Posts Tagged ‘Assisted Suicide’

How Can We Even Be Talking About Legalizing Assisted Suicide

Monday, June 11th, 2018

The recent suicides of celebrities has caused a sensation. One of the valuable side-effects of this is that our nation is being forced to realize that there is a genuine public health crisis that has been happening, mostly below the radar.

According to the National Institute of Mental Health, in 2016, 1 million U.S. adults made plans for death and attempted suicide. Read that again — 1 million adults. The Centers for Disease Control just put out a report highlighting the alarming incidence and increase in suicides. Some of the key conclusions:

  • Suicide rates have risen in every state but one.
  • In 2016, nearly 45,000 Americans age 10 or older died by suicide.
  • Suicide is the 10th leading cause of death and is one of just three leading causes that are on the rise.
  • The suicide rate has increased 25% in the US since 1999.
  • In half the states, the suicide rate increased over 30%. One state, North Dakota, saw a 57% increase.
  • New York’s suicide rate increased 28.8%.
  • 54% of people who died by suicide did not have a known diagnosed mental health condition at the time of death.

So how can we even be talking about legalizing physician assisted suicide?

The message sent by legalizing assisted suicide is precisely the message that is leading more and more people to kill themselves. According to one expert interviewed by the Chicago Tribune, there are “key variables” that make a person more vulnerable to suicide:

  • Perceived burdensomeness, “this idea that my death is more valuable than my life.”
  • Thwarted belongingness, “meaning I try to make meaningful connections, and they just don’t work out.”
  • Hopelessness, “OK, I have this, and it’s never going to get better.”
  • Acquired capability, the ability to set aside normal psychological and physical constraints and perform an act that may be painful or horrifying.

The first three key factors are precisely the messages that assisted suicide sends to people who are terminally ill or disabled. The last factor is what assisted suicide hands to that vulnerable person at their bedside — a deadly prescription from their doctor that will make the act seem easy.

The normalization of suicide is also a major factor here, no doubt fueled by celebrity suicides and prominent examples like Brittany Maynard, who has become the “poster girl” of the assisted suicide movement. Here’s what one expert said to the New York Times about the growing social acceptance of suicide:

“It’s a hard idea to test, but it’s possible that a cultural script may be developing among some segments of our population,” said Julie Phillips, a sociologist at Rutgers. Prohibitions are apparently loosening in some quarters, she said. Particularly among younger people, Dr. Phillips said, “We are seeing somewhat more tolerant attitudes toward suicide.” In surveys, younger respondents are more likely than older ones “to believe we have the right to die under certain circumstances, like incurable disease, bankruptcy, or being tired of living,” she said.

In other words, there is a growing culture of suicide, thanks to the same attitudes that lead to the demand for assisted suicide. Any rational person would realize that the current crisis would only be made worse by legalizing assisted suicide.

Our nation’s current response to the threat of suicide is woefully inadequate. Funding for prevention is stagnant and there is a dire shortage of mental health professionals and facilities, particularly for poor people who depend on Medicaid. The addiction crisis, which is largely the result of the mental health crisis, is also not being addressed adequately. It is also likely that suicides are seriously undercounted because many are seen as accidental overdoses.

There is a relentless push by advocates of assisted suicide to push legislation in the states, including in New York. They are facilitated by a compliant media, who regularly publish puff pieces about terminally ill people who kill themselves, and rarely allow opponents of assisted suicide — particularly people with disabilities — to voice their concerns. The medical profession is under particular pressure, as evidenced by the American Medical Association’s consideration of a resolution to go “neutral” about legalization. There is no such thing as neutrality on this issue — if you don’t oppose it, you’re de facto in favor of it.

The tragic suicides of prominent people have been a wake-up call to our nation about the suicide crisis. This is no time to be talking about legalizing suicide for anyone.

Hope and Assisted Suicide

Friday, May 11th, 2018

Yesterday was the Solemnity of the Ascension. That naturally should lead Christians to contemplate the virtue of Hope. The Catechism summarizes the basic principles: “Jesus Christ, the head of the Church, precedes us into the Father’s glorious kingdom so that we, the members of his Body, may live in the hope of one day being with him forever.” (CCC 666) And again, “Hope is the theological virtue by which we desire the kingdom of heaven and eternal life as our happiness, placing our trust in Christ’s promises and relying not on our own strength, but on the help of the grace of the Holy Spirit.” (CCC 1817)

I am particularly struck by the importance of this virtue because of recent experience. Last week, I gave testimony on behalf of the Archdiocese and the Catholic Conference at a hearing held by the Assembly Health Committee in Manhattan. The legislation at issue was the legalization of physician-assisted suicide.

It was a very long hearing. I sat in the hearing room for over eight hours before I testified, and the hearing went on for at least another hour and a half. By the end, almost 50 people testified – the majority in favor of the bill. I had also attended a previous hearing in Albany on the legislation, which lasted about three hours. So I’ve heard a lot of arguments in favor of legalizing assisted suicide.

Most of the witnesses who favored the legislation spoke of their desire to avoid suffering at the end of life, particularly the loss of autonomy, the effects of diminished capacity to perform basic tasks and enjoy favored pleasures, the fear of unbearable pain, and the desire to “end life on my own terms”. The tales of sadness and suffering were very heart-felt, and I deeply respect them for their sincerity.

But what made the stories most sad was that they lacked any sense of hope.

The subtext of their testimony was the bleak meaningless of suffering and even of life itself, the sense of loneliness and abandonment  of so many people with grave illnesses, the illusion that one can control one’s life though an exercise of will, and a utilitarian view of life that equated value with usefulness or function. I remarked to a colleague afterwards that the view of life of so many of the witnesses was flat and  almost two-dimensional – as if this visible life is all that there is. If that’s the case, then it makes a certain kind of sense to favor suicide as an answer to suffering.

