Prior to reading Mark O’Brien’s interview with Wesley J. Smith [“In the Name of Compassion,” February 1999], I would have said unequivocally that assisted suicide should be legalized. This piece turned me around completely.

When I read it, I had just spent eight agonizing months dealing with medical providers on behalf of my eighty-one-year-old mother (who, incidentally, was a member of the Hemlock Society). During the last year of her life, when the deterioration of her physical and mental functions accelerated, my mother began openly to express feelings of self-loathing. “I’m just a little old lady,” she would say despairingly. Toward the end, when she knew she was dying, she was prematurely discharged from the hospital. Within twenty-four hours of arriving back at the nursing facility where she lived, my mother began vomiting uncontrollably. Rather than give her medical attention, the head nurse put her alone in a room far from the nurses’ station. My mother continued to throw up and was too weak to use the call button, which wasn’t working anyway. If assisted suicide had been an option at that moment, she surely would have chosen it.

Though desperately ill, frightened, and alone, my mother found a way to summon me. When I arrived, she was heaving and covered in vomit. Emotion threatened to overwhelm me, but I took charge of the situation and made sure that my mother got the medical attention, pain relief, and emotional support she needed. My husband, my sister, and a dear friend helped out, and I arranged for a hospice aide to be with my mother around the clock. For the next ten days, we surrounded her with caring and love.

Once the staff realized that my mother had people who cared for her, their attitude toward her changed. Nurses, aides, security guards, and even janitors told us how kind, sweet, and funny my mother had been during previous stays there. Many told me that we were doing something wonderful, and they shared their own experiences of losing loved ones. Sick as she was, my mother created a sense of community around her deathbed.

She died peacefully just before Christmas, on the day it snowed in San Francisco.

Name Withheld

I was astounded by Wesley J. Smith’s implication that because I’m an HMO doctor I would kill a patient to save money. Maybe I can’t speak for all physicians, but I and the ones with whom I work still care about patients. And, by the way, the bonuses I receive from the HMO are based solely on quality of care. I do not receive a bonus for containing costs. Rather, I believe that high-quality care will save money in the long run.

That being said, I agree with Smith’s stand against assisted suicide. I believe if someone feels like ending his or her life, it is a problem that needs to be corrected, either by providing better pain control, treatment for depression, or whatever resources are needed to keep that person from feeling like a burden.

In twelve years of family practice, I’ve attended only one terminally ill patient who wished to hasten his end, and that man took matters into his own hands with a gun. He was a stoic, elderly gentleman too proud to complain about his pain. What he needed was not help in killing himself but rather a dose of morphine. As a profession, doctors are getting better at recognizing and treating pain. We may still have a ways to go, but that’s no excuse for taking the easy way out.

I recommend that any activist for the assisted-suicide movement do some volunteer work in a hospice and find out how much we really can do for the dying.

Gina Howey
Camarillo, California

Although Mark O’Brien’s interview with Wesley J. Smith was compelling, I feel Smith is mistaken to equate painlessness with quality of life. I am a social worker with a reputable hospice program. We boast an exceptional ability to alleviate pain, and also offer chaplaincy and counseling services to alleviate emotional or spiritual suffering. What we cannot do, however, is make lying in bed and wasting away a comfortable status for patients who have always been active and independent.

Many patients have asked me if I can hurry things up for them. I can’t. These patients are not necessarily clinically depressed. They are often bright, humor-filled people who are all too aware of what lies ahead for themselves and the people they love.

My hospice work has made me sure of one thing: I want to die quickly. I hope for an accident, a fatal heart attack, or some other exit that doesn’t involve weeks of incapacity. I do not want to watch television for hours on end or have nursing assistants wash and put lotion on my weakening body. I do not want the people I love to change my diapers or give me suppositories when I can no longer swallow.

Who better to assist with a painless death than a trusted physician?

Margie Thompson
Savannah, Georgia

I wonder if Wesley J. Smith has had a family member with Alzheimer’s disease. I suspect the experience might change his mind about assisted suicide.

I watched as Alzheimer’s transformed my father from a pleasant adult man into an infant needing twenty-four-hour care. My family wished desperately for a law enabling us to end his pathetic existence. For his last three years, my mother became a slave to his illness, spoon-feeding, bathing, and diapering him, and turning him every two hours, round-the-clock. He lay in a back bedroom, unable to speak or recognize anyone. The only thing he was able to do was open his mouth for food and swallow it. My father had never intended to punish my mother this way, but neither had he taken any steps to prevent it.

