Former Vermont governor and physician Howard Dean touts his medical experience as a reason to support his run for the presidency -- and well he should. Medicine is a noble calling -- when, that is, doctors adhere to "Do no harm" values. Unfortunately, Dean's recent support of assisted suicide and euthanasia shows that he apparently doesn't believe in the Hippocratic values that have served doctors and their patients so well for 2,500 years.
The Hippocratic Oath requires physicians to protect the lives and welfare of their patients and "keep them from harm and injustice." Toward this end, the Hippocratic doctor pledges, "I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect." Given this venerable history, it is unsurprising that nearly every medical professional organization in the world opposes legalization of euthanasia assisted suicide -- including the World Medical Association, the American Medical Association, and all but a couple of state medical associations.
There are exceptions to this general rule, of course, most notably the Dutch Medical Association. But look where Dutch doctors' abandonment of Hippocratic medicine has led their country: Not only do doctors in the Netherlands kill terminally ill people who ask for it, but they do the same for chronically ill people, disabled people, and depressed people who aren't physically ill too. Moreover, patients who do not ask for euthanasia are almost routinely dispatched -- and rarely with any legal or professional consequences. This includes babies born with birth defects based on quality-of-life determinations (eugenic infanticide) and approximately 1,000 patients a year who are lethally injected even though they have not asked to be euthanized. (The Dutch even have a term for non-voluntary euthanasia; they call it "termination without request or consent.")
But the clear dangers associated with euthanasia seem to matter little to Dean. When asked by a reporter for Oregon Public Broadcasting, "In general where do you stand on physician-assisted suicide and Oregon's vote on that issue?" Dean replied:
I think states have to make up their own mind. It's a very difficult moral problem. I as a physician would not be comfortable administering lethal drugs, but I think this a very private, personal decision and I think individual physicians and patients have the right to make that private decision. I am very amused by the Right Wing -- including the president and administration -- who talk about liberty but then decide they're going to scrutinize everyone's behavior and tell them what they can and cannot do. There can't be a much more personal decision an individual makes than how to die and I think that is a personal decision left to individuals, their physicians and families.
Pay close attention to the words Dean uses. He not only agrees with assisted suicide but appears to support doctors being allowed to personally administer lethal drugs (i.e., active euthanasia) -- an act that even the radical Oregon assisted-suicide law currently prohibits.
Jack Kevorkian must be bursting with pride that the putative frontrunner for the Democratic presidential nomination agrees so wholeheartedly with his euthanasia philosophy. Both Dean and Kevorkian are physicians (though Kevorkian lost his license to practice). They both believe administering lethal drugs should be merely a matter of personal decision-making among physicians, patients, and families. Indeed, Dean espouses views virtually identical to Kevorkian's when he told the OPB interviewer that opposition to voluntary euthanasia is a matter of the "right wing" telling people "what they can and cannot do."
This is bunk, of course. "Right-wingers" are far from the only opponents of assisted suicide/euthanasia. Moreover, support for medicalized killing flies directly in the face of Dean's supposed liberal positions on other issues.
Take civil rights. The disabled are among the most discriminated-against people in our society. Many disabled people are poor and must rely on Medicaid, resulting in their often experiencing profound difficulties gaining access to quality medical care. Frequent studies have shown that lack of adequate health care can lead to suicidal ideation. Moreover, disability-rights activists report that the value of disabled patients' lives are so discounted by some medical professionals that they are sometimes pressured to sign do-not-resuscitate orders (DNRs) -- even when being treated for non-life-threatening conditions.
It is in this context that the disability-rights community almost unanimously opposes legalizing assisted suicide/euthanasia. In an amicus brief filed in the U.S. Supreme Court opposing a constitutional right to assisted suicide, the disability-rights advocacy group Not Dead Yet put it this way: "Discrimination against people with severe disabilities pervades our society. Assisted suicide is the most lethal form of such discrimination. Applied only to people with significant health impairments, assisted suicide is the ultimate expression of society's fear and revulsion regarding disability."
Dean decries the problem of tens of millions Americans being unable to afford medical care because they have no health insurance. He is also a vocal critic of HMOs and managed health care -- under which profits are made from cutting costs, which sometimes has meant cutting the quality of care. Legalizing and legitimizing suicide and euthanasia would mean surrendering to these problems rather than solving them.