In contrast, the testimony by many of those who opposed the bill showed a richer, deeper sense of the inherent dignity of life. The best exemplars of this were the persons with disabilities who gave inspiring accounts of the meaning and value of their lives, despite their daily difficulties. Particularly impressive was the poignant testimony of Kristen Hanson, the widow of J.J. Hanson, who was such a warrior against his own deadly cancer and against the legalization of assisted suicide.

What made these opposition testimonies so powerful, I think, was the virtue of hope. That makes perfect sense. If you believe that there is a higher dimension to life, and particularly if you trust that Jesus is good to his word and that we have a chance for eternal life with God, you will look at sickness, pain and suffering in a different light. You will see it as a transitional stage in our lives, unpleasant to be sure, but part of a long continuum that we all have to travel and that can actually have a happy ending.

Hope rejects the idea that our loved ones are annihilated by death, but instead believes that they have entered into a new and glorious life – and that we hope to join them there. It helps us to see that suffering can have a kind of power, as St. Paul pointed out – “For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities; for when I am weak, then I am strong.” (2 Cor 12:10). It can also lead us to understand that a death infused with hope can be a beautiful experience for those left behind.

The depressing testimonies by the proponents of assisted suicide stand in such bold contrast to the confidence that the virtue of hope offers us. I couldn’t help but think of the strong exhortations by St. Paul in Romans 6 and 1 Corinthians 15 to reject the view that death is the end, and understand the significance of the victory of Christ over death and the joyful hope that it gives us.

The fight against assisted suicide, as with all the other incursions of the Culture of Death, is long and difficult. It can be tiring to battle for so long against so many opponents and with so few allies. But we have one great advantage on our side – the virtue of hope that comes from our faith in the power and glory of God. With that, we can take to heart St. Paul’s advice: “Therefore, my beloved brethren, be steadfast, immovable, always abounding in the work of the Lord, knowing that in the Lord your labor is not in vain.” (1 Cor 15:58)

The Cruelty of Euthanasia

Wednesday, April 18th, 2018

One thing is very clear from the ongoing debate about physician-assisted suicide — the advocates for death are never satisfied and will never give up. The advocates who are pushing for doctor-aided death try to convince people that they’re only interested in helping relieve suffering of people who are close to death with an incurable terminal illness. The reality is that they want to legalize and normalize not just assisted suicide but also euthanasia — a polite name for murder by doctor. Under the guise of “compassion”, they are actually pushing a cruel agenda that stigmatizes and dehumanizes persons with disabilities and that will harm vulnerable people and their families.

This can be seen by the latest initiative from End of Life Choices New York, the leading advocate for legalizing assisted suicide in our state. They have published a document they call the “Advance Directive for Receiving Oral Food And Fluids in Dementia”. The primary stated reason for this document is to enable patients to require their legal representatives and health practitioners to “stop efforts to provide assisted oral  feeding because of an advanced dementia.”

Let’s be clear about this. The document is designed to facilitate and normalize killing patients who do not have a terminal condition, but who are experiencing cognitive decline. It is intended to legally require family members, doctors and other caregivers to obey the directive. The inevitable result – and the explicit intention – is the deliberate killing of patients by dehydration and starvation.

This can be seen by looking at the way the advanced directive works. It is supposed to take effect only if a patient is “in an advanced stage of Alzheimer’s or other incurable, advanced dementing disease” and they are unable to make health care decisions or feed themselves.  This is a dangerous definition. While the directive provides a reference to a recognized test for an Alzheimer’s diagnosis, there is no definition for the term “other incurable, advanced dementing disease”. So who will decide that? What criteria will they use? Will there be any review by another physician? The risk of abuse is massive.

These triggering conditions contain other dangerous elements. The phrase “unable to make informed decisions” is also used without any further specificity as to what standard will be used or who will make that determination. Again, the lack of clarity opens up a real possibility of abuse, for example collusion between self-interested family members and a doctor who is sympathetic to euthanasia or assisted suicide.

Once the directive takes effect, it gets even worse. It offers the patient two alternatives concerning feeding and hydration. Option A is the most radical, and calls for the withholding of all medication and all food and water under all conditions. Even if the patient is clearly willing to accept food and water by hand, this directive would require caregivers to refuse them and then watch their loved one die of dehydration. It’s mandatory murder by neglect.

Option B also calls for the withholding of all medications and assisted food and water. But it also permits feeding by hand only if the patient meets some very ambiguous and subjective standards, like if she “appear[s] receptive and cooperate in eating and drinking by showing signs of enjoyment or positive anticipation”. It requires denial of all food and water “when I no longer seem to enjoy or appear willing to eat or drink”, or “once I no longer willingly open my mouth or I appear indifferent to being fed”, and adds that “I do not wish to be coerced, cajoled or in any way forced to eat or drink.”

There is no indication who is making these assessments, what standard is to be used, whether there is any review or accountability, and whether there is any opportunity for a patient to change their mind. The use of such vague standards (e.g., “showing signs of enjoyment”, “appear indifferent to being fed”, “cajoled”, etc.) leaves the fate of patients at the whim of some unknown person, who will interpret ambiguous signals from the patient and decide whether they will live or die. The vulnerability to abuse is obvious and severe.

Remember, this directive is not dealing with medical treatments for any kind of disease or disorder – it involves food and water, which are basic human needs. Nor is it limited to simple medical interventions like the insertion of a feeding tube. It would require family members and health professionals to stand idly by while an otherwise healthy patient, who is perfectly capable of eating and drinking with assistance, dies from dehydration and starvation.

