USCCB - Pro-Life Activities

Life at Risk

A Chronicle of Euthanasia Trends in America

Vol. 10, No. 5
July 2000
NCCB Secretariat for Pro-Life Activities

Maine, Congress Prepare for Suicide Votes

As the U.S. Senate awaits the end of its month-long August recess and an expected September vote on the Pain Relief Promotion Act, the issue of assisted suicide is about to become uppermost – literally – in the minds of many voters in Maine.

An initiative to legalize physician-assisted suicide, repeatedly rejected by Maine's legislature, will top the state ballot as "Question 1" on November 7, its position determined by a random drawing by the Secretary of State on May 25. Supporters of the "Death with Dignity Act" also have the advantage of ballot language designed to reassure – some say, to mislead – voters: "Should a terminally ill adult who is of sound mind be allowed to ask for and receive a doctor's help to die?"

The Act itself, modeled after Oregon's law, speaks of a patient's "request for medication for the purpose of ending that patient's life," but that language will not appear on the ballot. The proposed law does not change what patients would be "allowed" to request, but what physicians would be allowed to do that is now forbidden as the crime of "aiding or soliciting suicide."

Announcing formation of Maine Citizens Against the Dangers of Physician-Assisted Suicide on May 17, disability rights advocate Steven Tremblay said the Act is moving forward because Maine has been chosen as a target state by the national assisted suicide movement. "It has nothing to do with compassionate care," he said. "It has everything to do with a national political campaign marching into our state and forcing their agenda on Maine people" [Maine Citizens web site, www.noassistedsuicide.com/news/051700.htm].

Supporting his charge are the records of campaign contributions filed with the state through June 1. They show that the PAC promoting the initiative, Mainers for Death with Dignity, raised $606,018, about 95% of which came from out-of-state contributors. Four PACs opposing the initiative raised $629,337; but three of them listed no out-of-state contributions, while the fourth, Coalition for the Compassionate Care of the Dying, received more than 99% of its funds from within the state.

"We're getting a national battle fought out in the state of Maine," says political scientist Douglas Hodgkin of Bates College in Lewiston. He warns that Mainers "should be aware of the possibility that somebody could be hijacking the process from outside" [Portland Press Herald, 7/12/00]. In fact, supporters have emphasized their need for "generous support from all over the country to ensure a successful campaign" [Mainers for Death with Dignity web site, www.mdwd.org].

Out-of-state donors to the Maine effort include the political arm of the Hemlock Society, members of other Hemlock affiliates, and Oregon Death with Dignity. But these groups will soon have to dust off their "states' rights" rhetoric for the coming vote in Congress, where Senators Ron Wyden (D-OR) and Don Nickles (R-OK) have reached an agreement allowing the Pain Relief Promotion Act to reach the Senate floor in September. Senator Wyden says that he will filibuster the legislation -- but if supporters win 60 votes on an initial motion to limit debate and proceed to a vote, he "won't be unreasonable" in continuing to block consideration [The Oregonian, 7/28]. He says he may have to rely on a veto from President Clinton, who he personally briefed on the measure on June 19 aboard Air Force One [Id., 7/29].

The federal bill would not overturn the Oregon law or the Maine proposal, but forbid use of federally controlled drugs for assisted suicides performed under such laws while expanding federal protection for use of these drugs for pain control.

News Briefs

Dutch to Modify Child Euthanasia Bill

The Dutch government has resubmitted its proposal for formally legalizing assisted suicide and euthanasia, while modifying its controversial provision allowing euthanasia for children.

When first proposed to Parliament over a year ago, the bill allowed for cases where children from 12 to 16 years old could request and receive euthanasia "against the wishes of their parents." The modified proposal still allows child euthanasia in this age group, but not over parents' objections [New York Times, 7/14/00].

Still unclear is the fate of another controversial feature of the original bill, allowing adults to sign advance directives requesting euthanasia in the event of future mental incompetency. This would allow legal euthanasia for patients with dementia or Alzheimer's disease for the first time [Id., 6/20].

