Why I believe in
Voluntary Euthanasia and Assisted Suicide



An essay by Derek Humphry

Founder of the Hemlock Society USA in l980
Founder of Euthanasia Research & Guidance Organization
(ERGO) l993.


The movement for choice in dying is dedicated to the view that there are at least
two forms of suicide. One is 'emotional suicide', or irrational self-murder, in all
of it complexities and sadness. Let me emphasize at once that my view of this
tragic form of self-destruction is the same as that of the suicide intervention
movement and the rest of society, which is to prevent it wherever possible. I do
not encourage any form of suicide for mental health or emotional reasons.
Nevertheless, life is a personal responsibility and we know some people are so
tormented that they cannot bear to live. In such circumstances, understanding is
called for.

I believe that there is a second form of suicide -- justifiable suicide, which is
rational and planned deliverance from a painful and hopeless disease. I don't
think the word 'suicide' sits too well in this context but we are stuck with it. I
have struggled for twenty years to popularize the term 'self-deliverance' but it is
an uphill battle with a news media which is in love with the words 'assisted
suicide' and 'suicide.' They are headline grabbers. Also, we have to face the fact
that the law calls all forms of self-destruction 'suicide.' Additionally, all medical
journals today refer to 'assisted suicide' in their papers.*

Let me point out here for those who might not know it that suicide is no longer a
crime anywhere in the English-speaking world. (It used to be in many places,
punishable by giving all the dead person's money and goods to the government.)
Attempted suicide, which hundreds of years ago in Europe was punishable by
execution, is no longer a crime. Do not confuse this decriminalization with health
laws where a suicidal person can in most states be forcibly placed in a psychiatric
wing of a hospital for three days for evaluation.

But giving assistance in suicide remains a crime, except in the Netherlands in
recent times under certain conditions, and it has never been a crime in
Switzerland and Germany, although the taboos there are strong. The rest of the
world punishes assistance in suicide even for the terminally ill; although the
American State of Oregon recently (l994) passed by citizens' ballot measure a
limited physician-assisted suicide law. After court battles initiated by the pro-life
movement, the Oregon law took effect at the beginning of l998, a year during
which there were 16 lawful assisted suicides, while in l999 there were 27. Not
exactly the stampede our critics were predicting!

Even if a hopelessly ill person is requesting assistance in dying for the most
compassionate reasons, and the helper is acting from the most noble of motives,
any form of direct euthanasia remains a crime in the remainder of the
Anglo-American world. You cannot ask to be killed. Punishments for this are
usually 'life' and for assisted suicide, fines or up to fourteen years in prison. It is
this catch-all prohibition which ERGO and other right-to-die groups wish to
change. In a caring society, under the rule of law, we claim that there must be
exceptions for the hopelessly ill after all other avenues have been exhausted.

Dr. Jack Kevorkian was guilty in law but morally innocent (in my view) of
helping a terminal man to die by lethal injection. A Michigan jury found him
guilty of second-degree murder and he was jailed for 10-25 years. In recent years
two spouses in New York State have been imprisoned for assisting their sick
wives to die. Exactly there is the huge law reform problem we have to surmount.


Word origins and euphemisms

The word 'euthanasia' comes from the Greek -- Eu, "good", and Thanatos,
"death". Literally, "good death". But the word 'euthanasia' has acquired a more
complex meaning in modern times -- it is generally taken nowadays to mean
taking action to achieve a good death.

Suicide, self-deliverance, auto-euthanasia, aid-in-dying, assisted suicide,
physician-assisted suicide, physician-assisted dying -- call it what you like -- can
be justified by the average supporter of the right to die movement for the
following reasons:-

1. Advanced terminal illness that is causing unbearable suffering - combined
physical and psychic -- to the individual despite good medical care. This is the
most common reason to seek an early end. (And as Oregon research has shown,
being a burden to others is an additional factor.)

2. Total loss of quality of life due to protracted, incurable medical conditions.

3. Grave physical handicap which is so restricting that the individual cannot, even
after due consideration, counseling and re-training, tolerate such a limited
existence. This is a fairly rare reason for suicide -- most impaired people cope
remarkably well with their afflictions -- but there are some disabled who would,
at a certain point, rather die.

What are the ethical parameters for voluntary euthanasia and physician-assisted
suicide?

7 The person is a mature adult. This is essential. The exact age will depend on the
individual but the person should not be a minor, who comes under quite different
laws.

7 The person has clearly made a considered and informed decision. An individual
has the ability nowadays to indicate this with a "Living Will" (which applies only
to disconnection of life supports) and can also, in today's more open and tolerant
climate about such actions, discuss the option of a hastened death with health
professionals, family, lawyers, etc. But they may not demand it.

