From Chapter 1

In this excerpt from his newly revised book, Forced Exit:The Slippery Slope from Assisted Suicide to Legalized Murder, Wesley J. Smith analyses an article published in the New York Times Magazine and exposes some of the many ways in which journalists lead the public to a false understanding of the euthanasia issue.

Euthanasia Consciousness

The abuse and exploitation inherent in the euthanasia consciousness are rarely discussed explicitly but are often readily apparent, even in pieces that promote the practice. A prominent article published in a major magazine typifies the kind of euthanasia promotion that is so depressingly common throughout the media.

On November 14, 1993, the cover story of the New York Times Magazine was �There�s No Such Thing as a Simple Suicide.� It is the sad saga of a dying woman, �Louise,� who killed herself with the active assistance and moral support of Ralph Mero, a Unitarian minister and the cofounder of the pro-euthanasia group Compassion in Dying.

An offshoot of the Hemlock Society at the time, Compassion in Dying actively counseled dying people who expressed a desire to commit suicide and assisted in their self-killing. Its founder and former director, Mero insisted that he eschewed publicity and acted only out of selfless compassion. Yet he and his �work� somehow managed to be featured in an Ann Landers advice column, complete with mailing address, in the major article in the New York Times Magazine, and in many national print and television newsmagazine pieces and documentaries.

Lisa Belkin, a former New York Times reporter and author of the book First Do No Harm, about medicine and ethics, wrote the �No Simple Suicide� story. This excellently written piece presents Louise�s story as melodrama, taking the reader on an emotionally wrenching roller-coaster ride of her assisted suicide, complete with a cast of heroes and villains and a gripping life-and-death plot. To make matters more compelling, we are told that the tale is true, with only the dying woman�s name changed to protect her family�s privacy.

The Story

�No Simple Suicide� chronicles the last few months of Louise�s life. We learn early on that Louise suffers from an unidentified degenerative brain condition. Her doctor, described as �a warm, down-to-earth woman,� informs Louise that she has only months, perhaps weeks, to live. Louise is afraid of dying in a hospital, hospice, or other �facility,� a scenario her doctor bluntly tells her is quite likely to occur. Louise tells her doctor that rather than die in a cold, impersonal facility, she would rather kill herself. The doctor almost leaps at the chance to prescribe the drugs for Louise to take.

We are told that the doctor had previously �cooperated� with another patient�s suicide, but that there had been difficulties, so she contacts Ralph Mero at Compassion in Dying to solicit his help and active assistance in facilitating Louise�s death. The doctor later tells Belkin, �I was ecstatic to find someone who�s doing what [Mero is] doing. I loved the fact that there were guidelines. It made so much sense. This was a human being who could help, not some book.�

A few days later Mero visits Louise, who lives with her mother. He tells Belkin that Louise appeared relieved when he didn�t flinch or judge her desire to kill herself and that she asked Mero to be with her when she died. He agreed, stating that the decision was hers.

Louise has asked her friends to attend her suicide, but none will. When a medical assistant of one of her doctors hears that Louise�s �trusted friends� have refused to sanction her suicide, she befriends the ill woman and supports her in her self-destruction.

Mero, the medical assistant, Louise, and Louise�s mother become a cohesive group with one firm goal: Louise�s assisted suicide. They meet to discuss how the self-termination will be performed. The deadly drugs will be mixed with a small amount of food and anti-nausea medication so that they can be kept down. Louise is to be monitored as she dies, and the assistant is to administer anti-pain medication if Louise seems to be suffering. After the death, the doctor will report to the authorities that the deceased was terminally ill and that the death was from natural causes after a prolonged illness, so no autopsy will be conducted. The doctor is also to falsify the death certificate as to the actual cause of death.

Weeks pass. Louise grows ever weaker. Yet the frail woman does not kill herself. Mero becomes alarmed. He calls Belkin to inform her that he and the group have been told by the doctor that Louise is running out of time to kill herself. It is feared that the disease may soon render Louise mentally incompetent. Mero worries that Louise�s �window of opportunity will slam shut� because Compassion in Dying will assist suicides only for persons who are mentally competent. He also worries that if Louise waits much longer she will be unable to self-administer the deadly drugs.

