NCCB Secretariat for Pro-Life Activities
Hemlock Founder Slams "Greedy Geezers"
The founder of the Hemlock Society, the United States' oldest and largest organization promoting physician-assisted suicide, has declared that the practice will ultimately be accepted as an important "method of cost containment." The elderly, says Derek Humphry, are increasingly recognized as "greedy geezers" and are "putting a strain on the health care system that will only increase and cannot be sustained."
Humphry makes these statements in a new book co-authored with attorney Mary Clement, Freedom to Die: People, Politics and the Right-to-Die Movement (St. Martin's Press 1998). While early chapters of the book pay tribute to assisted suicide as a free choice -- "the ultimate civil liberty" -- Humphry says assisted suicide and euthanasia will be accepted and legalized in American society for reasons that have nothing to do with freedom. "In the final analysis," he says, "economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice."
Humphry even gives favorable attention to the idea that elderly citizens have a "duty to die" for the good of family and society. He predicts that insurance companies and Medicare will require patients to sign "living wills" refusing aggressive treatment as a condition for receiving health coverage, and that elderly patients will be helped to hasten death as "the morally correct thing to do for their family." As precedent he says that Japanese elders once understood that they had "an obligation to commit suicide" once they became a "burden," and that elderly Eskimos were abandoned to die when they were "no longer productive."
In the new book, the American Association of Retired Persons (AARP) joins the Catholic Church and the medical establishment on Mr. Humphry's enemy list. He says the AARP fights effectively for "the economic stability, health, and social well-being of its current members" -- but its opposition to health care rationing based on age shows that "the well-being of its future members does not carry the same weight."
Humphry also congratulates the state of Oregon for its health plan, the first in the nation to ration care for the poor based on a scale of cost-effectiveness. Beginning this month, Oregon has added assisted suicide to its list of funded services [see November 1998 Life at Risk].
The economic case in favor of assisted suicide has not been a major part of the American debate on this issue -- Humphry calls it "the unspoken argument" -- but is receiving increased attention. In the July 16, 1998 issue of the New England Journal of Medicine, Dr. Ezekiel Emanuel and Margaret Pabst Battin sought to answer the question, "What are the potential cost savings from legalizing physician-assisted suicide?", and concluded that legalization would actually save only a tiny percentage of the nation's health care budget. The authors added that the cost of care for debilitated and elderly patients may be a serious burden for individual families, and expressed a concern that such factors might "motivate families to pressure patients into requesting a physician's assistance with suicide" if the practice were available. But in a letter printed in the journal's December 10 issue, a physician-lawyer at Columbia Law School chides the authors for not embracing decisions to commit suicide to spare families the expense of care. William M. Sage expresses the hope that "future discussions of assisted suicide" will "explore the moral legitimacy of making a personal physical sacrifice for an equally personal financial benefit."
"The right-to-die is an evolving concept," says Humphry's new book. For him and some other advocates, it is "evolving" into a financial duty.
Oregon Rationing Plan Falters
As it implements the nation's only plan for state-funded assisted suicide for the poor [see Nov. 1998 Life at Risk], Oregon is less sure than ever that it can ensure access to anything else.
On December 1, Governor John Kitzhaber proposed new restrictions in his health care budget for 1999-2001, made necessary by the Oregon Health Plan's declining revenues and increased costs. He asked for a 28% increase in support from the state's general fund, tougher screening to ensure patients' eligibility, and a delay of several weeks before applicants can receive health benefits under the plan [The Oregonian, 12/2/98].
With 350,000 Oregonians still uninsured, the state has abandoned the goal of universal health coverage. The governor also proposes increasing the number of conditions for which the health plan simply will not provide treatment. When it began its rationing plan five years ago, Oregon covered 606 out of 745 conditions and treatments ranked on a cost-effectiveness scale; it now covers 574, and may move back to 564 [New York Times, 1/3/99]. Assisted suicide, ranked at 260, is in no danger of losing state support.
Commenting on these developments, the Washington Times observes: "The Oregon plan has turned out to be like one of those hospital gowns one can never quite close in back; it leaves patients with something less than complete coverage" [Editorial, "It's enough to make you sick," Washington Times, 1/5/99].
Hemlock to Provide "Caring Friends"
Hemlock Society USA has announced a new program to train volunteers who can "coach" terminally ill patients in committing suicide. Called "Caring Friends," the program will look to Hemlock's book Final Exit for guidelines on using drugs and plastic bags to induce death.
"We will not do anything illegal and we will not provide the medical means," says Hemlock executive director Faye Girsh. "We will coach them." She says patients will be trained to use plastic bags to suffocate themselves only as a last resort, if sufficiently lethal prescription drugs cannot be obtained from a physician [San Diego Union-Tribune, 11/13/98].
The program is an apparent response to the rise of groups like Compassion in Dying that, unlike Hemlock, have earlier announced a willingness to attend suicides. This move to direct action may also be a response to defeats in the public policy arena, where every state except Oregon has rejected Hemlock proposals.
Gerbode Foundation: Funding Assisted Death
The January 1999 issue of Foundation Watch, published by the Capital Research Center, reports on the San Francisco-based Wallace Alexander Gerbode Foundation, which it calls "the leading funder of advocates for physician-assisted suicide" in the U.S. Founded in 1961 by conservationist and family planning activist Martha Alexander Gerbode, the foundation approved $2.2 million in grants in 1997; in all it has given about $1 million to right-to-die groups.
