Other opponents of a ban on partial birth abortions claimed that it was used only when necessary to protect the mother’s life. Unfortunately for that argument, the physician who is the best-known practitioner of these abortions stated in 1993 that 80 percent of them are “purely elective,” not necessary to save the mother’s life or health.14 Partial birth understates the matter. The baby is outside the mother except for its head, which is kept in the mother only to avoid a charge of infanticide. Full birth is inches away and could easily be accomplished.
President Clinton did, in fact, veto the bill banning partial birth abortions, demanding a vague exception for health that would have amounted to a ratification of almost all such abortions. His veto and the feminist demand for what is, in truth, infanticide underscore the casual brutality born of nihilism that is an ever more prominent feature of our culture.
No amount of discussion, no citation of evidence, can alter the opinions of radical feminists about abortion. One evening I naively remarked in a talk that those who favor the right to abort would likely change their minds if they could be convinced that a human being was being killed. I was startled at the anger that statement provoked in several women present. One of them informed me in no uncertain terms that the issue had nothing to do with the humanity of the fetus but was entirely about the woman’s freedom. It is here that radical egalitarianism reinforces radical individualism in supporting the abortion right. Justice Harry Blackmun, who wrote Roe and who never offered the slightest constitutional defense of it, simply remarked that the decision was a landmark on women’s march to equality. Equality, in this view, means that if men do not bear children, women should not have to either. Abortion is seen as a way for women to escape the idea that biology is destiny, and from the tyranny of the family role.
The attitude towards human life that abortion fosters affects the debate about other matters as well. Tissue from fetuses is used for medical research and in treating certain disorders, such as Parkinson’s disease. The difficulty is that fetal tissue is far more valuable if the fetus is alive when the tissue is removed. Partial birth abortions, for example, produce brain tissue from a living child. The next step has been proposed. Science can create human life outside the mother’s body. A panel appointed by the National Institutes of Health recommended that human embryos be created in the laboratory so that they may be subjected to experiments that will kill them. One’s first thought might be that the panel consisted of technocrats oblivious to moral considerations, but that is not at all the case. Their report and the sources upon which it relies offer a philosophy to justify what they recommend. The embryos they would create may be human but, the panel said, are not entitled to a “personhood” that requires respect. Personhood is determined by our decision to bestow it. That decision determines whether or not the life involved is protectable. According to the report, an embryo that does not have “potential for further development” is not protectable, and the embryos they would create lack such potential.
The argument is breathtaking for, as Father Richard John Neuhaus observes: “Here the reasoning is utterly circular: An embryo is not protectable because it has no potential for further development, and it has no potential for further development because, having determined that it is not protectable, researchers will not permit it to develop further.“15 The separation of humanity from personhood in this fashion is, as already mentioned, an argument used by pro-abortionists: personhood is conferred when the fetus can live outside the womb or if the mother values the life she carries, etc. The philosophical separation of humanity and personhood carries ominous overtones for the very ill, the very old, the senile, and perhaps for others.