One of the critical moments in the history of euthanasia advocacy came in 1920, with the publication in Germany of the book Permitting the Destruction of Life Not Worthy of Life. That book, written by a leading lawyer and an influential doctor, rejected the inherent and equal dignity of human life for those with disabilities, and coined the infamous phrase “lives unworthy of living”. The authors said, “It can in no way be doubted that there are living human beings whose death would be a deliverance both for themselves and society, and especially for the state, which would be liberated from a burden that fulfills absolutely no purpose”.

This is what we are coming to, where people with dementia are deemed to be “lives unworthy of living” and who will be killed by their relatives and doctors. It is cruel and barbarous. We must resist this with all our might.

The Case Against Assisted Suicide

Monday, March 26th, 2018

On March 22, I had the honor of participating a symposium at Albany Law School entitled “Reconsidering the Right to Die: The Debate over Assisted Suicide”. This presentation was jointly written by me and my associate Alexis Carra, and it’s more or less what I actually presented at the event. It’s long but I wanted to share it because I think it presents a useful summary of the legal case against assisted suicide and the holding of the Court of Appeals in the Myers v. Schneiderman case. A more detailed version will be published later this year in the Albany Law Review.

If we were at a trial, I would object to the title of this symposium because it assumes a fact not in evidence – namely, that there is a “right to die” that exists and is now under reconsideration. The reality is that there is no such right.

The Supreme Court specifically rejected a “right to die” in its assisted suicide cases ( Glucksberg andVacco) and its case involving declining medical care ( Cruzan). Our own Court of Appeals specifically rejected it in Myers, saying  “Contrary to plaintiffs’ claim, we have never defined one’s right to choose among medical treatments, or to refuse life-saving medical treatments, to include any broader ‘right to die’ or still broader right to obtain assistance from another to end one’s life.” No other state high court has recognized such a right. There is no established “right to die” that needs to be “reconsidered”.

Even if there were such a right, it does not entail a right to have another person assist you in exercising it. In a certain sense, the Myers case was never really about inventing a “right to die.” Instead, any effort to legalize assisted suicide is best understood as being about whether to grant doctors immunity from prosecution if they assist someone in committing suicide.

We have to remember that the precise meaning of words matter. Clear definitions are the indispensable prerequisite for clear reasoning. And we also have to remember that the issue we’re talking about involves two people in the room — the patient and the doctor. The discussion of assisted suicide frequently confuses this fact. But it’s vital to remember that there are two actors in the room, and we have to look at their separate intentions and their separate roles in the line of causality to understand what is really going on. We do this all the time in the law, and we have to do it here as well.

Suicide is Still Really Suicide 

Physician-assisted suicide (“PAS”) advocates rely heavily on an argument that the word “suicide” does not encompass what they define as “medical aid in dying”. Instead of inventing new terminology, we have to look instead at the normal meaning of words.

The standard meaning of “suicide” is to take one’s own life, and the ordinary meaning of “assisted suicide” certainly encompasses physicians who knowingly and intentionally provide patients with lethal doses of medication to end their lives. The relevant section of the New York Penal Law is very clear in defining assisted suicide as when one “intentionally… aids another person to commit suicide.”  There is no definition in that statute because everyone knows what the ordinary meaning of the word “suicide” is. The five judges on the Court of Appeals understood that we are talking about suicide here. The four judges at the Appellate Division First Department unanimously understood that we are talking about suicide here. And the judge at the Supreme Court understood that we are talking about suicide here.

We also have to pay attention to the rules of statutory construction. Whether one uses the theory of original public meaning or legislative intent, it is clear. The drafters of the Penal Law specifically envisioned that the statute would encompass those who gave assistance in “the more sympathetic cases (e.g., suicide pacts, assistance rendered at the request of a person tortured by painful disease, and the like).”

So it’s perfectly clear here. We’re talking about suicide.

Assisted Suicide is Not the Same As Permissible Palliative Care 

One of the central arguments offered by the Plaintiffs before each court was that a procedure they called “terminal sedation” was a lawful form of medical treatment. They defined this term as “the administration of drugs to keep the patient continuously in deep sedation, with food and fluid withheld until death arrives” — in other words, sedating a person so that they may die of starvation or dehydration. They relied on this definition to try argue that if “terminal sedation” is acceptable, then PAS should be.

But this analogy does not work when you pay attention to the two separate actors in the room, and consider the differences in their intent and their role in the line of causality. When you do that, it is clear that there are major differences between palliative sedation and PAS.

The American Medical Association’s Code of Ethics uses the more accurate term “sedation to unconsciousness”, and states that while it may be ethical under certain circumstances, it “must never be used to intentionally cause a patient’s death.” The AMA goes on to say that “Physicians may offer palliative sedation to unconsciousness to address refractory clinical symptoms, not to respond to existential suffering arising from such issues as death anxiety, isolation, or loss of control.”

Thus, the relevant distinction is between (a) sedation to unconsciousness with the intent to cause death and (b) sedation to unconsciousness without the intent to cause death but with an intent to relieve clinical symptoms. The doctor who prescribes sedation without the intent to cause death is acting entirely within medical ethics and the law. The doctor who does so to deliberately cause death is not.

There is also a critical difference in causation. In the case of ethical palliative sedation, it is understood that death will happen due to other causes, such as the underlying illness. The sedation may indirectly contribute to the timing of the patient’s death, but it is not the direct cause of death. In contrast, with palliative sedation with intent to cause death, the patient’s demise is directly and unequivocally caused by the medicine provided by the doctor for that purpose.

The analogy between “terminal sedation” and PAS thus fails, even on its own terms.

Suicide is Not the Same As Declining Medical Treatment 

Although they both may result in death, PAS and declining unwanted medical treatment are not the same and cannot be treated as such. Again, when we look at the two actors in the room, we can see that there are key distinctions in terms of causality and intent. These distinctions have been recognized by the Court of Appeals prior to Myers and were a significant factor in the Supreme Court’s decisions in Glucksberg and Vacco.