Lisa Belkin drops everything and flies to Seattle to speak with Louise, who tells the reporter that she wishes to conclude some business and spend some more time with her mother before killing herself. This upsets Belkin, who blurts out the doctor�s prognosis: Louise does not have much time within which she will be capable of killing herself.

Yet, for all of her stated desire to commit assisted suicide, Louise still does not act. Some time later, the medical assistant-turned-friend tells the group she will talk to Louise to see if she can get the suicide back on track. She asks the dying woman, �I kind of want to get an idea of what your time line is. Where do we stand?� Louise�s eyes brim with tears, and she tells the medical assistant that she does not want to talk about it. The woman apologizes. Louise justifies her delay by saying that she wants to wait until Mero returns from out of town to get his opinion of her condition. The medical assistant replies that is a �bad idea� because Mero might not notice subtle changes in her condition.

Still Louise does not kill herself. Mero withdraws, checking in by phone but keeping the conversations short. He tells Belkin that he wants to remain in the background so as not to influence the outcome.

Then Mero gets a message: Louise is finally ready. The group assembles. Louise eats poisoned ice cream and applesauce that has been prepared according to Mero�s instructions and immediately falls asleep on the couch clutching a teddy bear. Hours pass as Louise sleeps. The group waits for her to die. She does not. Mero worries that he might have to accelerate the process with a plastic bag. Finally, Louise�s breathing slows, and she expires. Mero contacts the funeral director and leaves.

As the article concludes, we are informed that Louise�s death was not listed as a suicide and that her friends and relatives were told that she �died in her sleep with her mother at her side, as she had wanted.�

The Propaganda

Every drama is supposed to elicit a response from the audience. �No Simple Suicide� is no exception. On its face, the article appears to be an objective piece of journalism: Belkin does not praise or criticize the people involved or the events, nor does she give her personal opinion on the merits of Mero�s cause. Scratch the surface, however, and the piece can be seen as an advertisement for legalizing and legitimizing assisted suicide and euthanasia.

What leads to this conclusion? First is the manner in which the article came to be written. Belkin didn�t find the story; the story found her. As Belkin appropriately reveals, the board of directors of Compassion in Dying, who invited her to observe their usually secret suicide assistance activities, contacted her.

There is nothing illegal, immoral, or unusual about a reporter being contacted about a story. Stories are often found in this manner. It is safe to assume that nevertheless Mero and the board had more in mind than merely illustrating the emotional difficulties surrounding terminal illness. Surely they hoped to further their cause through the article. That being so, it is likely they would carefully choose a writer in the hope of finding one who could be expected to take a positive view of their work. In fact, in her story Belkin exhibits an uncritical acceptance of the methods and motives of Mero, the doctor, and the friend.

Whether Belkin approached her work with a pro-assisted suicide bias, a more important matter is the powerful message communicated by �No Simple Suicide.� Bluntly stated, whether Belkin intended it, the article promotes euthanasia by seeking to persuade the reader that assisted suicide is acceptable. Proponents of legalizing assisted suicide and euthanasia are ever about the task of proselytizing. The more we are exposed to depictions of assisted suicide, the more commonplace it will seem and, then, the more acceptable. Through this process we become desensitized. Practices that we once found abhorrent begin to seem like a normal part of life � or, more precisely, death. �No Simple Suicide� serves this purpose in several ways.

�No Simple Suicide� presents a false dilemma. One of the tools used by pro-euthanasia advocates when arguing for legalization is to create a false premise: Either we provide �deliverance� to suffering people, or they will be forced into cruel and unnecessary anguish. Either they die peacefully and painlessly now, or in agony later.

�No Simple Suicide� similarly casts Louise�s plight as a forced choice between two horrible options: assisted suicide or an out-of-control death at a �facility.� Not once is the reader (or Louise, as far as we know) informed that hospice and palliative care could probably have mitigated most, if not all, of her pain and discomfort. As reported, not once is the reader told that the hospice experience is designed to provide love, comfort, and support for the patient and the family, supplied by medical and mental-health professionals and volunteers. Not once is the reader told that hospice care can be supplied in the home�clearly a major issue for the dying woman. Not once is the reader told that the very purpose of hospice care is to facilitate a gentle and peaceful transition from life to whatever comes next. The fact that the truly compassionate option, from what is reported, was virtually unexplored speaks volumes about the doctor�s agenda, and that of Mero and perhaps the friend.

