Assisted Suicide: Is It the Government's Business?

This was the headline given to an online Web chat by Nicole Brochu, a columnist with the South Florida Sun-Sentinel. It took place this past Tuesday (April 12, 2011) and featured Derek Humphry (Hemlock Society USA, ERGO) and Greg Swartz (director of Another Harvest Moon, a new indie movie dealing with euthanasia) as panelists. I had been notified by Alex Schadenburg of the Euthanasia Prevention Coalition that this was taking place, and I took the opportunity to participate.

Below is the transcript of the chat. Comments and questions from participants other than the moderator and panelists are in italics; additional information and my own thoughts are noted with square brackets. All bolded emphasis is my own.

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1:56 - SunSentinel.com Health: Hi everyone. We will begin our chat momentarily. Please standby.

2:00 - Nicole Brochu [SFSS columnist, moderator]: Welcome, everyone, to today’s chat.

2:00 - Nicole Brochu: I’d like to introduce our panelists.

2:00 - Nicole Brochu: Derek Humphry, considered the father of the right-to-die movement, is the author of “Final Exit,” the groundbreaking how-to manual for terminally ill patients wishing to end their lives.

2:00 - Nicole Brochu: Also joining us is Greg Swartz, the director of the recently released film, “Another Harvest Moon,” starring Ernest Borgnine, Doris Roberts, Anne Meara and Cybill Shepherd and largely centered around one elderly character’s struggle with thoughts of suicide.

2:00 - Nicole Brochu: I am Nicole Brochu, a health columnist for the Sun Sentinel in South Florida, and I’ll be moderating today’s conversation.

2:01 - Nicole Brochu: Welcome, gentlemen.

2:01 - Nicole Brochu: I’ll begin by asking Mr. Humphry: When you wrote “Final Exit” in 1991, it had been 16 years since you helped your wife, Jean, end her suffering from inoperable, terminal cancer. Why did you feel the world needed a how-to on euthanasia?

2:02 - Greg W. Swartz: Hi. Thanks for having me.

2:02 - Derek Humphry: It was only after I wrote a book about Jean's way of death did I realize how much public interest there was, and 5 yrs later founded the Hemlock Societey USA

2:03 - Nicole Brochu: What is the Hemlock Society? What was its mission?

2:04 - Derek Humphry: The Hemlock Society (1980-2003) worked to help terminally ill people with their hastened deaths, if that's what they chose, and, secondly, worked to change the laws on assisted suicide in California and Washington.

[There's some interesting history that bears noting here. The Hemlock Society was founded by Humphry in California in 1980 and moved to Eugene, OR in 1988. Humphry and other Hemlock Society members (under various other names like Oregon Right to Die and End of Life Choices) were major players in the campaign to pass Measure 16, which became the Death With Dignity Act. However, the original draft of the Act would have legalized lethal injection - i.e., not just physician-assisted suicide, but active voluntary euthanasia as well. Since the inclusion of lethal injection was the reason a similar measure failed at the ballot in Washington in 1991, some members of the Measure 16 campaign wanted to take it out. Humphry was incensed and wouldn't let them. The conflict led to Humphry pulling out of the Oregon Right to Die campaign and forming his own organization, ERGO. The Hemlock remnant joined with Compassion in Dying (a Washington-based group) to provide the impetus to win passage of the DWDA in 1994.

I submitted this question through the website chat: "Mr. Humphry, do you support the use of lethal injection for suicides that don't go as planned, as the Dutch do?" The question was screened out by the moderator.]

2:04 - Nicole Brochu: What was the reaction you received in response to "Final Exit"? Was it positive or negative.

2:06 - Derek Humphry: To my surprise, Final Exit leaped into the NY Times bestseller lists and stayed there for 18 weeks. It surprised most people that such a book could be a bestseller. There was negative reaction from the Christian Right, but the intense argument over the book only intensified the sales!

