Maine voters' rejection on November 7 of an initiative to legalize physician-assisted suicide was only the latest in a string of defeats for the American euthanasia movement. Granted, the margin was narrow -- 51.5 percent to 48.5 percent. And with the Netherlands finally in the process of formally legalizing assisted suicide, no one should infer that this tenacious international movement is dead. Still, its advocates in this country have failed to move the ball since 1994, when Oregon voters passed a legalization initiative. The latest setback should spur the media to give less coverage to killing as "medical treatment" and more to the underreported subject of truly compassionate assistance to the dying, such as pain control, symptom management, and hospice care.
If the assisted-suicide movement was rebuffed in Maine, it was not for lack of investment in the campaign. Euthanasia activists from around the nation had carefully selected Maine as the most promising site for a breakthrough. "Maine is a small state with a small media market, and proponents believed that they could carefully control the message," explains Rita Marker, executive director of the International Anti-Euthanasia Task Force. "More importantly, some of the most vulnerable groups who oppose the assisted-suicide agenda nationally -- disability rights activists, minorities, advocates for the poor -- are not as numerous in Maine as they are elsewhere in the country, and thus assisted-suicide activists had substantial reasons to be optimistic about their chances of prevailing."
The practice in Maine of allowing an initiative's proponents to determine the wording that appears on the ballot also favored the measure. Euthanasia activists couched Question 1 in soothing language: "Should a terminally ill adult who is of sound mind be allowed to ask for and receive a doctor's help to die?" And to mobilize support for it, they mounted a national full-court press. Euthanasia organizations from all over the country urged their members to donate time and money to the campaign, with much success. More than 90 percent of the financing for the "Yes on Question 1" campaign came from outside Maine. Many of the nation's best-known assisted-suicide proponents -- including Oregon governor John Kitzhaber -- strove to persuade Maine voters to make it legal for doctors to write lethal prescriptions.
Initially, public support for the measure was high -- 70 percent, according to the Bangor Daily News of February 17, 2000. But as the campaign progressed and voters considered assisted suicide in the context of HMO cost-cutting, the potential for abuse and coercion, and the problems reported in Oregon despite the secrecy surrounding the practice there, public support steadily waned. When the final tally was made, the initiative lost by almost 20,000 votes.
The same pattern of early support for assisted-suicide initiatives, dwindling to eventual defeat at the polls, occurred in Washington state (1991), California (1992), and Michigan (1998). Even in Oregon, where the initiative passed, support shrank from nearly 70 percent at the beginning of the campaign to just 51 percent in the final tally.
The euthanasia movement, moreover, has also been stymied in the courts and legislatures. In 1997, its advocates failed to persuade the U.S. Supreme Court to issue an assisted-suicide Roe v. Wade. The vote in Washington v. Glucksberg was unanimous, a rare achievement for our often divided high court. Only a few months later, the Florida Supreme Court refused to rule that assisted suicide was a right under the privacy guarantee in the Florida Constitution.
And in 1999, a court in Michigan sentenced euthanasia's most notorious practitioner, Jack "Dr. Death" Kevorkian, to 10 to 25 years in prison for the murder of Thomas Youk. Thus ended a macabre career that had helped eliminate some 130 people and made kidneys removed from one disabled victim available to the public on a "first come, first served" basis. Kevorkian had outworn the patience of law enforcement by arrogantly providing a videotape of his crime for airing on the program 60 Minutes.
As for the legislative arena, not one of the many euthanasia bills introduced at the state level has had a realistic chance of passage. A robust coalition came together to fight these bills. In addition to the constituencies mentioned by Rita Marker, this alliance includes hospice professionals, religious organizations, pro-lifers, and medical associations, all of them willing to set aside their differences on other controversial issues in order to unite against the proposition that doctors should have license to kill their patients.
The only prospect euthanasia advocates have for gains in the immediate future is in Alaska, where a lawyer for the misnamed Compassion in Dying Federation has sued under the privacy guarantee of the state constitution to overturn the state ban on assisted suicide. The suit failed in the trial court and was recently argued before the Alaska Supreme Court, where the justices noted the Florida high court's refusal to legislate from the bench. The Alaska decision is expected next year.
Whatever happens in Alaska, assisted suicide won't soon be widely legalized in the United States. Thus, the time has come to look beyond a movement that actively harms the dying and disabled people it purports to help. Not only does it disparage the value of their lives, but it diverts media and popular attention from all that medicine can do to make people's dying days worth living.
It is high time that the issue of end-of-life care be given serious and concentrated consideration. For example, it is a national scandal that only 29 percent of Americans who died in 1999 received hospice services, and those who did often did so for only weeks or days. By contrast, in England the figure is 65 percent, and most hospice patients receive care for many months. For 30 years, the British have been educating the public about care for the dying, making hospice a household word. Nor do they place policy impediments between dying patients and hospice care -- as we do in the United States, where patients are required to refuse all further curative treatment in order to receive hospice relief. According to Dame Cecily Saunders, the creator of the modern hospice movement, this irrational American rule makes patients, families, and physicians far less likely to turn to a hospice, which is seen as the end of all hope.
In an era when the media are addicted to scandal, assisted suicide makes for juicier copy than hospice care and pain control. But the stalling of the euthanasia movement can and should change that. The big story should be the challenge of creating a medical environment in which no American dies alone or in pain.