It is also notable that Louise�s doctor treats her patient�s suicidal desire as expected, rather than as a cry for help. Yet studies prove that the vast majority of dying people do not exhibit suicidal tendencies. When dying patients do ask for suicide, they are almost always clinically depressed, just as are suicidal people who are not terminally ill. Depression is a treatable condition. Unfortunately, most doctors are not adept at recognizing depression in their dying patients. Thus, whether through ignorance or arrogance, Louise�s doctor probably abandoned her patient to the throes of depression which could well have been overcome.

It is also assumed by all involved in the young woman�s assisted suicide that she will not change her mind. Yet medical studies have shown that this is often not true. Indeed, the �will to live� among terminally ill people �shows substantial fluctuation.� In other words, one day a patient may request suicide but the next week be very glad they are still alive. And that seems to have been the case here. Louise did not have an unremitting desire to self-destruct. The only people with that unyielding death agenda were those who surrounded her.
�No Simple Suicide� creates the impression that euthanasia is a loving rather than a violent act. The suspicion that there was an unspoken agenda behind �No Simple Suicide� is supported by the striking artwork that illustrates many of the scenes described in the text. While Belkin undoubtedly had little or nothing to do with their creation, the pictures, which appear to be oil or watercolor paintings, are powerful and moving. The article doesn�t tell us Louise�s actual age or what she looked like, but the pictures depict Louise as a woman in her late twenties, her youth and delicate beauty adding to the tragedy of her condition. In one picture, Louise is curled up peacefully asleep on a couch after eating the poisoned ice cream. She is holding a teddy bear as her gray-haired mother sits beside her, the older woman�s hand resting lightly upon her dying daughter�s leg. In another picture, we see Louise and Mero in a counseling session. He is a strong presence, solid and dependable with his white beard and black suit, a striking contrast to the frail Louise, who has a blanket wrapped around her shoulders. In another picture, Louise�s mother is pictured leaning over her daughter, who is so weak the older woman can barely hear her speak.

The paintings have been created in the warm colors of autumn to invite us in, to linger as if we were standing in front of a crackling fire, indeed, to enter and become intimate participants in the unfolding drama. The paintings grab our hearts and rivet our attention solely on the suffering of the dying woman. In that way we are less likely to think critically, to look beyond Louise�s personal tragedy to the broader implications of what is being done to her. Also, by making the scenes seem gentle and warm, we are far less likely to recoil in horror at the actual events.
�No Simple Suicide� creates the impression that Louise�s assisted suicide was a necessary choice. The article supports the merit of Louise�s assisted suicide on several levels. Belkin�s prose creates the impression that Mero and the others are compassionate pioneers leading the country toward an enlightened view of facing and overcoming the ravages of terminal illness. In fact, according to Belkin, that is how the group viewed themselves, writing that each saw Louise�s pending assisted suicide as a �poetic expression of control, a triumph over the indignities of disease.� That is a typical view held by death fundamentalists and no doubt is the view Mero hoped Belkin�s readers would accept.

Belkin came to a less romantic but equally erroneous conclusion about the affair. The only time she expresses a personal opinion in the article, she describes Louise�s assisted suicide as a �second choice� to not being sick, and as the �most acceptable� of the dying woman�s �unacceptable options.� But that is a distinction without a difference. Whether euthanasia is pushed as a heroic statement of control or a rational choice between the lesser of two evils, the result is the same: legitimization of that which is ultimately profoundly destructive to individuals, the healthcare system, and society.

