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Death FundamentalismWESLEY J. SMITHIn this excerpt from his newly revised book, "Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder", Wesley J. Smith analyses an article published in the New York Times Magazine and exposes some of the many ways in which journalists lead the public to a false understanding of the euthanasia issue.
Euthanasia Consciousness
The
abuse and exploitation inherent in the euthanasia consciousness are rarely discussed
explicitly but are often readily apparent, even in pieces that promote the practice.
A prominent article published in a major magazine typifies the kind of euthanasia
promotion that is so depressingly common throughout the media.
On
November 14, 1993, the cover story of the New York Times Magazine was
“There’s No Such Thing as a Simple Suicide.” It is the sad saga of a dying woman,
“Louise,” who killed herself with the active assistance and moral support of Ralph
Mero, a Unitarian minister and the cofounder of the pro-euthanasia group Compassion
in Dying.
An offshoot of the Hemlock Society at the time, Compassion in
Dying actively counseled dying people who expressed a desire to commit suicide
and assisted in their self-killing. Its founder and former director, Mero insisted
that he eschewed publicity and acted only out of selfless compassion. Yet he and
his “work” somehow managed to be featured in an Ann Landers advice column, complete
with mailing address, in the major article in the New York Times Magazine,
and in many national print and television newsmagazine pieces and documentaries.
Lisa
Belkin, a former New York Times reporter and author of the book First
Do No Harm, about medicine and ethics, wrote the “No Simple Suicide” story.
This excellently written piece presents Louise’s story as melodrama, taking the
reader on an emotionally wrenching roller-coaster ride of her assisted suicide,
complete with a cast of heroes and villains and a gripping life-and-death plot.
To make matters more compelling, we are told that the tale is true, with only
the dying woman’s name changed to protect her family’s privacy.
The
Story
“No Simple Suicide” chronicles the last few months of
Louise’s life. We learn early on that Louise suffers from an unidentified degenerative
brain condition. Her doctor, described as “a warm, down-to-earth woman,” informs
Louise that she has only months, perhaps weeks, to live. Louise is afraid of dying
in a hospital, hospice, or other “facility,” a scenario her doctor bluntly tells
her is quite likely to occur. Louise tells her doctor that rather than die in
a cold, impersonal facility, she would rather kill herself. The doctor almost
leaps at the chance to prescribe the drugs for Louise to take.
We are told
that the doctor had previously “cooperated” with another patient’s suicide, but
that there had been difficulties, so she contacts Ralph Mero at Compassion in
Dying to solicit his help and active assistance in facilitating Louise’s death.
The doctor later tells Belkin, “I was ecstatic to find someone who’s doing what
[Mero is] doing. I loved the fact that there were guidelines. It made so much
sense. This was a human being who could help, not some book.”
A few days
later Mero visits Louise, who lives with her mother. He tells Belkin that Louise
appeared relieved when he didn’t flinch or judge her desire to kill herself and
that she asked Mero to be with her when she died. He agreed, stating that the
decision was hers.
Louise has asked her friends to attend her suicide,
but none will. When a medical assistant of one of her doctors hears that Louise’s
“trusted friends” have refused to sanction her suicide, she befriends the ill
woman and supports her in her self-destruction.
Mero, the medical assistant,
Louise, and Louise’s mother become a cohesive group with one firm goal: Louise’s
assisted suicide. They meet to discuss how the self-termination will be performed.
The deadly drugs will be mixed with a small amount of food and anti-nausea medication
so that they can be kept down. Louise is to be monitored as she dies, and the
assistant is to administer anti-pain medication if Louise seems to be suffering.
After the death, the doctor will report to the authorities that the deceased was
terminally ill and that the death was from natural causes after a prolonged illness,
so no autopsy will be conducted. The doctor is also to falsify the death certificate
as to the actual cause of death.
Weeks pass. Louise grows ever weaker.
Yet the frail woman does not kill herself. Mero becomes alarmed. He calls Belkin
to inform her that he and the group have been told by the doctor that Louise is
running out of time to kill herself. It is feared that the disease may soon render
Louise mentally incompetent. Mero worries that Louise’s “window of opportunity
will slam shut” because Compassion in Dying will assist suicides only for persons
who are mentally competent. He also worries that if Louise waits much longer she
will be unable to self-administer the deadly drugs.
Lisa Belkin drops everything
and flies to Seattle to speak with Louise, who tells the reporter that she wishes
to conclude some business and spend some more time with her mother before killing
herself. This upsets Belkin, who blurts out the doctor’s prognosis: Louise does
not have much time within which she will be capable of killing herself.
