Update 031: Volume 18, Number 2 (2004)

Ninth Circuit Appeals Court sides with
Oregon over Ashcroft Directive

The U.S. Court of Appeals for the Ninth Circuit has upheld a lower court ruling 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 was whether assisted suicide, which is legal only in the state of Oregon, is medically “legitimate” under federal law.


In November 2001, after reviewing legal precedents and an analysis done by the Office of Legal Counsel, U.S. Attorney General John Ashcroft issued his determination on the legitimacy of prescribing overdoses of federally controlled drugs to end patients’ lives. In that interpretive rule, now referred to as the “Ashcroft Directive,” he wrote, “I hereby determine that assisting suicide is not a ‘legitimate medical purpose’” under the federal Controlled Substances Act of 1970 (CSA). Furthermore, he concluded, “prescribing, dispensing, or administering federally controlled substances to assist suicide violates the CSA.” Physicians who engage in this activity risk losing their federally-issued drug prescribing licenses, he said. [Ashcroft, “Dispensing of Controlled Substances to Assist Suicide,” 11/6/01]

Since barbiturates, the drugs of choice in Oregon for inducing death, are controlled substances under federal law, proponents of the assisted-suicide law went to court to stop the implementation of the Ashcroft Directive. Oregon-based Federal District Judge Robert E. Jones issued a permanent injunction barring the DEA from rescinding the prescribing licenses of Oregon doctors if they write prescriptions for lethal doses of barbiturates.

Judge Jones held that it is up to individual states to determine “what constitutes a legitimate medical practice or purpose” in that state. “State statutes, state medical boards, and state regulations control the practice of medicine,” he wrote. [State of Oregon v. John Ashcroft, Civil No. 01-1647-JO (D. Ore. 2002)]

In response to Jones’ ruling, 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] The Dept. of Justice (DOJ) cited a 2001 U.S. Supreme Court ruling in United States v. Oakland Cannabis Buyer’s Coop in favor of the DOJ’s interpretation of the CSA. As with the Oregon case, California voters had passed a law, only in this case it was the provision of medicinal marijuana that became legal, not assisted suicide. In a unanimous decision, the high court 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]

Majority opinion

The DOJ appealed Jones’ ruling to the Ninth Circuit Court of Appeals, the most overturned court in the country. Predictably, the appellate court upheld Jones’ permanent injunction against the Ashcroft Directive. But the decision was not unanimous.

The three judge panel issued its 2-1 decision on 5/26/04. According to the majority opinion, written by Judge Richard C. Tallman, “We hold that the Ashcroft Directive is unlawful and unenforceable because it violates the plain language of the CSA, contravenes Congress’ express legislative intent, and oversteps the bounds of the Attorney General’s statutory authority.” [State of Oregon v. John Ashcroft, No. 02-35587, 2004 (9th Cir May 26, 2004) Vol. 1, at 6607. Hereafter cited as Majority.]

Careful to establish that they “take no position on the merits or morality of physician assisted suicide” and “express no opinion on whether the practice is inconsistent with the public interest or constitutes illegitimate medical practice,” the majority found that “the Ashcroft Directive interferes with Oregon’s authority to regulate medical care within its borders….” [Majority, at 6613] “The Ashcroft Directive is invalid,” they wrote, “because Congress has provided no indication—much less an ‘unmistakably clear’ indication—that it intended to authorize the Attorney General to regulate the practice of physician assisted suicide.” Furthermore, the directive encroaches “on state authority to regulate medical practice.” [Majority, at 6615] In the majority’s view, “Congress clearly intended to limit the CSA to problems associated with drug abuse and addiction,” not physician-assisted suicide. [Majority, at 6620]

As to giving deference to Ashcroft’s interpretive rule, the majority held that, “Given the plain language of the CSA and its legislative history, we are under no obligation to defer to the Attorney General’s interpretation of his role under the statute and its implementing regulations.” [Majority, at 6623]

Dissenting opinion

In his lengthy dissenting opinion, Senior Circuit Judge J. Clifford Wallace challenged the majority’s findings.

