Dying made easy

National Review, Nov 4, 1991 by Thomas W. Case

THIS ELECTION season, residents of Washington state are seeing some unusual ads. In one, a young girl is sobbing outside an intensive-care unit, plaintively crying, "My father never thought he'd have to die this way." He is inside, comatose, festooned with a complex web of IV tubes snaking from mouth and nose, nearly buried under a mass of hightech medical machinery. The ad urges voters to pass Initiative 119, which would make Washington the only place in the world where active euthanasia was sanctioned by law.

Leading the way for Initiative 119 is Washington Citizens for Death with Dignity. This PAC is run by the Hemlock Society, a formerly geriatric group that has boomed in recent years. It was properly front-page news when Final Exit, by Hemlock founder Derek Humphry, hit the New York Times best-seller list; rarely mentioned is the fact that the book's sales and the Society's boom are fueled by the rash of debilitating, disfiguring illnesses associated with the AMS virus. Dr. Robert W. Wood, director of the AIDS Control Program in the Seattle Department of Public Health, welcomes Initiative 119 "because it is my duty to serve my patients' best interests, and if they are competent they know their interests better than I can."

Opposition to the measure has coalesced gradually, as various organizations look more closely at the proposed changes. Another PAC, called 119 Vote No!, represents some 21 organizations, including the state branch of the American Medical Association, the state Hospital Association, and the state Catholic Conference. The director of 119 Vote No! is Eileen Brown, a registered nurse who is experienced in hospice care for the poor and has taught nursing and medical ethics in West Africa.

Her most important point is that the state's 1979 Natural Death Act already allows the withholding of extraordinary life support as directed by a "Living Will." Under the guise of making a "dignified" death a "fundamental right," Initiative 119 would make a number of radical, and undignified, changes. It redefines "artificial means of prolonging life" to include feeding tubes, sanctioning the grotesque practice (on the rise nationally) of starving comatose or helpless patients to death.

The new law would also allow doctors to give "aid in dying," which all parties understand to include lethal injections, to terminal patients (those whom two doctors diagnose as having six months to live), provided the patient has indicated his desire generally in advance via a Living Will, and specifically at the time of the ... procedure.

Initiative 119 also replaces the old Living Will with a Directive to Physicians which contains a flaw through which lawyers are sure to drive a truck-or a hearse. One section of the Directive allows advance authorization of a) removal of life support, and b) doctor-assisted suicide. The next section allows advance authorization of these measures if the patient is unable to ask for them, "such as while in an irreversible coma or persistent vegetative state." Leaving aside the many documented recoveries from such states, lawyers will certainly use this to argue for the "mercy killings" of comatose patients who have checked the appropriate boxes on the form.

Advertisements for 119 routinely and firmly claim that "aid in dying" can be administered only to a "conscious and mentally competent" patient. Eileen Brown's job is to make Washingtonians aware of the vagueness of the law despite the deceptiveness of its proponents.

Although cloaked in the rhetoric of "dignity," legalized euthanasia opens some troubling doors. Dr. Robin Bernhoft, a surgeon and head of Physicians against 119, worries that a two-tier system could develop, where people who have health insurance would receive pain killers and those who do not would get a different form of treatment: "Do you give transcutaneous fentanyl to bank employees and lethal injections to the poor?" He also doesn't want to be in a position where, though the law says no doctor need give "aid in dying," he is nonetheless pressured to do so. An intelligent person can commit suicide on his own," he says. You don't need a doctor to do it. There's no reason to corrupt the medical profession."

Albert R. Jonsen, chairman of the Department of Medical History and Ethics at the University of Washington, warns that "it is not enough to assert that this new form of private killing rests on an inherently moral motive, compassion. Similarly, it is not enough to assert that the voluntary request of the recipient of aid in dying renders it morally acceptable." A patient could be coerced into exercising his "fundamental right to death with dignity" under 119: "The coercion may be subtle and unspoken, but families, distressed by their relative's illness, may hint at it as a way out. Patients may feel that they are undue burdens on their families and so should remove themselves."

And then there was Helga Wanglie. Severely injured in an accident at the age of 86, she lay in a coma for 17 months while administrators and physicians at Hennepin County Medical Center in Minneapolis urged her husband to consent to a mercy killing. 01iver Wanglie refused, repeatedly and vehemently, on grounds that included Helga's religious beliefs. The hospital finally sued for the appointment of a conservator who would consent to euthanasia. Three days after state probate magistrate Patricia Belois rejected the suit and ruled in Oliver Wanglie's favor, Helga died of "natural causes.