Tomorrow, the United Supreme Court takes up one of the most important, and contested, ethical questions of our time: whether individuals have a constitutional right to obtain life-ending medication from a doctor.
The issue of physician-assisted suicide has split the medical profession. One of the most outspoken of those who oppose the practice is Dr. Herbert Hendin, the head of the American Foundation for Suicide Prevention. If assisted suicide is legalized, says Hendin, doctors will misuse their power as he believes they have in The Netherlands, where legal euthanasia is widespread. In his new book "Seduced by Death: Doctors, Patients and the Dutch Cure" (W.W. Norton), Dr. Hendin charges that Dutch doctors are killing thousands of mentally competent, terminally ill patients without their consent.
Salon talked with Dr. Hendin about right-to-die issues, the conflicts between palliative care and assisted suicide, and safeguards needed to avoid physician abuse.
I can't count the baby-boomers who've told me something like "When I lose my mind or body function, or have to go to a nursing home, I want to be put out." What would you say to them?
That they will change when they get to be 70. According to opinion polls, 70 percent of people under 40 favor euthanasia, and 70 percent of people over 60, the presumed beneficiaries, are against it. I've treated patients with Alzheimer's, and most people anticipating it may say, "Oh, I want to die if I get it." But when they get it, while they are semi-competent, that same person doesn't want to die any more. And that's the case with all kinds of terminal illness. I might say that if I'm going to be a quadriplegic, I'd rather be dead. But when the only alternative is being paralyzed or not being there at all, 99 percent of quadriplegics don't want to die.
In the U.S. we talk of assisted suicide. The Dutch speak of euthanasia. What's the difference?
Assisted suicide means that a physician gives the patient the means to end his life, usually a prescription for pills or a machine like Kevorkian uses whereby you give yourself an injection. Euthanasia means the doctor actively intervenes to end the life, usually by an intravenous injection of a narcotic.
Physician-assisted suicide is still illegal in the U.S., though the Supreme Court may change that. How does Dr. Kevorkian get away with it?
The courts have not been inclined to punish doctors in these situations. But I think it is now becoming clear that it's Kevorkian's need to be the instrument of ending somebody's life rather than his compassion for the person. One of the most recent cases involved a woman who wasn't in any way terminally ill. The husband wanted to be rid of his wife, and found a way of doing it through Kevorkian, who claims not to have known it. It's a sign of how superficial and casual putting somebody to death can be.
Which is why you're opposed to physician-assisted suicide.
I've watched it in operation in the Netherlands, so it's not what I think but what I've seen. What was intended for exceptional cases to relieve suffering has become a routine way of dealing with serious or terminal illness. People are put to death who could have months, and sometimes longer than that, of lifethey would be grateful for. And it discourages doctors from learning how to treat them better.
But shouldn't terminally ill people have control over how they die?
Yes, but legalizing it increases the power of doctors instead. More than half of Dutch doctors initiate the suggestion, seemingly oblivious to the fact that the criterion for euthanasia is always voluntariness. This is compromised when the doctor suggests it. The patient is bound to think that the doctor doesn't think his or her life is worth living, and that the doctor can probably foresee all kinds of horrible things in the future that are even worse than the frightened patient is already imagining.
Also, patients who say they want to die are very much like suicidal patients at all stages of life. They are ambivalent. They want to die in the morning and live in the afternoon. The patient may hope someone will say, "No, you're not such a burden and should live as long as you can." Instead the doctor says, "Well, how about next Tuesday, or next Thursday?"
In your book, you suggest that Dutch doctors go even further.
An official Dutch government study showed that thousands of patients are put to death not because the patient has requested it but because the doctor thinks it's time. I cite in my book a nun whose religious beliefs wouldn't permit her to ask for euthanasia. But the doctor felt she was dying of cancer and suffering, so he put her out of her misery. But she was competent. When I asked him why didn't she have the right to die the way she wanted, he had no reply.
You mean he didn't even ask her if she wanted to die or not?
No. No. He just gave her an injection, that's all.
Are you serious?
It's being done in thousands of cases.
But is it fair to assume that American doctors would behave the same way?
U.S. doctors are violating the law right now by putting people to death. They do so not because they are monsters, but out of a sort of misguided compassion. The trouble is that once you start, the boundary line of when you do it shifts.
What is the alternative to assisted suicide for patients in real pain?
Palliative care. They've done studies where model palliative care is instituted, and the painful symptoms and distress have been completely relieved in 87 percent of cases. Another 11 percent get adequate relief. Doctors don't understand it and the public doesn't know about it. If you're in an ideal place where you're getting palliative care you're going to be given extra months of your life that you're going to enjoy and be grateful for.
If I came to you and said I was in unbearable pain, and wanted relief, what would you tell me?
If there is one symptom that we can get rid of, it's pain. I can send you to a palliative care specialist who can relieve whatever pain you have. Also, I will be with you until the end, and we'll be talking about whatever it is that bothers you. This is the way to die with dignity, and it is far preferable to either assisted suicide or unnecessarily prolonging life with medical technology.
Aren't you fighting a losing battle? In your book, you say that outside of The Netherlands the country that most supports assisted suicide is the U.S. Why?
Part of the support, understandably, comes from the misuse of medical technology to prolong lives in ways that are just unkind and cruel. But we're also living in a culture where an old system of values has broken down. People don't feel connected in the same way to family, to government, to their work, to their religion. And in the process I think that the anxieties about death are much greater than 40, 50, 60 years ago.
How do you cope with the prospect of your own death?
There may be no ultimate consolation to the fact that you're going to die. But a life lived to the end is as good as one can do. What comforts me about my own death is the feeling that I'm doing work that will go on, that my family will go on. I always picture dying in the company of my family, and that's an enormous relief. It's the feeling that things I believe in are going on.
What is your position on the right to die controversy?
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Nation of laws, not men
A defense which rests on the claim that he failed to seek sufficient legal advice about applicable tax laws, and relied too heavily on his lawyers in his submissions, is simply inadequate for a maker of laws.
-- Rep. Jim Leach, R-Iowa, who opposes the re-election of Rep. Newt Gingrich, R-Ga., as House Speaker. (From "Gingrich Makes Appeal to Party; Moderate Urges Him to Step Down," in Tuesday's New York Times.
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