On the issues of the CSA’s language and Congress’ legislative intent, Wallace argued that “there is simply no textual support for the majority’s conclusory assertion that ‘the field of drug abuse,’ as discussed in the [CSA], does not encompass drug-induced, physician-assisted suicide.” In fact, Wallace wrote, the CSA’s text provides “ample evidence that Congress was concerned not only with street-variety drug trafficking and abuse but also with any other improper drug use” that threatens the welfare of Americans. The CSA’s legislative record “specifically identifies ‘suicides and attempted suicides’ as a ‘[m]isuse of a drug.’” [State of Oregon v. John Ashcroft, No. 02-35587, 2004 (9th Cir May 26, 2004) Vol. 2, at 6636-6637. Hereafter cited as Dissent.]

As to Ashcroft overstepping his authority, Wallace wrote, “General Ashcroft acted well within the scope of his statutory authority” when he declared that assisted suicide does not serve a “legitimate medical purpose.” [Dissent, at 6645] While the majority held that it is the secretary of Health & Human Services, not the attorney general, who should decide if assisted suicide is legitimate and serves the public interest, Wallace found that the CSA’s wording itself directly contradicts the majority’s assertion: “The Attorney General may deny an application for…registration [of a practitioner to dispense drugs] if he determines that the issuance of such registration would be inconsistent with the public interest.” [Dissent, at 6640]

Wallace also pointed out that the majority “vastly exaggerates” the Ashcroft Directive’s scope by implying that it outright bans physician-assisted suicide. On the contrary, the directive “proscribes only one method of assisting suicide: prescription, dispensation, and administration of controlled substances.” (Emphasis added.) Oregon doctors, Wallace wrote, can continue to assist suicides by using other means to end lives. [Dissent, at 6635]

Referring to the majority’s refusal to give deference to Ashcroft’s interpretive rule, Wallace explained that—because the Ashcroft Directive interprets an agency regulation, not a statute (CSA)—”we must accord it ‘substantial defer-ence.’” [Dissent, at 6652] “Nothing in the Controlled Substances Act’s text or legislative history authorizes the majority to deny deference…. [F]irmly established principles of administrative law formulated by the Supreme Court and our court command us to defer to the Attorney General’s interpretation….” [Dissent, at 6660] Wallace concluded that the Ashcroft Directive “commands immediate implemetation.” [Dissent, at 6657]

As of this writing, the DOJ has not indicated whether it will appeal the majority ruling.

(See Ashcroft for current status of case, text of the Directive, overview, etc.)

Case proves Oregon assisted-suicide law flawed

In 2001, a terminally-ill man with a clear history of bouts with acute depression and several suicide attempts was given a prescription for lethal barbiturates by Dr. Peter Reagan, an assisted-suicide advocate affiliated with Compassion in Dying (CID), the group which counsels and assists the majority of people who die under the Oregon Death with Dignity Act (DWDA).

The patient, Michael P. Freeland, 64, had been haunted by suicidal feelings most of his life. Shortly after his mother committed suicide when he was 21, Freeland attempted to kill himself, but ended up in a psychiatric hospital where he was treated for depression. He later made several other suicide attempts, and remained preoccupied with the possibility of ending his life. When Freeland and his daughter went to see Dr. Reagan about arranging a legal assisted suicide, Reagan said he didn’t think that a psychiatric consultation was “necessary.”

While the DWDA states that an assisted-suicide candidate must not be “suffering from a psychiatric or psychological disorder or depression causing impaired judgment,” it’s up to the lethally prescribing doctor whether or not the patient is referred for a psychiatric evaluation. [DWDA, §127.800 s.1.01(5)] In fact, in 2003, only 2 of the 42 patients who died under the DWDA that year were referred for such an evaluation.

