Politics & Policy

Whose Choice Will It Be?

Telling the truth about assisted suicide

Just a week ago now, 29-year-old Brittany Maynard, who had been diagnosed with a fatal brain tumor, took pills that ended her life. She had moved to Oregon, where assisted suicide is legal. Like many, I read the news on People magazine’s website, as the Hemlock Society, now known as Compassion & Choices, had aggressively campaigned to make her face known. 

But such activists — overtaking culture, law, and medicine in many cases — have misused words in driving this grave movement. They make false claims about “choice” that endanger lives at their most vulnerable moments. 

Margaret Dore is a lawyer in Washington State, where assisted suicide is also legal. Dore is a former law clerk to the Washington state supreme court and president of Choice Is an Illusion, a 501(c)(4) nonprofit corporation opposed to assisted suicide and euthanasia. She talks with National Review Online about assisted suicide as it exists now and how we might make a change. — KJL


KATHRYN JEAN LOPEZ: What is assisted suicide?

MARGARET DORE: Assisted suicide means that someone provides the means and/or information for another person to commit suicide. When a physician is involved, the practice is physician-assisted suicide. Euthanasia, by contrast, is the direct administration of a lethal agent with the intent to cause another person’s death. Euthanasia is also known as “mercy killing.” 

The term “physician-assisted suicide” can also be a misnomer, because non-physicians such as family members can be involved in the suicide. For example, the son who suggests assisted suicide to dad, the son who drives dad to the doctor’s office, and the son who picks the lethal dose up at the pharmacy.


Lopez: What is the status of assisted suicide in the U.S.?

Dore: Physician-assisted suicide is legal in three states: Oregon, Washington and Vermont.  Oregon’s law was passed by a ballot measure in 1997. Washington’s law was passed by another ballot measure in 2008 and went into effect in 2009. Vermont’s law was passed by its legislature in 2013. My understanding is that in Vermont no one has died under its law and that opponents are seeking to have it repealed. In the last four years, four states have strengthened their laws against assisted suicide. Those states are Idaho, Georgia, Louisiana, and Arizona. There are also two states where the status of assisted suicide is in litigation. Those states are Montana and New Mexico.


Lopez: What is the absolute first thing that you would like anyone who was moved by Brittany Maynard’s life and death to know?

Dore: I would want them to know that “eligibility” for legal assisted suicide is not limited to people who are near death. This is true for the following reasons:

Under the Oregon and Washington assisted-suicide laws, assisted suicide is legal for “terminal” patients, meaning those predicted to have less than six months to live. But such predictions can be wrong. Moreover, treatment can lead to recovery. Consider Jeanette Hall, who was diagnosed with cancer in Oregon in 2000 and was adamant that she would “do” Oregon’s law. Her doctor, who didn’t believe in assisted suicide, stalled her and convinced her to be treated instead. Today, 14 years later, she is thrilled to be alive. You can see her doctor’s affidavit here.

Once assisted suicide is legal, there is pressure to expand. For example, here in Washington State, we have already had “trial balloon” proposals to expand our law to euthanasia for non-terminal people. For me, the most disturbing proposal was a discussion in our largest paper suggesting euthanasia for people who didn’t have enough money for their old age. So, if you worked hard all your life, paid taxes, and then your pension plan went broke, this is how society will pay you back? With non-voluntary or involuntary euthanasia? (The newspaper column can be read here.)

In other words, with legal assisted suicide, people with years to live are encouraged to throw away their lives. Moreover, and contrary to the media hype, legal assisted suicide (or euthanasia) may not be voluntary.


Lopez: Is “suicide contagion” really a thing?

Dore: Yes. It is well established that a single suicide can encourage other suicides, which is called a “suicide contagion.” If the additional suicides use the same method, they are “copycat” suicides. Moreover, as explained below, this encouragement phenomenon is relevant to Compassion & Choices’ media campaign.

A famous example of a suicide contagion is the suicide death of Marilyn Monroe, which inspired an increase in other suicides. This encouragement phenomenon can also occur when the inspiring death is not a suicide. An example is the televised execution of Saddam Hussein, which led to suicide deaths of children worldwide. An NBC News article begins: 

The boys’ deaths — scattered in the United States, in Yemen, in Turkey and elsewhere in seemingly isolated horror — had one thing in common: They hanged themselves after watching televised images of Saddam Hussein’s execution.

Groups such as the National Institutes of Health and the World Health Organization have developed guidelines for reporting suicide to prevent suicide contagions. Important points include that the risk of additional suicides increases “when the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage.”  

The media campaign by Compassion & Choices, to promote the suicide of Ms. Maynard, violated and continues to violate all of these guidelines. We were told of the planned method, when and where it would take place, and who would be there. There was and is repeated extensive coverage in multiple media. With this situation, the risk of suicide contagion associated with Compassion & Choices’ media campaign is real. Moreover, in Oregon, where Compassion & Choices has already run similar but smaller media promotions, there is statistical evidence suggesting, though not proving, a suicide contagion. Please consider the following:

‐Oregon’s physician-assisted-suicide law went into effect in 1997.

