Culture & Ethics
Marcia Angell Is Enthusiastic for Euthanasia
Just as an illustration of where too many among the intelligentsia and technocratic classes are concerning euthanasia: I would like to briefly review a book review by former New England Journal of Medicine executive editor — and assisted suicide booster — Marcia Angell.
Angell reviews Being Mortal: Medicine and What Matters in the End, by Atul Gawande. I have read the book and written a review, not yet published, so I can’t expound on that here. But I would like to focus on Angell’s increasing zeal for legalizing assisted suicide — and now, in this review, euthanasia.
Angell spends about a quarter of her long review discussing just the few pages about assisted suicide in the book. From "A Better Way Out," published in The New York Review of Books:
He writes, "For the terminally ill who face suffering that we know will increase, only the stonehearted can be unsympathetic," but then goes on to say, "I fear what happens when we expand the terrain of medical practice to include actively assisting people with speeding their death. I am less worried about abuse of these powers than I am about dependence on them."
The implication is that we might begin to substitute assisted dying for palliative care and hospice. He points to the experience in the Netherlands, where he says the fact that "one in thirty-five Dutch people sought assisted suicide at their death is not a measure of success. It is a measure of failure."
Angell resents the implication:
Why, moreover, does Gawande simply assert that the one in thirty-five assisted deaths in the Netherlands are too many? Given the prevalence of terrible deaths from cancer, as Gawande describes so well in his book, why is it not the right number? In Oregon, the number is one in five hundred deaths. Is that the right number?
To show you where she is coming from, Angell previously said that "too few" people "request" assisted suicide in Oregon.
Moreover, the number of Netherlanders who die at the hands of doctors is far higher than that stated by Gawande — if you include intentional terminal sedation (artificial coma/removal of food and water), non-voluntary euthanasia, and intentional overdose of pain control drugs with the intent of causing death. Indeed, I have calculated that doctors kill in up to 14 percent of all Dutch deaths — a startling number considering that approaching half of deaths are sudden, such as cardiac arrest or auto accident.
Perhaps Gawande’s point, ignored by Angell, is that Dutch doctors euthanize well beyond the terminally ill, including the elderly "tired of life," the mentally ill, and the disabled. Once killing becomes blas�, it can become the course of least resistance.
Angell also notes correctly that most Oregonians who commit assisted suicide have been in hospice. But hospice that omits suicide prevention isn’t hospice. It is like saying that the person was in hospice — but not given morphine for pain. In other words, mere enrollment isn’t the same thing as receiving the proper care that hospice was designed to provide.
And then, with assisted suicide unequivocally legal in only three states — not the five she suggests (it’s complicated) — Angell embraces outright euthanasia — even for those who can’t ask for it themselves:
After my husband’s death, I have come to favor euthanasia as well, for home hospice patients in the final, agonal stage of dying, who can no longer ingest medication orally. These patients are usually no longer mentally clear enough to give contemporaneous consent, but if they have earlier made it known that this is what they would wish, I believe that a duly appointed proxy should be able to have that wish carried out.
What could go wrong?
You see how it works. Accept the premise of killing as an acceptable answer to suffering unleashes forces against which there are no brakes. Angell is a good example of how the slippery slope slip-slides away — even before the monster is completely unchained and out of its cage.