Freeland’s case report was presented at the American Psychiatric Association annual meeting by Portland psychiatrist Gregory Hamilton, former president of Physicians for Compassionate Care. [Hamilton, “Competing Paradigms of Responding to Assisted-Suicide Requests in Oregon: Case Report,” 5/6/04]

“Terri’s Law” ruled unconstitutional

Pinellas County Circuit Judge W. Douglas Baird has overturned a law passed by the Florida legislature in October 2003 giving the state’s governor authority to order a one-time stay in certain cases involving incompetent patients whose food and fluids are being withdrawn or withheld. The law is limited to cognitively disabled patients who have not executed a prior health care advance directive and there is disagreement among family members as to the patients’ wishes.

The law, dubbed “Terri’s Law,” empowered Governor Jeb Bush to issue what amounted to a stay of execution for Terri Schiavo, the cognitively disabled woman whose feeding tube had been removed by court order at the insistence of her estranged husband and legal guardian, Michael Schiavo. She was into her sixth day without any food or fluids when Gov. Bush acted on her behalf and ordered her nutrition and hydration restored pending further investigation into, among other things, her husband’s motives for wanting her dead. Angered by the legislature’s action and Bush’s order, Michael and his lawyers challenged “Terri’s Law” on state constitutional grounds.

On May 5, 2004, Judge Baird—who called the law “presumptively unconstitutional” prior to even hearing any arguments in the case—not surprisingly ruled that “Terri’s Law” “is unconstitutional on its face because it is an unconstitutional delegation of legislative power to the Governor and because it unjustifiably authorizes the Governor to summarily deprive Florida citizens of their constitutional right to privacy” to make their own medical decisions. [Schiavo v. Bush, Civil Case No. 03-008212-CI-20 (Fla. Cir. Ct., Pinellas Co.), 5/5/04]

But Baird based his ruling in large part on the assumption that Terri would not want to live in her present condition. Michael had managed to convince Baird’s colleague, Pinellas County Circuit Court Judge George Greer—who for years has ruled in Michael’s favor—that Terri once said she would not want to be kept alive artificially, a “wish” her family rejects and one which Michael expressed only after he received over $1 million from a malpractice suit. He had vowed to the malpractice court that he would take care of Terri for the rest of her life and be sure she got appropriate care and rehabilitation with any court awarded money. Instead, Michael, who lives with another woman and their two children, has denied Terri all therapy since 1991 and, since 1995, even refused her dental care, until earlier this year when five of her her teeth had to be pulled. [“Schindler Family Statement,” 5/17/04]

According to Ken Connor, Bush’s legal council, “There is a conflict of interest. He [Michael] stands to gain by her death.” [L.A. Times, 5/7/04] “In a million years a jury will never find for Michael Schiavo,” Connor said, comparing Baird’s and Greer’s findings to a jury trial. “Given all the information that has been developed in the intervening time, Michael Schiavo does not have the credibility to persuade a jury these were Terri’s desires.” [AP, 7/7/04]

Bush has appealed Baird’s ruling to Florida’s 2nd District Court of Appeal, which, in turn, fast-tracked the case to the Florida Supreme Court. Oral arguments before the state’s highest court are scheduled for August 31.

U.S. reaction to Vatican’s stand on provision of food and fluids

As reported in the last Update, Pope John Paul II issued a statement in March on the right of patients to receive basic care, including the provision of food and fluids. The pope specifically referred to those deemed to be in a “vegetative state,” a term the pope found demeaning. “I should like particularly to underline how the administration of water and food, even when provided by artificial means [by tube], always represents a natural means of preserving life, not a medical act,” he told international experts attending a conference on “Life-Sustaining Treatment and Vegetative State.” “Death by starvation or dehydration is the only possible outcome as a result of their withdrawal,” the pope emphasized, and, if it is “done knowingly and willingly,” it is truly “euthanasia by omission.” [Pope’s Address, official English trans., 3/20/04]