2:06 - [Comment From Chan] - When states enact laws that legalize assisted suicide, are provisions made for adequate safeguards to ensure that the individual has not been hastened to his or her decision by unscrupulous relatives who might have an ulterior motive, say, a potential inheritance?

2:08 - Derek Humphry: The existing Oregon and Washington laws permitting physician-assisted suicide for its terminal residents have a clause in the law making it a crime to pressure or influence a person to hasten death. [I sent in a comment on the chat noting that in Oregon, this supposed safeguard has been gotten around by determined families in documented cases, mentioning Kate Cheney by name and providing a citation. The comment was screened out.]

2:08 - Nicole Brochu: Greg, what inspired you to take on a film whose central character grapples with thought of killing himself?

2:08 - Greg W. Swartz: The film (which was a play first) appealed to me on a practical level because I wanted to make a drama that was small in scale but universal in subject matter. Then, I went through a very difficult time involving my own father's death. And that really made it personal for me.

2:09 - Nicole Brochu: How has the film been received by audiences as you take it from city to city?

2:10 - Greg W. Swartz: We have taken the film to many films festivals... from Hollywood to Indianapolis to Providence, RI, and the one thing that happens at every single screening is the line of people that forms afterward.

2:10 - Greg W. Swartz: They line up to tell me and the producers stories of their own that are similar to the one in the story... personal tales of people facing their own end-of-life dilemmas.

2:11 - [Comment From Dennis] - Where should the line be drawn if, indeed, assisted suicide should ever prevail? Could I decide if I were blinded that I simply wanted to exit life? If I were paralyzed, should I be able to choose assisted suicide or would it be strictly TERMINAL candidates only?

2:12 - Nicole Brochu: Shouldn't you be allowed to decide when and how you die no matter what you are suffering from, Dennis? [Ah - that’s the attitude Humphry, Kevorkian, and the others want.]

2:12- Nicole Brochu: I mean, who else should decide that? The government?

2:13- Nicole Brochu: In fact, suicide is perfectly legal in America. It's getting your doctor to help with painless, peaceful options that is banned in most places.

2:13- Greg W. Swartz: We chose not to take sides with the film, but rather to show the various characters representing various viewpoints. I have my own POV on the issue, but it's not necessarily in the film.

2:13 - Nicole Brochu: What's that point of view, Greg?

2:14 - [Comment From Dennis] - The govt won't have an opportunity to influence my decision to die in any case, legislated or not!!

2:14 - Derek Humphry: Physician-assisted suicide (PAS) should only be for a competent adult who is terminally ill and near the end. Two doctors should attest to this. I don't believe P A S should be available for persons with mental health issues, or clinical depression. Also, the present OR and WA laws forbid assistance on the grounds of old age or handicap. [What?!? That’s not true. It’s all about a handicap (a physically debilitating condition) determining whether your suicide is “rational” or not.] That's wise.

2:15 - Greg W. Swartz: As I said, I watched my father die an agonizing death. It happened in a matter of weeks, so it never quite came down to assisted suicide, but it's certainly something we discussed (about him and with him). I think it's a personal choice and, had he chosen that, I would have helped him. Or supported him in doing so himself. [And this POV is not in the movie? Really?]

2:16 - [Comment From George] - Can you ,in a simple explanation ,Mr.Humphry,state how a person can commit suicide?I have your book( 2002 ),but rather complex solution!

2:17 - [Comment From Bunny] - Terminally ill patients can choose hospice.

2:18 - Derek Humphry: It is not easy to bring one's life to an end, except violently, which is terrible. The various ways of peaceful, justifiable hastened death are outlined in the book 'Final Exit'. It requires courage, planning and -- hopefully -- family support.

2:18 - [Comment From Lionel from Belgium] - Here in my small country euthanasia has been legalised for almost 10 years now and was performed on thousands of people (official statistics). 80% of them did not consent. do you really believe that you are going to be able to prevent that in the US? Many non-terminal people are being pressurized today, I personally know dozens of cases.

