'Right' or Duty to Die? Depends on Who You Ask
Euthanasia debate pits sick and elderly against young, healthy
voters who think they need 'assistance' in suicide
by Richard Doerflinger
As the U.S. Supreme Court prepares to hand down some time next
year its first ruling ever on physician-assisted suicide, the
battle lines seem clear.
On one side are those who believe in the freedom of suffering,
terminally ill patients to end their lives with a physician's
help. Opposing them are Catholics and others who believe that
defense of the sanctity of life outweighs this new demand for
Yet, when Bishop Anthony M. Pilla spoke on this issue recently as
president of the National Conference of Catholic Bishops, he
observed that the issue is not so simple. A serious question can
be raised as to whose "freedom" would really be served by
legalizing assisted suicide.
"Remarkably," he said, "few have noticed that frail, elderly and
terminally ill people oppose assisted suicide more than other
"The assisted-suicide agenda is moving forward chiefly with vocal
support from the young, the able-bodied and the affluent, who may
even think their parents and grandparents share their enthusiasm.
They are wrong."
Far from "imposing" their values on others, he said, Catholics who
oppose assisted suicide "are standing with those who are
vulnerable and marginalized, those who often lack a voice in our
nation's policies and are at serious risk of having some demeaning
'values' imposed on them from the outside."
As Bishop Pilla issued his remarks at the U.S. bishops' annual
meeting in Washington last month, a cardinal often described as
the country's pre-eminent Catholic leader was preaching the same
message by his words and actions.
As one of his last public acts before succumbing to pancreatic
cancer, Cardinal Joseph L. Bernardin of Chicago wrote an
unprecedented personal letter to the justices of the Supreme Court
urging them not to create any "right" to assisted suicide.
"I am at the end of my earthly life," wrote Cardinal Bernardin in
his Nov. 7 letter. "There is much that I have contemplated these
last few months of my illness, but as one who is dying I have
especially come to appreciate the gift of life."
He warned the justices that "creating a new 'right' to assisted
suicide will endanger society and send a false signal that a less
then 'perfect' fife is not worth living."
In fact, Cardinal Bernardin's concerns are shared by many other
terminally ill patients. In the June 29 issue of the British
medical journal The Lancet, a team led by Dr. Ezekiel Emanuel of
Boston reports that cancer patients experiencing "significant
pain" are far more opposed to euthanasia and assisted suicide than
the general public.
Emanuel found little difference of opinion on this issue between
cancer patients overall and the general public. But the patients
who support assisted suicide for cases of "unremitting pain" are
not those in pain, but those diagnosed with clinical depression.
The patients actually dealing with pain here and now have a
Emanuel concludes that "having pain does not predispose a person
to desire or take actions to end his or her life.... Indeed,
oncology patients in pain may be suspicious that if euthanasia or
physician-assisted suicide are legalized, the medical-care system
may not focus sufficient resources on provision of pain relief and
A new study in the Oct. 28 issue of Archives of Internal Medicine
confirms these findings, and adds a more ominous note.
Here, researchers at Duke University Medical Center found that
frail elderly patients receiving treatment at a geriatrics clinic
overwhelmingly oppose legalizing physician-assisted suicide in
their home state, with only 34 percent in favor.
Support is even lower among patients who are poor, less educated
and experiencing cognitive impairment or a low "quality of life."
But 56 percent of the younger, healthy relatives bringing the
elderly patients in for treatment favor legalization-and they
often wrongly assume that the patients would favor it, too.
In short, the people most directly affected by policies on
assisted suicide are most opposed to it, but their own relatives
are often ignorant of this fact. Those younger relatives are the
very people who would likely be making "proxy" decisions on
euthanasia for elderly incompetent patients, if the Supreme Court
establishes a constitutional "right to die."
"These findings are provocative and of great concern," said lead
investigator Harold Koenig of Duke University, "because the frail
elderly, poorly educated and demented members of our society have
little power to influence public policy that may directly affect
This phenomenon is not restricted to the seriously ill. One
opinion poll after another has shown that the more vulnerable and
marginalized members of our society-the elderly, the poor and
members of racial minorities-are more opposed to assisted suicide
than other Americans.
When the Hemlock Society polled Americans in 1993 on this issue,
it was surprised to find that voters aged 18-29 were much more
likely than seniors to support the group's agenda.
The Hemlock Society's own newsletter commented that "the younger
the person, the more likely he or she is to favor this
legislation" allowing assisted suicide -a finding "somewhat at
odds with how Hemlock views its membership," since it sees itself
as a champion of seniors' freedom to die.
A poll published in the April 4 Washington Post found 50 percent
support nationwide for legalizing assisted suicide for the
terminally ill. In this poll, voters aged 35 to 44 supported
Legalization, 57 percent to 33 percent.
But these numbers were almost reversed among voters aged 65 and
older, who opposed legalization 54 percent to 38 percent. A
majority also opposed assisted suicide among those with annual
incomes below $15,000 (54 percent) and among black Americana (70
Support for the "right-to-die" agenda is strongest among affluent,
college-educated white males with no religious affiliation. These
young, healthy men may find it difficult to imagine that a life of
illness, disability or suffering has real value.
Many of them undoubtedly want assisted suicide to be available for
themselves if they face a lingering dying process in the future.
But they may also see it as a humane solution for patients who are
now seriously ill-and for the families who feel burdened by those
This struggle between the generations on assisted suicide comes at
a time when new questions are being raised about the future of
Medicare, Social Security and other programs in an aging U.S.
Some commentators have begun openly blaming American seniors for
the nation's social and economic problems. Writing in The New York
Times Magazine May 19, for example, economist Lester Thurow
charged seniors with "destroying government finances" and
"threatening the investments that all societies need to make to
have a successful future."
It is frightening to think that such scapegoating of seniors could
catch on with younger voters, increasing their enthusiasm for
frail elderly patients' "right" to die.
These considerations are surely relevant to the Supreme Court's
effort to sort out a just solution to the dilemma of assisted
suicide. Federal courts often see themselves as defending
endangered or unpopular individuals, protecting helpless
minorities against oppression by a powerful majority.
Many vulnerable seniors would welcome the courts' help in fending
off a "duty to die" that is all too popular among some of their
children and grandchildren.
Doerflinger is associate director for policy development at the
U.S. bishops' Secretariat for Pro-Life Activities
This article was taken from the December 15, 1996 issue of Our
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