The pope’s words elicited strong reactions in the U.S., particularly from ethicists. Media favorite Arthur Caplan, director of the Center for Bioethics at the Univ. of Pennsylvania, wrote, “[The pope’s] dictum threatens both to undermine a powerful social consensus about stopping medical care and to compromise the rights and dignity of tens of thousands of patients….” [Philadelphia Inquirer, 4/1/04] David Magnus, from Stanford University’s Center for Biomedical Ethics, said, “I think the pope is completely misguided on this.” [San Jose Mercury News, 4/2/04]

Despite the clarity of the pope’s statement, many associated with Catholic hospitals found it confusing. “We have to figure out more specifically what he meant and the implications,” explained Dan Dwyer, from Missouri-based St. John’s Health System. [USA Today, 4/15/04] Up until now, Catholic hospitals have considered tube feeding “medical treatment,” which can be withheld or withdrawn. Hospital officials say they need clarification from the U.S. bishops on how to apply what the pope said. But some are not confused. “I think it’s clear,” said Msgr. Kevin McMahon of Philadelphia. “There’s no need to go back to the drawing board. Those who disagree should just say: ‘We were wrong before… Now we understand.’” [Philadelphia Inquirer, 4/16/04]

Right-to-die groups to merge

After months of speculation and rumors, the boards of both End-of-Life Choices (formerly the Hemlock Society) and Compassion in Dying made it official: the two organizations are planning on merging in 2005. The new group’s name will likely be “Compassion and Choices.” [“Unification Statement,” Right-to-Die (email) List Serve, 6/21/04; hereafter cited as List.]

But not everyone in EOLC’s rank and file are pleased. In 2003, the Hemlock faithful had to endure a name change, now they are being told that their group is being assimilated into a new entity. As Derek Humphry, founder of the Hemlock Society, put it, “Has the mouse swallowed the cat?” “This is a merger made in la-la land.” [List, 6/26/04]

Many share Humphry’s opinion. EOLC has $2.6 million in the bank; CID’s reported revenue for 2002 was $1,037,451. [Denver Post, 6/29/04] According to Ted Goodwin, who resigned as EOLC’s National Board treasurer in June, “When the dust settled, it was crystal clear that our leadership had ceded, not only control of our agenda and mission to CID, but also control of our bank account when the acquisition is complete.” [List, 6/29/04] Ironically, CID was originally a Hemlock Society spin-off group in Washington State 10 years ago.

From CID’s perspective, the merger will benefit both groups. “United our size and experience will have an impact in statehouses, Congress and courtrooms throughout the nation….” [Coombs Lee & K. Lee, List, 7/7/04]

Australia: Nitschke ramps up efforts to circumvent law

Australia’s Dr. Death, Dr. Philip Nitschke, has increased efforts to thwart authorities trying to enforce the country’s laws banning euthanasia and assisted suicide.

Nitschke, who regularly conducts how-to workshops on suicide methods he’s devised, has a history of thumbing his nose at the assisted-suicide law. For example, one of his recommended death devices is a redesigned version of the plastic Exit Bag, intended to be used by drugged, suicidal people to suffocate themselves. In order to avoid prosecution, Nitschke puts warning signs all over them, stating that the bags are dangerous and should not be put over one’s head. [The Age, 7/9/02]

While staying out of jail is still a top priority, two recent legal developments have somewhat assuaged Nitschke’s fear of prosecution. The first involved the assisted-suicide death of Elizabeth Godfrey, a euthanasia activist in Hobart. Her son pleaded guilty to assisting her death, which carries a maximum 21-year sentence. But, in May, the son was essentially exonerated by a sympathetic judge who gave him only a 12-month suspended sentence. [The Age, 5/27/04; The Mercury, 5/27/04]

Nancy Crick

The second development dealt with the 2002 death of Nancy Crick, a Nitschke counselee, who chronicled her suicide plans on the Internet, claiming she was terminally ill with bowel cancer. A post-mortem autopsy, however, revealed she was cancer-free. [Courier-Mail, 6/9/04; Daily Telegraph, 6/8/04]