2:20 - Derek Humphry: As to Belgium, assisted suicide is only by doctors, according to a specific law. I don't believe that 80percent did not consent. That would be outrageous and cause an uproar in a country which is proud of its rule of law. [Oh, that’s nice – just deny it, implying that Belgium would be in chaos if it were true. Maybe they’ve been successful in Belgium where you haven’t yet been in America, Mr. Humphry – they’ve changed attitudes such that society doesn’t care anymore about sick, elderly, or disabled people who suicide.]

2:22 - [Comment From Dom] - I tried to volunteer at my local Compassion and Choices, but my offer was turned down. It bothers me that the focus of many right to die groups are just the old and the sick. I don't understand why this isn't being stressed as a human right for all people of all ages. [There it is again – “proper”, “sensible” thinking according to PAS advocates.]

2:22 - Nicole Brochu: Greg, how do feel a film of this nature would have been received 20 years ago, when polls on the public’s acceptance of the idea of assisted suicide were much lower? Would any Hollywood producer have dared to touch the subject?

2:23 - Greg W. Swartz: i think that the conversation has certainly changed. Dr. Kevorkian really brought it to the national table and that has really shifted public opinion... or at least opened up a dialogue. I think that 20 years ago, it would have been more controversial for sure. I'm just not sure that the film would have been made... at least in a serious way. It would likely have been some sort of melodrama back then.

2:23 - [Comment From Linda] Mr Humphry, How profitable $$ is your assisted death business?

2:28 - Nicole Brochu: Stand by. Mr. Humphry is preparing his answer now...

2:29 - Derek Humphry: My organization, ERGO, is a nonprofit group incorporated in Oregon since l993. It makes a tiny profit. As to my receiving royalties from the 15 books I've written, they put food on my table. I've been a full time writer for 60 years.

2:29 - [Comment From Kathleen] [Well, what do you know? They took one of mine!]

I have a family member who suffers from paranoid schizophrenia – I mean, really suffers. I know you said that assisted suicide should not be available for people with mental illness - but what about a past history of mental illness? A dual diagnosis of mental illness and some other chronic (painful, but not terminal) disease? Is there a difference in your mind between the suffering that would allow a terminally ill person to end their life and the suffering endured by the chronically mentally ill? What if the mentally ill person is suffering more than the terminally ill person? Haven’t the Dutch and the Swiss allowed mentally distressed people to die?

2:32 - [Comment From Diane] - Why is it that we can help our pets die peacefully,but not our loved ones or ourselves? Doesn"t make sense.

2:32 - Derek Humphry: I am not an expert in mental health issues. I leave that to persons more experienced. Yes, the Dutch and Swiss laws do permit assisted suicide for long-term, seriously ill mental patients who have not responded to treatment. But very few are actually helped [nice word choice!] because it is so difficult to assess the nature of the suffering. [Really? There are ‘natures’ or ‘degrees’ of suffering? I thought you thought suffering was simply evil in all its forms…] This is a real problem. [Ah, thanks for that. The problem is that too few mentally ill people are encouraged to die. I get it now.]

2:32 - Nicole Brochu: I like that point, Diane. I ask that all the time.

2:33 - [Comment From Lionel from Belgium] - The Belgian law allows mentally depressed people to have euthanasia after one month. A few years ago a 16 year old having attempted suicide was brought to an emergency room. The doctor did not want to resuscitate her because, he said, she had wanted to die. [This is horrifying. Do the panelists or the moderator follow up on it? No.]

2:34 - Greg W. Swartz: I am a filmmaker, not an expert on any of these issues, but i did my homework in preparation for this film and I really came to feel that every single case is unique and needs to be dealt with as such. I personally feel that we can build a system that, while not fool-proof, can certainly have a lot of protections built in to it. [That’s what the Oregonians and the Belgians thought they were creating – and that’s why we keep pointing out the gaping holes in the “safeguards”.]

