The day after the U.S. Supreme Court upheld the constitutionality of state laws that prohibit physician-assisted suicide, Salon spoke with people on both sides of this volatile political and moral debate.
Wesley Smith, a consumer advocate, hospice volunteer and author of the recently published "Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder" (Times Books), opposes all physician-assisted suicide. John Brooke, a minister in the United Church of Christ, is head of the California-based Americans for Death with Dignity -- which sponsored the l988 and l992 ballot initiatives on physician aid-in-dying in California, both of which narrowly failed.
From your perspective, what are the ramifications of this decision? Smith: I think this decision is great news for patients. We are about to move into a very detailed discussion of the whole issue of end-of-life care. We have been so focused on whether or not doctors should be legally allowed to kill patients that we have ignored the fact that rather than having to choose between an agonizing death and assisted suicide, doctors and hospices and other professionals can give tremendous care and comfort to a patient. A lot of people don't know that there is such a thing as a board-certified pain control specialist, people who are very advanced in their ability to treat pain.
The problem is that the medical profession is not doing a good enough job. Not enough doctors are trained in pain control. We've got HMOs that are putting tremendous financial pressure on doctors to restrict care. The wrong people are making health-care decisions -- health insurance executives. We've got to get doctors to take good care of their patients.
Do you think the media has done a fair job covering this debate? Smith: The media has been so caught up in the sensationalism of Kevorkian that they've missed a big part of the story -- pain management -- which I think now will come to the forefront. Brooke: The one thing that has bothered me about the coverage is that every newscast about the decision led with the response of Jack Kevorkian's attorney. Really, what we are proposing would provide regulation and protocols established in law, rather than being left to an individual physician, however well-meaning. Without these laws, that leaves the decision up to the paternalism of one physician, with no review, which greatly increases the risk for abuse. On Friday, The New York Times described the decision as "a tentative first step, rather than a definitive final ruling." Do you agree? Smith: This decision is by no means "a tentative first step." It is the beginning of the end of the euthanasia movement. This is the first blow against euthanasia, because there is no constitutional right to be killed by a doctor. Already I'm noticing a positive change in the way the matter is being discussed. I noticed in the New York Times and other papers that there is a lot more talk of the positive alternatives, and even Dr. [Timothy] Quill [one of the plaintiffs in New York] said we have to focus more on the alternatives. This is not a minor case. It is a very important and historic case. Brooke: I agree completely with the New York Times' summation. It's not an ending but a new beginning of the debate on this issue. I think that in the past, state legislators have been reluctant to deal with the issue at all, because it was perceived as a "no-win" issue for them to take a position on. Now the level of the debate has been raised by the Supreme Court, which basically said this matter should be adjudicated by the states. Will this decision drive doctors who are in favor of assisted suicide -- Jack Kevorkian being the most prominent example -- underground? Smith: First of all, Kevorkian is not a doctor -- his license was taken away. Hopefully now, instead of killing patients, doctors will realize that they have to take care of patients. Do you realize that only five medical schools out of about 126 have mandatory end-of-life medical training in pain management? We need to call on doctors to start doing more residencies in hospices. It seems to me that a doctor who says, "The only thing I can do to help a patient is to kill that patient" needs to send that patient to a better doctor. Brooke: Any physician who assists a patient in death will continue to be in the position of being a closet felon and risking their career. I don't foresee anyone being any more underground than they already are. This decision simply maintains the status quo. Are there any situations where physician-assisted suicide should be allowed? Smith: No. If you talk to the really well-trained end-of-life doctors, they say it is not necessary. They tell me that there is always something that can be done to alleviate suffering. I'm a hospice volunteer, and I notice that when people know they are cared for, that they are not going to be abandoned, then they reach a level of acceptance. It's just remarkable how people respond to being loved and cared for in the dying process. Hospice is about life. Euthanasia is about death. Are there any situations when physician-assisted suicide should be outlawed? What are they? Brooke: Of course there are situations where assisted suicide should not be permitted. I think those who are in support of this issue draw it very narrowly. Assisted suicide should only be available as an option for people who are in the dying process, who are competent to make a decision for themselves and who are subject to a number of safeguards, such as receiving more than one opinion by a doctor on their diagnosis. They should also be offered every other option of hospice and palliative care available. There also should be waiting periods to make sure the patient's decision is not an impulsive one. Is it difficult to be a clergy member advocating the right to die? Brooke: I think there is much more support with the religious community and among the clergy than you would guess -- even within the Catholic church, where the hierarchy has been strongly opposed but the clergy is just about as split as among Protestants. I'm from the progressive wing of Protestantism and I would say that the folk who agree with me on issues of social justice and peace, by and large, would agree with me on this.