NCCB Secretariat for Pro-Life Activities
"This is really not happening very often," says survey co-author Dr. Diane Meier of New York's Mount Sinai School of Medicine. "That's the most important finding. It's a rare event" [Associated Press, 4/23/98].
The survey was based on a questionnaire sent in 1996 to 3,102 physicians under the age of 65; 1,902 doctors responded anonymously. In all, 11% of respondents said they had ever received a request for a lethal injection (euthanasia) and 18% said they had been asked for a prescription for an overdose of pills to end life (assisted suicide). Five percent said they had ever given such an injection, while 3 % had written a lethal prescription; since some doctors had done both, the cumulative total of doctors who had ever helped deliberately end a patient's life was 6%. While most of those who engaged in such behavior had done so only once or twice, one doctor claimed to have written 25 prescriptions and given 150 lethal injections.
While responses were confidential and untraceable, the authors note that the survey may underreport these practices. On the other hand, the surveys were deliberately sent to doctors in ten specialties identified in previous surveys as "those in which physicians are likely to receive requests from patients for assistance in hastening death" [New England J. of Medicine, 4/23/98, p. 1193]. Thus the survey may overestimate the percentage of all U.S. physicians who have assisted suicides or performed euthanasia. The survey found that these practices are most common on the West coast, where one state, Oregon, voted to legalize assisted suicide in 1994 [see other details, p. 4].
Earlier surveys, usually confined to a particular state or region, had produced higher estimates for the frequency of assisted suicide or euthanasia [e.g., "1 in 5 Doctors Say They Assisted a Patient's Death, Survey Finds," Boston Globe, 2/28/92]. The new survey differed from these in having its questions tested beforehand with focus groups of physicians, to minimize confusion between these practices and medical actions which may indirectly or unintentionally hasten death.
Noting that 36% of doctors in the survey said they might assist suicides if the practice were legal, the Hemlock Society declared that the results support its position favoring legalization. "The survey demonstrates that compassionate doctors want to help their patients but hesitate to do so under threat of legal and professional sanctions," said Hemlock executive director Faye Girsh [News release, 4/23]. In fact Hemlock and other supporters of assisted suicide have generally claimed just the opposite: That legalization would not significantly increase the total number of assisted suicides, but simply bring a covert practice out into the open where it could be limited and regulated. The survey results contradict that claim.
Simultaneously with the publication of the survey results, co-author Dr. Diane Meier published an opinion piece in the New York Times explaining her own change of heart on the assisted suicide issue. She says that she once favored legalization, but "after caring for many patients myself, I now think that the risks of assisted suicide outweigh the benefits." Proposed safeguards in laws like Oregon's, she argues, are "unrealistic and largely irrelevant to the reality faced by the dying" -- for example, ensuring that a patient's choice is not coerced is "an impossible task." She adds that "legalizing assisted suicide would become a cheap and easy way to avoid the costly and time-intensive care needed by the terminally ill" [Diane Meier, "A Change of Heart on Assisted Suicide," The New York Times, 4/24].
In April Jack Kevorkian delivered more dead bodies to Detroit-area hospitals -- but found that some hospitals may no longer cooperate.
On April 2, Kevorkian regained possession of equipment seized by Southfield police February 26 after the death of Roosevelt Dawson [see March Life at Risk]. Included was a "suicide machine" made using an Erector set. A judge had said it must be returned unless Kevorkian is charged with a crime; prosecutor David Gorcyca says he won't charge Kevorkian until a clear law on assisted suicide is in place [Detroit Free Press, 4/2/98].
On April 9, Kevorkian brought the body of Shala Semonie of Phoenix, 47, to Huron Valley-Sinai Hospital in Commerce Township. Semonie, who had Lou Gehrig's disease, died from an intravenous injection. In accord with a policy developed after Kevorkian brought a body to the hospital March 5, hospital officials refused to take the body. They said this would take time away from patients, and "tamper with a crime scene"; the body was later picked up by police. Local medical examiner L.J. Dragovic praised the officials' stand, saying "they're not in the business of collecting dead bodies." Other hospitals have called asking for details of the policy [Detroit News, 4/10].
