False Compassion

Imagine that you have lung cancer. It has been in remission, but your latest test is bad news: The cancer returned and is likely to be terminal.

Still, there is some hope. Chemotherapy could extend your life, if not save it. You ask to begin treatment. But you soon receive more devastating news: A letter from the government informs you that the cost of chemotherapy is deemed an unjustified expense for the limited extra time it would likely provide. However, the government is not without compassion. You are informed that whenever you are ready, it will gladly pay for your assisted suicide.

Think that's an alarmist scenario to scare you away from supporting "death with dignity?" Wrong. That is exactly what happened last year to two cancer patients in Oregon, where assisted suicide is legal.

Barbara Wagner had recurrent lung cancer and Randy Stroup, prostate cancer. Both were on Medicaid, the state's health insurance plan for the poor that, like some NHS services, is rationed. The state denied both treatment for their cancer, but told each it would pay for their assisted suicide. "It dropped my chin to the floor," Stroup told the media. "[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?" (Wagner eventually received free medication from the drug manufacturer. She has since died. Stroup's denial of chemotherapy was reversed on appeal after his story hit the media.)

Despite Wagner and Stroup's cases, advocates continue to insist that Oregon proves assisted suicide can be legalized with no abuses. But the more one learns about the actual experience in Oregon, the shakier such soothing assurances become.

A study published in the Journal of Internal Medicine last year, for example, found that doctors in Oregon write lethal prescriptions for patients who are not experiencing significant symptoms and that assisted suicide practice has had little to do with any inability to alleviate pain -- the fear of which is a chief selling point for legalization. From the report:

Family members described loved ones "who pursue PAD ['physician assisted death,' a euphemism for assisted suicide] as individuals for whom being independent and in control is important, who anticipate the negative aspects of dying, and who believe the impending loss of self, abilities, and quality of life will be intolerable. They fear becoming a burden to others, yet want to die at home. Concerns about what may be experienced in the future, including physical symptoms, were substantially more powerful reasons than what they experienced at the time of the request."

When a scared and depressed patient asks for poison pills and their doctor's response is to pull out the lethal prescription pad, it confirms the patient's worst fears about the future -- that they are a burden, that they are less worth loving, that they will be allowed to die in agony. Hospice is geared to address such important existential concerns. But effective hospice care is undermined when a badly needed mental health intervention is easily avoided or short circuited via a state sanctioned physician-prescribed overdose of lethal pills.

But don't the guidelines protect depressed people in Oregon? Hardly. Not only does the law not require treatment when depression is suspected, but very few terminal patients who ask for assisted suicide are referred for psychiatric consultations. Indeed, in 2007 not one patient who received a lethal prescription was referred by the prescribing doctors for a mental health evaluation beforehand.

Moreover, as Dr. Kathleen Foley, perhaps America's foremost palliative care physician, and psychiatrist Herbert Hendin, an expert on suicide prevention, wrote in a scathing expose of Oregon assisted suicide published in the Michigan Law Review, physician are able "to assist in suicide without inquiring into the source of the medical, psychological, social and existential concerns that usually underlie requests for assisted suicide, even though this type of inquiring produces the kind of discussion that often leads to relief for patients and makes assisted suicide seem unnecessary."

Foley and Hendin provide actual case histories in their very detailed paper that demonstrate the tissue paper strength of Oregon's protective guidelines. For example, "Joan" was dying of Lou Gehrig's disease and asked for a lethal prescription. The doctor sent her for a psychological evaluation "to cover my ass." The evaluation -- if you can call it that -- was conducted by phone with the family repeating the questions to the patient, and, it is worth noting, laughing about them. Foley and Hendin conclude: "Based on these test results, the psychologist [who, it is worth reiterating, never met the patient] concluded that whatever depression Joan had was directly related to her terminal illness, which he considered a completely normal response."

That is hardly careful medical practice. And yet despite the clear problems in Oregon, Washington State has legalized assisted suicide and a trial judge in Montana declared that dying "with dignity" is a fundamental state constitutional right.

Oregon has become the model for how assisted suicide is supposed to work. But it actually demonstrates that the Oregon Trail is a dangerous path. For those willing to take the time to dig beneath the sloganeering and feel-good propaganda, it is easy to see that legalizing assisted suicide leads to abandonment, bad medical practice, and a disregard for the importance of patients' lives.