Since aiding and abetting a suicide is punishable up to life in prison in Queensland where Crick lived, Nitschke had devised a plan to make it difficult for authorities to investigate Crick’s suicide assisters. His group, Exit Australia, made hundreds of brass keys to Crick’s front door and sold them for $20 (Australian) each. Anyone who purchased a key could claim that they were present when she died. [The Age, 3/26/02, 3/27/02; AAP, 3/26/02]

Despite his plan, police determined that 21 people witnessed Crick’s death first hand. (At the time, Nitschke claimed he was not present to avoid possible prosecution.) But, when police tried to investigate Crick’s death, the 21 present refused to be interviewed. Finally, after 2 years of the investigation being stonewalled, Police Commissioner Bob Atkinson announced that no charges would be forthcoming. “At this point in time there is insufficient evidence to support any charge against any person…,” he told reporters in June. “Actually being present when someone takes their life does not in itself constitute an offence.” [Courier-Mail, 6/19/04]

Bill threatens Nitschke’s operation

With the Crick investigation safely behind him, Nitschke now faces a new threat: the Crimes Legislation Amendment (Telecommunications Offences and Other Measures) Bill 2004, currently making its way through Parliament. The bill would make it a crime to provide suicide and assisted-suicide promotional materials, how-to information, counseling, drugs or devices over the Internet and email. [Crimes Legislation Bill 2004, §474.27] If passed, the measure would put a large part of Nitschke’s operation out of business.

But, true to form, Nitschke has a plan to circumvent the law if the bill passes: move his website out of Australia. “The easiest way to do that would be to have it operating through an affiliate organization in North America,” Nitschke said. He would call that organization Exit North America and would have it in place by the end of the year. After conferring with lawyers in the U.S., Nitschke concluded that his legal problems in Australia would be “less likely to happen in the U.S., with the First Amendment.”

ITF Executive Director Rita Marker, however, pointed out that, while discussions and how-to information about assisted suicide are protected as free speech, “virtually every state prohibits actually assisting suicide.” Noting that Oregon is the only state to legalize the practice, Marker added, “Even there, Nitschke would be out of luck since he is not licensed to practice medicine in Oregon.” [CNSNews, 5/27/04 & 5/28/04]

The “Peaceful Pill”

Nitschke’s devious nature is, perhaps, most apparent in his latest invention, the “Peaceful Pill,” which isn’t really a pill, but a lethal drink consisting of easily attainable ingredients like alcohol and nicotine. “No government will be able to bring itself to ban these substances, so I think the process is safe,” Nitschke explained. “And if people can do it all themselves, with no help, there is no breach of the law.” [The Age, 6/11/04]

The still untested “pill” was recently highlighted in Nitschke’s documentary film, Mademoiselle and the Doctor. The film is about Lisette Nigot, 79, who attended a Nitschke how-to workshop in 2002 and, shortly after, committed suicide. Nigot, who wanted to die before she reached the age of 80, was perfectly healthy. [Sunday Times, 6/18/04]

The idea of a suicide pill was originally conceived by Prof. Huib Drion, a former Dutch Supreme Court justice who pushed for euthanasia legalization in the Netherlands. Drion, who died last April, proposed the “Drion Pill” in his 1991 essay, “Voluntary Death for Old People.” In it, he held that all persons over 70 should be given a euthanasia pill to end their lives whenever they wanted. Drion and Nitschke met in 2003 while Nitschke was in Holland for his film’s screening. [AP, 4/21/04; E-Deliverance (Nitschke’s on-line newsletter), 12/03].

This year, Nitschke lost funding for his “pill” when End-of-Life Choices (formerly the Hemlock Society USA) decided to take “a philosophical decision to direct its resources toward legislative strategies.” [E-Deliverance, 3/04]

Dutch continue to rationalize and expand induced death practices

The Dutch have a habit of turning unethical medical practices into acceptable “treatments” for the “good” of patients—particularly in regard to induced death practices.

Take, for example, euthanasia. Long ago, the Dutch nuanced the euthanasia definition to mean only the killing of a patient who asked to die. If a patient was killed without his/her knowledge, consent, or request, it was not considered euthanasia, but rather “life-terminating treatment” or “termination of life without patient’s explicit request.”

