically-assisted death. When asked how many of their patients in the last three years had asked for euthanasia or assisted suicide, 48% said none, 37% said fewer than five, 11% indicated five to 10, and just 2% said 10 or more.

The poll was conducted by Opinion Research Business and released ahead of a parliamentary debate over the “Patient (Assisted Dying) Bill,” which would legalize both euthanasia and assisted suicide. The second reading of that bill in the House of Lords is scheduled for June 6, 2003. [Daily Telegraph,5/13/03; BBC, 5/13/03]

New Zealand Parliament to debate euthanasia

New Zealand MP Peter Brown has introduced his Death with Dignity Bill, a measure which would ensure a parliamentary debate and conscience vote on euthanasia and assisted suicide legalization. If passed by parliament, the measure would have to be approved by a nationwide referendum in order to become law.

Eight years ago, a similar bill was overwhelmingly defeated by Parliament. The sponsor of that bill, former MP Michael Laws, said that he is not optimistic that the new bill will be passed by this parliament’s members. [Dominion Post, 3/7/03]

But the measure has the support of Prime Minister Helen Clark. “It is a complex issue which needs to be carefully handled, and it may well need modification in the select committee,” she said. [www.stuff.co.nz, 3/8/03]

Doctor knows best …
but it’ll be too late for you, if he’s wrong

By Wesley J. Smith

Who should have the right to decide whether you receive life-sustaining medical treatment during a critical or terminal illness? Most would say with great confidence, “Me. Or, if I am unable to decide, then my family.”

That should be true. Indeed, it used to be true. But in a growing number of hospitals, your right-to-decide is being taken away from you (or your family) by bioethicists and members of the medical intelligentsia who believe that their values and priorities should count more than yours when determining whether you shall receive wanted medical treatment. To put it bluntly, even if you want to live, even if you want medical treatment to enable you to fight for your life, you may be told that the hospital reserves the right to refuse service.

Welcome to the world of “futile-care theory,” one of the hottest and most-dangerous topics in contemporary bioethics. While you may never have heard of it, stories about the spread of futile-care theory are rife throughout medical and bioethics literature, reported and argued about in such influential publications as The Journal of the American Medical Association, The New England Journal of Medicine, and The Hastings Center Report.

Unfortunately, few people read these highbrow publications. Worse, despite being a bombshell story, this growing threat has mostly been ignored by the popular media.

This better change fast. As you read these words, quietly, slowly, inexorably, mostly behind the closed doors of hospital ethics committees, “futile care” or “inappropriate care” protocols are being put into place in hospitals throughout the country. The first time most patients and their families become aware that doctors are being given the right to say “no” to wanted medical treatment (other than comfort care) is during a medical crisis when they are at their most defenseless and vulnerable.

Hospitals in Des Moines, Iowa, appear to be the latest institutions to stealthily adopt futile-care policies. As reported by the January 2, 2003, Cedar Falls Courier, some area hospitals now have rules in place that permit “medical staff to withdraw treatment over a family’s objection.” True, when there is a dispute, families and patients have a right to a hearing in front of a hospital ethics committee. But that isn’t much solace. Such committees could easily become more stacked decks than dispassionate decision makers, mostly comprised of well-meaning people who either are part of the institutional culture or who have been trained to believe that futile-care theory is the right thing to do.

According to the Courier report, if patients lose the right to receive treatment in the ethics committee, they have two choices. First, they can find another hospital. But this would be no easy task given that patients refused treatment are likely to be the most expensive to care for. With the coming of HMOs, and the Medicare Diagnosis Related Group (DRG) capitated payment system, hospitals now generally lose money on patients requiring intensive or extended care. Thus, getting another hospital to accept a patient that a current hospital doesn’t want to treat anymore may be a near impossible task.

That leaves the courts and filing a lawsuit to force the hospital to sustain the patient’s life. That could work, but it is no sure bet. There have been lawsuits filed in various parts of the country over refused treatment, but the results have gone both ways. Moreover, no definitive case has yet been litigated to the appeals court stage. Thus, there are no legal precedents governing the legality or permissible scope of these quickly spreading futile-care policies.

But even though a lawsuit could be successful in theory, it might very well prove utterly impracticable to pursue. These are not the kind of cases that lawyers accept on a contingency basis. This means that if you try to legally force a hospital to continue treatment, you would probably have to pay your lawyer by the hour. Lawyers often charge hundreds of dollars an hour, meaning that a fully litigated case, even without appeals, could cost literally tens, if not hundreds of thousands of dollars.

On the other hand, having very deep pockets, the hospital administration would not be concerned in the least about the cost of their lawyers. If fully unleashed, the hospital’s corporate lawyers could file enough motions, take enough depositions, and pursue every possible appeal, to the point that you, quite literally, could litigate yourself into bankruptcy.

