When Vermont became the first state to legalize physician-assisted suicide through the legislature in summer 2013, I predicted here at Public Discourse that proponents would more aggressively target other New England states to spread their agenda in 2014. Therefore, it was not surprising that New England faced a powerful onslaught of voluntary euthanasia bills within the past few months, particularly in New Hampshire and Connecticut. While New Hampshire overwhelmingly voted down the proposal by a margin of 219 to 66, Connecticut legislators allowed the bill to die a quiet death in committee.
I was among the last of over 100 witnesses to testify on the Connecticut bill in a hearing that lasted over ten hours. At the hearing, I observed the latest strategies employed by euthanasia advocates to sell suicide to the catastrophically ill. These can be ultimately whittled down to two primary strategies: first, wordplay that attempts to soften the truth about assisted suicide; and second, false dilemmas, which suggest that suicide is inevitable and that death by poison is preferable to other methods.
Sanitizing Suicide: Killing as Compassion
Physician-assisted suicide advocates learned in the early days of their crusade that people do not like the word “suicide.” Prior to Vermont, states that decriminalized the practice did so through carefully crafted ballot initiatives that glossed over the academic literature and its concerns about state-sanctioned killing. These campaigns used clever slogans to suggest that assisted suicide is a positive act, a personal choice, and a matter of compassion for the dying. The Hemlock Society even rebranded itself, changing its name to Compassion & Choices. This suggests that offering an ill person poison is compassionate and that suicide is a legitimate choice for persons with terminal diagnoses. Word choice is critical: a 2013 poll showed a steep 19-point difference when people were asked if they support “assisted suicide” rather than “ending a patient’s life.”
Although the act is the same, the perception of euthanasia is shrewdly euphemized as “aid in dying” or “death with dignity” to make what is tragic and cruel appear helpful, empowering, and even compassionate. Conversely, such euphemisms imply that pain control and palliative care are somehow lacking in empathy.
The organization now known as Compassion & Choices condemns the term assisted suicide, insisting that there is a distinction between taking one’s life when mentally competent and terminally ill, and taking one’s life due to depression when not facing a terminal illness. Again, this glosses over the academic literature that shows the extent of untreated depression among those seeking such “aid in dying” and the failure to refer for mental health evaluations in other states that have legalized this practice.
By “aid-in-dying” standards, as long as a person has a prognosis of fewer than six months to live, regardless of the accuracy of that prognosis, it is not suicide for that patient to choose “death with dignity.” This, of course, disregards the number of physicians who misdiagnose patients as terminal who may have years to live. Pro-euthanasia groups claim that suicide chosen by those with mental illness ought to be prevented, yet they argue that suicide for those with physical illnesses is a right that others must support.
Unlike abortion advocates, who employ the word “choice” and shy away from the word “death,” voluntary euthanasia proponents do not recoil from the words “death” and “dying.” Instead, they try to present assisted suicide as a positive form of death; the phrase “death with dignity” implies that natural death is undignified. “Aid” and “dignity” are positive terms, like the appeal to autonomy implicit in the mantra “My Life. My Death. My Choice.”
All of this rhetoric conceals the substance of what is being chosen: suicide. It seems that euthanasia advocates know that most people naturally believe that taking one’s own life is a tragedy of those without hope.
A False Dilemma: ‘tis better to die by poison than pistol
The voluntary euthanasia advocates appear to recognize that sanitizing suicide can only go so far. Therefore, many abandon the soft approach and resort to shock value. Those who might see through the “death with dignity” rhetoric and oppose euthanasia are bombarded by tales of violent suicides and traumatized survivors.
Testimony in favor of assisted suicide in Connecticut included horrifying accounts of those who committed suicide without “aid in dying.” These stories emphasized the suffering that persons' suicide inflicted on themselves and their loved ones. One pro-euthanasia witness recounted a story about a desperate spouse who tried to stab himself to death with a pair of scissors and another story about an ailing parent who was killed when an adult child slipped a plastic bag over the parent’s head.
These are horrific stories, to be sure. In this context, however, they were brandished as desperate attempts to suggest that it would have been better for these people simply to die of poisoning. Natural death was not mentioned as an alternative. Likewise, suicide was not presented as a hopeless and tragic act, regardless of the manner of death. On the contrary, the witnesses assumed that suicide was an acceptable option, as long as the method used was not particularly “messy.” The witnesses suggested that those who wish to die prematurely should have an easier method with which to take their own lives.
The goal was to suggest that suicide is inevitable and that the only choice is between desperate, brutal suicide and “dignified,” professionally aided suicide. This is, of course, a false dilemma. No person is forced to take his or her life when facing a catastrophic prognosis.
The false dilemma approach is a logical fallacy, commonly used to promote a supposed “lesser of two evils”: an action that is neither palatable nor desirable on its own merit, but merely preferable to an inevitable worse option. Those testifying in favor of assisted suicide very rarely acknowledged natural death as a valid alternative to artificial death. Some went so far as to suggest that continuing to live was worse than suicide. Accounts of manageable pain were absent, supplanted by stories of people who feared the loss of their ability to live independently and worried that they would become a burden on their family. Sadly, when “aid in dying” is offered, many patients feel coerced and pressured into a choice that is not freely made at all.
While waiting to testify, I had conversations that reminded me of one of the greatest dangers of assisted suicide: enabling patient neglect. I talked with a woman in support of assisted suicide who was a patient advocate for better palliative care. We bonded over our mutual conviction to ease suffering, and she disclosed that her support of voluntary euthanasia came from watching her late husband endure unnecessary anguish at the end of his life due to poor palliative care. She admitted that it was not a situation where pain control was inadequate (as there were medicines to ease his pain); it was that these medicines were not provided as they should have been. She was supporting death only as an alternative to the unnecessary suffering of medical neglect, not so that assisted suicide might decrease the quality of care for those who did not want to take their lives.
I stated that I was fearful that assisted suicide actually encourages or enables the kind of suffering her husband faced, since it offers a quicker, cheaper alternative to pain control that insurance companies have been shown to favor. It was clear that she did not want to pressure her husband to commit suicide: she just did not want him to suffer. I assured her that neither do I, and, although she did not change her position, we hope to work together to help patients obtain acceptable pain control.
I am convinced that much of the public support for assisted suicide truly is coming from a concern for compassion, but compassion cornered by desperation from lack of proper care. It is critical that we make clear that the best thing for suffering patients is to end the suffering—not the patient.
The committee was required to hear more than just emotional appeals and clever softball semantics by professional pro-euthanasia lobbyists. Experts were able to share study after study that show the dangers of legalized, state-sanctioned suicide. I was among a host of medical professionals, disability rights advocates, and bioethicists who sliced through semantics to show the clear dangers of voluntary euthanasia and call for an end to death as an alternative to true compassionate care. There is care to ensure comfort at the end of life, and it is a human moral duty that we not deny it.
Ultimately, in spite of petitions, anecdotes, and evidence presented both in favor of and against voluntary euthanasia, the legislative committee in Connecticut ultimately chose to run out the clock on the bill. However, many committee members were sympathetic to assisted suicide, and proponents of the euthanasia bill will return next session. Sadly, I was also present in New Jersey during the first week of June and witnessed, in spite of compelling testimony, the Committee on Health and Senior Services vote in favor of releasing a bill that would legalize physician-assisted suicide, even without any witnesses at death.
Now is the time for renewed vigilance for those who oppose euthanasia. The worst of this battle for life in New England may be yet to come.
Jacqueline C. Harvey, PhD, a bioethicist whose research focuses primarily on end-of-life legislation, is an Associate Scholar at the Charlotte Lozier Institute.