King Phillipe of Belgium recently signed into law an amendment to the 2002 Belgian Act on Euthanasia. It allows children experiencing "constant and unbearable suffering" to authorize their own deaths. Astonishingly, a Europe that bled when it did not respond quickly enough to the Hitler who put euthanasia on the map is now leading the pack in bringing it back.
Will the United States get pulled into a sinkhole of ever-widening latitude in helping the Grim Reaper do his job? Writing in the May 21 issue of the Journal of the American Medical Association (JAMA), Drs. Orentlicher, Pope, and Rich don't think so. Or at least they hope not. Some of us, however, are not so sure.
Between referenda, legislatures, and courts, five states in the U.S. have legalized physician-assisted death. The trend continues. Six more legislatures considered legalizing such assistance in their 2014 sessions. All of them, so far, limit such assistance to mentally competent, terminally ill patients. More liberal standards govern passive forms of euthanasia. Since the Quinlan case of 1976, societal trends favor a patient's right to refuse life-sustaining treatment in order to be free of accompanying pain or loss of dignity. That has led to calls for allowing physicians to actively euthanize patients under similar conditions.
The JAMA contributors oppose this. "There are real risks if patients are allowed to receive a prescription for a lethal dose of medication. Not all patients who would ask for a prescription would be suffering from an irreversible and severe illness. Some might have become tired of life, depressed, or feel that that their life has insufficient meaning." At the same time, the authors do not wish to turn back the clock. They note with satisfaction that the euthanasia laws in effect in some states have not led to "a slippery slope of abuse." Society achieves the proper balance, they argue, "by restricting aid in dying to competent and terminally ill adults."
The complete European record, however, shows more complexity. Doctors had been quietly euthanizing patients long before the Netherlands legalized it in 2001. While authorities disagree sharply about the numbers of patients legally euthanized, we have little doubt about how attitudes changed. Eugene Volokh and Gary Schwartz summarize in the February 2003 Harvard Law Review.
[A] sort of equality-based slippage has indeed happened in the Netherlands. Dutch courts began by declining to punish doctors who assist the suicides of the terminally ill. They then extended this to those who are subject to "unbearable suffering," without any requirement that they be terminally ill. They then extended this to a person who was in seemingly irremediable mental pain, caused by chronic depression, alcohol abuse, and drug abuse ... Dutch courts then extended this to a 50-year-old woman who was in seemingly irremediable mental pain caused by the death of her two sons, again on the theory that "her suffering was intolerable to her." The Journal of Medical Ethics found that 21 percent of Dutch people polled believe that euthanasia should be allowed for those who ... are simply "tired of living."
Americans do not allow children to drink or vote or be tried as adults, because we recognize that they lack mature judgment. How do Belgians justify asking even younger children—even more susceptible to the suggestion of others—whether they want to live or die? A group of sixteen pediatricians assures us: "In cases of serious illness and imminent death, minors develop very quickly a great maturity."
Americans will be prone, in time, to the same fuzzy thinking. For the moment, some of us are still able to detect such fuzziness. Writing in the same issue of JAMA, Drs. Siegel, Sisti, and Caplan strike at the core of the Belgian legislation. "Adults choose euthanasia for reasons that go beyond pain. For adults, the decision to end their life can be based upon the fear of a loss of control, not wanting to burden others, or the desire not to spend their final days of life fully sedated… Children seem to be asked to choose between unbearable suffering on the one hand and death on the other." Why, they ask, cannot such tragic circumstances be addressed—as they can be in any Western country—through aggressive pain management, rather than helping them die? We might ask the same concerning adults.
Is Europe unique? Some argue that is because it euthanized religious teachings a long while
ago. With the Judaeo-Christian legacy first questioned, then mocked, it is not surprising that it is Europe that leads in undoing the sanctity of human life. The United States, however, cannot be far behind. Longer life spans, spiking medical costs, and shrinking economies leave us all vulnerable to the same pressures to promote practicality before principle.
Too many of us have forgotten how German doctors and scientists killed the physically and mentally handicapped en route to the murder of six million Jews. To kill millions methodically with impunity, the Nazis had to undo the notion of the specialness of homo sapiens—that other goals may be important, but they do not trump the inviolate nature of innocent human life, created as such by G-d Himself.
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