‐By 2000, Oregon’s regular suicide rate was “increasing significantly.” See here: “After decreasing in the 1990s, suicide rates have been increasing significantly since 2000.” 

‐By 2007, Oregon’s other (regular) suicide rate was 35 percent above the national average.  

Lopez:  What is the experience of assisted suicide in Oregon and Washington as you’ve seen it?

Dore: My legal analyses of the Oregon and Washington laws show that these laws are a recipe for elder abuse. A more obvious problem is that a patient’s heir, who will benefit from the patient’s death, is allowed to help the patient sign up for the lethal dose. Once the lethal dose is issued by the pharmacy, there is no oversight. Not even a witness is required. If the patient struggled, who would know? The patient’s control over the “time, place, and manner” of his death is not guaranteed.

I have former clients who run an elder-care facility. Four days after the election passing our assisted-suicide law, the adult son of one of their clients wanted to know how to get the pills to kill his father. It wasn’t the father saying that he wanted to die.

I have also had two clients whose parents signed up for the lethal dose. In the first case, one side of the family wanted the father to take the lethal dose, while the other did not. He spent the last months of his life caught in the middle and traumatized over whether or not he should kill himself. My client, his adult daughter, was also traumatized. The father did not take the lethal dose and died a natural death.

In the other case, it’s not clear that administration of the lethal dose was voluntary. A man who was present told my client that the father refused to take the lethal dose when it was delivered (“You’re not killing me. I’m going to bed”), but then took it the next night when he was high on alcohol. The man who told this to my client later recanted. My client did not want to pursue the matter further.

(For those who want to read more about the issue, see herehere and here.)


Lopez: Why is the “death with dignity” language misleading?

Dore: Because it’s a euphemism, which doesn’t readily disclose that we are talking about assisted suicide and euthanasia for people who may or may not be dying anytime soon, and that such death may not be voluntary.

Lopez: Who is Compassion & Choices? Is its name misleading?

Dore: Compassion & Choices is a successor organization to the Hemlock Society, originally formed by Derek Humphry. In March 2011, Humphry was in the news as a promoter of mail-order suicide kits from a company now shut down by the FBI. This was after a 29-year-old man had used one of the kits to commit suicide. Seven months later, on October 22, 2011, Humphry was the keynote speaker at Compassion & Choices’ annual meeting here in Washington State.

Compassion & Choices’ name is misleading because it does not disclose its true nature as a suicide/euthanasia advocacy group. The name is also misleading because Compassion & Choices’ true mission is to reduce choice in health care and to change public policy so as to reduce patient cures.


Lopez: Speaking of names: How did your group arrive at Choice Is an Illusion?   

Dore: The name, Choice Is an Illusion, is a commentary on Compassion & Choices because the laws it promotes do not assure patient choice.


Lopez: But is it compassionate to insist that one live through pain?

Dore: Oregon’s most recent annual assisted-suicide report lists “concerns” as to why the people who died requested the lethal dose. The data for these concerns is originally generated by the prescribing doctor who uses a check-the-box form developed by suicide proponents. One listed concern is “inadequate pain control or concern about it.” There is, however, no claim that anyone who ingested the lethal dose was actually in pain. See Margaret Dore, “Oregon’s new assisted suicide report: chronic conditions; people with money and more,” here.


Lopez: Are you concerned about growing social pressure toward assisted suicide?

Dore: Yes.


Lopez: What can be done about assisted suicide?

Dore: I would hope that more people would become educated on what these laws really say and do, and start fighting back. Of course, money is also needed.


Lopez: Why do you point to William Melchert-Dinkel, a nurse who drew depressed people into suicide? Surely, such things are not widespread. 

Dore: William Melchert-Dinkel is a convicted suicide predator who sought out suicidal people in order to convince them to kill themselves in front of his webcam. I agree that his specific conduct is probably not widespread. His conduct does, however, illustrate a reality that people tend to forget, that with legal or illegal assisted suicide, the assisting person can have an agenda. For Melchert-Dinkel, his agenda, according to police, was the “thrill of the chase.” Meanwhile, in Oregon, that state’s Medicaid program has a well-documented agenda to steer patients to suicide via coverage incentives. Similarly, the former Hemlock Society, Compassion & Choices, has an agenda for a public-policy change to reduce patient access to cures. Compassion & Choices also has an agenda to ensure that its assisted suicides succeed. Its members are nearly always present during assisted suicides. With this situation, there can be pressure on the person to go forward to take the lethal dose.


Lopez: What might you want to leave readers with in closing?

Dore: Problems with legal assisted suicide include:

 ‐The encouragement of people with years to live to throw away their lives.

‐New paths of elder — abusefor example, in the context of inheritance.

‐A push to expand euthanasia to non-terminal individuals.

Don’t make Washington State’s mistake.

— Kathryn Jean Lopez is senior fellow at the National Review Institute, editor-at-large of National Review Online, and founding director of Catholic Voices USA.


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