An Open Letter to Baroness Warnock on Assisted Suicide
By Rita L. Marker
When she said people with Alzheimer's should be able to appoint someone to request euthanasia for them, Britain's leading medical ethicist, Baroness Mary Warnock, caused a firestorm of controversy. A similar, but little known, proposal was made by those in the forefront of Oregon's assisted-suicide law and the current Washington State initiative to legalize assisted suicide.
The following open letter to Baroness Warnock explains how she will be far more likely to move toward her goal if she follows the Oregon model.
Dear Baroness,
Your recent interview on a duty to die certainly caused a stir when you said you hope people will soon be licensed to "put down" those who are unable to look after themselves. To hear the fuss from commentators around the world, one would think you'd never expressed that idea before. But I imagine few people read about a lecture you gave at Giggleswick School in 1990 where you said virtually the same thing. Truth be told, when I first read the account of that lecture in the Craven Herald and Pioneer, I thought it was a very bad joke. Maybe that was due, in part, to the name of the school. Not being a Brit, I didn't realize what a prestigious institution it is. Still, I thought it was a bit radical to suggest that some people were "quite unambiguously entitled to end the life of those whose life chances are seen as very poor."
I can see now that you really meant it then and that you haven't budged in your stance. However, in your latest call for designated death deciders you really went over the top when you pointed out that it would save money for the National Health Service. And you hurt your own cause.
Quite frankly, Baroness, it's time to face the fact that it has been eighteen years since you first voiced your proposal in an open forum and you're no closer now than you were then to achieving your goal. If you want to succeed, you really must change your approach.
You may want to consider following a model that seems to be working here "across the pond."
That model is from Oregon. It started with a proposal much like yours. In 1991, Senator Frank Roberts sponsored a measure (SB 1191) to permit "aid-in-dying," defined as "a medical procedure" performed by a physician "to end the life of a patient in a dignified, painless and humane manner." Of course, it meant killing the patient with a lethal injection but, you'll note, that the soft phrase, "aid-in-dying," was used. That's an important point since words like "euthanasia," "assisted suicide" or, as you say, "put others down" really turn people off.
Senator Roberts' legislative aide was Barbara Coombs Lee. (Keep that name in mind, Baroness. You really do want to emulate what she has done over the years.) Lee worked to gain approval for the proposal. But, despite the euphemistic phrases and Lee's hard work, the measure failed. It had several fatal flaws that made it unpalatable.
First, the printed version of the bill noted that it was sponsored "at the request of the Hemlock Society," making it far too clear that a special interest euthanasia advocacy group was behind it. Second, it went too far, too fast. It provided that an individual could give another person the right to "instruct my physician to provide assistance in ending my life in a painless, dignified and humane manner if I have a fatal disease such as advanced Alzheimer's disease that makes me unable to speak intelligibly...."
Sound familiar to you? It should, since it's exactly what you're calling for.
But, at the time, it was just too much for people in Oregon to swallow.
The backers of the measure could have just kept proposing the same bill over and over, but they didn't. Unlike your, dare I say, stubborn insistence on pushing for everything at once, assisted-suicide and euthanasia activists here learned from their failure. They realized they had to change their image from that of Hemlockian activism to one of compassionate concern.
The players didn't change, but the script did. Three years after Roberts' euthanasia-for-Alzheimer's-patients bill failed, Barbara Coombs Lee became the chief petitioner for Measure 16, Oregon's "Death with Dignity Act." By then she was vice president of a fast-growing managed care company and was working withCompassion in Dying (a spin-off of the Hemlock Society.) Unlike the earlier legislative measure, this one went directly to the voters. It was a scaled back proposal, permitting assisted suicide only (not euthanasia by lethal injection). And it didn't make any provisions for a third party to request an incompetent patient's death. Additionally, politically savvy campaigners made sure that the chilling name, "Hemlock," was no longer attached to the push to legalize assisted suicide.
