385 Ballot initiatives: After the bills including provisions for both physician-assisted suicide and voluntary euthanasia had been defeated in California and Washington, Oregon dropped voluntary euthanasia from its proposed bill to maximize the chances of its passage.
386 “For many people”: D. Colburn, “Fewer Turn to Assisted Suicide,” Oregonian, March 11, 2005. The Oregonian has provided the most detailed coverage of the Death with Dignity Act.
386 “I don’t know if I’d ever take it”: D. Colburn, “Assisted Suicide Advocate Dies at 79,” Oregonian, October 28, 2003.
386 deaths have been gentle: The stories of Oregonians who have used the Death with Dignity Act are taken mostly from Lee, Compassion in Dying. An exception is the story of the fifty-four-year-old former health care worker, which was taken from J. Estrin, “In Oregon, Choosing Death Over Suffering,” New York Times, June 1, 2004, F4. The story of Peggy Sutherland is taken both from Lee, Compassion in Dying, and from a lovely piece by Todd Schwartz, “A Death of Her Choosing,” Oberlin Alumni Magazine,Summer 2003, www.oberlin.edu/alummag/summer2003.
388 not always foolproof: In some 18 percent of physician-assisted suicides in the Netherlands, patients lived more than three hours after taking the lethal dose; doctors usually intervened with a lethal injection—a practice that would, of course, be illegal in Oregon.
389 “To confine legalized”: Humphry and Clement, Freedom to Die, 336.
389 one country: In 2002, Belgium became the second country to legalize physician-assisted suicide and voluntary euthanasia. In 1996–97, voluntary euthanasia was legal for nine months in Australia’s Northern Territory, a rural area where little palliative care is available; four people were given lethal doses of medications before the territorial law was overturned by Australia’s national parliament. In Switzerland, assisted suicide (but not euthanasia) has long been permitted, by doctors and laypeople alike, if done for “altruistic purposes.” There is evidence that more than a few people have traveled to Switzerland for the express purpose of receiving assisted suicide.
Chapter II “Your Good End in Life Is Our Concern!”
392 “There is only one prospect worse”: A. Koestler, in Exit: A Guide to Self-Deliverance, preface, 3.
395 the formation of the Hemlock Society: Hemlock is one of forty-six right-to-die societies in twenty-three countries from Australia to Israel to Zimbabwe. Although most societies share a common goal—to guarantee people the right to choice in their own death—the groups disagree on the lengths to which they will go. The groups range from those that favor only passive euthanasia to those that wish to legalize assisted suicide and voluntary euthanasia.
399 by writing Final Exit: Quotes from this and the following two paragraphs are from Humphry, Final Exit.
400 deaths by plastic bag: P. M. Marzuk et al., “Increase in Suicide by Asphyxiation in New York City After the Publication of Final Exit,” New England Journal of Medicine 329 (20) (1993): 1508–10; and P. M. Marzuk et al., “Increase in Fatal Suicidal Poisonings and Suffocations in the Year Final Exit Was Published: A National Study,” American Journal of Psychiatry 151 (1994): 1813–14.
400 “This misuse I regret”: D. Humphry, Final Exit, 3rd ed. (New York: Dell, 2002), xv.
401 no one had ever written: A few books and pamphlets have tackled the subject in a darkly comic mode, most notably 21 Delightful Ways of Committing Suicide, written and illustrated by Jean Bruller and published in the United States in 1930.
401 “It is the sovereign right”: Guide to Self-Deliverance, 31.
402 “I feel no remorse”: Boston Globe, September 20, 1982.
404 a fatal overdose: The story of Wickett’s death is told in Deadly Compassion by Rita Marker, an antieuthanasia activist who had debated Humphry over the years. Surprisingly, after Humphry left her, a distressed Wickett turned to Marker, and they became friends. According to Marker, Wickett came to believe that legalizing physician-assisted suicide or voluntary euthanasia would be a mistake, because it might coerce vulnerable, elderly people to seek a premature death. Wickett believed her mother had not, in fact, wanted to die, but had felt subtle pressure from her father to go along with him. Marker, Deadly Compassion, 213.
406 “Compassion is not an advocacy”: Michaele Houston in Coombs Lee, Compassion in Dying, 50. For my description of Compassion in Dying’s work I have relied heavily on this book, and on B. C. Lee, “A Model That Integrates Assisted Dying with Excellent End-of-Life Care,” in Quill and Battin, Physician-Assisted Dying, 190–201.