In his concurrence in Myers, Judge Garcia explained this clearly in terms of the differences in causation. He wrote that when “a patient refuses life-sustaining treatment and succumbs to illness, the cause of death is the underlying disease.” The doctor is not doing anything to cause the patient’s death, but is rather respecting the patient’s wishes about continued treatment — a respect that the doctor is required under the law to show, lest he be prosecuted for battery. In contrast, when “lethal medication is ingested, the cause of death is not the pre-existing illness, but rather, the prescribed medication.” The commission of assisted suicide and the declining of medical treatment are also distinguished with regards to intent, as discussed previously.

The Constitutional Analysis

To determine whether the current ban on PAS is constitutional, the Court of Appeals evaluated the statute under the rational basis standard. That test gives great weight to the judgment of the legislature, and will invalidate a statute only if it bears no rational relationship to a legitimate government purpose. As the Court of Appeals found, the current ban on PAS easily passes the rational basis test.

In the per curiam opinion, the Court summarized many policy reasons underlying the current ban on PAS. These include “prohibiting intentional killing and preserving life; preventing suicide; maintaining physicians’ role as their patients’ healers; protecting vulnerable people from indifference, prejudice, and psychological and financial pressure to end their lives; and avoiding a possible slide towards euthanasia.” The Court concluded that “the Legislature of this State has permissibly concluded that an absolute ban on assisted suicide is the most reliable, effective, and administrable means of protecting against its dangers.”

Because those policy reasons and the dangers are so important, I want to spend a few minutes discussing several of them.

The PAS Ban Supports Current Efforts to Prevent Suicides 

Suicide is a serious public health concern. It is it is the second leading non-disease cause of death for whites and for all those ages 10 and above; it kills as many people as homicides and motor vehicle accidents combined; and the number of deaths from suicide has increased over 26% over the previous decade. In response, clear messages to discourage suicide are ubiquitous in New York, such as billboards, signs on bridges, and posters on mass transit urging people who are contemplating suicide that “life is worth living.” Legalization of PAS, even for a small class of persons, would contradict and undermine efforts to prevent suicide.

Legalization, and the inevitable publicity surrounding cases of PAS, would also likely lead to an increase in suicides in general. Studies have shown that when assisted suicide is legalized, overall suicide rates are higher than in the general population. In Oregon, for example, the overall suicide rate is 42% higher than the national average. The phenomena of “suicide contagion” and “suicide clusters”, in which one suicide leads to others within a social group, is well recognized as a substantial danger. Even popular culture is aware of it, for example in the increase in suicides after a prominent suicide of a celebrity. The current ban on assisted suicide is thus a way to prevent an increased suicide rate, which would be undermined by legalizing PAS.

PAS Cannot Be Limited 

Judge Fahey grounded his concurrence on the fact that a right to PAS would inevitably expand beyond the terminally ill who face imminent death to those who experience what they consider “unbearable suffering”. In countries where it has been legalized, PAS has extended to those who simply feel old, isolated, or experience various forms of psychiatric suffering. Belgium and the Netherlands have even gone so far as allowing involuntary euthanasia — killing people who did not even ask for death, including children. Oregon regularly reports that the great majority of people who request deadly medicine are not doing so because of imminent death or intractable pain, but rather “the three most frequently reported end-of-life concerns were decreasing ability to participate in activities that made life enjoyable (88.1%), loss of autonomy (87.4%), and loss of dignity (67.1%).”

There is also no limiting principle that will contain PAS. I believe we have to show respect to the advocates for PAS and listen to what they are saying. Advocates for PAS have openly and repeatedly stated that their ultimate goal is to permit assisted suicide for anyone who desires it, regardless of their medical condition, and they have also expressed support for removing any legal restrictions on PAS such as age restrictions, the requirement of a terminal illness, and so on.

Kathryn Tucker, who co-wrote the Plaintiff’s brief in the Court of Appeals herself wrote an article a few years ago in an online journal that rejected any legislative protections (which she called “burdens and restrictions”) and argued that the medical community should be allowed to self-regulate. Prof. Thaddeus Mason Pope, a law professor from Minnesota wrote for an online journal for oncologists an article entitled “Medical Aid in Dying: When Legal Safeguards Become Burdensome Obstacles”. The professor advocated expanding PAS to “mature minors”, to those who lack contemporaneous decision-making capacity, from a requirement of terminal illness to those whose death is ‘reasonably predictable’, and from the patient self-ingesting to having a physician administer the deadly drugs.

That would essentially eliminate all protections and take us from assisted suicide to euthanasia. We have already seen this same trend to erode procedural and substantive protections in Europe, Canada, and other states, and there is no reason to expect it will be any different here in New York.

The PAS Ban Upholds the State’s Duty to Protect Vulnerable People

This debate about limiting principles is particularly important, given the state interest in protecting vulnerable persons. Studies consistently show that disparities exist in access to and quality of healthcare across demographic categories, particularly race, sex, socioeconomic status, and geographic location. These inequities are exacerbated by the economic pressures of the current medical system, where cost containment is a priority. In this environment, pressure will inevitably be felt by low-income patients to choose suicide rather than putting an economic burden on their families. In his concurrence, Judge Fahey pointed “to a particular risk of non-voluntary euthanasia when a patient’s socioeconomic disadvantages, uninsured status, and/or dementia or mental incompetence make it impossible for the patient to advocate vigorously for his or her health care.”