Consequently, Dutch “euthanasia” studies focused on voluntary euthanasia deaths—as opposed to involuntary euthanasia deaths—and promoted the contention that euthanasia was a necessary and socially safe medical treatment option for suffering patients who wish to die.

The definition’s exclusion of “life-terminating treatment” as a form of euthanasia also enabled doctors to take patients’ lives without having to follow established “euthanasia” guidelines or report the deaths as “euthanasia” to authorities.

Terminal sedation

Now Dutch doctors and ethicists are playing a smoke and mirrors game with the practice of terminal sedation. According to a recent Nijmegan University study, doctors no longer see a need for euthanasia because of better palliative care and pain control techniques. Instead, the survey of over 1,500 Dutch physicians found that doctors now consider terminal sedation—the induced unconsciousness of terminally ill patients—the best way to successfully treat these patients’ suffering.

The study’s author, pain control expert Bernardus Crul, released his findings early in hopes of stimulating a debate on terminal sedation as an alternative to euthanasia.

But, in the Netherlands, terminal sedation usually involves more than just rendering a patient unconscious. It also entails withholding all food and fluids until the patient dies. [Reuters, 5/29/04]

While the Dutch may consider terminal sedation a way of letting patients die “naturally,” the fact that patients are intentionally starved and dehydrated to death hardly fits the definition of natural death. Opponents of the practice call terminal sedation “slow euthanasia.”

Even some euthanasia advocates oppose terminal sedation. Australia’s most visible euthanasia activist, Dr. Philip Nitschke, argues that, while doctors may personally prefer terminal sedation over euthanasia, it is not in the patient’s best interest. “No one has ever come to my [suicide] workshops and said ‘I want to spend five days dying slowly,’” he explained. [The Age, 5/30/04]

Euthanasia reporting declines

Since the Dutch government legalized euthanasia in 2002, more than half the doctors fail to report euthanasia deaths as mandated by “safeguards” in the new law. In response, Dutch health minister Clémence Ross wrote to Dutch parliament members, “There must be absolutely no misunderstanding… doctors must report.” She added that euthanasia reporting is part of “medical professionalism.”

Her letter was precipitated by official 2003 figures showing that only 1815 reports were submitted to the government’s regional euthanasia oversight committees, compared to 1882 in 2002, 2054 in 2001, and 2123 in 2000. The biggest decline in reporting occurred between 2001 and 2002, after euthanasia became legal.

Ironically, the Dutch government’s main rationale for passing that law was precisely to stop physician non-reporting.

Ross’ concern is that it is “difficult to appreciate the declining numbers reported” as a result of “insufficient insight” into the total number of euthanasia cases. She has ordered that a follow-up study be conducted in 2005 to determine whether it is doctors’ reporting that is declining or the number of euthanasia cases.

Dr. Peter Holland, chairman of the Royal Dutch Medical Association, concluded that the declining numbers are the result of increased availability of “alternatives such as pain relief and sedation” and doctors’ improved expertise in palliative care. [British Medical Journal, 6/5/04]

However, as long as terminal sedation is considered an alternative to euthanasia, doctors will not be required to report these deaths, and the actual number of euthanasia deaths each year will remain unknown.

OK given to euthanize patients with dementia

Dutch Justice Minister Piet Hein Donner has backed an earlier Procurators-General Council decision that dementia can be a valid justification for euthanasia. On October 8, 2003, the council dismissed charges against a doctor who euthanized an early onset Alzheimer’s patient—at the patient’s request, but in violation of the euthanasia guidelines.

Speaking at a Utrecht congress on the termination of life, Procurators General Board president, Joan De Wijkerslooth, said that the prospect of physical and mental decline associated with Alzheimer’s could be considered “unbearable and incurable” and “anticipated suffering.” [The Lancet, 6/12/04; expatica.com, 6/3/04]

Compassionate or Callous?
Contrasting approaches to the care of Alzheimer’s patients

by Wesley J. Smith

Compassion, literally defined, means, “to suffer with another.” That is why I have always found the monopolization of that word by proponents of euthanasia and assisted suicide so discordant. Euthanasia isn’t about suffering with anybody. It’s about using someone’s suffering—and the pity it evokes—as a justification to kill.