Another twist was added as well. During the campaign prior to the vote, proponents of the assisted-suicide bill played on Oregon's anti-Catholic biases. They deluged the airwaves, telling voters that the Catholic Church was behind all opposition to the bill and that one religion was trying to deny dying patients the right to choose death with dignity.
The strategy worked. Oregon's "Death with Dignity Act" passed by a vote of 51 - 49% in November 1994 and went into effect three years later.
Baroness, can you see how this process works?
It's really quite simple.
Remember, you need to take things step-by-step; use carefully-chosen, comforting words to describe what you are proposing and find a bête noire (such as the Catholic Church or evangelical Christians). Above all, you must be ready to make changes if something isn't working.
When Oregon's assisted-suicide law passed, those who share your views thought they would rapidly achieve similar victories, but that didn't happen. In fact, in the ensuing years, Oregon-style laws were proposed in twenty-three states (multiple times in some of those states). Yet, each and every one of them failed.
That didn't stop your U.S. counterparts. They forged ahead. They solidified their organizational structure, changing their name to Compassion & Choices (by merging the Hemlock Society and Compassion in Dying). And, most important, they collected "proof" that Oregon's law is working well.
[ Appeals to religious bias. Using words like "compassion" and "choice" on behalf of taking life. Gee. ]
Under Oregon's law, doctors who prescribe lethal drugs for patients must file reports with the state and, then, that information is used to formulate official annual reports. And, since Compassion & Choices has arranged and participated in 75% of the state's assisted-suicide deaths, it has maintained control of most information contained in annual reports. (Oregon officials acknowledge that there is no way to verify whether the self-reporting by assisted-suicide-prescribing doctors is accurate or complete.) All that can be claimed with certainty, is that, after ten years of assisted suicide in Oregon, there have now been ten annual official reports which are, at best, questionable. Nonetheless, this "proof" has become the most powerful tool for those who share your views. They've been able to claim that there have been absolutely no problems or abuses.
Baroness, you might think the Oregon statistics are not relevant to your efforts in Britain but, I assure you, those figures have and will continue to be an important part of the arsenal of anyone, anywhere, who is promoting assisted suicide and euthanasia.
If you are wondering whether your statements - which have, until now, been counterproductive - have somehow disqualified you from being effective in the future, I want to reassure you.
The same people who have previously failed can be very effective as long as they change their words and strategy. Their experience with the 1991 euthanasia-for-Alzheimers'-patients proposal in Oregon did not require its early supporters to bow out of the action.
For example, a few weeks ago, just as you were making your counterproductive "putting people down" statement, your far more savvy American counterparts - who are currently engaged in an assisted-suicide initiative campaign in Washington State (I-1000) - were pointing at Oregon as a model of compassion and choice. In a letter to the editor of the Seattle Post-Intelligencer, former Oregon governor Barbara Roberts assured Washingtonians that "I-1000 is not a slippery slope." Roberts is the widow of Senator Frank Roberts who, you recall, introduced the failed euthanasia-for-Alzheimers-patients measure.
Omitted from her letter was any mention of the fact that, in Oregon, some patients are now being told that their health care plan will pay for assisted suicide, but not for life-saving treatment that their doctors prescribe.
You see, Baroness, once an assisted-suicide law is passed, it can be used to save money. But Roberts is smart enough to know that mentioning the cost containment aspect would cause Washington voters recoil from an Oregon-style assisted suicide law. Instead, she painted the Oregon experience with rosy hues, describing "beautiful accounts of compassion, sharing, dignity and gentle exits."
It should come as no surprise that she also failed to mention Barbara Coombs Lee's leadership in the Washington effort, even though Lee is the current president of Compassion & Choices, which has poured hundreds of thousands of dollars into the Washington State effort. In a recent letter to supporters, Lee wrote, "Very soon - with your help, Washington State could be the next to pass an Oregon-style aid-in-dying law."