In 1996 Gerbode gave $150,000 to Oregon Death with Dignity, chief sponsor of the Oregon law allowing assisted suicide. It has given two $100,000 grants to Compassion in Dying, which attends patients' suicides and has sought to establish a constitutional "right" to assisted suicide. The foundation has subsidized projects to develop or discuss practical guidelines for physician-assisted suicide, as well as media campaigns and national polls designed to spread the "right to die" message. Foundation Watch urges reporters to "watch the money trail" when covering the assisted suicide movement. For more information: Capital Research Center, phone 202/483-6900, Web site www.capitalresearch.org.
VERBATIM: Recent Commentary on Kevorkian
As Jack Kevorkian prepares for a March 1999 trial on murder and assisted suicide charges [see November 1998 Life at Risk], commentators with many different views have weighed in on the televised killing of Thomas Youk and Kevorkian's future. Some samples:
"If ever there was a reason to pay no attention to a zealot like Kevorkian, the fact that he would use the death of a patient in the service of his own political agenda should suffice.... The act of Kevorkian slipping his home video of the severely disabled Youk to the '60 Minutes' crew showed that he is willing to abuse the dignity of any individual in the name of his jihad.
"No one capable of such moral callousness is anyone who has anything worth listening to about how Americans should die."
- Arthur Caplan, Ph.D., in his "Breaking Bioethics" column, MSNBC's Web site, 12/2/98
"Those who look for a better way [of dying] have a worthy goal, but Kevorkian is an embarrassment; he is an unworthy standard bearer... He seeks martyrdom, but the real martyrs are those who will continue to suffer as a result of the damage he is doing to his own cause.
"Those less strident and more helpful individuals and agencies that embrace the concept of death with dignity have no choice but to voice support for his activities, for he is their best-known spokesman. But surely they know he is hurting their cause."
- Otis Pike, columnist for Newhouse News Service, MSNBC Website, 11/24/98
"Kevorkian is courageous enough to practice civil disobedience by taking his case to the public and challenging the courts to determine if this act of kindness and compassion can be considered by twelve people to be the same as murder or homicide."
"Many attribute sinister motives to Kevorkian -- wanting publicity or having a morbid interest in death -- and to CBS for wanting to increase its ratings. Let's remember, though, that we are talking about one of the most serious issues facing Americans and all people in industrialized countries who die from diseases where the dying course is protracted and debilitating: how to increase choices for dying people and their families."
- Faye Girsh, director of Hemlock Society USA, in St. Louis Post-Dispatch, 1/8/99
"By this outrageous and appalling action, Jack Kevorkian clearly committed a heinous crime and violated the most sacred patient protections of medicine's code of ethics that demand that physicians place their patients' interests above their own.
"We are terribly disappointed in '60 Minutes' for becoming a willing accomplice to this tragedy... Caring and concerned people can only respond with revulsion at this most extreme example of 'reality television'. We would hope that the more responsible media would advance the essential debate over how to help patients at the end of life in a more thoughtful and responsible way."
- Nancy Dickey, M.D., president of American Medical Association; Press release, 11/23/98
"What we saw was essentially a snuff film bearing no more resemblance to authentic caring than hard-core pornography does to true love... Kevorkian's act of civil disobedience is a violent assault on the heart of our cultural values."
- Ira Byock, M.D., hospice physician, in the Washington Post, 12/6/98
Background: States Acting to Improve End-of-Life Care
Advocates on both sides of the euthanasia debate agree that pain management and other care for terminally ill patients must be improved. Recently three states that ban assisted suicide took significant steps in this regard.
In Michigan, where voters defeated a proposal to legalize assisted suicide in November, legislators have passed six bills to promote hospice care and pain control. The bills, passed earlier by the House, were unanimously approved by the state Senate on December 3 and signed by Governor Engler December 29. They establish an interdisciplinary advisory committee on pain and symptom management; require health plans to report whether they cover hospice care and pain management for the terminally ill; set standards for hospital pain control programs; and assure physi-cians of their authority to prescribe controlled substances to treat pain. "We have a clear policy that use of opiates is approved of, and physicians no longer have to be afraid to prescribe morphine," says Sen. John Schwarz, the legislature's only physician [Livonia Observer & Eccentric, 12/10/98].
In Connecticut, where the nation's first hospice was founded in 1974, state attorney general Richard Blumenthal is working with hospice groups and the state bar association to promote an idea called Physician Assisted Living (PAL). Before reaching the most severe stage of terminal illness, patients are informed of their right to make decisions about future care, including palliative care. Each patient has an opportunity to sign a "Notice of Desire for Hospice Care," to notify physician and family in advance of a patient's interest in hospice care when it becomes appropriate. Former HEW Secretary Joseph Califano hails the initiative as a model deserving national attention. "Physicians must establish palliative care and attention to the needs of the family as the gold standard for the terminally ill with the same fervor that they exhibit in pursuit of aggressive treatments for those who can be saved by radical surgery, radiation or chemotherapy," he writes [J. Califano, "Physician-Assisted Living," Washington Post, 12/31/98, and America, 11/14/98, pp. 10-12; see Connecticut Medicine, December 1997, pp. 773-86].
In Nebraska, a statewide nonprofit group has been formed to promote quality end-of-life care and prevent euthanasia and assisted suicide. The Nebraska Coalition for Compassionate Care brings together political, medical, religious and other figures to improve care for terminally ill patients and raise public awareness about care already available. At the coalition's first press conference November 5, president Scott McPherson, M.D. said the urgency of this effort is underscored by a recent case in which retired farmer Bob Ohlrich shot his wife to death while she was dying of cancer in a Nebraska hospital. Dr. McPherson said it is important "to understand and learn from such tragedies so we can try to prevent them in the future." The group's first major conference, to be held April 22, is co-sponsored by state medical and hospice associations. For more information: phone 402/477-0204; Web site www.nebrcc.org.