“Access” Undermining Choice in the Agenda for Assisted Suicide
Bioethics in Law & Culture Spring 2023 vol. 6 issue 2
Conclusion: Lessons Learned
On both abortion and assisted suicide, lethal actions once defended as a tragic private choice have been welcomed by legislators as a positive good, a standard form of health care that must be made more “accessible” to all.
One lesson from the assisted suicide debate in Washington is that personal stories are more persuasive to many people than facts and policy arguments. This was certainly true of the “citizen legislators” in Washington, who serve in the legislature for only about three months a year.
On abortion, there is more of a level playing field, in the sense that women who speak positively about their abortions can be countered by women who greatly regret theirs or who deeply love the child they were persuaded not to abort, and by adults who had been at risk of being aborted or had survived attempted abortions. On assisted suicide, groups like EOLWA, which has boasted of being directly involved in “95 percent” of the annual “death with dignity” cases, can call upon patients, caregivers, and health care providers they had already formed a relationship with to provide stories. But the people who have already been harmed by this agenda are dead and cannot speak for themselves; and the potentially far greater number who will be harmed by the expanded law may be concealed from view by the law’s guarantees of confidentiality, its reliance on reports solely by health care providers who approve and provide the lethal prescriptions (as well as the state’s carelessness as to whether even those reports exist), and its requirement for falsifying death certificates to report death by natural causes. Opponents of the assisted suicide law have been able to highlight some personal accounts – e.g., people who sought reimbursement for potentially life-affirming treatment but were invited to consider assisted suicide instead – but may need to be far more organized in providing opportunities for patients, families, and health care providers to share their experience publicly. Some opposed legislators in Washington shared personal stories of “good deaths” by natural causes in their own family – but these had little impact, as supporters could respond that each patient can choose his or her own manner of death.
Second, the “expansion” agenda in Washington and other states is far from over. Future targets will include the current law’s requirement that lethal drugs be “self-administered” (which is already ambiguous in the Washington law) and its assurance that individual and institutional healthcare providers may freely choose not to participate (an assurance already weakened by the law’s narrowed definition of what constitutes “participation”). Another possible expansion, hinted at in both of Rep. Rude’s study proposals, is mandated coverage for “death with dignity” in health plans (already required for abortion in Washington, as is the reporting of health care facility policies to the state).
This account also invites broader reflection on the idea of a “slippery slope.” That has long been a charge against proposals for assisted suicide and euthanasia, and its validity has been amply borne out by developments in Europe and now in Canada.
This “slope,” however, does not apply to the major organizations dedicated to this agenda, like Compassion & Choices. Their leadership always saw laws like those in Oregon and Washington as first steps to be expanded later. Their legislative agenda included lethal injections by physicians from the beginning, and only after these proposals were defeated in Oregon, California, and Washington from 1987 to 1992 did they make the tactical decision to emphasize “self-administration” in the 1994 Oregon initiative. Some advocates even predicted that this would lead inevitably to active euthanasia when it became clear that self-administered drugs sometimes fail or have horrific complications. And the prime sponsor of the Washington ballot initiative of 2008, former governor Booth Gardner, had openly declared that it was a first step toward “death with dignity” for people with chronic illnesses and disabilities.
In short, these organizations are not on the slippery slope. They have placed the rest of us on one. Or to use another metaphor, they are the cooks gradually raising the temperature in a pot of water, so the frog being cooked will not realize its danger and hop out until it is too late. Voters and their elected representatives are the frogs.
There are both logical and psychological components to the slippery slope. Logically, once one has transgressed a fundamental moral and cultural principle – for example, against the taking of innocent human life to solve problems – one may come to see that every later step to expand that agenda is less fundamental than the one already taken. For example, if ending a short life of suffering is good, why is ending a long life of suffering not even better? Psychologically, no one wants to admit having done something wrong and dangerous, so one will have every incentive to justify oneself by numbing oneself to the darker realities. Euphemisms like using “death with dignity” for assisted suicide, and “access” for discarding protections against coercion and abuse, are a great help in the task of self-justification.
During the 2023 debate in Washington, supporters of the expansion bills tried to dismiss opposition and deflect attention from their own ever-expanding proposals by claiming that “those who oppose the proposed changes to our law typically oppose the original law.” However, opposing groups could easily respond with two points. First, it is the movement for “expanding” the law that is attacking the original law’s provisions; critics of expansion are warning that this law’s safeguards against abuse are not enforced or taken seriously, and are to be weakened further. Second, anyone paying attention should have opposed the original law in the knowledge that it was only a first step in a campaign designed to prepare for later “expansion.”
The lesson for states with legalized assisted suicide is that proponents of the original laws are not serious about retaining the “safeguards” against abuse, so preparations should be made to counter their inevitable efforts to expand “access” to the detriment of patients. The lesson for states facing a current legalization proposal is this: It will certainly not be the last time you are asked to treat vulnerable people’s deaths as a solution – it will only be the first time.
Keywords: assisted suicide; abortion; barriers to access; safeguards; state laws; slippery slope
Richard M. Doerflinger retired in 2016 from the U.S. Conference of Catholic Bishops, where he had served as Associate Director of the Secretariat of Pro-Life Activities. For 36 years he prepared testimony and other materials on abortion, euthanasia, and other issues. His writings on assisted suicide have appeared in Hastings Center Report, Duquesne Law Review, Issues in Law & Medicine, and other publications. He is a Fellow at the University of Notre Dame’s de Nicola Center for Ethics and Culture, an Associate Scholar at the Charlotte Lozier Institute, and an Adjunct Fellow in Bioethics and Public Policy at the National Catholic Bioethics Center. He holds B.A. and M.A. degrees from the University of Chicago, and conducted doctoral studies in Theology there and at the Catholic University of America. He and his wife live in La Conner, Washington.
 Testimony of Bob Fell, president of End of Life Washington, on HB 1141 before the Senate Health & Long-Term Care Committee, at https://tvw.org/video/senate-health-long-term-care-committee-2021031289/?eventID=2021031289, beginning at 0:49.
 See supra note 12 and accompanying text.
 On Canada see: Salkeld, Brett, “When the ‘choice’ of assisted suicide becomes an obligation,” Our Sunday Visitor (March 19-25, 2023), p. 6; Kim, Scott, “In Canada, MAID has become a matter of ideology,” The Globe and Mail (February 25, 2023), at https://www.theglobeandmail.com/opinion/article-in-canada-maid-has-become-a-matter-of-ideology/.
 For documentation see: Doerflinger, Richard, “Physician-Assisted Suicide: The Path to Active Euthanasia,” On Point Issue 27, Charlotte Lozier Institute (November 2018), pp. 3-5, at https://lozierinstitute.org/wp-content/uploads/2018/11/Physician-Assisted-Suicide_The-Path-to-Active-Euthanasia_Richard-Doerflinger.pdf; Bergner, Daniel, “Death in the Family,” The New York Times Magazine (December 2, 2007), at https://www.nytimes.com/2007/12/02/magazine/02suicide-t.html.
 Doerflinger, Richard, “Assisted suicide: The not-so-hidden agenda,” The Arlington Catholic Herald (April 29, 2021), at https://www.catholicherald.com/article/columns/assisted-suicide-the-not-so-hidden-agenda/. This author is grateful to the editors who selected the accompanying photo.
 Testimony on HB 1281 of Susan Powell, M.D., consultant to End of Life Washington, before the House Health Care & Wellness Committee, January 25, 2023, at https://tvw.org/video/house-health-care-wellness-2023011491/?eventID=2023011491, beginning at 0:22.