Likewise, the risks presented by assisted suicide present a special danger for the elderly, people with mental illness, and disabled people. The widespread and under-reported problem of elder abuse highlights the risk of undue influence in end-of-life decisions. People with mental illness are also at a higher risk. A large number of people who request assisted suicide are suffering from treatable depression. Indeed, legalized assisted suicide in the Netherlands has “already descended to the level of condoning the suicide or killing of people whose primary suffering is not physical pain, but chronic depression.” And it is clear that depressed people who request suicide drugs are not likely to be treated for depression. In Oregon, only 3.5% of those who request the drugs are referred for psychiatric evaluation — and that evaluation is only to determine decision-making capacity, not to screen and treat for mental illness.

People with disabilities are especially vulnerable, which is why disabilities rights groups are particularly strong in their opposition to PAS. Again, Judge Fahey pointed out that legalization would “convey a societal value judgment” that indignities such as “physical vulnerability and dependence mean that life no longer has any intrinsic value.” That is precisely the message that is being received, since the vast majority of requests for lethal drugs in Oregon are due to concerns about losing life functions — essentially, a fear of becoming disabled.

Conclusion

The Court’s per curiam opinion in Myers was brief and unequivocal, and was strengthened by two very strong concurrences. Together with the lower courts, every New York judge who considered Plaintiffs’ arguments rejected them. That is not just a New York phenomenon — in the twenty years since Glucksberg and Vacco, every other state’s highest court that has been asked to has refused to recognize PAS as a constitutional right.

The decision in Myers was a decisive defeat for PAS as a constitutional issue. The Court of Appeals wisely held that the debate over assisted suicide belongs in the legislative arena based on policy arguments, and that debate should not be terminated by the courts.

No Limits to Assisted Suicide

Friday, March 2nd, 2018

This is how the public debate over assisted suicide goes. Those who support it will often express concern about ensuring patient safety and claim that the safeguards in their proposed bills and existing laws protect vulnerable patients. We respond that these protections are insufficient and that the goal of the assisted suicide movement it to expand eligibility beyond the terminally ill. When we do that, we are typically accused of alarmism, fear-mongering, and resorting to an invalid “slippery slope” fallacy.

Here’s the thing. Everything we say is absolutely true, and the advocates know it. Not only that, they confirm it by specifically advocating for reduced safeguards and expanding assisted suicide. I noted this last year by citing an article by Kathryn Tucker, a leading assisted suicide proponent, who was advocating the elimination of all safeguards — which she called “barriers”.

Now we have another example, this time from a prominent law professor, Thaddeus Mason Pope from Minnesota. He recently wrote an article for an online journal for oncologists, entitled “Medical Aid in Dying: When Legal Safeguards Become Burdensome Obstacles”. The title alone is enough to tell you the awful agenda, but the substance of the article is even worse, especially since an oncologist is often the primary physician for cancer patients.

Prof. Pope noted that the current laws in the six states that have legalized assisted suicide focus on four qualifications for eligibility: the patient is (1) an adult (2) with decision-making capacity (3) who has a terminal diagnosis and (4) is a resident of the state. The laws also involve procedural rules, a requirement that the patient takes the deadly pills herself, and some kind of referral for psychiatric evaluation. All that is true, although in New York, the propsed bill does not require residency, which would make New York a mecca for suicide.

But instead of viewing those provisions as essential protections for vulnerable patients, Prof. Pope claims that “These safeguards may be more restrictive than necessary, and in at least one important respect they may not be demanding enough.” Here is what he proposes:

Expanding From Adults to Mature Minors — He considers limiting assisted suicide to adults to be “unduly restrictive.” Study after study confirms that teenagers are not developed enough to make important decisions, and that adolescence continues well into one’s twenties. Does anyone really believe that teenagers are capable of making life-and-death decisions at an age when they cannot legally drive, enter into a contract, or vote?

Expanding From Contemporaneous Capacity to Advance Directives — This means that the patient no longer has to have decision-making capacity at the time of their suicide, but rather that the request can have been made years earlier. This would mean that patients with dementia or Alzheimer’s would be given suicide drugs to swallow at a time when they have no idea what is going on. This is no longer “suicide” in any meaningful sense — it would be euthanasia, or, to call it by its real name, murder.

Expanding From Terminal Illness to ‘Reasonably Predictable’ — The definitions in assisted suicide laws are already dangerously vague. New York’s bill would designate a person as “qualified” if they have a “terminal condition” that would lead to death in six months. To expand the definition to those whose death is merely “reasonably predictable” could mean that a person with many chronic conditions could qualify himself for assisted suicide by declining further treatments — which officials in Oregon recently confirmed when asked about that scenario. Prof. Pope clearly envisioned that precise situation, saying “this rigid time frame [the six-month requirement] excludes patients with grievous and irremediable conditions that cause suffering intolerable to the individual.” This is precisely the road that Belgium and Holland have gone down — permitting assisted suicide for those who are not going to die imminently, but who no longer wish to live because of their suffering.

Expanding From Self-Ingestion to Physician Administration — This is the final frontier. He is no longer speaking about “suicide”. This is direct advocacy for euthanasia — murder by doctor. The situation in Canada, where doctors are already euthanising patients, is cited favorably. But, unsurprisingly, he does not cite the case of Belgium and Holland, where some patients are euthanised without any request but because the family asks for it or the doctor deems the patient’s life no longer worth living.

Strengthening Mental Health Assessments — This is the only apparently positive recommendation on offer. But note the professor doesn’t advocate for a mandatory referral of the patient for assessment and treatment of a mental health problem, like depression. Rather, it would leave the referral purely within the discretion of the doctor — which is done in only about 3% of the cases in Oregon.

Note the use of terms — always “expanding”. Articles like this confirm the dangers of legalizing assisted suicide. Advocates are not interested in limits, they view them as obstacles or barriers, and will always immediately push for expansion. We cannot afford to give this movement an inch of space. The results will be much more deadly than advertised.