407 launched Caring Friends: The description of the Caring Friends program comes from several Web sites, including www.endoflifechoices.org; from R. Marker, “Patience and Plastic Bags,” Human Life Review, Spring 2003; and from a speech by Dr. Richard MacDonald, “The Caring Friends Program—Five Years of Peaceful Dying,” delivered at a picnic in Milwaukee, as reported in an End-of-Life Choices chapter newsletter, vol. 14, no. 3, http://communities.madison.com/endoflifechoiceswis.
408 “This isn’t rocket science:” Marker, “Patience and Plastic Bags.” The description of the Exit Bag is also taken from this article.
408 “the helium makes the voice”: “Helium,” Hemlock Timelines 83 (Spring 2000): 12.
408 “I’m sort of a midwife”: Marker, “Patience and Plastic Bags.”
410 “If you can’t get your sulfuric acid”: Age, May 31, 2003, www.theage.com.au/articles/2003/05/31.
412 “Then—the highlight of the weekend”: “Network Trains 15 Exit Guides in St. Louis!” Final Exit Network Newsletter, vol. 1., no. 1, www.finalexitnetwork.org/newsletter.
412 “We have 33 cases”: “We Are ‘Transparent,’ “ Final Exit Network Newsletter, vol. 1, no. 2, www.finalexitnetwork.org/newsletter.
Chapter III “The Limits Are Obscure . . . and Every Errour Deadly”
415 “whether it was logical”: Mannes, Last Rights, 62–63.
415 “It seems unimaginable”: Fletcher, Morals and Medicine, 193.
415 “Their argument turns”: Battin, Ethical Issues in Suicide, 179.
415 interferes with God’s will: In 1847, when ether was first used in the delivery room, many people protested that labor pains were divinely ordained and to use anesthetics went against God’s will.
415 “If it is for God alone”: J. Rachels, The End of Life: Euthanasia and Morality (Oxford: Oxford University Press, 1986), 163.
415 “Human life consists”: Mannes, Last Rights, 141.
416 “When life is more terrible”: Choron, Suicide, 78.
416 “The final stage”: Maguire, Death by Choice, 151.
416 “Even if this is true”: Seneca, “Letter to Lucilius, No. 70,” in The Stoic Philosophy of Seneca, trans. M. Hadas (Gloucester, Mass.: Peter Smith, 1965), 203.
416 forty-four-year-old Maryland woman: People, October 13, 1986, 43–44.
417 “People say they want”: T. Schwartz, “A Death of Her Choosing,” Oberlin Alumni Magazine, Summer 2003, www.oberlin.edu/alumnimag/summer2003.
417 In 1919, German psychiatrist: A year later, Hoche coauthored The Permission to Destroy Life Unworthy of Life.
417 Richard Brandt compared: R. Brandt, “The Rationality of Suicide,” in Battin and Mayo, Suicide, 117–32.
418 described six cases: Jackson and Youngner, “Patient Autonomy.”
418 “How free or informed”: L. R. Kass, “ ‘I Will Give No Deadly Drug’: Why Doctors Must Not Kill,” in Foley and Hendin, Case Against Assisted Suicide, 24.
418 uncompleted suicide pacts: M. Rosenbaum, “Crime and Punishment: The Suicide Pact,” Archives of General Psychiatry 40 (1983): 979–82. See also Fishbain et al., “A Controlled Study.”
418 emotionally coerced: If Koestler is to be blamed, however, the blame must be not for his wife’s death but for her life. “A good man would have weaned her,” wrote Barbara Grizzuti Harrison. “. . . I think it’s fair to say he killed her.” But to call Koestler a murderer seems as patronizing and demeaning to Cynthia as her husban
d may have been, denying her any volition of her own. “For a man in grave and failing health, self-deliverance was the final right,” wrote Hemlock Society cofounder Ann Wickett. “For Cynthia, it was the final act of devotion. That too was her right. One regrets, however, less the nature of her death, than the nature of her life. She deserved more.”
419 “She was his appendix”: A. Wickett, “Why Cynthia Koestler Joined Arthur,” Hemlock Quarterly, January 1985, 4–5.
419 “It is hardly an exaggeration”: Ibid.
419 “Some writers opposed”: M. P. Battin, “Suicide: A Fundamental Human Right?” in Battin and Mayo, Suicide, 279.
419 “Activists draw”: A. Solomon, Noonday Demon, 268.
