Compassion Can Kill You

In an otherwise unpredictable political world, one thing you can count on (in addition to more government and higher taxes) is that proponents of assisted suicide and euthanasia will persist in their efforts to change the law, no matter how often they are rebuffed.

Thus far, they have little to show for their labors, their principal achievement being the 1997 Oregon initiative that enacted the nation’s first and only assisted-suicide law. Although legislators or voters in other states have repeatedly rejected efforts to imitate the Oregon model, assisted-suicide advocates are back at it in the state of Washington,trying to gather enough signatures to place an Oregon-style measure on this November’s ballot.

Meanwhile, in California, having failed four times in as many years to enact an assisted-suicide statute, two members of the Assembly, Patty Berg and Mel Levine, have come up with a new proposal, Assembly Bill 2747, the so-called “Right to Know End-of-Life Options Act.” Instead of an overt, frontal assault against laws that protect vulnerable patients, Berg and Levine decided this time around to launch their assault by creeping in on little cat feet. I don’t know about you, but whenever I encounter a bill with a title like theirs, my first inclination is to pack the family off to Aunt Maisie’s, lock up the silverware, and double-bolt the doors. Sure enough, you don’t have to wander very far into the details of A.B. 2747 before discovering that it would do little by way of expanding “options” and “the right to know” but a lot when it comes to easing terminally ill patients out of this world.

It does this in the first instance by expanding the definition of what constitutes a diagnosis of “terminal illness,” which under the bill’s terms could be no more than a doctor or a nurse opining that a patient has “a year or less to live.” Once that judgment is made, the patient would then be offered access to information and counseling about end-of-life care as well as a menu of treatment choices, including terminal sedation and VSED (voluntary stopping of eating and drinking). These treatments are currently and properly reserved for patients in the actual process of dying, when death is truly imminent. You begin to appreciate the true purpose of A.B. 2747 when you realize that these final-stage palliative measures would for the first time be extended to those who are yet a long way from their final days. As for information and counseling, the bill would expand the list of eligible providers to include advocacy organizations that favor assisted suicide. Put all of these elements together, and what you get is a slow-walk toward assisted suicide in the name of expanding patient “options.”

The bill purports to expand patient autonomy. But very ill patients who have just received a diagnosis of terminal illness, especially if they are poor, are among the least autonomous people in the world. Understandably, they can and often do become depressed and confused, and they are particularly vulnerable to suggestions that living out the rest of their lives may be burdensome or expensive to family, or that the only way to avoid unendurable pain is to ask for terminal sedation and VSED as soon as possible. And, as anyone who’s had to wrestle with health-care providers and insurers will tell you, there’s a whole cadre of bean-counters who are only too ready to encourage patients in that direction.

Proposals like A.B. 2747, which acquire their emotional appeal by stirring compassionate instincts, rest on a series of false assumptions. It’s a myth that large numbers of people are kept “artificially” alive at great and useless expense. It’s a myth that the only way to avoid pain and suffering at the end of life is through terminal sedation and/or VSED. It’s a myth that counselors who come recommending hemlock to patients in distress are necessarily doing them a favor. And it’s a myth that patients’ decisions made under emotionally or physically stressful circumstances are always freely made.

A.B. 2747 recently passed the California Assembly and is now being marked up before heading to the Senate floor. If it passes in our trend-setting, largest state, it will be widely imitated elsewhere. Reports indicate that some of its more obnoxious provisions (such as allowing VSED treatment in the early stages of a terminal diagnosis) have been altered or eliminated by the Senate Health and Judiciary Committees. Let us hope that is the case, but the wisest course of action would be to ensure that this legislation is terminally sedated.

Michael Uhlmann (1939-2019) served in the Reagan White House and taught American politics at the Claremont Graduate University.