A similar progression may be underway with respect to organ transplants. The “dead donor” rule protects those who have agreed to give their organs for transplantation after death from the possibility of being killed by the removal of their organs while they are still alive. An exception to the rule is now proposed, however. The exception would apply only to anencephalics, children born without the thinking part of the brain. These unfortunates will usually live only a few days and when they die their organs are useless as transplants. The American Medical Association’s Council on Ethical and Judicial Affairs recommends the removal of anencephalics’ organs before they die. The members seek a change in the current law, which forbids removal of organs from living persons. The Council’s report assures us: “Because anencephalic neonates lack functioning cerebral hemispheres, they never experience any degree of consciousness. They never have thoughts, feelings, sensations, desires or emotions.“16 The Council takes this position even though it concedes that these babies “may be able to breathe, suck, engage in spontaneous movements of their eyes, arms, and legs, respond to noxious stimuli with crying or avoidance maneuvers, and exhibit facial expressions typical of healthy infants.“17 Charles Krauthammer reports that they can also exhibit complex behaviors such as consolability, conditioning, and irritability, and some even distinguish their mothers from other people. It is, he says, simply unknown and unknowable whether anencephalics possess consciousness.18
It is proposed, nonetheless, that anencephalics’ organs be taken while they are alive. If that line is crossed, it may not be a long step to removing the organs of normal dying persons while they are still alive. As Krauthammer says, “The heart, say, from a person not-quite-dead might be less deteriorated and thus more useful for transplantation.” The Council recognizes this fear, which it deals with under the label “Slippery Slope Concerns”: “[M]any fear that individuals who are in a persistent vegetative state, infants with profound neurological injury, and elderly adults with severe dementia would be considered acceptable sources of organs.” To reassure us that this particular slope is not all that slippery, the Council offers analogies: “When patients requested permission to reject life-sustaining treatment, opponents argued that granting such permission would open the way to euthanasia.” That remark is not terribly comforting, since a society grown accustomed to the removal of life-sustaining treatment is now moving towards assisted suicide, and very probably from there to euthanasia. It will certainly occur to someone that a person seeking assisted suicide or euthanasia could be rendered unconscious and his or her organs “harvested” while the person is alive. The persons wish would be carried out and the organs would be in better condition than if death had occurred before the organ removal. Doctors will make the same case the AMA’s Council makes for removing the organs of living anencephalics: there are “important, unmet social needs” and the donor is not really harmed. And a further step is likely to be taken: patients who have not requested euthanasia will be subjected to it nonetheless. There is, after all, a very great unmet social need for organs. This may be dismissed as wholly unrealistic fear-mongering. I do not think it should be.
ASSISTED SUICIDE AND EUTHANASIA
Decisions about life and death in one area influence such decisions in others. Despite assurances that the abortion decisions did not start us down a slippery and very steep slope, that is clearly where we are, and gathering speed. The movement to make assisting suicides legal was made virtually inevitable by the Supreme Court’s creation of a right to abortion. The power of the abortion right to influence opinion about assisted suicide, and soon, euthanasia, arises from the fact that by now we have all come to realize, despite the philosophical fog the pro-abortionists throw up, that abortions destroy human lives for the convenience of others. So long as we permitted ourselves to think that the embryo or the fetus was an undifferentiated piece of tissue, abortion had no implications for other takings of life. But now we know better. The result is that a moral line has been crossed and we are on our way to assisted suicide and euthanasia. Modern liberalism’s obsession with the autonomy of the individual is taking us to a culture of death. Ironically, the freedom of the individual to choose death has made it far easier for others to choose his death. The autonomy is often theirs, not his.
The attack on
the statutes banning assisted suicide derives its emotional power from the picture painted by the partisans of the right-to-die movement: a terminally ill patient with nothing but intense suffering between him and death. The picture is, in large measure, false. There are ways of managing pain in most of the terminally ill. Something other than pure compassion must be in play. There are, moreover, many people who are in constant discomfort, physical or emotional, but who are not terminally ill. Why should they be denied the relief of assisted suicide? There are 31,000 suicides annually in the United States, and only 2 to 4 percent of those are by people who are terminally ill.19 Many people have an urgent desire to be released from life. Dr. Jack Kevorkian, whose macabre trade of helping people out of this world elicits considerable public approval, does not confine his “practice” to the terminally ill, and a large percentage of his “patients” are not in that condition. It is telling, however, that he presents himself as one who aids the suffering and dying.