By now you should realize that Lee has been very effective in the years since she first worked on a proposal that mirrored yours. And, Baroness, you can also be effective. All you need to do is remember a few crucial points:
• Be very careful with language. Use soothing phrases.
• Don't try to achieve your entire goal at one time. Use a step-by-step approach.
• Manufacture statistics. Use them to bolster your claims, whatever they are.
• Portray any opposition as "anti-choice religious zealots."
• Keep all focus on the current proposal. Never discuss your plans for expansion.
• Always portray your motivation as caring and compassionate. Never, ever, let anyone know that you see legalized assisted suicide and euthanasia as a means of cost containment.
If you follow these few simple steps, you could be well on your way to achieving your end goal. You might want to reflect on the sentiments expressed by Booth Gardner, the former governor of Washington State and the principle spokesperson for the current Washington campaign. In December 2007, Gardner was interviewed by The New York Times Magazine. According to that article:
Gardner's campaign is a compromise; he sees it as a first step. If he can sway Washington to embrace a restrictive law, then other states will follow. And gradually, he says, the nation's resistance will subside, the culture will shift and laws with more latitude will be passed...."
In closing, Baroness, I hope this advice has given you some guidance in how you can be more effective.
However, more than that, I hope those who read this advice will see you as an ethics guru, grown arrogant by too much deference, whose agenda is a cold, cruel dismissal of the lives of those who are most vulnerable. Furthermore, I hope they will recognize that Washington's assisted-suicide proposal and Oregon's law are rooted in the same mentality.
Rita L. Marker
Rita L. Marker is an attorney and executive director of the International Task Force on Euthanasia and Assisted Suicide.
americanthinker.com
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Letter noting assisted suicide raises questions
Barbara Wagner
Story Published: Jul 30, 2008 at 6:30 PM PDT
Story Updated: Jul 31, 2008 at 9:01 PM PDT
By Susan Harding and KATU Web Staff
Video
SPRINGFIELD, Ore. - Barbara Wagner has one wish - for more time.
"I'm not ready, I'm not ready to die," the Springfield woman said. "I've got things I'd still like to do."
Her doctor offered hope in the new chemotherapy drug Tarceva, but the Oregon Health Plan sent her a letter telling her the cancer treatment was not approved.
Instead, the letter said, the plan would pay for comfort care, including "physician aid in dying," better known as assisted suicide.
"I told them, I said, 'Who do you guys think you are?' You know, to say that you'll pay for my dying, but you won't pay to help me possibly live longer?' " Wagner said.
An unfortunate interpretation?
Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, said Wagner is making an "unfortunate interpretation" of the letter and that no one is telling her the health plan will only pay for her to die.
But one critic of assisted suicide calls the message disturbing nonetheless.
"People deserve relief of their suffering, not giving them an overdose," said Dr. William Toffler.
He said the state has a financial incentive to offer death instead of life: Chemotherapy drugs such as Tarceva cost $4,000 a month while drugs for assisted suicide cost less than $100.
Saha said state health officials do not consider whether it is cheaper for someone in the health plan to die than live. But he admitted they must consider the state's limited dollars when dealing with a case such as Wagner's.
"If we invest thousands and thousands of dollars in one person's days to weeks, we are taking away those dollars from someone," Saha said.
But the medical director at the cancer center where Wagner gets her care said some people may have incredible responses to treatment.
Health plan hasn't evolved?
The Oregon Health Plan simply hasn't kept up with dramatic changes in chemotherapy, said Dr. David Fryefield of the Willamette Valley Cancer Center.
Even for those with advanced cancer, new chemotherapy drugs can extend life.
Yet the Oregon Health Plan only offers coverage for chemo that cures cancer - not if it can prolong a patient's life.
"We are looking at today's ... 2008 treatment, but we're using 1993 standards," Fryefield said. "When the Oregon Health Plan was created, it was 15 years ago, and there were not all the chemotherapy drugs that there are today."