A Great Victory for Life

Thursday, September 7th, 2017

The New York State Court of Appeals has unanimously upheld our state ban on assisted suicide. The decision is a tremendous victory for life, and will strengthen our efforts to hold off legislation that seeks to legalize assisted suicide.

The lawsuit involved was filed by persons who had terminal illnesses and several doctors. They argued that they had a fundamental right under our state constitution to what they euphemistically call “aid-in-dying”. They also argued that it violated equal protection to allow patients to decline life-sustaining treatment but deny assistance to others who wish to commit suicide. Their arguments were supported by many organizations that filed amicus curiae briefs, including groups of doctors and law professors, as well as the New York Civil Liberties Union.

The Attorney General of New York opposed the lawsuit very ably. The New York State Catholic Conference filed amicus curiae briefs in opposition, written by myself and my colleague Alexis Carra. Several other amicus briefs were filed on our side, by Catholic and Christian doctors, our allies in Not Dead Yet (a leading disability rights group), and Agudath Israel.

The case was very well argued on both sides, both at oral arguments and in the briefs. The lower courts all rejected the plaintiff’s arguments in opinions that were very thoughtful and well done. But in the end, it was all up to the Court of Appeals, the highest court in our state and the final authority on our New York State Constitution.

Thanks be to God, the Court categorically rejected all of the plaintiffs’ arguments. With strong opinions — the unanimous opinion of all five judges and several concurrences — the Court firmly rejected the absurd notion that “aid-in-dying” was somehow excluded from the current definition of suicide. They also followed the United States Supreme Court’s holding in the 1995 Quill v. Vacco case that neither the Due Process Clause nor the Equal Protection Clause supported the creation of a fundamental right to assisted suicide.

Most significantly, the Court strongly upheld the strong and unequivocal state interest in prohibiting assisted suicide. The various opinions cited major concerns that were raised by our side, including the risk of expanding assisted suicide to voluntary or even involuntary euthanasia, the stigmatization of disabled persons, the degradation of the medical profession, the need to protect vulnerable populations, and the risk of abuse and misuse of medications. These opinions will be of great assistance to us in opposing further efforts to legalize assisted suicide in the Legislature.

It’s easy sometimes for pro-lifers to get discouraged, especially in a state like New York where the deck seems stacked against us. Victories are few and far between, and defeats are all too common. This lawsuit was the most significant battle that we have had in the pro-life cause in New York in the last twenty-plus years.

God has been good to his people of New York by granting us a victory in this case. We can legitimately say, with Psalm 98, “O sing to the LORD a new song, for he has done marvelous things! His right hand and his holy arm have gotten him victory!”

Dangerous Signs of the Times

Thursday, August 3rd, 2017

We have been fighting against the legalization of assisted suicide for years, and we have been constantly warning about where that would lead — to direct and involuntary euthanasia of vulnerable people. We have been consistently accused of lying, scare-mongering, and exaggerating. But in the past few weeks, we have seen increasingly dangerous signs of the times that have confirmed all of our fears and warnings about the dangers of opening the door to euthanasia.

The first sign was the terrible tragedy of the Charlie Gard case. Charlie was an infant in the United Kingdom who had a very grave genetic disorder that was growing progressively worse. He was hospitalized and he was breathing with the assistance of a ventilator. His parents wished to take him out of the hospital and bring him to other hospitals for an experimental treatment that other medical teams thought had a chance of reversing the course of Charlie’s condition. Astonishingly, the doctors and the hospital resisted that request, and the case went to court. Equally astonishingly, the UK courts ruled that Charlie’s parents could not transfer him to another hospital, nor were they even allowed to bring him home for his last days. He died in the hospital after doctors removed the ventilator, against the parents’ wishes.

Prof. Charles Camosy, a theologian who specializes in medical ethics, has written a penetrating analysis of the case, and some of what he said is worth quoting directly (although you should read the whole thing). Commenting about the court’s decision, he noted that:

Implicit in this judgment is the view that the harm that would have been done to Charlie by his parents was so obvious and of such magnitude that the decision had to be taken out of their hands… Those who held power over Charlie decided that his life was not worth living. They reached this judgment on the basis of his expected mental disability. They denied him treatment, and ordered his ventilator removed, not because of the burden of the treatment, but because of the burden of his life. In a cruel act proposed by doctors, approved by courts, cheered by the press, and blessed by certain high clerics, Charlie Gard was euthanized. It was euthanasia by omission, but it was euthanasia all the same.”

This is chilling indeed, and it is a frightening sign of where medicine is heading. Similar judgments about “quality of life” and “medical futility” are being made in secret all the time by doctors against the desires of patients and even without their knowledge. The result is an unknown number of cases of passive euthanasia – death caused by omitting treatments that would extend life. Legalizing assisted suicide would bring these decisions out of the shadows, and would inevitably increase the number of cases like Charlie Gard’s.

This is not fear-mongering, it’s current events. All we have to do is look at studies of the Netherlands that have recently come out. One study came out in May from the Dutch Regional Euthanasia Commission, the government agency responsible for oversight. The other study was published in the prestigious New England Journal of Medicine just last week.

The NEJM study found some alarming things. Doctors report that 4.5% of deaths in that nation are due to euthanasia. That is a staggering number. If it were in the United States, it would represent almost 120,000 deaths per year and would be the sixth leading cause of death – more than Alzheimer’s, diabetes, suicide, murder or drug overdoses.

Even  more alarming is what was found in the official Dutch study. They reported that euthanasia cases aren’t limited to the superficially sympathetic cases of people with terminal diseases. Instead, there was an increasing number of psychiatric and dementia patients who were being euthanized– 141 in 2016 compared to only 12 in 2009 – and that 431 people had been euthanized without their explicit consent. This is so shocking that one of the leading euthanasia supporters accused the Euthanasia Commission of concealing that “incapacitated people were surreptitiously killed,” and even went so far as to say that “executions” were taking place.

