- The Washington Times - Tuesday, April 17, 2001

Death evokes dread. That is why death insurance is mis-merchandised as life insurance.The instinct is especially pronounced in hedonistic societies whose cultures celebrate the intoxications of sensual pleasures to the serenity of grappling with human purpose between ashes to ashes and dust to dust. Maudlin sonnets and childhood poetry predominate over William Cullen Bryants "Thanatopsis."

That substantially explains the heated opposition to Oregon´s 3-year-old physician-assisted suicide law and a Dutch first cousin enacted last week. Agitation in the United States Congress is afoot to stiletto Oregon´s initiative, the Death with Dignity Act. But the ostensible reasons fueling the clamor are unpersuasive and counterfactual. A comprehensive report on physician-assisted suicide in Oregon issued last February by the Oregon Health Division of the Department of Human Services ("Oregon´s Death with Dignity Act: Three years of legalized physician-assisted suicide") discredits the Doubting Thomases.

The law´s inspiration was benign, not sinister: a yearning to be remembered as effervescent and indomitable, not cadaverous and agonized. As was written of Mrs. Rutherford B. Hayes, wife of the 19th president, after a premonition of a stroke: "Fears that she might be paralyzed or lose her mind, as her brother had done, assailed her. If she were paralyzed or worse, she begged, would not her husband take her to Philadelphia and hide her in any asylum to the end, so that her friends might remember her as radiant and lovely."

Oregon´s law is thus carefully hedged commensurate with its high purpose .It is no scheme to purge society of an underclass, the genetically inferior, or the disabled. Such ugliness was epitomized by Supreme Court Justice Oliver Wendell Holmes´ Darwinian callousness in Buck vs. Bell(1927) (upholding compulsory sterilization of epileptics and the feebleminded): "It is better for all the world, if instead of waiting to execute the degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind… . Three generations of imbeciles are enough."

The Death with Dignity Act, in contrast, sharply confines eligibles for physician-assisted suicide and eschews invidious classifications. Adulthood, mental competence, and a projected life of less than six months because of illness are all required. Further, assisted suicide candidates must twice orally request of their physicians a prescription for lethal medication, separated by at least 15 days. Two witnesses to a written request also are required.

The prescribing physician and a consulting physician must confirm the patient´s diagnosis and prognosis and competence. Alternatives to assisted suicide must be elaborated, including comfort care, hospice care, and pain control. And patients are urged to notify their next-of-kin of any prescription request.

Oregon´s Health Division report is reassuring. Assisted suicide is a rarity, not a commonplace. In 2000, 27 died from lethal doses of medication, or 9/10,000 of statewide deaths. All but one patient was white, two-thirds were married, approximately one-half were college graduates, more than a quarter held advanced graduate degrees, and all enjoyed health insurance. Most suffered from cancer.

A cluster of reasons contributed to assisted suicide choices: becoming a burden on others; loss of autonomy; dwindling ability to enjoy life´s pleasures; losing control of bodily functions; and pain. The most recurring was loss of autonomy.

Evidence was convincing that patients did not opt for suicide because pressured by others who might be burdened by a choice for extended life. Family members were eager to provide care, and a companion study revealed that patients placed burdensomeness among but one of eight important factors that informed their decisions. Moreover, such a concern bespeaks more of laudatory altruism than of a besieged mind.

The Health Division´s 2000 study generally echoed the findings for 1999 and 1998. The three years together discredit allegations that assisted suicide is a snare for minorities, the uninsured, the isolated unmarried, the mentally or physically disabled, or the uneducated. Indeed, patients laureled with post-baccalaureate degrees were 19 times more likely to request assisted suicide than individuals lacking a high school education.

Some have insinuated that profiteering health insurers were behind Oregon´s DWDA, which makes it suspect. But Oregonians approved the measure twice by direct popular vote in 1994 and 1997, the latter by a 60 percent margin. No evidence has arisen suggesting that public discourse over the issue was distorted by either overt or covert issue advertising by insurers.

Many international detractors hysterically likened the Dutch DWDA counterpart to Nazi Germany´s systematic extermination of the handicapped. But that is as fatuous as equating slavery with free labor. The exterminated did not volunteer, unlike DWDA patients, and voluntariness is generally the demarcation line between liberty and oppression.

An influential Polish Roman Catholic bishop deplored the Dutch legislation because, "It is an attempt by man to correct God. Human life is not in our hands, because we are not the giver of life." That well-intentioned but indiscriminate canon, however, would deny humans the benefits of countless medical discoveries that prolong life or make it more fulfilling. It would make all wars immoral, which is not a tenet of Roman Catholicism. Indeed, the religious commandment would disown the history of civilization from the Stone Age onward, which marks human effort to overcome or harness the elemental forces of the planet.

Supreme Court Justice Louis D. Brandeis lectured that the right to be left alone is a right scrupulously honored in any free society. Government should meddle only for strong and substantiated reasons. And nothing in either experience or morals suggests that with the procedural safeguards of DWDA, terminally ill Oregonians should be denied the freedom to compose their last codas.

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