by Richard M. Doerflinger
February 19, 1999
Opponents of legalized euthanasia have always warned that a "right to die" can easily become a duty to die. Begun in the name of individual freedom, a campaign viewing death as a solution to the problems of the sick and elderly will devalue their lives, and put pressure on them to acquiesce in their own premature deaths.
In quick succession, several events have underscored how steep that slippery slope is.
First was the publication this past fall of Derek Humphry's new book, Freedom to Die: People, Politics and the Right-to-Die Movement (St. Martin's Press 1998). Humphry, the founder of the Hemlock Society, has always declared assisted suicide to be "the ultimate civil liberty." In this book, though, he sings a different tune. In a chapter called "The Unspoken Argument," he says something that many of his allies believe but do not like to say aloud: Assisted suicide will be legalized in our nation chiefly as a method of "cost containment."
Describing senior citizens as "greedy geezers" eating up the nation's health care dollars, Humphry proposes some frightening solutions: Medicare and private health plans may soon force patients to sign "living wills" refusing aggressive treatment as a condition for receiving coverage; doctors and hospitals will be empowered to refuse patients' and families' requests for life-sustaining care if they judge their preference for life to be "unreasonable"; and elders should be helped to see assisted suicide as "the morally correct thing to do" to avoid burdens on family and society. He likens this to an old Eskimo practice of abandoning the elderly on ice floes to die once they are "no longer productive."
Humphry has nothing but praise for the Oregon Health Plan, which rations care for the poor. The Plan denies access to life-preserving treatments the State sees as less "cost-effective," but has begun providing full funding for assisted suicide. Lethal drugs are, after all, very cheap and very effective.
Now other fans of the Oregon system have begun pressing for federal legislation. Their current focus is a bill with the disarming name of "Advanced Planning and Compassionate Care Act of 1999." While the "compassionate care" part of the bill may help improve care of the dying, the "advanced planning" section bears a closer look.
This section builds on a federal "Patient Self-Determination Act" passed by Congress in 1990 over the protests of the Catholic bishops' conference and others. It requires all hospitals and nursing homes, as a condition for receiving federal funds, to counsel all patients upon admission about their right to request or refuse treatment and to sign documents such as "living wills."
This was never as good an idea as it sounded like to some legislators. It meant that the federal government would equally promote all kinds of documents to patients, whether carefully written or not. When Oregon legalized assisted suicide in 1997, Congress had to go back and amend the law so at least it would not require Catholic and other hospitals in Oregon to tell all patients where to get lethal overdoses!
But the new proposed law is much worse. It would require all states to honor living wills from other states, even if they are far more broadly written than anything allowed in the state where treatment decisions must be made. The more irresponsible a document is -- the more it ignores distinctions between terminal and curable illnesses, between ordinary and extraordinary means, between allowing a natural death and hastening death by neglect -- the more legal power it will have nationwide.
A third event, from the state of Florida, provides an example of what this might mean in practice. Despite objections from the state Catholic conference and others concerned about patients' safety, the Florida legislature is considering a bill that would drop all references to terminal and incurable illness in the state's living will law. With passage of this law, a Florida resident who signs one vague document -- thinking, perhaps, that it only refuses extraordinary life support in harrowing medical situations -- could actually be authorizing doctors to hasten death by medical neglect at any time he or she becomes unable to make medical decisions. With passage of the new federal bill, that dangerous policy could be exported to every other state in the nation.
What reason would government have to promote such open-ended documents, refusing even effective life-saving treatments? One answer can be found in Mr. Humphry's book. Once one sees sick and elderly people as an economic burden, the sick and elderly who may live a long time with continued care appear to be the greatest burdens. After all, they will require more care than those who will inevitably die soon.
We are a long way from the slogans about individual freedom that the euthanasia movement has so often used to gain support. Increasingly, it seems the "right to die" boils down to healthy people's "right" to abandon the sick and helpless.
(Mr. Doerflinger is Associate Director for Policy Development at the Secretariat for Pro-Life Activities, National Conference of Catholic Bishops.)