419 suicide prevention experts are sympathetic: Some may describe it as something other than suicide. “We need not argue the issue of whether it is rational for an individual with a painful terminal illness to refuse extraordinary life-saving measures or to arrange more actively to end his life,” writes Herbert Hendin (Suicide in America, 214–15). “. . . The person facing imminent death who is in intractable pain and arranges to end his life may be a suicide in the dictionary definition of the term, but not in the psychological sense.” Many others in the field object to the right-to-die movement, while reserving the right to an assisted death for themselves. “I believe in suicide prevention, but I have Alzheimer’s in my family, and I’m fearful of death without dignity,” a leader in suicide prevention told me. “If you’re incompetent, they keep you from killing yourself. Well, the point at which I want out is when I lose competence. I have made a suicide pact with two of my sisters.” Edwin Shneidman participated in the initial Hemlock think tank and delivered the keynote address at Hemlock’s 1985 national conference. “I like Derek Humphry and I approve of what he does,” he told the audience. “But I’m not a card-carrying Hemlock member, and I maintain some substantial differences with the goals of the organization.” A friend of Shneidman’s interprets: “Ed doesn’t believe in rational suicide—except for himself.”
420 “From an intellectual standpoint”: Seiden, “Self-Deliverance or Self-Destruction?”
420 “Physician-assisted suicide is mistakenly understood”: D. Callahan, “Reason, Self-determination, and Physician-Assisted Suicide,” in Foley and Hendin, Case Against Assisted Suicide, 60.
420 “the limits are obscure”: Donne, Biathanatos, 216.
421 oft-quoted 1949 essay: L. Alexander, “Medical Science Under Dictatorship,” New England Journal of Medicine 241 (2) (1949): 39–47.
421 “I think there is no way”: Quoted on “Rational Suicide?” produced by Barry Lando for 60 Minutes, CBS-TV, October 12, 1980.
422 “Once any group”: Humphry and Wickett, Right to Die, 164.
422 “Miss Voluntary Euthanasia”: Y. Kamisar, “Euthanasia Legislation: Some Non-Religious Objections,” in Downing, Euthanasia, 115.
422 “I have seen the true wish”: Wallace and Eser, Suicide and Euthanasia, 102.
422 “Where is the sense”: Humphry and Wickett, Right to Die, 313.
422 government-sponsored study: The studies were summarized in P. J. van der Maas et al., “Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995,” New England Journal of Medicine 335 (1996): 1699–1705.
422 a slippery crevasse: Criticism of the Dutch program can be found in Hendin, Seduced by Death; H. Hendin, “The Dutch Experience,” in Foley and Hendin, Case Against Assisted Suicide, 97–121; Jochemsen and Keown, “Voluntary Euthanasia Under Control?”; J. Keown, “Some Reflections on Euthanasia in the Netherlands,” in J. C. Willke et al., Assisted Suicide and Euthanasia, Past and Present (Cincinnati: Hayes Publishing Company, 1998). See also H. Hendin, “Suicide, Assisted Suicide, and Euthanasia,” in Jacobs, Harvard Medical School Guide, 540–60.
424 “Virtually every guideline”: H. Hendin, “Summary for Congressional Subcommittee on the Constitution. Suicide, Assisted Suicide and Euthanasia: Lessons From the Dutch Experience,” http://www.house.gov/judiciary/2169.htm.
424 “The man, afraid of being left”: Hendin, “Dutch Experience,” 109.
426 “Given legal sanction”: Ibid., 117.
426 “It may be more than ironic”: Hendin, “Summary for Congressional Subcommittee.”
427 “I am concerned”: B. Steinbock, “The Case for Physician Assisted Suicide: Not (Yet) Proven,” Journal of Medical Ethics 31 (2005): 235–41.
427 a woman in her mideighties: The case of the first patient is described in E. Hoover and G. H. Hill, “Two Die Using Oregon Suicide Law,” Oregonian, March 26, 1998, A1. Criticism of the case can be found in, among others, K. Foley and H. Hendin, “The Oregon Experiment,” in Foley and Hendin, Case Against Assisted Suicide, 144–74. Also in Steinbock, “Case for Physician Assisted Suicide.” Compassion in Dying’s senior medical adviser offers a spirited rebuttal in P. Goodwin, “The Distortion of Cases in Oregon,” in Quill and Battin, Physician-Assisted Dying, 184–89.
428 “If I get rebuffed”: W. Claiborne, “An Oregon Statute Is Blunting Death’s Sting,” Washington Post, April 29, 1998, A1, as quoted in Foley and Hendin, “Oregon Experiment,” 148.
429 “Under these conditions”: Ibid., 146.