Beyond the financial impracticalities of suing a hospital, one of the primary reasons for crafting futile-care protocols has been to improve the chance that the hospital would prevail in court. Indeed, an article in the Fall 2000 Cambridge Quarterly of Health Care Ethics explicitly advised hospital bioethicists to put these protocols in place as a way to prepare for the litigation bioethicists presume would be filed by people furious at having wanted medical treatment refused. As the authors of The Cambridge Quarterly article opined, “Hospitals are likely to find the legal system willing (and even eager) to defer to well-defined and procedurally scrupulous processes for internal resolution of futility disputes.”

Nobody knows just how many hospitals have adopted these protocols, or where they have been put in place. But if the professional literature is to be believed, futile-care theory is spreading quickly. The Cambridge Quarterly article cited above found that 24 out of 26 surveyed hospitals in California had such policies in place and that of these; only seven left the final decision to the patient or family. I have read about policies being adopted by some hospitals in Houston, Philadelphia, and Detroit, just to mention a few.

It used to be that people were afraid of being hooked up to machines when they wanted nothing more than to go home and die a peaceful, natural death. The early bioethics movement deserves great thanks for helping do away with that form of abuse by pointing out that patient autonomy means the right to say no to unwanted interventions.

But that was before the bioethics movement largely abandoned the sanctity of life ethic for an express or implicit utilitarianism that views the value of human life through a distorting prism of “quality.” That was before most bioethicists came to believe that health-care rationing should be imposed.

Now, a new medical hegemony is arising, one that proclaims the right to declare which of us have lives worth living and therefore worth treating medically, and which of us do not. In essence, what is being created in front of our very eyes (if we would only see) is a duty to die. Unless people object strongly and legislatures take active steps to intervene, this new and deadly game of “Doctor Knows Best” will be coming soon to a hospital near you.


Wesley J. Smith is an attorney for the International Task Force and a senior fellow at the Discovery Institute. He is also the author of Culture of Death: The Assault on Medical Ethics in America (Encounter Books, 2000), Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (Times Books, 1997), and 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 originally published by National Review Online on 1/6/03 and is reprinted here with the author’s permission.

2003 assisted-suicide bills languish in committees

Despite right-to-diers’ high hopes for Hawaii to be the next state to legalize physician-assisted suicide, the 2003 version of the Hawaii Death with Dignity Act has died in committee. Last year’s version passed the House and was narrowly defeated in the Senate. But this year there was a new governor who opposed it, and physician groups rallied to stop the bill in committee. [Honolulu Advertiser, 4/29/03; AMNews, 3/10/03]

Other bills were introduced this year in the following states:

Arizona—Introduced by Rep. Linda Lopez, the Arizona Aid in Dying Act (drafted by the Hemlock Society) failed to get out of the House Health Committee. Lopez didn’t expect the bill to gain approval this year, but said that the stage is set for passage next session. [Capitol Times, 2/18/03; Daily Sun, 2/24/03]

Vermont—The Vermont Death with Dignity Act was sent to the Senate Health & Welfare Committee on 2/20/03, where it remains. A coalition of physicians and health care professionals opposed the measure. [Times Argus, 3/13/03]

Wisconsin—For the past 10 years, Rep. Frank Boyle and Sen. Fred Risser have introduced bills to legalize assisted-suicide with no success. Their 2003 version, introduced in April, is not expected to fare any better. [Journal Sentinel, 4/27/03]

North Carolina—Sen. James Forrester, M.D., and Sen. William Purcell, M.D. co-sponsored an anti-assisted suicide bill. Amendments to the bill are the result of concerns brought up at a legislative hearing. “It’s in its sixth version, and there will probably be a lot more before it’s passed,” Dr. Forrester, said. [AMNews, 5/19/03]

Oral arguments heard in Oregon v. Ashcroft

On May 7, 2003, a three-judge panel from the Ninth District Court of Appeals heard oral arguments in Oregon v. Ashcroft. At issue is whether Oregon doctors who intentionally prescribe controlled substances for assisted suicide violate federal law.

Last November, U.S. Attorney General John Ashcroft issued a ruling stating that, under the federal Controlled Substances Act (CSA), “assisting suicide is not a ‘legitimate medical purpose’” and that “prescribing, dispensing, or administering federally controlled substances to assist suicide violates the CSA.” The state of Oregon contested the ruling, arguing that it is up to individual states to decide what is “legitimate” medical practice within their borders. (See Update, 2003, #1.)

The Ninth Circuit panel is expected to issue its decision sometime this summer. The losing side will appeal. [Reuters, 5/7/03; AMNews, 5/7/03] (More on Oregon v. Ashcroft case.)