It is, in any event, curious that there should be a demand by those not helpless for assistance in committing suicide. The thing is not all that difficult. There is an abundant supply of high buildings and bridges. If the candidate lives where there are none, or shrinks from the pain of an abrupt landing, there is the gas oven in the kitchen, carbon monoxide from the automobile in the garage, an overdose of sleeping pills, and a variety of other painless ways of shuffling off. For many would-be suicides, however, these are apparently not sufficient. They would be if all that were involved was the individual’s assertion of his or her personal autonomy. “Yet,” as Elizabeth Kristol writes, “the ‘right to choose’ is precisely what assisted suicide is not about. The unique service offered by professional suicide assistants is actually an escape from the burden of autonomous choice…. [T]he ultimate responsibility for taking one’s life … can be validated by a doctor, an expert we have come to entrust with a wide range of decisions regarding our well-being.“20
Kristol perhaps understates the role physicians will sometimes play. They may well initiate and urge the idea of suicide or euthanasia. As Judge John Noonan observed in a Ninth Circuit panel opinion subsequently overturned by the en banc court: “Physician neutrality and patient autonomy, independent of their physician’s advice, are largely myths. Most patients do what their doctors recommend. As an eminent commission concluded, ‘Once the physician suggests suicide or euthanasia, some patients will feel that they have few, if any, alternatives but to accept the recommendation.”’21
This reality puts assisted suicide in a somewhat more sinister light, as it does euthanasia. Euthanasia, in which the doctor does the actual killing, is only a half step beyond assisted suicide. It is sure to arrive as accepted practice if assisted suicide is accepted. The courts that have found assisted suicide to be a right have not specified the safeguards that must be followed. We can see the difficulties that will attend any effort to provide safeguards by looking at the conditions required by Oregon’s Death With Dignity Act, adopted in 1994. The patient must, for example, make three requests for assistance with suicide (the third one witnessed, transcribed, and signed), and two physicians must determine that the patient has six months or less to live. A physician may then prescribe a lethal dose of medication.
This sounds simpler and safer than it will be. Determinations of life expectancy for the terminally ill can be very wrong. When my first wife was diagnosed with cancer, the doctor told me she would live only six months to two years. She lived nine and a half years, and those were good years, for her, for me, for our children, and for her friends. Mistakes of that nature, and some of that magnitude, are certain to be made under any assisted suicide regime.
Mistakes do not express the full pathos, and evil, that will certainly attend assisted suicides. The patient who is a candidate for medical termination of his life will be in a greatly weakened physical condition, probably frightened or in despair, which means that his will and his capacity for independent thought will also be weakened. He will be flat on his back with his relatives and the authority figure of the doctor looking down at him. There can be few better subjects and settings for subtle or not-so-subtle psychological coercion. The patient will know, and probably will be informed, that prolonging his existence, which the physician says will be brief, places an enormous emotional and financial burden on his family. A great many people in this position are likely to accept premature death under coercion. That can hardly be called death with dignity.
Even when the patient requests aid in committing suicide, that will not always be instance of personal autonomy. Herbert Hendin, a professor of psychiatry, says that chronically ill and dependent people who ask help in committing suicide are not always exercising free choice. “The request can be a way of begging for support…. A patient requesting assisted suicide is often ambivalent. The request may cloak a cry for reassurance that one is loved and valued despite physical decline. If the family and the doctor don’t wish to listen, the patient may become trapped by the request and feel that he or she has no choice.“22 In fact, many hard-pressed or even not-so-hard-pressed families will prefer to be rid of the encumbrance, and the physician will almost always go along with them. What a wonderful way for an elderly, ill person, who has begged for reassurance, to depart this life and those he or she had hoped were loved ones.
Assisted suicide will certainly lead to euthanasia. “It has been reported that roughly one quarter of assisted suicides fail,” writes Doctor Edmund D. Pellegrino. That would spell disaster for any assisted suicide program. “For this law to be effective requires the next step, i.e., authorization of the physician ‘to administer the coup de grace if necessary.’ However, this is the very step the proponents of the law said would never come.“23
Quite aside from the practical necessity of euthanasia to complete botched suicides, public acceptance of assisted suicide will certainly lead to acceptance of the morally indistinguishable practice of euthanasia. Then we will really be racing down a slippery slope. Because proponents of euthanasia routinely point to the experience of the Netherlands to demonstrate that the practice is humane and not subject to abuse, I offer the contrary views of those who have studied it.