Whether motivated by the death-fundamentalist notions of Mero, the �pragmatic choice� view of Belkin, the participants� genuine desire to serve Louise, or a combination of these factors, Louise was pushed by those around her into suicide because that was the death they wanted her to have. As the psychiatrist Dr. Herbert Hendin, former director of the American Foundation for Suicide Prevention, has written about the case, �Like many people in extreme situations, Louise . . . expressed two conflicting wishes � to live and to die � and found support only for the latter.� One wonders what the outcome would have been had someone � anyone � supported Louise�s often expressed desire to live and had stayed with her to the natural end of her life. Perhaps, then, her friends would have surrounded her in her final days. Perhaps Louise and her mother would have had a more meaningful time together, spared the undignified and excruciating dilemma over when and whether Louise would kill herself. Perhaps Louise could have truly died in peace.
�No Simple Suicide� suggests that it should be easier to help people die. Louise�s assisted suicide took place in the underground, amid people who lied and broke the law in order to facilitate her so-called death with dignity. The attitude of the article is implicitly critical of the fact that this subterfuge was necessary. The reader is given a subliminal message, often voiced out loud by assisted-suicide advocates, that goes something like this: Unreasonable people who refuse to allow others to control their own destiny are insensitive, thoughtless, and cruel. They force dying people to endure unnecessary suffering. Such judgmental attitudes caused Louise�s friends to abandon her when all she wanted to do was control the time and place of her own death. Her caring doctor was prevented from actively participating in her patient�s final �treatment� because euthanasia by lethal injection is forbidden. Mero, a compassionate clergyman, was forced to risk imprisonment in his pursuit of providing care and comfort to the suffering.

The Other Side of the Story

The irony is that the members of the little group surrounding Louise were the ones who were thoughtless, insensitive, and cruel, for they took from Louise, in Dr. Hendin�s words, �her own death.�

Louise was unable to give informed consent to her suicide because she was denied information about hospice care. The story indicates that both the doctor and Mero allowed Louise to believe that she would have to either die in a �facility� or kill herself at home. Apparently, neither discussed hospice care with Louise or described the palliative care that could have reduced her discomfort. It appears they presented Louise with a false dilemma.
The medical assistant pushed Louise into going forward with the assisted suicide. The medical assistant who suddenly embraced Louise as a friend is suspect. Was she part of a pro-euthanasia group? Did she have an agenda? We are not told. Was not Belkin even a little curious about this? Regardless of her motives, the assistant is a powerful actor throughout the drama, urging Louise on to self-destruction. Recall that when it became clear that Louise was delaying her self-destruction and appeared not to want to go forward, the medical assistant grew impatient and confronted the ill woman, saying, �I kind of want to get an idea of what your time line is. Where do we stand?� When Louise says she doesn�t want to talk about it but would rather wait for Mero to return to give his opinion of her medical condition, the friend tells her it is a �bad idea� and urges her not to wait because Mero may not be able to notice �subtle changes in Louise�s temperament and thus might give the wrong advice.� That is pressure disguised as advice.
Ralph Mero�s �compassion� was available to Louise only if she carried out her designated role. This is the most insidious part of the story. It is important to remember how emotionally vulnerable most terminally ill people are as the end of life approaches. Louise was certainly no exception. Then, along comes �compassionate� Ralph Mero � a minister, no less � who tells Louise, �I�ll be with you and I�ll support you.� From that point on it is quite clear that Louise has become dependent on the moral judgment and emotional support of Mero, to the extent that she even wanted to rely on him for medical advice as to how far her decline had progressed.

Note that throughout the early part of the process, Mero was there for Louise. He held her hand. He patiently and gently went over the guidelines for the assisted suicide. He presented himself as a source of strength, a nonjudgmental rock to lean on in this difficult time. But when Louise hesitated and refused to be pressured into suicide, what did this altruistic man of compassion do? Did he hold her hand and discuss alternatives to killing, such as hospice care? Did he pray with Louise so that together they could seek God�s guidance? (He is a minister, after all.) Did he assure her that whatever her choice might be, he was her friend and would be there to the end? No. He withdrew: �Over the next few days, Mero checked in with Louise and her mother by telephone, but kept the conversation short. �I was measuring my phone calls,� he says. He wanted to remain in the background and allow Louise to control the timing and pace. Her growing dependence on him was making him uncomfortable, and he needed to keep it clear in her mind, and his, that she was the driver and he was just along for the ride.� But when she seemed to be choosing a different course, his absence made it clear that Louise was on her own if she chose a natural death.