In the early stages of his disease, my mother had struggled to keep my dad at home. But after ten years, when he no longer knew who she was and began spitting and urinating in strange places, she placed him in a nearby nursing home. There, still able to walk but rarely uttering a sound and not knowing who or where he was, my dad shuffled up and down the corridors for three years. Finally, the chronic neglect he suffered (how could he complain?) forced my mother to take him back home or suffer high blood pressure and perhaps a stroke from worrying about him. So the round-the-clock saga in the back bedroom began.

Smith might wish to believe that this describes a loving wife making the ultimate sacrifice for her husband, but that just isn’t true. My real father had departed years before, leaving behind an empty husk requiring her slave labor to maintain it. We weren’t preserving his life, but we were destroying my mother’s health. Eventually, the strain affected her immune system, and she contracted a bad pulmonary infection, which she unwittingly passed on to my father. He died a short time later. (For a long time, I had been sure he would outlive her.)

Had there been a law in place in Washington State allowing euthanasia, I’m sure my father would have met all the criteria. Smith describes assisted suicide as “just getting rid of the person in one fell swoop.” I hardly believe that after sixteen years of dealing with my dad’s Alzheimer’s, my mother could have been accused of that. Smith worries about potential abuses of a law providing for assisted death. But what about the daily abuses occurring in nursing homes all over the country? Let’s do whatever it takes to preclude abuse of such a law, so we can stop keeping people like my dad in back bedrooms or awful nursing homes, forcing them to stay alive when they can no longer tell us they don’t want to live anymore. I would gladly have given my own father a lethal injection had it been legal, and I know my mother felt the same. And yes, it would have been in the name of compassion.

Marcia Wollam
Seattle, Washington

Maybe Wesley J. Smith cannot imagine himself ever wanting physician-assisted suicide, but I can, and I vehemently resent his effort to deny me that choice. To compare withholding it to keeping someone from enslaving himself is to say that anyone who wants to end his life acts out of self-abasement and unsound mind. There’s nothing as offensive as someone trying to dictate another person’s behavior. To claim the attempt is motivated by protectiveness is patronizing and denies the other person the full autonomy that is his or her birthright.

Smith says assisted suicide is wrong because someday it might be twisted around to kill someone who isn’t willing. This is too insubstantial and hypothetical to justify a restriction of personal liberty. In fact, Smith’s whole argument is built on hypothetical scenarios. We have to give doctors time to perfect pain relief, he says. But who’s to say they ever will? We shouldn’t have death with dignity until we have life with dignity, he says. But in this imperfect world, we won’t ever have it. Legalizing assisted suicide will make people feel less valued, he claims. But in this country, where lack of universal health care, child poverty, urban violence, and unemployment have already devalued people, that’s like shutting the barn door after the horse is gone. And Smith’s main point — that systematic euthanasia will be the inevitable outcome of legalization — is based only on his own fears, assumptions, and cynicism.

Smith seems bent on keeping everyone alive no matter what, and if people disagree with him it’s because they’re mentally incompetent — “clinically depressed,” he calls it. I say if someone wants to die, that is his or her business, and all Smith’s scare tactics and allusions to Nazi atrocities can’t disguise it.

In the world Smith would give us, where no one suffers needlessly, no one is lonely, neglected, humiliated, or shunned, and everyone is valued and welcomed, denying assisted suicide doesn’t seem all that cruel. But no one lives in that world. How can we value people on their deathbeds when we don’t value the child in the street? People live in the present and contend every day with staggeringly harsh realities. They don’t need to have their hands tied by the self-appointed guardian of some idealistic vision.

Brenda Koehler
Mohnton, Pennsylvania

I was in my first year of medical school in Oregon when citizens here voted to legalize assisted suicide. I didn’t know how I felt about the issue until a patient I met helped me decide that I believe legalized physician­-assisted suicide is important.

The patient had been diagnosed with late-stage cancer and was going to die soon. She knew that cancer is often painful, and relief from pain is bought only with a high level of narcotics. She did not want to live in pain, nor did she want to live in a stupor. She tentatively asked the attending physician if he would help her with suicide if and when she wanted it. He told her that it would be an option. The woman was incredibly grateful for this knowledge and appeared to take a much more optimistic view of her disease. She lived several more months and, as far as I know, never requested help to end her life.

The option of physician-assisted suicide empowered this woman. She knew that, if she chose to die, she would have the support of her physician and community. She was now in control of her disease, and if she began experiencing intractable pain, she would not be forced to “transcend” it or live in a narcotic haze. I realized that it was incredibly selfish to take away a person’s control over her body in the name of higher ideals.

I do not know if I will assist patients with their deaths when I am a physician. I do know that I am grateful to live in a state where patients will be legally able to approach me and ask for an end to their suffering.