Yet,
for all of her stated desire to commit assisted suicide, Louise still does not
act. Some time later, the medical assistant-turned-friend tells the group she
will talk to Louise to see if she can get the suicide back on track. She asks
the dying woman, “I kind of want to get an idea of what your time line is. Where
do we stand?” Louise’s eyes brim with tears, and she tells the medical assistant
that she does not want to talk about it. The woman apologizes. Louise justifies
her delay by saying that she wants to wait until Mero returns from out of town
to get his opinion of her condition. The medical assistant replies that is a “bad
idea” because Mero might not notice subtle changes in her condition.
Still
Louise does not kill herself. Mero withdraws, checking in by phone but keeping
the conversations short. He tells Belkin that he wants to remain in the background
so as not to influence the outcome.
Then Mero gets a message: Louise is
finally ready. The group assembles. Louise eats poisoned ice cream and applesauce
that has been prepared according to Mero’s instructions and immediately falls
asleep on the couch clutching a teddy bear. Hours pass as Louise sleeps. The group
waits for her to die. She does not. Mero worries that he might have to accelerate
the process with a plastic bag. Finally, Louise’s breathing slows, and she expires.
Mero contacts the funeral director and leaves.
As the article concludes,
we are informed that Louise’s death was not listed as a suicide and that her friends
and relatives were told that she “died in her sleep with her mother at her side,
as she had wanted.”
The Propaganda
Every
drama is supposed to elicit a response from the audience. “No Simple Suicide”
is no exception. On its face, the article appears to be an objective piece of
journalism: Belkin does not praise or criticize the people involved or the events,
nor does she give her personal opinion on the merits of Mero’s cause. Scratch
the surface, however, and the piece can be seen as an advertisement for legalizing
and legitimizing assisted suicide and euthanasia.
What leads to this conclusion?
First is the manner in which the article came to be written. Belkin didn’t find
the story; the story found her. As Belkin appropriately reveals, the board of
directors of Compassion in Dying, who invited her to observe their usually secret
suicide assistance activities, contacted her.
There is nothing illegal,
immoral, or unusual about a reporter being contacted about a story. Stories are
often found in this manner. It is safe to assume that nevertheless Mero and the
board had more in mind than merely illustrating the emotional difficulties surrounding
terminal illness. Surely they hoped to further their cause through the article.
That being so, it is likely they would carefully choose a writer in the hope of
finding one who could be expected to take a positive view of their work. In fact,
in her story Belkin exhibits an uncritical acceptance of the methods and motives
of Mero, the doctor, and the friend.
Whether Belkin approached her work
with a pro-assisted suicide bias, a more important matter is the powerful message
communicated by “No Simple Suicide.” Bluntly stated, whether Belkin intended it,
the article promotes euthanasia by seeking to persuade the reader that assisted
suicide is acceptable. Proponents of legalizing assisted suicide and euthanasia
are ever about the task of proselytizing. The more we are exposed to depictions
of assisted suicide, the more commonplace it will seem and, then, the more acceptable.
Through this process we become desensitized. Practices that we once found abhorrent
begin to seem like a normal part of life — or, more precisely, death. “No Simple
Suicide” serves this purpose in several ways.
- “No
Simple Suicide” presents a false dilemma. One of the tools used
by pro-euthanasia advocates when arguing for legalization is to create a false
premise: Either we provide “deliverance” to suffering people, or they will be
forced into cruel and unnecessary anguish. Either they die peacefully and painlessly
now, or in agony later.
“No Simple Suicide” similarly casts Louise’s plight
as a forced choice between two horrible options: assisted suicide or an out-of-control
death at a “facility.” Not once is the reader (or Louise, as far as we know) informed
that hospice and palliative care could probably have mitigated most, if not all,
of her pain and discomfort. As reported, not once is the reader told that the
hospice experience is designed to provide love, comfort, and support for the patient
and the family, supplied by medical and mental-health professionals and volunteers.
Not once is the reader told that hospice care can be supplied in the home—clearly
a major issue for the dying woman. Not once is the reader told that the very purpose
of hospice care is to facilitate a gentle and peaceful transition from life to
whatever comes next. The fact that the truly compassionate option, from what is
reported, was virtually unexplored speaks volumes about the doctor’s agenda, and
that of Mero and perhaps the friend.
It is also notable that Louise’s doctor
treats her patient’s suicidal desire as expected, rather than as a cry for help.