Imagine how painful it must have been for Louise when her minister, the man she was leaning on for strength and guidance, was suddenly holding her at arm�s length, especially after being so intensely a part of her life over the previous weeks. This certainly looks like emotional manipulation on Mero�s part, communicating a harsh and powerful message to the dying woman: kill yourself and I am your man; stick it out to the end and I am out of here. That is not compassion. That is cruel abandonment.
The reporter also pushed Louise toward killing herself. As if all of that isn�t disturbing enough, what are we to make of the reporter, Lisa Belkin, and her participation in these sad events? Recall when the doctor informed Mero and the reporter that Louise was likely to slip quickly and become mentally incompetent and therefore become unable to kill herself or receive Mero�s assistance, Belkin immediately flew to Seattle, unaware that Louise has not been told of this prognosis. During an interview on that occasion, Louise tells Belkin that she wants to wait a week or so before killing herself. Belkin is appalled:

I was surprised, confused and extremely uncomfortable. . . . Without thinking, I blurted out a question: �Your doctor feels that if you don�t act by this weekend, you may not be able to . . .�

My words were met with a wrenching silence. Louise blanched, her pale skin turned even paler. I was horrified with myself . . .

�She didn�t . . . she never . . . I didn�t know that,� Louise said, sharply looking at her mother.

�That�s what she told me,� her mother offered gently.

Louise became silent. . . .

�It�s O.K. to be afraid,� her mother said.

�I�m not afraid. I just feel as if everyone is ganging up on me, pressuring me,� Louise said. �I just want some time.�

Indeed, Louise was being pressured, now even by the reporter who at that point crossed the line from an observer and chronicler of events to a participant in them.
There is no compassionate voice of opposition. �No Simple Suicide� presents a one-sided version of assisted suicide. Except for one brief passage, people who resist legalizing euthanasia are not heard from, nor are the many reasons given why opponents of the death culture are so devoted in their resistance. Notice also that the one quotation selected for use in the article by Belkin, presumably from a longer interview, describes opponents to euthanasia as �harsh,� reinforces the false stereotype that opposition is based primarily on religion, and does not express any concern for the well-being of Louise.

Such short shrift was not accorded proponents of assisted suicide. At one point in the article, Mero describes his work for Compassion in Dying as an experiment to �show, demonstrate, prove, that when people make a claim for humane treatment, it can be provided in a way that does not jeopardize vulnerable people or pose a threat to the social fabric.� Leaving aside the perversion of the word �treatment� in that sentence, we can assume that Mero hoped that by inviting Belkin to observe his work, his vision of a world where the ill can be routinely euthanized would be accepted by readers.

But as this analysis of �No Simple Suicide� � an article typical of this genre � demonstrates, what actually happened to Louise was just the opposite of the impression the story sought to convey. Instead of receiving compassion (literally, �suffering with�) from those she trusted, a sick and vulnerable woman was pushed by them into suicide. In Dr. Hendin�s words, Louise�s �death was virtually clocked by their [Mero�s, the doctor�s, her mother�s, the medical assistant�s, Belkin�s] anxiety that she might want to live. Mero and the doctor influence the feelings of the mother and the friend so that the issue is not their warm leave-taking . . . but whether they can get her to die according to the time requirements of Mero, the doctor, the reporter, and the disease. . . . Individually and collectively, those involved in [Louise�s assisted suicide] engender a terror in Louise with which she must struggle alone, while they reassure each other that they are gratifying her last wishes.� Ralph Mero was unavailable for comment about my criticisms.

ACKNOWLEDGEMENT

Wesley J. Smith. "Death Fundamentalism." Excerpted from Chapter 1, Forced Exit:The Slippery Slope from Assisted Suicide to Legalized Murder (Dallas, Texas: Spence, 2003).

Forced Exit:The Slippery Slope from Assisted Suicide to Legalized Murder ISBN 1-890626-48-1 400 pages, can be purchased for $8.97 from the Spence Publishing web site.

Through original reporting, exhaustive research, historical analysis, and extensive interviews, Smith makes a compelling case against legalizing assisted suicide. He explores the truly humane and compassionate alternatives that can change a death wish into a desire to live.

THE AUTHOR

Wesley J. Smith is a senior fellow at the Discovery Institute and an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide. He is an international lecturer and public speaker, appearing frequently at political, university, medical, legal, bioethics, and community gatherings across the United States, Canada, Great Britain, and Australia. Wesley J. Smith is the author or co/author of 9 books. Most recently his revised and updated Forced Exit: The Slippery Slope From Assisted Suicide to Legalized Murder, Culture of Death: The Assault of Medical Ethics in America, and Power Over Pain.

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