The Netherlands has allowed euthanasia for more than 30 years, supposedly under strict guidelines to protect the vulnerable from abuse. But the list of those “eligible” has steadily lengthened, to the point that it now includes depressed people without organic illnesses. And now, the Dutch government has opened the legal door to killing patients with Alzheimer’s disease. In doing so, the nation sent a powerful message to Alzheimer’s patients and their families: The lives of those with this dreaded disease are so burdensome and undignified that they are not worth maintaining or protecting.

Contrast this with the message Nancy Reagan and her family sent the world by lovingly caring for Ronald Reagan in his declining years. This is what true compassion looks like. Through their unwavering devotion—giving wholeheartedly to Reagan even when he had little to give back in return, and taking some of his suffering on their own shoulders for ten difficult years—the Reagan family provided a vivid demonstration of the power of unconditional love. Nothing that has been done to recognize the late president—the naming of an airport after him, the public outpouring of respect during the week of mourning, the burying of political hatchets—could have honored Ronald Reagan the man, husband, and father more appropriately.

Ronald Reagan understood clearly how crucial it is to value all people equally, regardless of their capacities or state of health. Writing in Human Life Review in 1983, in words that are especially poignant considering what befell him ten years later, he warned:

Regrettably, we live at a time when some persons do not value all human life. They want to pick and choose which individuals have value. Some have said that only those individuals with “consciousness of self” are human beings.

This dehumanization offended Reagan to his core. He warned that the philosophy established at the Founding of the United States that all are created equal, possessing an inalienable right to life, is subverted when some of us are seen as disposable. And he recognized that sanctioning their killing—even in a desire to alleviate suffering—undermines our essential humanity.

Of course, some would say that the reverse is true, that a life with Alzheimer’s isn’t really living. Better to put people out of their misery than allow them to die slowly, while losing their identities. Such an end is seen as especially burdensome for those who have lived robust lives of independence, intellectual rigor, achievement, and accomplishment—people who would be humiliated to see themselves having to depend so totally on others for their care.

But the life Reagan led in his declining years demonstrates how wrongheaded such views are. True, Reagan was no longer able to occupy the public stage. True, he was very ill. True, this caused him and his family tremendous anguish. But it is untrue that falling prey to catastrophic illness meant that he possessed less human dignity and moral worth than he did when telling Mikhail Gorbachev to “tear down this wall.” Indeed, what we have learned in the last week about Reagan’s gentle life in his final, private years demonstrates that there can be profound meaning even in the most difficult and trying circumstances.

Betsy Streisand’s “Memories of a Friend in the Park,” a first-person observation piece published in the June 21, 2004, U.S. News and World Report, was especially touching in this regard. Streisand recounts how, as Reagan’s Alzheimer’s forced him out of the public limelight in the late 1990s, he frequented a park in Beverly Hills. Reagan, accompanied by his nurse, liked to sit on a park bench and watch children at play. She recalled:

Reagan didn’t speak much to adults. It was our children he was interested in. Time and again these sticky little specimens encrusted with juice and sand would come up next to him as they made their way to the bags of snacks on the bench. And he would beckon them closer…And although he gradually stopped speaking to us—and our children—we never stopped speaking to him or having the kids play close by where he could watch.

As Reagan’s cognitive and verbal abilities collapsed, his human desire to love and be loved remained undiminished. Reagan’s son Michael spoke emotionally to this when he described his dad’s joy at hugging and being hugged. “As the years went by and he could no longer recognize me,” Michael said in a tribute to his father, “I began a process of hugging him whenever I would see him.” Most poignantly, the son recalled once forgetting to hug his father goodbye. As he was about to get into his car, Michael’s wife told him to turn around. There in the doorway was Ronald Reagan, arms outstretched, waiting for his hug. Tears in his eyes, Michael rushed back to his father and the two embraced.