Author Michael Fumento cites the Netherlands’ experience to oppose euthanasia, to show what it, probably inevitably, becomes.24 Until fairly recently, the Dutch law, like Oregon’s, forbade any medical killing unless a dying patient requested it. That has changed. The evolution was accomplished by Dutch courts and ratified by the legislature in 1995. In 1973, a doctor killed her terminally ill mother, was convicted, but given only a suspended sentence of one week in jail. The next step was to dispense with convictions and absolve doctors who killed patients with terminal illnesses. Then the Dutch High Court held that killing was permissible if the patient’s disability, although not fatal, was incurable. Thus, a doctor who killed a young girl with multiple sclerosis went free.
Next, the requirement that the patient request euthanasia was dropped. Doctors killed babies born with diseases such as spina bifida that were disabling but not fatal, as well as patients in persistive vegetative states. By 1990, about 11,800 deaths (9 percent of all deaths) were inflicted by doctors, about half of them without the patient’s consent. Some critics think that a socialized health care system lends itself to rationing resources by killing the sick.
The Dutch experience has also been studied by Carlos F. Gomez, a physician at the University of Virginia School of Medicine.25 He argues that what began as an exercise in patient autonomy has become something altogether different, that the Dutch experience shows that the practice cannot be regulated, and that if the practice is transplanted to the United States, our experience will be no better and perhaps a good deal worse.
Though the public theory is patient empowerment, the private practice has come to encompass a range of activities and of patients that the original proponents said would clearly be beyond acceptable limits. Gomez found, for example, that a 2-day-old child with Down’s synd
rome and duodenal atresia was killed with the tacit consent of his parents. A 70-year-old man who had had a stroke was killed without being able to consent (or dissent) because the doctor thought no one would want to live that way, although the patient was only five days into his potential recovery. Euthanasia now extends to incompetent and unconsenting patients. In a substantial number of cases, euthanasia is a unilateral decision by the physician.
Gomez calculates that euthanasia accounts for about 7 percent of all deaths in the Netherlands. If the United States had a similar rate, there would be about 140,000 cases annually. If Fumento’s 9 percent figure is correct, the United States number would be 180,000. And if it is correct that half of the Dutch euthanasias are unconsented, applying that proportion here would mean that the number of physician-inflicted unconsented deaths in this country would be between 70,000 and 90,000 annually. In fact, matters might be much worse. The Dutch practice is virtually unregulated despite the guidelines laid down by the courts. The cause of death is often misleadingly reported as something other than euthanasia—cardiac arrest, for example. We will probably never know the number of persons killed by doctors in the Netherlands or the number killed without their consent. The same ignorance will surely prevail if euthanasia comes to the United States.
In fact, Gomez thinks the U.S euthanasia rate would be higher than that in the Netherlands. Given that the rapidly rising cost of health care cannot be sustained at its current rate, it would be dangerous to introduce a license to kill. Those most in danger would be those who now overpopulate the public hospitals and clinics because private institutions will not take care of them—patients with AIDS, minorities, the demented, and those just this side of dementia.
David C. Thomasma also compares the Dutch experience and the likely American experience of euthanasia.26 He points out that terminal care in the Netherlands is part of a comprehensive national health plan so that the terminally ill need not worry that their care will bankrupt their relatives. That is not so in the United States, where the expense of caring for the terminally ill or the merely aged falls in large measure on the family. The Dutch tend to die at home, while Americans tend to die in hospitals or nursing homes. Thus, in the Dutch case there are no financial or institutional urgencies, while in the American situation there are. These, and perhaps other factors, would press towards euthanasia more urgently in the United States than in the Netherlands.
Slouching Towards Gomorrah Page 22