Yet studies prove that the vast majority of dying people do not exhibit suicidal
tendencies. When dying patients do ask for suicide, they are almost always clinically
depressed, just as are suicidal people who are not terminally ill. Depression
is a treatable condition. Unfortunately, most doctors are not adept at recognizing
depression in their dying patients. Thus, whether through ignorance or arrogance,
Louise’s doctor probably abandoned her patient to the throes of depression which
could well have been overcome.
It is also assumed by all involved in the
young woman’s assisted suicide that she will not change her mind. Yet medical
studies have shown that this is often not true. Indeed, the “will to live” among
terminally ill people “shows substantial fluctuation.” In other words, one day
a patient may request suicide but the next week be very glad they are still alive.
And that seems to have been the case here. Louise did not have an unremitting
desire to self-destruct. The only people with that unyielding death agenda were
those who surrounded her.
- “No
Simple Suicide” creates the impression that euthanasia is a loving rather than
a violent act. The suspicion that
there was an unspoken agenda behind “No Simple Suicide” is supported by the striking
artwork that illustrates many of the scenes described in the text. While Belkin
undoubtedly had little or nothing to do with their creation, the pictures, which
appear to be oil or watercolor paintings, are powerful and moving. The article
doesn’t tell us Louise’s actual age or what she looked like, but the pictures
depict Louise as a woman in her late twenties, her youth and delicate beauty adding
to the tragedy of her condition. In one picture, Louise is curled up peacefully
asleep on a couch after eating the poisoned ice cream. She is holding a teddy
bear as her gray-haired mother sits beside her, the older woman’s hand resting
lightly upon her dying daughter’s leg. In another picture, we see Louise and Mero
in a counseling session. He is a strong presence, solid and dependable with his
white beard and black suit, a striking contrast to the frail Louise, who has a
blanket wrapped around her shoulders. In another picture, Louise’s mother is pictured
leaning over her daughter, who is so weak the older woman can barely hear her
speak.
The paintings have been created in the warm colors of autumn to
invite us in, to linger as if we were standing in front of a crackling fire, indeed,
to enter and become intimate participants in the unfolding drama. The paintings
grab our hearts and rivet our attention solely on the suffering of the dying woman.
In that way we are less likely to think critically, to look beyond Louise’s personal
tragedy to the broader implications of what is being done to her. Also, by making
the scenes seem gentle and warm, we are far less likely to recoil in horror at
the actual events.
- “No Simple
Suicide” creates the impression that Louise’s assisted suicide was a necessary
choice. The article supports the merit of Louise’s assisted suicide
on several levels. Belkin’s prose creates the impression that Mero and the others
are compassionate pioneers leading the country toward an enlightened view of facing
and overcoming the ravages of terminal illness. In fact, according to Belkin,
that is how the group viewed themselves, writing that each saw Louise’s pending
assisted suicide as a “poetic expression of control, a triumph over the indignities
of disease.” That is a typical view held by death fundamentalists and no doubt
is the view Mero hoped Belkin’s readers would accept.
Belkin came to a
less romantic but equally erroneous conclusion about the affair. The only time
she expresses a personal opinion in the article, she describes Louise’s assisted
suicide as a “second choice” to not being sick, and as the “most acceptable” of
the dying woman’s “unacceptable options.” But that is a distinction without a
difference. Whether euthanasia is pushed as a heroic statement of control or a
rational choice between the lesser of two evils, the result is the same: legitimization
of that which is ultimately profoundly destructive to individuals, the healthcare
system, and society.
Whether motivated by the death-fundamentalist notions
of Mero, the “pragmatic choice” view of Belkin, the participants’ genuine desire
to serve Louise, or a combination of these factors, Louise was pushed by those
around her into suicide because that was the death they wanted her to have. As
the psychiatrist Dr. Herbert Hendin, former director of the American Foundation
for Suicide Prevention, has written about the case, “Like many people in extreme
situations, Louise . . . expressed two conflicting wishes — to live and to die
— and found support only for the latter.” One wonders what the outcome would have
been had someone — anyone — supported Louise’s often expressed desire to live
and had stayed with her to the natural end of her life. Perhaps, then, her friends
would have surrounded her in her final days. Perhaps Louise and her mother would
have had a more meaningful time together, spared the undignified and excruciating
dilemma over when and whether Louise would kill herself. Perhaps Louise could
have truly died in peace.
- “No Simple
Suicide” suggests that it should be easier to help people die.
Louise’s assisted suicide took place in the underground, amid people
who lied and broke the law in order to facilitate her so-called death with dignity.
