February 9, 2002

11:58 AM

21 assisted suicides in 2001. Physician assisted suicide, officially known as Oregon's Death with Dignity Act, has been used by 91 people since 1998. The Oregon Public Health Service has released its Annual Report, and the demographics are very interesting. The fear-mongering critics have been proved wrong in that it's not poor, uninsured, uneducated or minorities asking for this, yet the Bush administration and John Ashcroft are trying to nullify the law. Is physician assisted suicide wrong, and if so, why? Is it the business of the Federal government to interfere in a State issue such as this, and is this just another wedge of their pro-life agenda?
posted by Mack Twain (15 comments total)

I think that, if nothing else, this shows just how much people want to live. I'm astounded at the 14 of the 44 who had the drugs prescribed and yet still died from their disease.

Clearly, Ashcroft has cranio-rectal inversion, as usual. It's clear that the availability of this option hasn't caused mass suicides, and even the people who get the prescriptions aren't all using them. I wonder what's going on in that pointy head of his that makes him want terminally ill people to have to suffer a cruel, painful death. I bet he's really pissed off about that whole "lethal injection instead of the electric chair" thing.
posted by mr_crash_davis at 12:19 PM on February 9, 2002

hint: conservatives champion states rights up until the moment the states want do things they don't like. liberals abhor states rights unless the state fights the govt for one of their pet projects.

and so it goes.
posted by lescour at 12:57 PM on February 9, 2002

Few things more arrogant or infantile that trying to decide when it's appropriate for someone else to die.

Having said that, I wish he would.
posted by dong_resin at 1:06 PM on February 9, 2002

I think Lescour, that you will find that liberals tend to dislike "states rights" because they often are at odds with what is perceived to be conventions that lead to a better life for all of us rather than for some of us in various states. Thus, if abortion became a right of a state but not of other sates, then those states allowing it would get lots of new traffic from pregnanat women. If states had a right to decide for or against slavery, then how would we have national unity on that issue? If a state could decide that anyone could get a gun, no matter the age, and without any restrictions, then close-by states would find themselves in trouble with guns coming into their states. And on and on.
Or, more to the point: why should my taxes go to West Virginia to help them out and my state get much less back than it pays in to the federal government?
posted by Postroad at 1:07 PM on February 9, 2002

I think this is a wedge of the GOP's "pro-life" agenda -- though in a possibly more-complicated sense than most people realize.

The opinion of the Supreme Court, judging from recent decisions (including one challenging the very Oregon law that Ashcroft is tilting at, and one challenging a New York law that prohibits medical suicide), seems to be that the federal government does not have the power to dictate to the states what their laws governing physician-assisted suicide must be.

If you accept that, though -- that the federal government has no role in prohibiting a medical procedure because of federal moral objections to it -- then I think you have to accept that the feds have no role in prohibiting the prohibition of another medical procedure, i.e. abortion.
posted by tino at 1:09 PM on February 9, 2002

My sister who lives in Oregon recently emailed me, saying that she was filling out an advanced directive - in the event that her s/o is unable to do so, I'll be in charge of seeing that her wishes are honored regarding life support or physician-assisted suicide.

Fortunately, her health is fine... but it just goes to highlight the importance of taking action ahead of time if you are concerned about the circumstances under which you are willing to live and/or die.
posted by insomnia_lj at 1:19 PM on February 9, 2002

tino - You are correct when you say that "[t]he opinion of the Supreme Court ... seems to be that the federal government does not have the power to dictate to the states what their laws governing physician-assisted suicide must be. " The real question in applying this reasoning to abortion, however, is why the federal government does not have that power.

In the abortion context, the Court has determined that abortion comes within the sphere of fundamental rights protected by substantive due process. See, e.g., Planned Parenthood v. Casey, 505 US 833 (1992). On the other hand, the Supreme Court has definitively stated that the right to a physician assisted suicide does not fall within that protection. See Washington v. Glucksberg, 521 US 702 (1997).

