Euthanasia out of control

Caryn Lipson

November 22, 2024

Where assisted suicide is legal in the U.S.

In the United States assisted suicide is legal in Oregon, Washington State, California, New Mexico, Colorado, Montana, New Jersey, Vermont, Hawaii, and Washington, D.C.

Currently, there are about twenty states considering such legislation including Florida, Arizona, Virginia, Maryland, Massachusetts, Minnesota, New York, and Tennessee, as Maya Goldman reported for Axios.

Unpacking the push for assisted suicide

A drastic solution to a deeper problem

A broken healthcare system has caused assisted suicide to become a default solution for many cancer patients according to Mercy Health CEO Emeritus Michael D. Connelly. He considers assisted suicide to be a solution for a symptom — patients wishing to die — that does not address a potential root cause of the problem — a broken healthcare system. Patients in despair, afraid of prolonged suffering from painful treatments are not given the information they need to be able to choose hospice and palliative care instead of death, he argued in America Magazine.

The real problem with physician-assisted suicide is that it attempts to treat symptoms (patients no longer wishing to live) and not the cause of their despair (a broken health care system). Patients are not educated about, nor referred to, hospice and palliative care in a timely fashion. So they end up receiving excessive and painful treatments that add unnecessary suffering. They turn to assisted suicide from fear of being “overtreated” by the health system.

Evidence for this, he states, is the fact that 70 percent of patients who have elected assisted suicide are cancer patients interested in avoiding the suffering that chemotherapy and radiation treatments entail.

One piece of evidence for this view is a recent study by the Penn School of Medicine showing that more than 70 percent of those who selected physician-assisted suicide over a 20-year period were cancer patients, who often undergo extensive chemotherapy and radiation treatments. In some cases, these treatments might be avoided by timely referrals to palliative care.

Ethical concerns and potential abuses

Connelly also pointed out that countries like the Netherlands, Belgium, Canada, and Australia, which have permitted assisted suicide for decades, have seen a weakening of safeguards against potential abuses. As such, some Canadian and Australian practitioners are reconsidering their practice of medicine because of the increased social pressure for patients to choose assisted suicide. He quoted one Ontario, Canada physician who is considering leaving geriatric medicine because of family pressure on patients to end their lives early.

David D’Souza, a physician in Ontario, told me, “I think already there’s a lot of abuse going on, and I’m seeing it in my own practice,” including when families pressure loved ones to die so that estates or insurance payouts become available sooner. “It’s making me think twice about whether I should be continuing in geriatric care.”

President and CEO of the American Association of People with Disabilities Helene Berger raised the same concern in an article for The Hill. Berger noted that there are no checks and balances to prevent abuse of the disabled and elderly. She pointed to the pressure of family members and abusive caregivers on frail patients to end their lives and the lack of supervision of the process may even lead to those relatives or caregivers picking up the prescription and administering the drug themselves.

But there is more cause for alarm. In states where assisted suicide is legal, nothing prevents a relative who stands to benefit from the patient’s death from steering that person towards suicide, witnessing the request, picking up the lethal dose, or even administering the drug. The same goes for abusive caregivers. No witnesses are required when the lethal drugs are administered, and despite assurances by assisted suicide proponents, there are no checks or balances that would prevent abuses.

Doctor forcibly injects woman

These ethical concerns are not hypothetical. In one case in the Netherlands, a 74-year-old woman with Alzheimer's was forcibly euthanized, according to Debbie White for Mail Online. The woman had an advance directive authorizing her doctor to kill her when her condition became severe. ‍However, whenever the question came up she repeatedly said it wasn't time. After being admitted to a care home, the woman's husband persuaded the doctor that she wanted to die.

She had written an 'advance directive' asking to be killed if the disease became too severe.

But whenever the issue of asking to die was raised, she also added: 'Not now, it's not so bad yet'.

However, after she was admitted to a care home, seven weeks before her death, its specialist doctor was persuaded by the Dutch woman's husband that she wanted the lethal injection.