2:34 - [Comment From Tom] - This is really sad that people are so unintelligent to think that it's okay to make someone else suffer through living when they simply don't want to. This is so sad and outrageous and please how do we change it?

2:35 - [Comment From Bill] - I saw Harvest Moon Saturday in Boca Raton with an all senior crowd. Over half of them, about 25 walked out when they saw the gun in the movie. They couldn't deal with the subject matter, even though I feel you had toned it down quite a bit so as not to offend anybody. Anyways, thank you, I enjoyed the movie.

2:35 - Derek Humphry: As to pets suffering, the tough answer is that there are very few laws regarding pet euthanasia -- as long as it is done painlessly and justifiably. Whereas we humans have erected a huge amount of laws -- and taboos [Ha! Knew he’d use that word!] -- protecting human life.

2:36 - Greg W. Swartz: Thanks. I'm glad that you enjoyed the movie. I have seen the film with more crowds than I can count and I haven't seen anyone walk out, but I do know that it's pretty intense subject matter (and the films certainly doesn't hide from that). It's not always an "easy" film to watch, but the performances are, in my opinion, very strong and I hope that most people find it a worthwhile experience.

2:36 - [Comment From Sherman] - What can people do to advance the legalization of suicide?

2:37 - Nicole Brochu: Greg, did you feel like you were taking a risk with the subject matter, given that assisted suicide, and suicide in general, is still a controversial topic?

2:38 - Greg W. Swartz: Yes. we knew it was a risk. That was part of the appeal to the artist in me. But we approached some truly legendary actors and they responded so strongly that we knew that there was an audience (because those actors are not only great, they ARE the audience).

2:40 - Derek Humphry: Sherman: Suicide is NOT a crime, anywhere. It used to be in Europe. It's the careful advancement of physician-assisted suicide for the dying which I am fighting for. [Pants! On! Fire! You advocated for lethal injection. You think the chronically mentally ill should be allowed to suicide. You admit to an economic/cost-saving argument in favor of legalizing PAS. “Careful”, my arse!] Assisted suicide is state, not Federal law, so the law should be reformed either by legislators or by citizen vote, such as we have done in Oregon and Washington states.

2:41 - [Comment From Bob] - Isn't it difficult to have each state reaching a different decision on assisted suicide? Is there any movement for some sort of federal law to make it legal?

2:42 - [Comment From Guest] - I read that assisted suicide is also legal in Montana. Is this so?

2:42 - Derek Humphry: Bob: Assisted suicide is STATE law. Nothing to do with Federal law. I think we'd have to change the Constitution to alter this!! [ “’…Man is endowed by his Creator with certain inalienable rights, among them the right to death’… uh… hey, Tom, what should we put next?”]

2:43 - Nicole Brochu: Yes, Guest, Montana became the third state to legalize physician-assisted suicide at the end of 2009 -- by a state Supreme Court decision. [Not quite – the court said there’s no constitutional right to it, but there’s no law against it as of yet.]

2:44 - [Comment From Rene Barrett] - Are there lobbiest & others in the medical arena opposed to assisted suicide because of the trememdous revenue generated by end of life care?

2:45 - [Comment From Eunice] - How about Florida?

2:45 - Nicole Brochu: No, Eunice. Assisted suicide is not legal in Florida.

2:46 - [Comment From Anne] - What is behind the fear in resisting this idea? My sense is that many people shut off the notion, refuse to think about or discuss it. Is religion the main culprit? What is the root of the fear, do you think?

2:46 - Derek Humphry: Rene: Yes, There are divergent views on assisted suicide, but mostly those opposing do so on ethical and/or religious grounds. I have heard that some groups -- on both sides -- employ lobbyists.

2:48 - Greg W. Swartz: One of the characters in the film (Ella, as played by Anne Meara) has a very intense scene where she is praying about the fate of her friend, Frank (Ernest Borgnine). It was an interesting part of the film for me because Anne and I both felt like the character was not religious, so she's not very "good" at praying. It is yet another impossible-to-answer part of this that is definitely very personal.