Nevertheless, on April 13 Kevorkian delivered the body of a 64-year-old Missouri woman with Lou Gehrig's disease to POH Medical Center. On April 16 he delivered two bodies to William Beaumont Hospital: a 73-year-old California woman with chronic arthritis and asthma, and an 89-year-old Florida man with prostate cancer. The same day, Kevorkian's attorney Geoffrey Fieger declared his candidacy for the Democratic nomination for governor of Michigan [Detroit Free Press, 4/17]. On April 24 Kevorkian brought another woman's body to a Rochester Hills hospital [Detroit News, 4/25].
U.S. Surgeon General Targets Suicide
As U.S. attorney general Janet Reno ponders whether assisting suicide can be a "legitimate medical purpose" for use of federally regulated drugs [see March Life at Risk, p. 4], another federal official is taking a clearer stand.
U.S. surgeon general David Satcher said April 16 that suicide prevention should be a health priority for the United States. He said he has commissioned a government report on suicide and suicide prevention efforts, to help "shape a different future" for the U.S. on this problem. "Many experts think hopelessness is common to suicide and homicide and violence in general," Dr. Satcher said [CNN and Washington Times, 4/17].
The U.S. Centers for Disease Control report that between 1980 and 1995, suicidal behavior among all youths increased; it increased more rapidly among black youths, so that by 1995 "high school-aged blacks were as likely as whites to attempt suicide." Previous reports found suicide to be less common among black youths [Morbidity and Mortality Weekly Report, 3/20/98, p. 193].
Newborn Euthanasia Institutionalized by Dutch
In the Spring 1998 Issues in Law & Medicine, Dutch ethicist Henk Jochemsen recounts how the 1994 Dutch law regulating euthanasia is now used to permit nonvoluntary euthanasia for newborn children. In two 1995 court cases, he says, doctors were found blameless in killing handicapped infants because they faced a "conflict of duties" between supporting life and ending suffering -- although there could be no voluntary consent from the patient. Jochemsen says the courts' reasoning invalidly equates euthanasia with discontinuing life support and providing pain relief, and is "capable of further extension to other classes of vulnerable, incompetent patients."
In the March 1998 Pediatrics, Agnes van der Heide and other Dutch physicians try to show that valid consent is obtained in such cases. Their interviews with Dutch pediatricians show that, at least according to the pediatricians themselves, newborn euthanasia decisions "were usually made after discussing it with parents and did not occur while parents were known to disagree" (emphasis added).
"Now that the Supreme Court has rejected their main constitutional arguments, at least for the near future, I believe that proponents of PAS [physician-assisted suicide] are in a weaker position than they were before these lawsuits ever commenced. For the constitutional arguments they made without success in the Supreme Court and the policy arguments they have been making, and will continue to make, in the state legislatures or state courts or on the op-ed pages of hundreds of newspapers greatly overlap." - Yale Kamisar of University of Michigan, p. 900.
"Many states have constitutions that are either more textually explicit regarding protection of individual liberties than is the Federal Constitution, or have similar text that has been construed by the state's high court as more protective of individual liberties.... State court challenges to assisted-suicide prohibitions based on state constitutional provisions protecting individual privacy, liberty, or dignity may offer a route to reform in such states." - Kathryn Tucker of Compassion in Dying, pp. 933, 934.
"Clinicians must believe, to some degree, in a form of the principle of double effect in order to provide optimal symptom relief at the end of life. This is so because all physicians ought to be equally committed to palliative goals. Roughly a third of physicians, however, are strongly opposed to PAS or euthanasia on moral grounds. At least that third of physicians must be reassured that if they use the most effective palliative techniques, no one will accuse them of violating their own moral codes and deliberately causing death.... For a similar reason, it is highly desirable that a rough practical distinction be maintained between both the ethics and the law of forgoing therapy and of PAS or euthanasia." - Howard Brody of Michigan State University, pp. 959, 960.