Patients like Wagner can appeal a decision if they are denied coverage. Wagner appealed twice but lost both times.
However, her doctors contacted the pharmaceutical company, Genentech, which agreed to give her the medication without charging her. But doctors told us, that is unusual for a company to give away such an expensive medication.
katu.com
Oregon Offers to Pay to Kill, but Not to Treat Cancer Patient
By Tim Waggoner
SALEM, Oregon, June 4, 2008 (LifeSiteNews.com) - Lung cancer patient, Barbara Wagner, was recently notified that her oncologist-prescribed medication that would slow the growth of cancer would not be covered by the Oregon Health Plan; the plan, however, she was informed, would cover doctor-assisted suicide should she wish to kill herself.
"Treatment of advanced cancer that is meant to prolong life, or change the course of this disease, is not a covered benefit of the Oregon Health Plan," read the letter notifying Wagner of the health plan's decision.
Wagner says she was shocked by the decision. "To say to someone, we'll pay for you to die, but not pay for you to live, it's cruel," she told the Register-Guard. "I get angry. Who do they think they are?"
[ Oh, no no no. Its "compassionate". The pro-euthanasia folks are all about "compassion" and "choice", though strangely the Oregon Health Plan doesn't offer this patient a choice. Some "compassionate choice" Barbara Wagner was offered.
This past Monday morning, however, Wagner had reason to rejoice. A representative from the company that manufactures the treatment called the cancer patient to say they would give her the medication for free.
"I am just so thrilled," she said. "I am so relieved and so happy."
Dr. Walter Shaffer, medical director of the state Division of Medical Assistance Programs, which administers the Oregon Health Plan, attempted to defend the health plan's decision. "We can't cover everything for everyone," he said. "We try to come up with polices that provide the most good for the most people." Shaffer then addressed a priority list that had been developed to ration health care. "There's some desire on the part of the framers of this list to not cover treatments that are futile," he said, "or where the potential benefit to the patient is minimal in relation to the expense of providing the care."
According to an AP story on Wagner's case, local oncologists in Oregon have said that, despite the Health Services Commission's assertion that they were just clarifying policies already in place, healthcare practitioners have observed a sizable shift in policy in the way recurrent cancer is treated in the state. Increasingly, say local oncologists, sufferers of recurrent cancer are not receiving coverage for chemotherapy. They are always, however, eligible for state-funded assisted suicide.
Wesley J. Smith, a prominent conservative bioethicist, says that he was not surprised by the events.
"We have been warning for years that this was a possibility in Oregon. Medicaid is rationed, meaning that some treatments are not covered. But assisted suicide is always covered. And now, Barbara Wagner was faced with that very scenario."
Smith also mentioned a similar circumstance that had occurred in the past: "This isn't the first time this has happened either. A few years ago a patient who needed a double organ transplant was denied the treatment but would have been eligible for state-financed assisted suicide."
lifesitenews.com
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Even a child murderer may deserve a little compassion
Minette Marrin
The celebrated moral philosopher Baroness Warnock and the child murderess Joanne Hill have something in common. In the past few days they have become figures of public loathing. Their shared interest in a final solution for people with disabilities has hit the news and they are now generally regarded as neo-Nazis.
Horrifying though both women are, however, I think this outrage against them is not entirely what it seems. Part of the anger has to do not with what they’ve done or said but with the way both women have pressed us up against hard questions that we prefer to turn away from.
Warnock, from her exalted position as one of the great and good, has been pronouncing for years on morals and medical ethics. In an interview with the Church of Scotland’s magazine Life and Work, discussing the predicament of old people with dementia, she spoke of “a duty to die”.
