The U.S. Supreme Court heard oral arguments in January regarding the constitutionality of state laws in Washington and New York that make it a crime for one person to help another commit suicide. The Court is expected to issue a decision on the case later this year.
On January 7, the day before the Court heard the case, participants in an Amgen Forum at AEI debated whether physician-assisted suicide should be legal. The four speakers were Herbert Barnard, counselor for health and welfare of the Royal Netherlands Embassy; Samuel Klagsbrun, executive medical director of Four Winds Hospital in Katonah, New York; Charles Krauthammer, a syndicated columnist and self-described psychiatrist in remission; and Edmund Pellegrino, John Carroll Professor of Medicine and Ethics at Georgetown University. AEI Senior Fellow Ben J. Wattenberg moderated the forum, which was sponsored by Amgen, Inc.
Mr. Krauthammer argued that permitting doctors to be involved in the killing of patients is pernicious and dangerous. In his view, any law or ruling that allows physicians to help patients kill themselves will inevitably lead to abuse.
This, Mr. Krauthammer insisted, is not a hypothesis, but a truth demonstrated by the results of a policy in the Netherlands whereby assisted suicide is against the law, but the prohibition is not enforced. He cited a report issued by the Dutch government in 1990 on the practice of physician-assisted suicide to that point. In over 1,000 cases, physicians admitted hastening or causing death without the patient's permission.
Samuel Klagsbrun explained that after years in his psychiatry practice with the dying and their families, he now feels that, under a specific set of rare circumstances, a patient should have the right to request the assistance of his doctor in ending his life and the doctor should be allowed to comply.
Dr. Klagsbrun listed these requirements: First, the patient must have already received the best available palliative care to alleviate pain and loneliness in the terminal phases of life. Where palliative care is excellent, the thought of assisted suicide seldom arises. Second, the physician must have known the patient well and for a long time so that he knows the motive, the circumstances, and any other factors influencing the patient's request. In particular, since depression is treatable, the physician must have complete confidence that untreated depression is not coloring the request. Finally, the physician should comply with the request only if he or she suffers over the decision along with the patient.
Dr. Pellegrino agreed with Mr. Krauthammer's position that assisted suicide and euthanasia should be strictly banned. To those who say that assisted suicide is compassionate, Dr. Pellegrino responded that pain is now thoroughly treatable. In his experience, only patients who are also depressed request assistance for suicide, and depression is also treatable.
Against those who say that the need to respect individual autonomy requires us to allow assisted suicide, Dr. Pellegrino argued that the practice does not involve autonomous or voluntary choice by the patient. First, depression is often a factor, and it reduces the patient's ability to make an autonomous decision. Second, Dr. Pellegrino argued that in the Netherlands, where the practice has been tolerated, reports indicate that physicians have the authority to decide whether a patient should be allowed to die and, if so, when. The physician also is the judge of whether a patient's desire to die is a result of depression.
Mr. Barnard pointed out that opponents of assisted suicide view its practice in the Netherlands as a nightmare, while proponents consider it a model of enlightenment. In his view, both sides often comment on Dutch policy in inaccurate and tendentious ways.
After discussing the results of a study published in December 1996 by the government of the Netherlands, Mr. Barnard concluded that there is no scientific basis for thinking that the Dutch policy has led to the slippery slope toward abuse and no indication that an increasing number of patients are being euthanized without their consent.