7 The euthanasia has not been carried out at the first knowledge of a
life-threatening illness, and reasonable medical help has been sought to try to cure
or at least slow down the disease. The pro-choice movement does not believe in
giving up on life the minute a person is informed of a terminal illness, a common
misconception spread by our critics. Life is precious, you only pass this way
once, and is worth a fight. It is when the fight is clearly hopeless and the agony --
physical and mental -- is unbearable that a final exit is an option.

7 The treating physician has been informed, asked to be involved, and the
response taken into account. What the physician's response will be depends on
the circumstances, of course, but we advise people that as rational suicide is not a
crime, there is nothing a doctor can do about it. But it is best to inform the doctor
and listen to the response. For example, the patient might be mistaken -- perhaps
the diagnosis has been misheard or misunderstood. In the last century, patients
raising this subject were usually met with a discreet silence, or meaningless
remarks, but in this century's more accepting climate of personal freedoms most
physicians will discuss potential end of life actions, however cautiously.

7 The person has made a Will disposing of worldly possessions and money. This
shows evidence of a tidy mind, an orderly life, and forethought -- all something
which is paramount to an acceptance of rational suicide.

7 The person has made plans to exit that do not involve others in criminal liability
or leave them with guilt feelings. As I have mentioned earlier, assistance in
suicide is a crime in most places, although the application of the law is growing
more tolerant. Few cases actually come to court. But care must still be taken and
discretion is the watchword.

7 The person leaves a note saying exactly why he or she is taking their life. This
statement in writing obviates the chance of subsequent misunderstandings or
blame. It also demonstrates that the departing person is taking full responsibility
for the action. If the aim is to attempt to allow the death to be seen as 'natural' and
not suicide, this note should be kept in a private, secure place and only shown
later if necessary.


Not always noticed

A great many cases of self-deliverance or family-assisted suicide, using drugs
and/or a plastic bag, or inert gases, go undetected by doctors, especially now that
autopsies are the exception rather than the rule (only 10 percent, and only when
there is a mystery about the cause of death).

Also, if a doctor asked for a death certificate knows that the patient was in an
advanced state of terminal illness then not much fuss will be made over the
precise cause of death.

Police, paramedics, medical examiners, and coroners put a low priority on
investigation of suicide, particularly when evidence comes before them that the
person was dying anyway.


Need for both methods

Some claim that it is sufficient to legalize physician-assisted suicide and not
voluntary euthanasia as well. I have never taken that halfway view. Here's why:-

(a) Physician-assisted suicide (drinking prescription lethal medication) is not as
efficient as voluntary euthanasia (lethal injection). Even using the best
barbiturates, the oral route takes much longer - up to 11 hours in a few cases -
which is a terrible strain on family present. In the Netherlands, doctors will only
let such a case linger for four hours before administering a lethal injection.
Injection into a vein always ends of the life of the patient within about ten
minutes.

(b) Some terminally ill patients are unable to drink, or keep down, the lethal fluid
because of invasive surgery. If help in dying is restricted to those who can take
oral fluids, then a great many patients who most need help are sidelined.

(c) As the constant attacks on the Oregon law show, the pro-life movement will
seek to destroy any and all laws on assisted dying, no matter how moderate and
limited. So the right-to-die movement should fight to legalize what is best for the
patient - both methods - and make no concessions to the religious right. But let us
see what their main arguments are.

Some arguments against

Having considered the logic in favor of euthanasia, a person should also
contemplate the arguments against it:-

First, should the person go instead into a hospice program and receive not only
first-class pain management but also comfort care and personal attention?
Hospices by and large do a great job with skill and love. The right-to-die
movement supports their work. But not everyone wants a lingering death; not
everyone wants that form of care. Today many terminally ill people take the
marvelous benefits of home hospice programs and still accelerate the end when
suffering becomes too much. Some 60 percent of those who took advantage of
the Oregon physician-assisted suicide law the first two years were in hospice
care.

A few hospice leaders claim that their care is so excellent that there is absolutely
no need for anyone to consider euthanasia. They are wrong to claim perfection.
Neither hospice nor euthanasia has the universal answer to all dying. Fortunately
most, but not all, terminal pain can today be controlled with the sophisticated use
of drugs, but the point these leaders miss is that personal quality of life is vital to
some people. If one's body has been so destroyed by disease that it is not worth
living, then that is an intensely individual decision which should not be thwarted.
In some cases of the final days in hospice care, when the pain is very serious, the
patient is drugged into unconsciousness ('terminal sedation'). If that way is
acceptable to the patient, fine. But some people do not wish their final days to be
spent in that drugged limbo.