The attitude of the article is implicitly critical of the fact that this subterfuge
was necessary. The reader is given a subliminal message, often voiced out loud
by assisted-suicide advocates, that goes something like this: Unreasonable people
who refuse to allow others to control their own destiny are insensitive, thoughtless,
and cruel. They force dying people to endure unnecessary suffering. Such judgmental
attitudes caused Louise’s friends to abandon her when all she wanted to do was
control the time and place of her own death. Her caring doctor was prevented from
actively participating in her patient’s final “treatment” because euthanasia by
lethal injection is forbidden. Mero, a compassionate clergyman, was forced to
risk imprisonment in his pursuit of providing care and comfort to the suffering.
The
Other Side of the Story
The irony is that the members of the
little group surrounding Louise were the ones who were thoughtless, insensitive,
and cruel, for they took from Louise, in Dr. Hendin’s words, “her own death.”
- Louise was unable to give informed
consent to her suicide because she was denied information about hospice care.
The story indicates that both the doctor and Mero allowed Louise to believe that
she would have to either die in a “facility” or kill herself at home. Apparently,
neither discussed hospice care with Louise or described the palliative care that
could have reduced her discomfort. It appears they presented Louise with a false
dilemma.
- The medical assistant pushed
Louise into going forward with the assisted suicide. The medical
assistant who suddenly embraced Louise as a friend is suspect. Was she part of
a pro-euthanasia group? Did she have an agenda? We are not told. Was not Belkin
even a little curious about this? Regardless of her motives, the assistant is
a powerful actor throughout the drama, urging Louise on to self-destruction. Recall
that when it became clear that Louise was delaying her self-destruction and appeared
not to want to go forward, the medical assistant grew impatient and confronted
the ill woman, saying, “I kind of want to get an idea of what your time line is.
Where do we stand?” When Louise says she doesn’t want to talk about it but would
rather wait for Mero to return to give his opinion of her medical condition, the
friend tells her it is a “bad idea” and urges her not to wait because Mero may
not be able to notice “subtle changes in Louise’s temperament and thus might give
the wrong advice.” That is pressure disguised as advice.
- Ralph
Mero’s “compassion” was available to Louise only if she carried out her designated
role. This is the most insidious part of the story. It
is important to remember how emotionally vulnerable most terminally ill people
are as the end of life approaches. Louise was certainly no exception. Then, along
comes “compassionate” Ralph Mero — a minister, no less — who tells Louise, “I’ll
be with you and I’ll support you.” From that point on it is quite clear that Louise
has become dependent on the moral judgment and emotional support of Mero, to the
extent that she even wanted to rely on him for medical advice as to how far her
decline had progressed.
Note that throughout the early part of the process,
Mero was there for Louise. He held her hand. He patiently and gently went over
the guidelines for the assisted suicide. He presented himself as a source of strength,
a nonjudgmental rock to lean on in this difficult time. But when Louise hesitated
and refused to be pressured into suicide, what did this altruistic man of compassion
do? Did he hold her hand and discuss alternatives to killing, such as hospice
care? Did he pray with Louise so that together they could seek God’s guidance?
(He is a minister, after all.) Did he assure her that whatever her choice might
be, he was her friend and would be there to the end? No. He withdrew: “Over the
next few days, Mero checked in with Louise and her mother by telephone, but kept
the conversation short. ‘I was measuring my phone calls,’ he says. He wanted to
remain in the background and allow Louise to control the timing and pace. Her
growing dependence on him was making him uncomfortable, and he needed to keep
it clear in her mind, and his, that she was the driver and he was just along for
the ride.” But when she seemed to be choosing a different course, his absence
made it clear that Louise was on her own if she chose a natural death.
Imagine
how painful it must have been for Louise when her minister, the man she was leaning
on for strength and guidance, was suddenly holding her at arm’s length, especially
after being so intensely a part of her life over the previous weeks. This certainly
looks like emotional manipulation on Mero’s part, communicating a harsh and powerful
message to the dying woman: kill yourself and I am your man; stick it out to the
end and I am out of here. That is not compassion. That is cruel abandonment.
- The
reporter also pushed Louise toward killing herself. As if all
of that isn’t disturbing enough, what are we to make of the reporter, Lisa Belkin,
and her participation in these sad events? Recall when the doctor informed Mero
and the reporter that Louise was likely to slip quickly and become mentally incompetent
and therefore become unable to kill herself or receive Mero’s assistance, Belkin
immediately flew to Seattle, unaware that Louise has not been told of this prognosis.
