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Assisted Suicide


July 20, 2020

The federal government may enter the fray and outlaw doctor-assisted suicide, at least if certain lawmakers on Capitol Hill and the National Conference of Catholic Bishops have their way.

At hearings last week, the Constitution Subcommittee of the House Judiciary Committee heard testimony about the Lethal Drug Abuse Prevention Act, a euphemism for a measure that bans distribution of a drug covered by law for the purpose of causing or assisting persons wanting to self-terminate their lives. Introduced by Rep. Henry Hyde (R-Ill) and Sen. Don Nickles (R-OK), the measure would also establish a federal "board of experts" to decide if doctors acted improperly in fatal cases involving pain management. Penalties would include revocation of a doctor's license for providing medication used in an assisted suicide.

Unreported in much of the national media, though, is the fact that the legislation was drafted for Istook and Nickels by the Bishop's Secretariat for Pro-Life Activities. In an obscure story by Patrick O'Neill of Newhouse News Service, one of the authors of the bill is identified as Richard Doerflinger, associate director of the Secretariat. He described the first-time legislation as having the goal of limiting doctors so that they only "prescribe controlled substances as medically appropriate in order to relieve pain and discomfort... if there is no intent to cause a patient's death." Doerflinger added that the bill would permit physicians to use drugs to control pain, even if the treatment ultimately resulted in the death of the patient.

But the distinction has doctors' groups concerned, including the powerful American Medical Association, as well as Oregon Governor John Kitzhaber. Indeed, the Lethal Drug Abuse Prevention Act is seen as an effort to overturn a voter-approved resolution passed in Oregon which permits doctor-assisted suicide. The "Death With Dignity Act, " approved in 1994 was opposed by many religious groups in Oregon, including the Roman Catholic Church and the Southern Baptist Convention. The referendum was not put into law until 1997, however due to legal challenges. The first legal death by assisted suicide came in March of this year.

Kitzhaber, a trained emergency room physician, told lawmakers that the Oregon law was approved after "an earnest and profound debate" on the merits and ethics of assisted suicide. He argued that any Congressional action which found the Oregon statute to be "unconscionable" should not automatically result in legislation such as the Istook-Nickels proposal, but instead an "explicit debate" on euthanasia.

"Don't intimidate and put at risk physicians when your true objective is in fact altering the choices available to terminally ill patients," declared the governor. He described the bill as "an unprecedented expansion of the federal government into the practice of medicine."

The president-elect of the American Medical Association struck a middle ground in the debate, saying that while the professional group opposed assisted suicide, it also disagrees with the thrust of the Hyde-Nickels bill. Dr. Thomas Reardon said that the proposed measure "would have a tremendous inhibiting effect" on the care of terminally ill patients, and that the use of federal Drug Enforcement Agency personnel to investigate cases may discourage doctors from using aggressive and needed pain management techniques.

Rep. Darlene Hooley (D-Ore.) warned that the bill threatens an intrusion by "big government" into the decision made by Oregon voters amidst heated, yet thoughtful debate. Four of Oregon's five representatives gave testimony criticizing the proposal as well.

A Strategy To Raise "Life Issues"

While the debate over physician assisted suicide is a complex one involving medical ethics, government power and other considerations, the issue is a clear political stalking horse for religious groups, including the Roman Catholic Church. The National Conference of Catholic Bishops has explicitly raised euthanasia (whether through self-termination or the assistance of others) as a "life issue" being linked to abortion and even questions about genetic research and engineering, and use of fetal tissue in fighting disease. All of this is in keeping with the constant references made by Pope John Paul II and ecclesiastical leaders which describe abortion rights and other practices, including physician-assisted euthanasia, as part of a "culture of death" abhorred by the Roman Catholic Church. And the Bishop's Conference is increasingly playing the role of political point-man in the efforts to enact favorable legislation; the group has condemned President Clinton for his veto of federal legislation to outlaw so-called "partial birth" abortions, a late term procedure.

A Complex Issue...

In 1997, the U.S. Supreme Court ruled unanimously that states could both prohibit or permit assisted suicide. On June 5, 2020, Attorney General Janet Reno allowed the use by doctors of federally regulated drugs to assist euthanasia in Oregon, saying that the Controlled Substances Act did not empower the government to take action against patients or doctors in those cases. That action overturned a decision by U.S. DEA czar Thomas Constantine, who last December claimed that the CSA did prohibit doctors from prescribing drugs such as barbiturates or morphine, in order to terminate life.

But other factors beside legal rulings enter into the debate over euthanasia and assisted suicide.

  • Euthanasia is sure to become more of an issue as the American demographic profile changes, and the population continues to "age." Analysts say that after ten years of holding the line on hospital and other care expenses, costs in the field are about to explode. People debate the grim possibility of "rationed" health care, and whether or not terminally ill patients will feel pressure -- either self-imposed, or from relatives and others -- into choosing unwanted suicide. Lisa Gigliotti of the Michigan Protection and Advocacy Service, a lobbying organization for people with disabilities, warns, "People who are sick already feel that they are a financial and emotional burden to their families and society."

    Laurence Tribe, professor of constitutional law at Harvard University, though, takes a different approach, and claims that those fears are exaggerated. "There are far greater economic pressures on patients who must maintain expensive life-sustaining treatment than on those forced to endure painful, drawn out illnesses where no such therapy is available," Tribe informed the New York Times. "And there is no evidence that people in those situations are being pushed to withdraw treatment because of the high cost."

  • When does euthanasia or assisted suicide (especially involving medical professionals) shift from being a "last resort" to one of a palette of options in a treatment arsenal? What guidelines would need to be in place, so that the "right to die" is not interpreted as an obligation to commit suicide? Are clergy, drug agents or even government representatives capable of establishing these guidelines?

  • Rep. Tom Coburn (R-Okla), said in last week's hearing that the discussion over physician assisted suicide is a "matter of what the profession of medicine is all about... This is the beginning of a very, very slippery slope downward." But is that true? Coburn also argued, "There is no right to death in our society. There is a right to life." Given that assertion, though, the "slippery slope" argument would require Coburn and other political or religious conservatives to oppose the government death penalty, a practice which few are willing to take a stand against, and many even support. While the Roman Catholic Bishops have mentioned the death penalty as one of their "life issues," most Protestant evangelicals and fundamentalists, including the more conservative groups such as Christian Coalition, remain firm supporters of the death penalty. So, where and under what circumstances does the "slippery slope" argument really apply?

  • Is the Oregon referendum essentially a government or social sanction of suicide? Herbert Hendin, professor of psychiatry at New York Medical College, testified that "Sanctioning assisted suicide -- and permitting the use of controlled substances for assisted suicide is sanctioning the practice -- should not be permitted because it would markedly worsen the care we provide to terminally ill patients." Critics of the Istook-Nickels proposal, however, argue that the Oregon referendum and similar proposals legalizes the option of self-termination, and is distinct from any hypothetical legal compulsion which would require euthanasia under legal penalty.

  • Whatever the ethics of euthanasia and physician-assisted suicide may be, is the Istook-Nickels bill an example of "bad law" and an unworkable, even dangerous effort that would create rather than solve legitimate problems? It may be. Dr. Reardon of the AMA warned of a possible "chilling effect" on doctors who treat terminal patients in pain. Are federal drug agents able to accurately gather and evaluate evidence in suspected cases of doctor-assisted suicide? And how anxious should we be to "federalize" this complex problem?

Pending further hearings, the Lethal Drug Abuse Prevention Act will remain in the Judiciary Committee awaiting a vote before possibly heading to the full House.


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