A state may choose to provide its citizens with more rights that the federal Constitution and the 14th Amendment protect, but it may not provide less. Therefore, because the 14th Amendment protects the right to have an abortion, the states may not restrict, or place an "undue burden" on that right. On the other hand, the 14th Amendment does not protect physician assisted suicide, and the states are free to regulate that area as they see fit.

The dichotomy between the rights is really a matter of substantive due process, but the action Ashcroft has taken in seeking to penalize Oregon for its choice of law has clearly implicate questions of federalism. May the federal government seek to coerce a state into passing laws, or not passing laws, as the federal government deems necessary? The answer to that question depends, at least in part, upon the meaning of the 10th Amendment. In a complex case, the Court ruled that elements of the Low-Level Radioactive Waste Policy Amendments of 1985 represented an unconstitutional intrusion by the federal government into traditional state matters. The Court held that "even where Congress has the authority under the Constitution to pass laws requiring or prohibiting certain acts, it lacks the power directly to compel the States to require or prohibit those acts." New York v. United States, 505 U.S. 144 (1992). It would seem, therefore, that the answer to the question must be "no." States which seek to protect the right to physician assisted suicide may not be constitutionally coerced by the federal government to prohibit the exercise of that right.
posted by monju_bosatsu at 1:54 PM on February 9, 2002

May the federal government seek to coerce a state into passing laws, or not passing laws, as the federal government deems necessary?

Like the executive branch's refusals to turn over documents to Congress and fighting undeclared wars, it may because it does. Whether it *should* or is *legally empowered* to do so is another issue.

It's simple: government will do whatever it wants, until enough people get offended enough to take enough action to put a stop to it.
posted by rushmc at 2:54 PM on February 9, 2002

A findlaw article called "ASHCROFT V. OREGON: Telling The States What To Do In Cases Of Physician-assisted Suicide from November 14th of last year, frames some of these issues on states' rights and the supremacy clause in a reasonably articulate manner. Here we have a right granted by Oregon which is legal under the State's law. The Attorney General has directed that physicians who follow the Oregon law be prosecuted under a federal controlled dangerous substances act because the practice of assisted suicide is not legal under the federal statute (as he interprets the law).

When state law and federal law clash head on, the supremacy clause of the constitution dictates that the federal law preempts the state law, in most instances. Yet, there's a lot of question as to whether this federal law preempts the Oregon State law because they don't necessarily cover the same subject matter. There is no federal statute directly on point.

What the findlaw article points out that might add to this discussion is that Attorney General Ashcroft might be acting as if he were a legislative body here rather than as a prosecutor. If the federal legislature passed legislation preempting the Oregon law, then a court might likely rule in favor of Ashcroft. Here, that hasn't happened. So this is more than a states' rights versus supremacy clause issue. It's also a separation of powers' issue.
posted by bragadocchio at 6:57 PM on February 9, 2002

getting back to the moral (as opposed to legal) issues here...i think it is perfectly consistant to be pro-choice and anti-assisted suicide.

the problem with legalizing this practice is that it has the effect of normalizing the idea of suicide. for better or worse, society's morals tend to be reflective of the legal structure. part of this is a result of the democratic process (i.e. laws get passed because society wants them) but the reverse is also true: the passing of a law will, over time, affect mores. just as an example, does anyone doubt that legalizing pot would, over time, have a major effect on societal attitudes towards it?

so, the question, as i see it, is whether we really want to normalize the practice of killing oneself. i say no for three related reasons:

1. people that don't really want to kill themselves will feel pressure to do so because of their guilt about financial burden they are imposing on their family by staying alive. also, some not-so-nice people will actually pressure their dying family members to consider suicide. a societal taboo against suicide enforced by law protects against this.

2. from an economic perspective, society has every reason to want these people dead. they cost a lot of money to take care of and make no contribution to the economy. there is already a temptation in society to marginalize these folks (witness the huge inadequecies in Medicaid and Medicare funding) since they are worth so little in economic terms. market forces want these people dead, and legalizing PAS can only help the market to achieve that goal. on the other hand, a total ban on suicide acts as a very effective check on the market since it criminalizes the market's preferred outcome.