Even at the very end, love triumphed over disease. Reagan loved his Nancy deeply and intensely, and as he was breathing his last breaths, somehow, some way, he dug deep within himself and found some final reserve of devotion. He opened his eyes, recognized her, and giving her one final look, he died. Nancy Reagan and the family called his final great communication a “wonderful gift.”

Now juxtapose this story of anguish—as well as love, grace, and devotion—with euthanasia in the Netherlands, which will now be applied to patients with Alzheimer’s. The best view of it is found in a book by a nursing-home doctor named Bert Keizer. In Dancing with Mr. D, Keizer describes several euthanasia cases in which he provided lethal injections. In every case, he depicts the lives of frail and dying people under his care as pointless, useless, ugly, grotesque. Those with whom he interacts all seem to share these views, including his colleagues, family members of patients, and the patients themselves—allowing Keizer to kill patients without bad conscience.

One man he describes probably has lung cancer but the diagnosis is never certain. When a colleague asks, “Why rush?” while pointing out that the man isn’t suffering terribly, Keizer snaps, “Is it for us to answer this question? All I know is that he wants to die more or less upright and that he doesn’t want to crawl to his grave the way a dog crawls howling to the side walk after he’s been hit by a car.”

Keizer either doesn’t know or doesn’t care that with proper medical treatment, people with lung cancer don’t have to die in unmitigated agony. The next day, he lethally injects the patient, telling his colleagues as he walks to the man’s room, “If anyone so much as whispers cortisone [a palliative agent] or ‘uncertain diagnosis,’ I’ll hit him.”

Another patient Keizer kills is disabled by Parkinson’s disease. The patient requests euthanasia, but before the act can be carried out, he hesitates after receiving a letter from his religious brother who warns that God is against suicide. This upsets Keizer, who writes: “I don’t know what to do with such a wavering death wish. It’s getting on my nerves. Does he want to die or doesn’t he? I do hope we won’t have to go over the whole business again, right from the very start.”

Keizer decides to push the process along. He asks the nursing-home chaplain to assure the man that his euthanasia will not upset God. The man reconsiders and again decides he wants to die. Keizer is quick with the lethal injection, happy the man has “good veins.” The patient expires before his uncertainty can disturb his doctor’s mood again.

Where is the compassion in this? Caring, unlike killing, can be costly in time, money, and emotional anguish. But, as the near universal outpouring of admiration for Nancy Reagan as caregiver demonstrates, it also ennobles and liberates. Indeed, as Ronald Reagan wrote long before he knew the words would apply so personally:

My Administration is dedicated to the preservation of America as a free land, and there is no cause more important for preserving that freedom than affirming the transcendent right to life of all human beings, the right without which no other rights have any meaning.

Wesley J. Smith is an attorney for the International Task Force and a prolific writer on end-of-life issues. His article is reprinted from National Review Online, 6/17/04, with the author’s permission.

Bulgaria imposes ban on euthanasia

The Bulgarian Parliament has banned the practice of euthanasia. On June 2, 2004, after a week of heated debate, 93 out of the 107 members of Parliament voted in favor of the ban.

“The duty of doctors is to save lives,” explained deputy minister of health Petko Salchev. Addressing State TV viewers, he added “Any ending of one’s life amounts to a murder.” [Sofia Morning News, 6/2/04; Bulgarian News Network 6/2/04]

Euthanasia bill defeated in South Australia

An attempt by the Australian Democrats to legalize euthanasia in South Australia has been defeated. The Dignity in Dying Bill failed to pass the Legislative Council by a vote of 13 to eight.

The bill’s sponsor, Democrat MP Sandra Kanck, said she was disappointed by the vote, but believed that the South Australia Parliament would eventually pass a euthanasia bill. Her bill would have allowed terminally-ill patients to end their lives under medical supervision. [The Australian, 6/3/04]