If you’re demented, Warnock said, “you’re wasting people’s lives - your family’s lives - and you’re wasting the resources of the NHS”. Consequently, she believes, there is nothing wrong with feeling you ought to be allowed to die - helped to die - if you are a burden on others or the state: “Actually I think that’s the way the future will go, putting it rather brutally. You’d be licensing people to put others down. Actually I think why not . . . ”
As far as I know, Warnock has not translated thought to action. But Hill “put down” her own daughter. She drowned four-year-old Naomi in the bath because she didn’t wish to live with a child who had mild cerebral palsy.
Accounts vary, but it seems that she was ashamed of her daughter (who had to wear callipers to walk) and resented the extra time needed for her care (she had various medical problems, including incontinence). Naomi’s disabilities were only physical; mentally she was unimpaired and a bright and loving child, according to her father. I doubt whether her mother took a considered view that Naomi had a duty to die, or was a burden on the state, but clearly she felt her little girl was an unacceptable burden. When her husband refused to agree to let Naomi be adopted, Hill killed her.
It ought to be obvious that what Warnock said and what Hill did was wrong and that one leads directly to the other. The thought is father, or rather mother, to the deed. What’s alarming is that Warnock has had official influence on public policy in such matters. All the same, I think there is room for more compassion and careful consideration in both cases.
People who don’t have a disabled child may not understand how difficult it can be. Quite apart from any practical problems, which can sometimes be overwhelming, the mother (or father) will probably have many sadnesses and fears to contend with. We live in a world that is obsessed with bodily perfection and where children who are peculiar are teased and bullied mercilessly.
Then there are feelings that are not allowed to be named – in a hypocritical culture where the expression of feeling is usually compulsory – and shame is one of them. Commentators spoke disdainfully of Hill’s alleged feelings of shame about her disabled child and pointed out (inconsistently) that Naomi was only mildly disabled anyway – would shame have been okay if she’d been severely disabled?
Having grown up close to such questions, I’ve come to realise that shame is not only natural but understandable. One feels at a deep level like a failure as a mother or father. Men often feel this much more strongly than mothers and don’t want to be associated with a damaged child. Well-adjusted people are able to put this shame behind them and I think it’s a mark of a good person in a civilised society that she or he can do so. But it may be difficult. A poorly adjusted person may find it impossible.
Hill has had a history of marked mental illness since the age of 17 and suffered serious postnatal depression after Naomi’s birth: she was a heavy drinker and clearly a problem person with a failing marriage. She knew she was not proving a good mother, so clearly that she asked for her child to be adopted. That is highly unusual; she could hardly have sent out a clearer signal of alarm. It was ignored.
None of this makes her innocent of murder, but it is ground for some compassion and understanding rather than righteous indignation. I suspect the indignation comes from an unwillingness – an inability – to confront the inescapable harshness of disability and the painful truth that it is indeed a burden.
As for the preposterous Warnock, there is little reason and still less incentive to try to defend her. In fairness, however, she has said such things before and her comments to the Scottish magazine were mostly taken out of context.
It is silly of her to talk of a duty to die. It shows her seigneurial indifference to what most people feel and to what the media will pick up. She seems to have no idea of what someone in her position can and cannot say, or that the public arena is not a philosophy seminar. However, the phrase comes, as she explained in the interview, from the title of an essay she has written for a Norwegian periodical, entitled A Duty to Die?. And it has a question mark.
The question mark is the point. Nobody has a duty to die unless he or she independently thinks so. It is wrong to suggest it to anyone and to frighten people with the thought. Yet men and women struggling with the miseries of looking after old people with dementia at home can surely be forgiven for wishing, sometimes, that they would die. And some people, facing dementia, might indeed feel it would be better if they did die before the misery – or some other horror – set in.
I think they should have the right to die, with help if necessary. But it can never be a duty, and to use the word “duty” suggests to anyone who hadn’t already come to the same conclusion that Warnock is unfit for purpose and indeed something of a burden on the public mind and purse.
Fortunately for her, and despite her efforts, it is not her duty to hasten to join the choirs invisible; nor is it anyone’s right to send her there, whatever the temptation.
timesonline.co.uk |