None of this should really be a surprise. As Cardinal Willem Eijk of Utrecht commented, “When one breaks the principle that human life is an essential value, one steps on the slippery slope. Dutch experiences teach that we will be confronted time and again with the question whether the ending of life shouldn’t also be possible with less serious forms of suffering.” The principal author of the NEJM study also saw what was going on: “When assisted dying is becoming the more normal option at the end of life, there is a risk people will feel more inclined to ask for it.”

We cannot afford to ignore what is happening around the world, and we must stop it from happening here. We are talking about the most vulnerable lives – handicapped children, old people with chronic problems, mentally ill people. Health care professionals are already being confronted with the question of whether their lives are worth living. If we allow assisted suicide, it is certain that doctors will become accustomed to doing it and will start recommending it, the secret euthanasia that is already happening will become more mainstream and open, and more people will start asking for it.

Prof. Camosy makes a crucial point that we have to focus our attention on:  “Nothing moral follows from medical facts. Judgments about whether or not treatment is worth pursuing will have to be made. And physicians, even with perfect medical knowledge, are not the best persons to make them.” I would add, neither are the government or insurance companies.

These decisions must be made by families and patients, and we in the Church need to do much more to make sure that they are informed by the truths of Church teaching about the sanctity and dignity of every human life, regardless of condition or capability.

Life in the Balance

Wednesday, May 31st, 2017

On May 30, the New York State Court of Appeals heard oral arguments in the case of Myers v. Schneiderman, which is seeking to legalize assisted suicide in New York. The case was previously rejected unanimously by the trial court and the Appellate Division. Our pro-life coalition, along with disabilities-rights groups, have been opposing this effort, and the Catholic Conference filed an amicus brief in both the lower court and at the Court of Appeals.

It was a lively oral argument. The Judges were definitely engaged in the issues and asked tough questions of both sides. We were very fortunate that the Deputy Solicitor General did an excellent job representing our side. The essence of her argument was that the lower courts correctly dismissed the case because the Legislature has already enacted a “bright line prohibition” against assisted suicide and the Court should leave it to the Legislature to make any changes in that rule. One of the Judges affirmed that, noting that no other state (with the ambiguous exception of Montana) had legalized assisted suicide by court decision, but instead had enacted extensive legislation.

The Judges showed little interest in defining a broad constitutional right to assisted suicide or in sending the case back down to the trial court for a fact-finding hearing. Several Judges also stated that they had read a brief submitted by a disabilities-rights organization which stressed that legalizing assisted suicide sends a message that their lives are less worthy of respect. And one judge clearly recognized that once you permit assisted suicide for some patients, it is difficult to deny it to others.

On the whole, though, I’m still pessimistic. There was no reason for the Court to take this case, except to reverse the lower courts. One Judge pressed the Solicitor General repeatedly over the state’s interest in protecting life at the last extremity, when it already allows patients to be sedated into a state of unconsciousness and to then die of starvation or dehydration. This suggested strongly that the Judge was trying to figure out a way to define a statutory right to assisted suicide in a way that has a reasonably-definable limit. But that’s a bad thing for them to be even considering — again, whether or not to draw lines, and where you put them, is for the Legislature to decide, not the courts.

None of the judges pressed the plaintiff’s attorney to explain why the lower court judges were unanimously wrong or why the right to decline medical treatment includes having a third party (i.e., the doctor) give them a drug that will directly kill them. They also did not seem to grasp the fundamental difference between declining treatment and committing suicide — the crucial difference is in the intention and causation between those acts. Other state interests, such as the preservation of the integrity of the medical profession and the potential negative effect on other anti-suicide activities, were not addressed in the arguments (although they were extensively discussed in the briefs, including ours).

It is so hard to read oral arguments, especially when one judge said nothing and another very little. A decision is expected in June. I fear that the most likely result is that the Court will create some kind of statutory right to assisted suicide for patients who are at the very end of life and would otherwise be eligible for palliative/terminal sedation, and then either leave it to the Legislature to enact procedural protections (or, even worse, leave it to doctors to self-regulate). Of course, there’s no way to hold that limit, or to trust the Legislature to do it right, and we’ll inevitably slide right down the slippery slope to euthanasia along with Canada, Belgium and Holland. The Culture of Death has quite a grip on New York already, and things will only get worse.

One last point. It’s easy to be cynical about the law and about judges. I certainly am. The law is an extension of politics, it serves the powerful better than the weak, and it is easily manipulated for special interests. Judges often consider themselves to be our Black-Robed Platonic Guardian Rulers and arrogate to themselves authority that should belong to the people.

But to sit in that magnificent courtroom, listening to a very high level of legal argumentation on such a momentous issue, with the portraits of so many Judges looking down at us, with the portrait of the Founding Father John Jay in the center facing the bronze statute of Chancellor Robert Livingston and Judge Benjamin Cardozo looking on from the side, is an extraordinary reminder of something very important. The law and the judicial system, for all their faults, demonstrate the remarkable human capacity for reason and self-government. The administration of law is awe-inspiring and fearsome, and there’s still quite a bit of nobility in it. Whichever way the Court rules, we should not forget that.

The Awful Truth of Assisted Suicide Advocacy

Wednesday, January 11th, 2017

When they speak to the general public or to legislators, advocates for assisted suicide routinely express concern about ensuring patient safety, and point to the allegedly rigorous safeguards that they have written into their proposed bills. We have long countered that these safeguards are mere shams, and provide no real protection for vulnerable patients.