Consider this: The drugs to carry out an assisted suicide cost only about $40. But it could cost $40,000 to treat the same patient properly so that he or she doesn't want assisted suicide. The economic forces that would be unleashed if killing became merely another medical treatment could be devastating to the very people Dean claims are being victimized by inadequate access to health care. After all, what "treatment" could be cheaper than medicalized killing for those without insurance, or for the most expensive patients?
Indeed, should euthanasia ever become socially legitimized and commonly practiced by doctors, life termination as a "final treatment" could come to be viewed as a splendid form of cost control. Even assisted-suicide guru Derek Humphry, founder of the Hemlock Society, acknowledges this, writing in his book Freedom to Die: "Economic reality [...] is the main answer to the question, Why [legalize euthanasia] now?"
Dean boasts proudly of his record fighting against "domestic violence" during his terms as Vermont's governor. He is certainly right about the seriousness of the problems associated with family dysfunction and elder abuse, both of which are rife in our society. Unfortunately, when the issue of assisted suicide and euthanasia comes up, proponents like Dean immediately divorce themselves from these realities, envisioning patient-killing as something that would be conducted only idyllically, by deeply caring doctors who make house calls and loving families whose first, last, and only concern is the well-being of their disabled or dying relatives. The reality, however, is that euthanasia would inevitably involve issues of family coercion, guilt about burdening loved ones, family discord, abuse, and the desire for inheritance and the proceeds from life insurance. How can this self-proclaimed champion of the weak and vulnerable -- who is alert to abuse in other contexts -- be so blind to the realities of medicalized killing?
Jack Kevorkian's career clearly illustrates these dangers. One of his earliest victims, who had multiple sclerosis, decided she wanted assisted suicide after her husband abandoned her, took their children, and forced her to live with elderly parents who she worried were being burdened by the rigors of her care. Another woman was brought to Kevorkian for assisted suicide by her husband only two weeks after she had accused him, to police, of spousal abuse. (Her autopsy detected no signs of illness.) In another case, the woman who brought a suicidal disabled friend to Kevorkian inherited $500,000 after the resulting assisted "suicide."
Then there is the Kate Cheney case in Oregon. According to reporting by the Oregonian, Alzheimer's and terminally ill cancer patient Kate Cheney was assisted in suicide despite a psychiatrist reporting that she did not have the mental capacity to make a rational decision -- and his determination that the driving force behind the proposed life termination was not Cheney, but her daughter.
That should have been the end of it. Instead, Cheney's HMO authorized another mental-health review, this time by a clinical psychologist rather than an M.D. psychiatrist. Like the first psychiatrist, the psychologist found that Cheney had significant memory problems, such as not being able to recall when she had been diagnosed with cancer. The psychologist also worried about family pressure, writing that her decision to commit suicide "may be influenced by her family's wishes." Still, despite these reservations, the psychologist determined that Cheney was competent to elect assisted suicide.
The final decision to approve the lethal prescription was made by a Kaiser Permanente Northwest administrator/ethicist. Cheney told him she wanted the lethal prescription not because of pain, but because she was worried about not being able to attend to her personal hygiene. Satisfied that Cheney was qualified, under the law, for the lethal prescription, the administrator okayed the assisted suicide. Even then, Cheney only took the poison pills on the very day she returned home after having been sent to a nursing home for a week.
Assisted suicide/euthanasia is bad medicine and even worse public policy, exposing the most weak and vulnerable among us to the ultimate abuse. Moreover, opposition to assisted suicide is not "right wing" but broad-based. One can obviously be politically liberal and remain ideologically consistent in opposing assisted suicide -- disability-rights activists, for example, are almost all on the left; Ralph Nader, who is hardly a conservative, announced his opposition to legalizing assisted suicide during his 2000 Green-party presidential campaign.
Howard Dean's support for assisted suicide/euthanasia strikes at the very heart of the compassionate, liberal values to which he claims to be devoted. He needs to rethink his position. He should adhere to the venerable principles of Hippocratic medicine that have served humankind for millennia.
Wesley J. Smith is a senior fellow at the Discovery Institute and an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide. His revised and updated "Forced Exit: The Slippery Slope From Assisted Suicide to Legalized Murder" was recently published.
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