2:49 - [Comment From Jack] - What are the plans for releasing this movie on dvd or blu-ray?

2:50 - [Comment From Rene Barrett] - Of course they have to use "ethical and/or religious grounds". They can't admit to wanting to make money from a drawn out anguished death. [Would you rather the government or insurers make (e.g. save) money from ill people suiciding?]

2:51 - Greg W. Swartz: The movie is going to be released on DVD and on Blu-Ray, but we don't yet have dates because it's still showing in theaters (and we're hoping that it continues to show to wider and wider audiences. It has been showing in Florida for two weeks now. If you belong to Netflix, you can put it in your queue, but it doesn't have a date. It will also be on iTunes and the trailer is showing there already.

2:52 - [Comment From Guest] - Isn't part of the problem, too, because of life insurance? That insurers don't want to make payments in cases where people have ended their own lives?

2:55 - Derek Humphry: Life insurance is really not an issue here. The law throughout the USA is that if a person commits suicide (for whatever reasons) and the policy is two years old, then the money must be paid. (One year in Colorado.) So check the date on insurance policies.

2:55 - [Comment From Gary Stein] - Did the Kevorkian movie, You Don't Know Jack, help bring a greater understanding of assisted suicide? Do you think it helped change attitudes?

2:56 - Greg W. Swartz: I don't know that my film or the Kevorkian will directly change minds, but they get people thinking and they can, if we're lucky, help people make up their minds. I'm not a moralistic artist, so I'm just trying to get people talking.... thinking... whatever it takes. [Sure you are. Everyone’s got a moral point of view. And yours will be reflected in your movie. Guaranteed.]

2:58 - [Comment From Fred] - There's no excuse not to be informed. Greg, will you please make a documentary about inmendham so that people can figure out that suffering is additive?

2:58 - Greg W. Swartz: I'm not really a documentarian and I'm not familiar with him, but I'll certainly look into it. Today.

2:58 - Derek Humphry: Gary: I credit Dr Kevorkian with bringing huge attention to the whole euthanasia issue. Last year's film and documentary were very impressive. My reservation with Kevorkian is that he has left nothing behind for other dying people to take advantage of -- no legal reform, no medical advancement. [Really? Is that all? No concern about his desire to vivisect people as they die? No concern that he killed people without terminal or even chronic diseases? No other reservations? Really?]

2:59 - [Comment From Eunice] - Thank you for addressing this problem.

2:59 - Greg W. Swartz: thank you.

2:59 - [Comment From Noreen] - Thanks for this chat. I can see that there are no clear solutions and each candidate must do her/his own search of what is possible....before it's too late. Thanks for raising the issue and inviting people to consider end-of-life issues.

2:59 - [Comment From Fred] - thank you.

2:59 - Derek Humphry: It was a good debate. [Debate? Not so much. There were some comments and questions sent in that would have made it something less than the lovefest this was, but they were screened out by your sympathetic moderator – see her comment at 2:12.] Thanks. Derek H

3:00 - Nicole Brochu: Thank you all for participating in today's discussion. It's a very complex issue. Any final thoughts from our panelists?

3:00 - Derek Humphry: Perhaps pay a visit to my web site www.finalexit.org

3:00 - Greg W. Swartz: please feel free to keep asking questions about this at our film's site or on our facebook page. I hope that you'll check out the film. It's been a pleasure.

3:00 - SunSentinel.com Health: Thanks to our panelists for joining us today and participating is this discussion. And thanks to everyone who sent questions and linked to our health chat today.

3:01 - SunSentinel.com Health: Check out Nicole Brochu’s column from April 11, "Assisted suicide: Uncle Sam should just butt out."

3:01 - SunSentinel.com Health: Finally, a transcript of this chat will be available shortly at www.SunSentinel.com/transcript

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This was a very interesting experience. Felt like a good workout... I have the feeling I'll have to keep myself "in shape". I don't think this issue is going away anytime soon.