During an interview on that occasion, Louise tells Belkin that she wants to wait
a week or so before killing herself. Belkin is appalled:
I was surprised,
confused and extremely uncomfortable. . . . Without thinking, I blurted out a
question: “Your doctor feels that if you don’t act by this weekend, you may not
be able to . . .”
My words were met with a wrenching silence. Louise blanched,
her pale skin turned even paler. I was horrified with myself . . .
“She
didn’t . . . she never . . . I didn’t know that,” Louise said, sharply looking
at her mother.
“That’s what she told me,” her mother offered gently.
Louise
became silent. . . .
“It’s O.K. to be afraid,” her mother said.
“I’m
not afraid. I just feel as if everyone is ganging up on me, pressuring me,” Louise
said. “I just want some time.”
Indeed, Louise was being pressured, now
even by the reporter who at that point crossed the line from an observer and chronicler
of events to a participant in them.
- There
is no compassionate voice of opposition. “No Simple Suicide” presents
a one-sided version of assisted suicide. Except for one brief passage, people
who resist legalizing euthanasia are not heard from, nor are the many reasons
given why opponents of the death culture are so devoted in their resistance. Notice
also that the one quotation selected for use in the article by Belkin, presumably
from a longer interview, describes opponents to euthanasia as “harsh,” reinforces
the false stereotype that opposition is based primarily on religion, and does
not express any concern for the well-being of Louise.
Such short shrift
was not accorded proponents of assisted suicide. At one point in the article,
Mero describes his work for Compassion in Dying as an experiment to “show, demonstrate,
prove, that when people make a claim for humane treatment, it can be provided
in a way that does not jeopardize vulnerable people or pose a threat to the social
fabric.” Leaving aside the perversion of the word “treatment” in that sentence,
we can assume that Mero hoped that by inviting Belkin to observe his work, his
vision of a world where the ill can be routinely euthanized would be accepted
by readers.
But as this analysis of “No Simple Suicide” — an article
typical of this genre — demonstrates, what actually happened to Louise was just
the opposite of the impression the story sought to convey. Instead of receiving
compassion (literally, “suffering with”) from those she trusted, a sick and vulnerable
woman was pushed by them into suicide. In Dr. Hendin’s words, Louise’s “death
was virtually clocked by their [Mero’s, the doctor’s, her mother’s, the medical
assistant’s, Belkin’s] anxiety that she might want to live. Mero and the doctor
influence the feelings of the mother and the friend so that the issue is not their
warm leave-taking . . . but whether they can get her to die according to the time
requirements of Mero, the doctor, the reporter, and the disease. . . . Individually
and collectively, those involved in [Louise’s assisted suicide] engender a terror
in Louise with which she must struggle alone, while they reassure each other that
they are gratifying her last wishes.” Ralph Mero was unavailable for comment about
my criticisms.
ACKNOWLEDGEMENT
Wesley
J. Smith. "Death Fundamentalism." Excerpted from Chapter 1, Forced Exit:The
Slippery Slope from Assisted Suicide to Legalized Murder (Dallas, Texas: Spence,
2003). Reprinted by permission of Spence Publishing. All rights reserved. Forced
Exit:The Slippery Slope from Assisted Suicide to Legalized Murder ISBN
1-890626-48-1 400 pages, can be purchased for $8.97 from the Spence Publishing
web site. Through original reporting, exhaustive research, historical analysis,
and extensive interviews, Smith makes a compelling case against legalizing assisted
suicide. He explores the truly humane and compassionate alternatives that can
change a death wish into a desire to live. THE AUTHOR
Wesley J. Smith, a senior fellow at the Discovery Institute, is an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide and a special consultant to the Center for Bioethics and Culture. He is an international lecturer and public speaker, appearing at political, university, medical, legal, bioethics, and community gatherings across the United States, Canada, Europe, South Africa, and Australia.
Attorney Wesley J. Smith is the author or co/author of 10 books. His most recent book Consumer's Guide to a Brave New World, ponders the dangers and potential benefits of human cloning, stem cell therapies, and genetic engineering. Among his other books are Culture of Death: The Assault on Medical Ethics in America, Power Over Pain: How to Get the Pain Control You Need, and Forced Exit: the Slippery Slope from Assisted Suicide to Legalized Murder. He is currently conducting research for a book he will write on the animal rights/liberation movement. Wesley J. Smith is on the advisory board of the Catholic Educator's Resource Center.
Copyright © 2003 Spence
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