There ought not to be conflict between hospice and euthanasia -- both are valid
options in a caring society. Both are appropriate to different people with differing
medical needs and ethical values. Later in the 21st century, I am confident that
hospice will become a place where people go either for comfort care, terminal
sedation, or for assisted suicide. It is the appropriate place for a dignified end.

Religious feelings

Another consideration is theological: does suffering ennoble? Is suffering, and
relating to Jesus Christ's suffering on the cross, a part of preparation for meeting
God? Are you merely a steward of your life, which is a gift from God, and which
only He may take away? My response is this: if your answer to these questions is
'Yes, God is my master in all things,' then you should not be involved in any
form of euthanasia. It just does not fit.

There are millions of atheists and agnostics, as well as people of various
religions, degrees of spiritual beliefs, and they all have rights to their choices in
abortion and euthanasia, too. Many Christians who believe in euthanasia justify it
by reasoning that the God whom they worship is loving and tolerant and would
not wish to see them in agony. They do not see their God as being so vengeful as
refusing them the Kingdom of Heaven if they accelerated the end of their life to
avoid prolonged, unbearable suffering.

Another consideration must be that, by checking out before the Grim Reaper
routinely calls, is one depriving oneself of a valuable period of quality life? Is
that last period of love and companionship with family and friends worth
hanging on for? Our critics heavily use the argument that this is the case.

Not necessarily so! In my twenty years in this movement, and being aware of
many hundreds of self-deliverances, I can attest that even the most determined
supporters of euthanasia hang on until the last minute -- sometimes too long, and
lose control. The wiser ones gather with their families and friends to say
good-byes; there are important reunions and often farewell parties. There is
closure of wounds and familial gaps just the same as if the person was dying
naturally - perhaps more so since the exact timing of the death is known.

Euthanasia supporters enjoy life and love living, and their respect for the sanctity
of life is as strong as anybody's: sanctity as distinct from sacredness. They are
willing, if their dying is distressing to them, to forego a few weeks or a few days
at the very end and expire at a time of their choice. Moreover, they are not the
types to worry what the neighbors will think.

A doctor's choice

There is another rightist argument that the acceptance of euthanasia practices will
quickly destroy the traditional bond of trust between doctor and patient; that the
patient will never know if the doctor is going to kill them or not; that
commercialized medical practices will jump at the chance to get rid of long-term
patients who are short of insurance funding.

Those arguments have been answered by the 20 years euthanasia has been
practiced in the Netherlands, and by the nearly three years physician-assisted
suicide has been available in Oregon. No evidence of a breakdown in
relationships has emerged. Those doctors who are ethically opposed to hastening
the end of life just don't do it.

The laws in the Netherlands, Oregon, and the ones which have failed to pass, all
give medical professionals the right to refuse to be involved -- a conscience
clause. This exemption will always be so as far as I am concerned.

In fact, many patients hold their medical advisors in higher regard if they know
that he or she will go to great lengths to keep them from terminal suffering, even
to the extent of providing, if necessary, a gracious final exit.

Comfort of knowledge

What people often do not realize is that, for many, just knowing how to kill
themselves is itself of great comfort. It gives them the assurance to fight harder
and therefore often extends lives just a bit longer. Many people have remarked to
me that my book, 'Final Exit' is the best insurance policy they've ever taken out.
Once such people know how to make a certain and dignified deliverance, with
loved ones supporting them, they will often renegotiate the timing of their death.

For example, a man in his 90s called to tell me his health was so bad he was
ready to terminate his life. I advised him to read 'Final Exit,' which he did and he
called me back. He had managed to get hold of lethal drugs from a friendly
doctor and so everything was in position.

"So what are you going to do now?" I asked him.

"Oh, I'm not ready to go yet," he replied. "I've got the means, so I can hold on a
bit longer."

Now he had the knowledge, the drugs, and encouraged by the control and choice
now in his grasp, he had negotiated new terms with himself concerning his fate.
Surely, for those who want this way, this is commendable and is in fact an
extension rather than a curtailment of life's span.

Thanks to the work in the last century of a forceful right-to-die movement, a
hidden reality has emerged about terminal suffering, indicating that the time has
come for change. What are needed now are laws permitting voluntary euthanasia
and physician-assisted suicide surrounded with a bodyguard of rules -- but not so
many that the patient in unable to jump through all the hoops.

With the inevitability of gradualness, as the idea takes hold amongst rising
generations, reform will undoubtedly come. We who believe must ceaselessly
work for it.

© Copyright 2000 Derek Humphry
The above essay may be reproduced for scholarly purposes without permission
being sought, provided source acknowledgement is given. Reproduction in any
journal or book must have the author's permission. Length: 2,900 words.
This essay is Chapter 4 of the book "Supplement to Final Exit" published by the
Norris Lane Press and ERGO, 2000. Oregon, USA.

Also visit: ERGO website


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