The Popularity of Assisted Suicide?
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A survey of U.S. oncologists suggests that support for euthanasia and assisted suicide in this profession has declined dramatically in recent years. The survey polled 3299 members of the American Society of Clinical Oncology in 1998. It found 22.5% support for physician-assisted suicide for a terminally ill patient with prostate cancer in unremitting pain, compared to 45.5% support in 1994. Euthanasia in this situation was supported by 6.5%, compared to 22.7% in 1994.
Surgical oncologists were more likely to support these practices; Catholics, those who view themselves as religious, and those who say they have sufficient time to talk to dying patients about end-of-life care were less likely to do so.
Those who oppose euthanasia and assisted suicide are also less willing to increase the dose of morphine for a patient who has unremitting pain despite previous pain relief efforts. "This reticence," they note, "probably reflects fear that increasing opioid dose increases the risks for respiratory depression and death and might be construed as a form of euthanasia. This view may be encouraged by proponents of euthanasia who have argued that there is no difference between increasing morphine for pain relief and euthanasia." The authors urge increased efforts "to educate physicians on the ethical and legal acceptability of increasing narcotics for pain control, even at the risk of respiratory depression and death" [E. Emanuel et al., "Attitudes and Practices of U.S. Oncologists regarding Euthanasia and Physician-Assisted Suicide," 133 Annals of Internal Medicine (3 October 2000) 527-532 at 530].
Numerous studies have established that the Americans most directly affected by the issue of physician-assisted suicide -- those who are frail, elderly and suffering from terminal illness -- are also more opposed to legalizing the practice than others are:
* A poll conducted for the Washington Post on March 22-26, 1996, found 50% support for legalizing physician-assisted suicide (Washington A18) Voters aged 35-44 supported legalization, 57% to 33%. But these figures reversed for voters aged 65 and older, who opposed legalization 54% to 38%. Majority opposition was also found among those with incomes under $15,000 (54%), and black Americans (70%).
* An August 1993 Roper poll funded by the Hemlock Society and other euthanasia supporters indicated that voters aged 18-29 supported "physician-aided suicide" 47% to 35%; voters aged 60 and older opposed it 45% to 35%.
Hemlock's newsletter commented that "the younger the person, the more likely he or she is to favor this legislation." The newsletter added that "this is somewhat at odds with how Hemlock views its membership," since it sees itself as defending the interests of elderly citizens. (Humphry; Poll 9) A study of cancer patients found that terminally ill patients experiencing significant pain are more opposed to physician-assisted suicide than other terminally ill patients or the general public. The patients who did tend to favor assisted suicide were those who had been diagnosed with clinical depression. The researchers commented: "Patients with pain do not seem to view euthanasia or physician-assisted suicide as the appropriate response to poor pain management. Indeed, oncology patients in pain may be suspicious that if euthanasia or physician-assisted suicide are legalized, the medical care system may not focus sufficient resources on provision of pain relief and palliative care" (Emanuel 1809)
* Researchers at Duke University recently surveyed hundreds of frail elderly patients receiving outpatient treatment and their families. The elderly patients themselves strongly opposed physician-assisted suicide: only 34% favored legalization, with support even lower among female and black patients. But 56% of their younger relatives favored it, and they were usually wrong in predicting the elderly patients' views. (Koenig)
And how about legalized euthanasia in Oregon? The 2001 report from the Oregon Health Division on legally permitted physician-assisted suicides in 2000 provides no information on abuses of the state's guidelines, and is not designed to do so. The 27 assisted suicides reported for this third year of Oregon's "experiment" in lethal medicine are simply those cases which the physicians themselves chose to report. The total number of actual cases, not to mention the number of times various "safeguards" were ignored, remains concealed in the name of physician-patient confidentiality.
However, even the data released by physicians who assist suicides are disturbing. Twenty-seven Oregonians died last year from lethal overdoses of controlled substances deliberately prescribed by physicians, who invoked prescribing privileges granted to them by the federal Drug Enforcement Administration. The most significant changes compared to the previous year are as follows:
* A startling 63% of these patients (compared to 26% in 1999) cited fear of being a "burden on family, friends or caregivers" as a reason for their suicide. Some patients and families are learning all too well the deeper message of Oregon's law: terminally ill patients have received this special "right" to state-approved suicide not because they are special in any positive way, but because they are seen as special burdens upon the rest of us.
* 30% cited concern about "inadequate pain control" as a reason for their death (compared to 26% the year before), despite claims by the Oregon law's defenders that legalizing assisted suicide would improve pain control and eliminate such concerns.
* Also rising is the percentage of victims who were married (67%, up from 44%) and who were female (56%, up from 41%). It seems some older married women in Oregon are receiving the message that they are a "burden" on their husbands, and then acquiescing in assisted suicide.
* Despite a medical consensus that the vast majority of suicidal wishes among the sick and elderly are due to treatable depression, in only 19% of these cases (compared to 37% the previous year) did the doctor bother to refer the patient for a psychological evaluation.
The Supreme Court has been involved only to a limited extent with assisted suicide. The Court upheld two state laws absolutely prohibiting assisted suicide, stating that Washington state's law does not violate constitutional guarantees of "liberty" (Washington v. Glucksberg) and that New York's similar law does not violate constitutional guarantees of equal protection (Vacco v. Quill). Oregon's law selectively permitting assisted suicide for certain patients had been found by one federal district court to violate equal protection; that ruling was not before the Supreme Court (Lee). As Chief Justice Rehnquist said in his majority opinion in Glucksberg: "Lee, of course, is not before us... and we offer no opinion as to the validity of the Lee courts' reasoning. In Vacco v. Quill..., however, decided today, we hold that New York's assisted-suicide ban does not violate the Equal Protection clause" (Washington). To this day no appellate court in the country has ruled on the constitutionality of a law like Oregon's.
The Court also said nothing about assigning this issue to state as opposed to federal jurisdiction. In reviewing the Nation's longstanding tradition against assisted suicide, it cited federal enactments such as the Assisted Suicide Funding Restriction Act of 1997 alongside state laws. Illustrating the government's interest in protecting terminally ill patients, the Court favorably cited an earlier decision upholding the federal Food and Drug Administration's authority "to protect the terminally ill, no less than other patients," from life-endangering drugs (Ibid. 2272).
What the Court did rule is that laws prohibiting assisted suicide (whether state or federal) are constitutionally valid and serve several important and legitimate interests.
Emanuel, Dr. Ezekiel et al.. "Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public." 347 The Lancet 1805 (June 29, 1996):1809
Humphry, Derek. "What's in a word?" Euthanasia Research & Guidance Organization 1993, Table 1-A.
Koenig, Dr. Harold et al.. "Attitudes of Elderly Patients and their Families Toward Physician-Assisted Suicide." 156 Archives of Internal Medicine 2240 (Oct. 28, 1996)
Lee v. Oregon, 891 F.Supp. 1429 (D. Or. 1995), vacated on other grounds, 107 F.3d 1382 (9th Cir. 1997), cert. denied, 118 S. Ct. 328 (1997).
"Poll Shows More Would Support Law Using Gentler Language," TimeLines (Jan.-Feb. 1994):9
Washington v. Glucksberg, 117 S. Ct. 2258, 2262 n. 7 (1997.
-- -- --. 117 S. Ct. at 2272, quoting United States v. Rutherford, 442 U.S. 544, 558. 1979.
Washington Post, April 4, 1996.