Dutch euthanasia practice has long included lethal injections for children, including newborn infants, with parental consent.

ABC Suing to Interview Kevorkian

Barred from conducting an on-camera interview with Jack Kevorkian in prison, ABC News is waging a court battle against the Michigan Department of Corrections.

Corrections Director Bill Martin has refused a request from the ABC program "20/20" to let Barbara Walters interview Kevorkian and two fellow inmates. Martin invoked a state prisons policy that took effect last March, barring TV crews except for stock footage and scenes of inmates taking part in prison activities. A county circuit judge found in favor of ABC on July 13, saying the prison policy infringes on First Amendment rights [AP, 7/13]. However, this ruling was blocked two weeks later by a state appellate court [Washington Times, 7/30]. Kevorkian is serving a 10-to-25-year sentence for second-degree murder, for giving a lethal injection to Thomas Youk last September.

Euthanasia Cases in the News

In New York, federal officials have brought murder charges against Michael J. Swango for giving lethal injections to three patients. Each patient died under his care at a Veterans Affairs hospital in Northport, New York while he was a medical resident with the Stony Brook Health Sciences Center in 1993. Prosecutors say Swango is a serial killer who obtains medical posts through "lies and deception" and has been killing and endangering patients since medical school. The indictment was issued as he finished serving three and a half years in a federal prison in Colorado for fraudulently obtaining the Northport post. He won that job by lying about an earlier incident in Illinois, in which he made five co-workers ill by lacing their coffee and doughnuts with an arsenic-based ant killer [New York Times, 7/12].
In New Mexico, a hiker who stabbed his friend to death in what he claimed was a "mercy killing" was sentenced on May 10 to serve two years in prison and five years of probation. Raffi Kodikian, 26, said he killed David Coughlin, 26, at his request after the two had been lost for days in the desert without water [AP, 5/11].
In Utah, a jury has convicted psychiatrist Robert Allen Weitzel on two counts of manslaughter and three counts of negligent homicide for his role in the death of five patients. Prosecutors had sought a murder conviction, claiming that Weitzel intentionally killed the patients by weakening them with large doses of sedating drugs and then administering lethal doses of morphine; his defense attorney claimed he acted in good faith to provide comfort care. Accepting neither claim, the jury found that Weitzel acted recklessly and with criminal negligence. The patients, who died in a period of 16 days under Weitzel's care, had been receiving treatment for loud and combative behavior stemming from senile dementia [Salt Lake Tribune, 7/11].

Verbatim: Academic Experts on the Pain Relief Promotion Act

On April 24, a group of 47 bioethicists wrote to the Senate Judiciary Committee opposing the Pain Relief Promotion Act, now poised for a Senate vote in September. The signers said they have "differing views about the moral issues arising in end-of-life situations," but agree that the Act is "a dangerous bill" that "will undercut the effective delivery of pain relief." Drafting the letter was University of Pittsburgh law professor Alan Meisel; he and 15 other signers submitted amicus briefs in 1997 unsuccessfully urging the Supreme Court to create a constitutional right to assisted suicide.

On July 28 a response was sent to all Senators by the Act's chief sponsors, Don Nickles (R-OK) and Joe Lieberman (D-CT). The new letter, signed by 104 experts in law, medicine and ethics, was prepared by Americans for Integrity in Palliative Care, an ad hoc alliance of palliative care experts and others who support the Act. Signers include former surgeon general C. Everett Koop, Harvard law professor Mary Ann Glendon, palliative care expert Eric Chevlen, and Dr. C. Christopher Hook, director of ethics education for the Mayo Clinic. Excerpts follow:

The Act promotes pain management and palliative care for the terminally and chronically ill in several ways. First, it calls on the Department of Health and Human Services to collect and disseminate available protocols and guidelines on palliative care to make these more widely known among medical professionals, health care entities and the general public. Second, it provides $5 million a year for training grants to help medical professionals learn the latest techniques for pain management and palliative care. Third, it provides a new explicit "safe harbor" in the federal Controlled Substances Act (CSA) for medical professionals' use of federally controlled drugs to relieve pain, even in those rare cases where death may unintentionally be hastened. Fourth, it provides for continuing education for Drug Enforcement Administration (DEA) agents and other law enforcement personnel, so they will understand this safe harbor and the legitimate need for large palliative doses of painkilling medications. Fifth, it clarifies the law so the CSA is not construed to authorize use of these federally controlled drugs for assisted suicide and euthanasia.