The elderly woman was reported as being in tears, stressed and angry, and she was found wandering the care home during the night, searching for her husband.

On the scheduled day of death, the doctor put a sedative in her coffee. When sedatives failed to work and the woman became aware of her surroundings she fought the injection. The doctor then asked family members to hold her down as she gave her the lethal shot.

The report said the unnamed woman then appeared to become aware of her surroundings, and the doctor prepared to inject her with a lethal dose of the drug thiopental.

It added: 'When the physician tried to administer the thiopental, the patient sat up. This is what the physician had previously referred to as physical resistance.

'The family then held her and the physician quickly administered the rest of the euthanatic.'

A watchdog report about the incident concluded that the doctor was trying to prevent the woman from objecting when she put the sedative in her coffee and couldn't be sure the woman really wanted to die.

By giving a sedative covertly in a cup of coffee she had 'wanted to deprive the patient of the possibility to resist... [and then] when the patient did respond negatively, the physician wrongly failed to consider whether this could be interpreted as an important sign that she did not want a needle to be inserted'.

Although the doctor was investigated, she was ultimately exonerated.

No longer just a solution for unbearable pain

A broken healthcare system has enabled assisted suicide to become a default option for individuals who fear losing autonomy and dignity at a later point in their illness. Connelly writes that "what starts as a “compassionate” and rarely used option can metastasize into something like euthanasia, especially in certain populations."

Assisted suicide was ostensibly legalized as a compassionate measure for people who were expected to die within the next 6 months, many of whom live with unbearable pain. But, as Connelly wrote, the reasons for people choosing to die have changed from a means of avoiding pain to a means of retaining autonomy and avoiding loss of dignity, which is predominantly important to white males who are not religiously affiliated.

The Penn School of Medicine study indicates that the people who have chosen physician-assisted suicide since it was legalized in their states tend to be white, male and religiously unaffiliated—and also that they most often cite a loss of autonomy and dignity as the reasons for choosing suicide, rather than for relief from physical pain.

A duty to die

Connelly focuses on physician-assisted suicide as a solution for the elderly, stating that it "does not adequately answer the problem of older citizens facing a dire death experience." However, it’s not only the elderly or white males who choose assisted suicide. Berger’s concern is for vulnerable populations, which include but are not exclusively elderly, white, or male, likely to be mistreated by medical professionals when viewed by family members as emotional or financial burdens.

Multiple studies show that people with disabilities, senior citizens, poor people, and people of color are more likely to be mistreated by medical professionals, and the likelihood of being mistreated increases if family members view them as an emotional or financial burden.”

Not wanting to be a burden on family members as a reason for choosing assisted suicide has increased to the point that she believes it will soon become a “duty” to die.

When it comes to assisted suicide, we see in states like Oregon, where assisted suicide has been legal for two decades, the percentage of Oregon deaths attributed to a patient’s reluctance to “burden” their families rose from 13 percent in 1998 to 40 percent in 2014.

This reveals that the right to die “option” for some vulnerable populations has quickly become more like a duty to die.

Valuing life

The ethical concerns surrounding assisted suicide raise important questions about the value society places on human life. The decision for a society to legalize assisted suicide rather than focusing on providing life-affirming options such as hospice and palliative care and focusing on supporting patients through difficult times is a sign of a broken healthcare system. This raises deeper questions about the role of government and the healthcare system itself in promoting death as an option rather than focusing on improving healthcare and promoting life.

In a follow-up article, we will explore how the structure of healthcare—from insurers’ reluctance to fund life-prolonging treatments, to the normalization of assisted suicide as a medical option in some countries—contributes to this troubling trend. We will also address concerns about systemic issues like doctors' time constraints and errors in diagnosis — flaws in the system that push people toward assisted suicide. These systemic failures call for reflection on how we can shift toward solutions that prioritize proper treatment, and improve end-of-life care so that suicide is not considered a preferable option.

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