"The picture of a patient writhing in pain and begging for PAS or euthanasia is... largely a myth. All the available evidence indicates that there is virtually no causal connection between pain and interest in PAS or euthanasia.... Indeed, [in a recent study] cancer patients experiencing pain were (1) more likely to find PAS or euthanasia unaccept-able, (2) more likely to state that discussion of PAS or euthanasia with the physician would not increase trust, and (3) more likely to change physicians if their physician mentioned that he or she had provided PAS or euthanasia." - Ezekiel Emanuel of the National Institutes of Health, pp. 997, 998-9.
"The enduring disparities in health status between blacks and whites perpetuate black mistrust of medicine. African-Americans rightly wonder what sort of society would allow such disparities to continue unchecked. They are understandably suspicious of those who express concern that blacks are being denied a fair opportunity to assistance in ending their lives if PAS is prohibited.... Given the general distrust of medical institutions and the medical profession and the belief that their lives are undervalued, African-Americans are likely to view the legalization of PAS with suspicion." - Patricia King and Leslie Wolf of Georgetown University, pp. 1040, 1041.
"[T]he data tell an important story. They show that patients need not choose between agony and assisted suicide; numerous techniques for pain relief and palliative care are available, including sedation to unconsciousness. When patients do seek assisted suicide, it is usually because untreated depression or inadequate pain relief drives them. These patients are not independent agents freely choosing an uncoerced option, as in a commercial transaction. And termination of life-sustaining treatment, high-dose pain relief, and sedation to unconsciousness are distinct practices with significant therapeutic uses, each one distinguish-able from assisted suicide." - Susan Wolf of University of Minnesota, p. 1100.
- Of 1902 physicians who responded, 18% reported ever having received one or more requests for assistance with suicide. Three percent of the total (16% of those who had received a request) said they had prescribed drugs for suicide; in 59% of cases the patients used the drugs to end their lives. Twenty-five percent of such requests were described as "indirect" rather than explicit.
- Eleven percent of respondents said they had received one or more requests for a lethal injection. The entire sample, however, was asked whether they had ever given such an injection, to include cases in which one was given without the patient's request. Five percent of the total sample had given a lethal injection; 54% of requests for such an injection came from a family member or partner, and 79% were described as "indirect" rather than explicit requests.
- Five percent of the patients who received prescriptions and 7% of those who received lethal injections were described as "confused 50% or more of the time." Nineteen percent of the former and 39% of the latter were described as "depressed" by the physician who helped end their lives.
- Thirty-six percent of respondents would be willing to assist suicides if it were legal; 24% would be willing to give lethal injections.
- Asked about the reasons for the request in their most recent case of assisted suicide or euthanasia, physicians cited discomfort other than pain (79%), loss of dignity (53%), fear of uncontrollable symptoms (52%), actual pain (50%), loss of meaning in life (47%), being a burden (34%), and dependency (30%). Physicians' reasons for acceding to the request were severe discomfort other than pain (cited by 78%), untreatability of symptoms (72%), life expectancy of less than six months (69%), and severe pain (29%).
- The drugs prescribed to assist suicides were opioids (75% of cases) or barbiturates (25%). Those used in injections were opioids (83%) or potassium chloride (17%). Only 43% of physicians delivered their most recent lethal injection themselves; 57% asked someone else, usually a nurse, to do so, or ordered an increase in the dose of an intravenous drug already being administered.
- Male physicians were five times as likely as female physicians to have complied with a request. Catholic physicians were least likely to have complied, while those who are Jewish or of no religious affiliation were most likely. Physicians in the West were most likely to have ended life.
- In 34% of assisted suicide cases and 11% of lethal injections the physician reports trying to dissuade the patient from hastening death.