429 “The fears that we had”: M. Vitez, “Oregon Is the Laboratory in Assisted-Suicide Debate,” Philadelphia Inquirer, March 13, 2005.
429 25 percent of cancer patients: Webb, Good Death, 114.
430 only 6 percent felt confident: L. Ganzini et al., “Attitudes of Oregon Psychiatrists toward Physician-Assisted Suicide,” American Journal of Psychiatry 157 (2000): 595–600.
430 an eighty-five-year-old widow: E. H. Barnett, “Is Mom Capable of Choosing to Die?” Oregonian, October 16, 1999. See also Lee, Compassion in Dying, 72–83.
431 no Kevorkianesque abuses: Which is no guarantee that they will never happen. Surgeon and author Sherwin Nuland, while generally supportive of physician-assisted suicide in some form, would like to see the Oregon Death with Dignity requirements strengthened to include repeated requests made to a physician with whom the patient has had a long-standing relationship; mandatory consultation with a physician whose specialty is in the area of the patient’s disease; evidence that all therapeutic options have been exhausted; mandatory consultation with a palliative-care expert—“not just the local anesthesiologist but a true palliative care expert”; mandatory evaluation by a psychiatrist experienced with end-of-life care; mandatory pastoral consultation of some sort; and mandatory notification of next of kin (“I’m not talking about veto power but about a frank discussion with people important in your life. When one takes one’s own life, it has a profound and permanent influence on the lives of other people, and they should be involved”). Nuland’s final recommendation? That a council of wise, civic-minded individuals should be convened to discuss the case and grant final consent. “I believe that by permitting physician-assisted suicide, a society is commenting on its values,” he says. “And therefore, I believe it’s the responsibility of society to validate these decisions.”
431 “They have one way only”: Herodotus, The Histories (London: Penguin, 1972), 128.
431 The Tschuktschi of northern Siberia: Some of this list is drawn from Humphry and Wickett, Right to Die, 2.
431 The perhaps apocryphal story: Maguire, Death by Choice, 86.
431 “Like leaves which fall”: Time, April 9, 1984, 68.
432 “The time is not far off”: Lamm, “Long Time Dying,” 21.
432 “our technological sophistication”: J. Hardwig, “Is There a Duty to Die?” Hastings Center Report 27 (2) (1997): 39–42.
433 “the postponement of an individual’s death”: New York Times, September 5, 1984.
433 “creatively and honorably accepting”: Callahan quotes are from Time, November 2, 1987, 76.
433 “Any sophisticated doctor”: Los Angeles Times, May 25, 1984, pt. 5, p. 27.
434 “The report entirely ignored”: N. G.
Hamilton, “Oregon’s Culture of Silence,” in Foley and Hendin, Case Against Assisted Suicide, 180.
434 “One must look at”: Humphry and Clement, Freedom to Die, 313.
434 “Today, the needs of the individual”: Portwood, Common-Sense Suicide, 46–47.
434 “Assisted suicide and euthanasia”: New York State Task Force on Life and the Law, “When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context” (Albany, N.Y.: May, 1994), 43.
435 “When asked to describe” and “The primary issue”: D. Coleman, “Not Dead Yet,” in Foley and Hendin, Case Against Assisted Suicide, 220, 225. (Not Dead Yet was particularly incensed when Dr. Kevorkian’s assistant Janet Good remarked, “People can endure pain. But once children have to wipe their butts, that’s the end. When that dignity is gone, no one wants to live.”) Historian Paul Longmore has observed, “If a non-handicapped person expressed a desire to commit suicide, that person would immediately get crisis intervention therapy. Let a disabled person express such despair, and he or she is assumed to be ‘rational.’ “ (Marker, Deadly Compassion, 301.)
435 “We argue” and “conclude in support”: A. I. Batavia, “Disability and Physician-Assisted Dying,” in Quill and Battin, Physician-Assisted Dying, 63, 70.
436 “creatures born defective”: Humphry and Wickett, Right to Die, 14. The notion that the “incurably mentally ill” should be euthanized cropped up throughout the first several decades of the twentieth century, in part as an outgrowth of the eugenics movement, which held that many mentally and physically disabled people should be sterilized (see Whitaker, Mad in America, 65–66). Decrying the money spent to warehouse “gangsters and lunatics,” Nobel Prize–winning physician Alexis Carrel, in 1935, suggested they be “humanely and economically disposed of in small euthanasic institutions supplied with proper gases.” (Ibid., 66.) The discussion was silenced by the advent of World War II and the eventual knowledge of the horrors of the Third Reich.
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