Testimony in opposition to legislation to legalize assisted suicide in California

Good morning. My name is Wesley J. Smith. I am an author, and consumer advocate, and an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide.

For more than ten years I have been deeply engaged in public policy debates about the most important bioethical issues our nation and our states face. These include researching and writing about the ongoing erosion of Hippocratic medical values in bioethics involving areas such as assisted suicide, end of life medical treatment, and other areas of concern. I am the author or coauthor of 11 books, including Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder and Culture of Death: The Assault on Medical Ethics in America, both of which deal substantially with the issue of assisted suicide. Culture of Death was named “Best Health Book of the Year” at the 2001 Independent Publishers Book Awards.

My work in the fields in which I advocate is entirely secular, which I believe is appropriate to the creation of public policy in a nation governed by the rule of law.

I appear today to urge you to maintain California’s law prohibiting assisted suicide. The case against assisted suicide is broad and deep, and can only be summarized briefly in the time I have to speak today.

First: Assisted Suicide would be disastrous in today’s dysfunctional health care system and culture: When I hear proponents advocate legalizing assisted suicide, they almost always depict the act as occurring in an idealized world that does not exist. To these folk, all decisions to commit assisted suicide would take place in loving families, facilitated by a family doctor who has known the patient for decades, as a last resort when nothing else can be done to alleviate unbearable pain and suffering.

But ladies and gentlemen, Marcus Welby is dead and “Leave it to Beaver” was fiction. In the real world of California, there are 7.5 million people without health insurance, which means by definition that they may not have access to quality medical treatment. Perhaps that is why you don’t see poor people demanding the right to assisted suicide. Making matters worse, doctors are forced to work in an economic system dominated by managed care and HMOs, in which their interaction with patients may be limited to 12 minutes per visit. Profits are earned by cutting costs, which too often means chipping away at quality care. The cost for the drugs used in assisted suicide is about $50. It could take $500,000 to provide the patient with proper care so they don’t want assisted suicide. Should assisted suicide become legalized and legitimized, the economic force of gravity is obvious. After all, what could be a “cheaper” medical treatment then hastened death?

Meanwhile, many of our families are under increasing strain. Debt is at an all time high, for example, and the temptation would exist to consider inheritance and life insurance issues when making crucial life and death decisions. Moreover, too many of our seniors languish abandoned in nursing homes and elder abuse is epidemic.

Assisted suicide would be wrong even under the most ideal conditions. But considering these stark realities, in California it would be a catastrophe.

Second: Guidelines Cannot Protect Against Abuse: Assisted suicide proponents always seek to assuage fears about these hard truths by assuring that regulations will protect against abuse. But this is a false assurance. In the Netherlands, where euthanasia and assisted suicide have been permitted for more than 30 years, doctors have gone from hastening the deaths of terminally ill people who ask for it, to chronically ill people who ask for it, to depressed people aren’t physically sick who ask for it, to babies born with disabilities who, by definition, cannot ask for it. Dutch doctors also euthanize about 900 people a year who have not asked for it, with nothing meaningful being done about it. And now, the government is contemplating allowing 12-year olds to consent to hastened death.

How is this possible? If assisted suicide is proclaimed by the force of law to be a proper answer to the problem of human suffering, then what possible reason is there to limit it to the dying? After all, disabled and elderly people may suffer far more than dying people, and for a longer period of time. Thus, if a person who will suffer less can obtain suicide, how can we keep it from a person who would suffer more? This kind of thinking quickly alters our perceptions about the protective guidelines. Once we have changed suicide from a bad thing to be prevented to, at least in some cases, a good thing to be facilitated-then it is easy to see how supposed protections against abuse come to be seen instead as obstacles to the good to be surmounted.

This phenomenon has already begun to be observed in Oregon. It is important to know that assisted suicide in that state is conducted behind an iron shroud of secrecy. There is no independent state oversight. Rather, the state mostly collects statistical data from the death-prescribing doctors who fill out forms. The state then publishes an annual statistical summary based on the forms sent in by lethally prescribing doctors. If a doctor violates the law, he or she is hardly likely to admit it in writing.

Still, we do know some facts that refute the idealized view of assisted suicide its advocate like to depict. We know, for example, that some patients go “doctor shopping,” that is, when their own doctors refuse to participate in assisted suicide they simply go to euthanasia advocacy groups, which refer them to doctors willing to write lethal prescriptions. As a result, in some cases the death-prescribing doctors never treated the patients for their illnesses. Indeed, some patients knew the prescribing doctor for two weeks or less before dying. That isn’t good medical practice; it is sheer Kevorkianism.

Occasionally, we learn about real cases. The Portland Oregonian reported on the case of Kate Cheney who received assisted suicide even though a psychiatrist recommended against it because he found that her Alzheimer’s disease left her incapable of understanding what she was asking for and that her assisted suicide was being pushed by Cheney’s daughter.

Then there was the case of Michael P. Freeland, as described in a paper presented to the American Psychiatric Association, who received a lethal prescription nearly 2 years before he died a natural death-meaning he probably wasn’t terminal when the prescription was written-and who was permitted to keep his poison even after being hospitalized because he had become delusional.

Third: Assisted Suicide Violates the Spirit of Hospice: The root meaning of compassion is to “suffer with.” That is why the true compassionate method of caring for dying people is hospice care.

The hospice philosophy is to value the common humanity and personal importance of every patient and care intensely until its natural end. Indeed, as a hospice volunteer, I was explicitly trained that a desire for suicide by a patient meant that a crucial need was not being met. Further, once proper care is provided, the desire to commit suicide usually abates. Thus, I was required, as a member of the hospice team, to report when a patient expressed a desire for suicide so appropriate treatment could be provided.

The ideology of assisted suicide is just the opposite of hospice. By definition, assisted suicide sends the subliminal message that some lives are not worth living, not worth protecting, not worth spending the time and resources to “suffer with”. Worse, assisted suicide claims that an acceptable answer to the problems associated with dying, dis

ability, or hopeless illness is to artificially induce death and “get it over with.” No wonder Dame Cecily Saunders, the creator of the modern hospice movement and one of the great medical humanitarians of our time, and virtually all other notable hospice medical professionals, such as Dr. Ira Byock, author of Dying Well, agree that assisted suicide is not proper medical practice.

There is much more to say about this important issue. But my time has expired. I thank the committee for its attention.