3. HMOs. I guess this is related to #2 but it's worth special consideration. if i were running an HMO, i would be thrilled about Oregon's law. i'd be sending out letters to all my terminally ill patients letting them know that suicide was now a covered benefit and telling them about how easy and painless it is, maybe suggesting doctors in the network that they may want to consult. you may think that this sounds to macabre even for the hated HMOs, but you have to think about the cost savings for them. paying for treatments for a long drawn out struggle with a terminal illness will cost an HMO hundreds of thousands of dollars per patient. these pills cost something like $18. most people, even fairly decent people, become a little morally flexible with they start thinking about that kind of money.

finally, let's face it: most people that really want to kill themselves are going to find a way to do it regardless of what the law says. most juries won't even convict doctors that help people to die. fine. what i'm saying is that the taboo against suicide serves a useful function in society, particularly as it relates to people who have little economic value.
posted by boltman at 1:13 AM on February 10, 2002

If one of my animals is terribly injured or ill beyond hope of cure or any quality of life, I can relieve it's suffering by according it a swift, painless death.

Now, we as humans have awarded ourselves domain over all animals, isn't it time that we took up the challenge of domain over ourselves? ...... or is that just TOO scary?
posted by Arqa at 2:43 AM on February 10, 2002

That is too scary. Humans should not have such total power over each other, and legalizing assisted suicide erodes those legal and societal checks on such exercises of power. Of course it's legal to kill an animal in pain; heck, humans kill aniimals en masse for food. It can be perfectly legal to kill a pet who is sick, in pain, and whose treatment would cost more than an owner is willing to pay. But we don't do that to humans, and in fact recoil at the thought of such things. This is because we hold human life to be much more precious, in itself, than animal life. Or at least, society as a whole would like to. Also, it would like to have social relations wherein no one is allowed to kill another person.

Admittedly, this is one of those marginal cases where personal liberty and the desire to end suffering can run aground of the goals of maintaining life and preventing homicide. But I think keeping physician-assisted suicide should stay illegal. However, I also disagree with John Ashcroft trying to make an end-run around the democratic will of the people of the state of Oregon, and find his actions not only borderline unconstitutional, but also hypocritical. Does this make me a hypocrite too, or just all mixed up?
posted by skoosh at 12:04 PM on February 10, 2002

I don't agree with your stance, but I appreciate the thoughtful views, boltman. Thanks.
posted by rushmc at 4:22 PM on February 10, 2002

Oh, I see, boltman, if I'm evil enough to be willing to persuade my elders that, since they no longer make much of an economic contribution, that they should talk with their doctor and get some little death pill--if I'm that evil, mind you--keeping physician assisted suicide illegal is going to stop me from offing the oldsters. Right.

Physicians still have to write the scripts: and they don't give out assisted suicide meds just because you're tired of living or having a bad day. The scope of this "therapy" (if that's the word) is limited to the terminally and incurably ill and is meant to be an option to relieve unnecessary suffering at the end stagest of debilitating diseases.

Is there potential for abuse? Sure. Find me an area of medicin where there is none. Should assisted suicide be carefully watched over and regulated? Sure--all medical procedures need careful regulation. Should people be allowed to choose death over a life of pain without hope of cure? I think so.

But please, don't let evidence to the contrary of your thesis get in the way of your holding onto it.
posted by wheat at 11:41 PM on February 10, 2002

My sister who lives in Oregon recently emailed me, saying that she was filling out an advanced directive

insomnia_lj, I don't mean to pick on your sister, but I wonder in general if people who aren't already experiencing this kind of debillitating illness can really make an accurate prediction ahead of time whether they would want to live or die in that situation. Wouldn't it be awful to get in that position, decide that you wanted to live as long as possible after all, but be unable to communicate that desire to your caregivers?

More than a quarter of the people who were already that sick, and got prescriptions for fatal medication, apparently decided not to do it. How many more people are likely to feel differently when they are actually in that position than they do now just trying to imagine what terminal illness is like?
posted by straight at 8:26 AM on February 11, 2002