Now, thanks to an article at an obscure legal blog, we know what the assisted suicide advocates really think. They want no safeguards at all. They believe that any patient protections written into law are harmful and unnecessary. They want assisted suicide to be a normal part of medical practice and for doctors alone to set the standards.

In other words, they’ve been deceiving us all along about what they really want.

The truth was revealed in a recent article by Kathryn Tucker, who is the Executive Director of the “End of Life Liberty Project”. She is a leading advocate for assisted suicide, and is one of the attorneys who is suing New York State to have assisted suicide legalized. She was commenting on the recent District of Columbia law that legalized assisted suicide — a bill that her fellow advocates drafted and which is similar to all the bills that have been introduced around the country, including the one her own organization has endorsed in New York.

But despite the lip service that they pay to patient protection, the reality is that she has no use for  safeguards that are designed to protect patients from abuse and manipulation. Instead she calls them “burdens and restrictions”, and adds:

While in some ways these enactments are a step toward expanding end of life liberty, they impose heavy governmental intrusion into the practice of medicine, which is concerning because it creates barriers to patient access and to physician participation.

“Barriers” to more death, in other words.

She then went on to object to such common-sense protections as:

  • Requiring the patient to make multiple requests, including at least one in writing, which is designed to ensure that the patient isn’t acting rashly.
  • Requiring that the request be witnessed, which would ensure that the request is being made by a competent person who is not under coercion.
  • Obtaining a second opinion, which is intended to protect the patient from a mis-diagnosis
  • Referring the patient to a mental health specialist to ensure that they are competent to make medical decisions.
  • Mandating a fifteen-day waiting period, again to ensure that the decision isn’t being made rashly.
  • Requiring that doctors collect and report data about the case, which would allow public health authorities and law enforcement to oversee what is happening and take action if there are abuses.

Now, to be clear, we consider all of these supposed safeguards to be inadequate to protect vulnerable patients. They leave too many loopholes, such as the failure to insist on a psychological screening for depression. And most alarming, they don’t provide any protection whatsoever after the medicine has been dispensed and the patient leaves the hospital. These problems can’t be fixed, and that alone is a reason to oppose legalization.

But now we know what assisted suicide activists are really after. They want more patients to have “access” to suicide, so that more people can kill themselves. And they want more doctors who are willing to participate in the killing. They don’t want to give patients even the minimal protections that go along with the execution of simple legal documents like wills, health care proxies or powers of attorney. They want doctors like Dr. Kevorkian to make up their own rules. And they don’t want anyone to be able to oversee what’s happening and hold people accountable.

The awful truth is that their agenda is death, and more of it. They want to push us down the slippery slope. They must be stopped.

The Danger Signs on Suicide are Clear

Saturday, April 23rd, 2016

It is hard not to have sympathy for those who are advocating for the legalization of assisted suicide as a way of alleviating suffering. Suffering is a terrible reality of human life, an experience of evil that cannot be avoided. Without a Christian understanding of the meaning of suffering (see St. John Paul’s magnificent letter Salvifici Doloris), it is a fearsome thing to face.

But even a non-believer should be able to discern the clear danger signs about the inevitable effects of legalizing any form of suicide, and step away from that precipice.

The experience of European countries that have legalized assisted suicide are test cases. We can see the way that the practice spread from the terminally ill, to those with chronic illnesses, to those with psychiatric or developmental problems, to minors, and utimately to people who were put to death even though they never requested it. It is abundantly clear that there are no limiting principles that can stop the spread of assisted suicide, and its progress to outright euthanasia.

The danger signs can also be seen in the most recent statistics released by the Centers for Disease Control on the incidence of suicide in the United States.

The situation is truly alarming — suicide has increased dramatically over the last two decades. Here are some of the lowlights of the report:

  • From 1999 through 2014, the suicide rate increased 24%, with the pace of increase accellerating after 2006.
  • Suicide rates increased from 1999 through 2014 for both males and females and for all ages 10–74.
  • In 2014, the rate for males was more than three times that for females, but the percent increase was greater for females (45% increase) than males (16% increase).
  • Although there were few suicides compared with other age groups, the suicide rate for females aged 10–14 tripled.
  • In both 1999 and 2014, suicide rates were highest among men aged 75 and over. Men aged 45–64 had the second-highest suicide rate for males in 2014 and the largest percent increase (43%) in rates.
  • Suicide is increasing against the backdrop of generally declining mortality, and is currently one of the 10 leading causes of death overall and within each age group 10–64.

With this information, how can it possibly make sense to legalize assisted suicide, which sends a clear, strong message that some lives are not worth living, and that death is the solution? Shouldn’t we instead redouble our efforts to convince people to reject suicide?

Advocates for assisted suicide insist that society defer absolutely to their autonomy, based on a notion that people have absolute liberty to do whatever they like. Yet our society has never done so. As Justice Oliver Wendell Holmes said in his famous dissent in the Lochner case, “The liberty of the citizen to do as he likes so long as he does not interfere with the liberty of others to do the same, which has been a shibboleth for some well known writers, is interfered with by school laws, by the Post Office, by every state or municipal institution which takes his money for purposes thought desirable, whether he likes it or not.” The idea that people have complete autonomy is both incoherent and an invitation to anarchy.

Again, the suffering of individuals is compelling and naturally rouses sympathy. We must do everything we can to alleviate the physical, psychological, social, emotional and spiritual suffering of all our brethren.

But the particular desires of individuals cannot be the basis of making law for our entire society. St. Thomas Aquinas defined law as “an ordinance of reason for the common good”. The good of all of society must be the controlling concern when we make law, not the idiosyncratic interests of some people or groups.

The danger signs of relaxing our immemorial ban on suicide are very, very clear that it would lead to many more unnecessary and tragic deaths. We must continue to resist any effort to legalize any form of suicide, for the good of all of society.