This last-named feature is itself an important contribution to palliative care. If our society is to commit itself to addressing the real needs of dying patients for pain control and compassionate care, our government must say clearly to these patients that it will not support the "quick fix" of deliberately seeking the death of seriously ill citizens. To condone physician-assisted suicide would erode trust between patients and their physicians, and undermine society's commitment to the more difficult but infinitely more rewarding task of meeting patients' real needs.

In an April 24 letter, some bioethicists express a different view. They suggest that the Act's explicit rejection of assisted suicide and euthanasia is an imposition on physicians, a needless assault on medical decision making that will undermine optimum palliative care.

With due respect to these colleagues, their argument is seriously flawed. Specifically they do not recognize or understand key provisions of the Act or the legal context in which they are offered.

Below we answer the key questions raised by the April 24 letter.

Does the Act's "intent standard" force physicians to become more cautious in treating pain?

On the contrary: Currently the DEA has authority to act whenever controlled substances are used contrary to the "public interest," including any case where they are used to endanger "public health and safety" (21 USC823, 824(a)(4)). Under these broad standards, federal authority to revoke a physician's DEA registration for unintentional involvement in suicides or other overdoses has no clear statutory limit. By requiring proof of intent to cause death in cases where physicians sought to relieve pain, the Act provides new protection compared with current law. As approved by the Senate Judiciary Committee the Act adds still greater protection for physicians, by requiring that such intent be proved by "clear and convincing evidence" rather than the usual "preponderance of evidence" now used in all DEA administrative proceedings...

Will a more explicit policy against use of these drugs for assisted suicide have a "chilling effect" on their use for pain control?

The April 24 letter says it will, and adds that "the evidence for this claim is legion." In fact, the evidence against that claim is overwhelming. In recent years a number of states have enacted laws similar to the federal Act – laws which forbid assisted suicide while explicitly allowing pain control that may unintentionally hasten death. These states have seen dramatic increases in use of controlled substances like morphine for pain control. After Iowa and Rhode Island passed such laws in 1996, per capita use of morphine doubled in those states (see April 25 testimony of Dr. Eric Chevlen before the Senate Judiciary Committee). South Dakota saw a similar increase in 1997, after it imposed civil penalties for aiding a suicide while enacting a disclaimer on the legitimacy of pain control. Veterans Administration hospitals showed dramatic improvements in palliative care after a similar policy was applied to them by the Assisted Suicide Funding Restriction Act of 1997.

Physicians may well be "chilled" in doing pain control when the law increases scrutiny of their use of drugs for pain control. But the Pain Relief Promotion Act reduces such scrutiny, by stating: "For purposes of this Act and any regulations to implement this Act, alleviating pain or discomfort in the usual course of professional practice is a legitimate medical purpose for the dispensing, distributing, or administering of a controlled substance that is consistent with public health and safety, even if the use of such a substance may increase the risk of death." To call any practice a "legitimate medical purpose" in the CSA is to place it beyond DEA scrutiny, because the agency has authority only to scrutinize the diversion of these drugs toward "nonmedical" use....

Many signers of the April 24 letter are more closely associated with campaigns for assisted suicide than with the drive for better palliative care; 16 of them have signed amicus curiae briefs to the Supreme Court favoring a constitutional "right" to assisted suicide. That fact does not, by itself, nullify their arguments. It does indicate that some attacks on the proposed Act may be motivated by factors other than concern for palliative care.