P. N.
Portland, Oregon

Wesley J. Smith’s international Anti-Euthanasia Task Force pretends to address physician-assisted suicide as a secular public-policy issue, but its real agenda is religious. This seeps out when Smith talks about the dying getting to “the other side.”

Rather than saying what he believes — that it’s morally wrong for people to receive assistance in dying — Smith insists that no terminally ill individual is capable of making that decision; be it for lack of pain medication or because of depression, the express wishes of the dying are never to be trusted. Smith delivers this insult without batting an eye, thus belying all of his talk about compassion.

I do not need for Smith to hover over me and take some of my pain onto his shoulders, as he so quaintly puts it. It’s enough to have Bill Clinton feeling everyone’s pain.

Herb Berkowitz
Anchorage, Alaska

Wesley J. Smith responds:

It is always interesting to read responses to my views on assisted suicide that demonstrate the very points I make. Margie Thompson, the hospice social worker who favors assisted suicide, damns hospice with faint praise. This is typical of assisted-suicide advocacy and demonstrates why assisted-suicide philosophy and hospice philosophy cannot coexist. As a hospice volunteer, I have seen patients react with tears of heartfelt gratitude to the home-health-care workers washing them and rubbing them with cream. Being touched, being valued, being looked upon with care and devotion means so much at this difficult stage of life. Indeed, the entire hospice philosophy is to care for people so well that they know it doesn’t matter that they are not as pretty as they once were, or that they may have odors, or that they are no longer productive. They are still valued members of the community, worthy of the attention and care hospice provides. I do hope that the patients Thompson works with do not perceive her personal disgust over the difficulties that dying people sometimes face.

Marcia Wollam’s letter proves that legalized assisted suicide would not long be restricted to people who are mentally competent. As Wollam makes clear, the killing of people with Alzheimer’s would often be about family suffering rather than patient suffering. The problem of care-giver burnout is very real and needs to be addressed by society. There are services in most communities and through the Alzheimer’s Association that provide respite and help to those coping with the great difficulty of caring for someone with Alzheimer’s. Surely, we can honor our loved ones with Alzheimer’s disease and improve services to families without resorting to killing helpless and mentally incompetent people.

Brenda Koehler seems to say we are already so dehumanized as a society that adding to our degradations won’t make any difference. I disagree. Her attitude is to surrender to our problems rather than solve them. The idea that preventing doctors from killing patients is a restriction on personal liberty is part of a libertarian belief system that permits no argument. Belief systems certainly belong in the debate, but they are not the be-all and end-all.

Herb Berkowitz’s accusation that my agenda is religious is another approach typical of assisted-suicide advocates. Focusing on religion, which I did not discuss, allows them to avoid dealing with hard facts that they would rather ignore. To have compassion is to share in another’s suffering. If that becomes undesirable, then we are really in trouble.

P. N.’s salute to the Oregon law is, in my view, terribly misguided. A recent study published in the New England Journal of Medicine found that pain or the fear of pain was not the reason that the fifteen people who are reported to have committed assisted suicide in Oregon decided to ask for lethal prescriptions. Rather, the primary reason was fear of needing help with the tasks of daily living. Assisted suicide is sold as a last-resort alternative to unbearable pain to be used only in cases of extreme medical urgency, but it is practiced more often in other situations — many of which it is unlikely voters would have approved. Fear of needing assistance with living is a serious medical and psychological issue. But it can be and is being dealt with through hospice and other forms of care-giving. Moreover, if we come to accept that such fears are legitimate grounds for doctors to prescribe lethal medications, how can we restrict such “beneficence” to people who are terminally ill? Surely, assisted-suicide should be available to people who are disabled or elderly; after all, they must deal with dependency issues for far longer than do the dying. The persuasive power of arguments like this one proves the existence of the slippery slope and demonstrates why assisted suicide will never be limited to people who are terminally ill.

To Dr. Howey: I don’t believe that most doctors would become killers because of cost-cutting pressures from HMOs. But some would, especially as assisted suicide became more routine and people became desensitized to it. And, should killing turn out to be profitable, the pressure could become quite strong, not only on doctors, but on patients, who could be made to feel selfish for not opting out of life. This is especially true if the patients think they are perceived as having a “pathetic” existence or are the cause of “slave labor” on the part of beloved family members.

Finally, I appreciate the first letter writer’s kind words and am sorry that her grandmother was treated so disdainfully. I hear of such cases every day. Ignoring the context in which assisted suicide would be implemented is like trying to describe how a fish breathes without mentioning water.