The Magazine


Jul 28, 1997, Vol. 2, No. 45 • By NELSON LUND
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Wesley J. Smith
Forced Exit
The Slippery Slope from Assisted Suicide to Legalized Murder
Times Books, 304 pp., $ 25

While awaiting the Supreme Court's recent decision on assisted suicide, the pundits came to an unusual consensus. Without the usual left-right discord, most commentators agreed that this dangerous practice should not be constitutionalized. The Supreme Court has now agreed, unanimously refusing to create a broad new constitutional right to assisted suicide.

But the underlying issue is far from settled. Five justices were careful to signal that they might well create some kind of constitutional right in a future case involving different facts. More important, the court's decision did not even suggest that Congress or the states would be forbidden to legalize assisted suicide. And despite the current trend of elite thinking, there appears to be no genuine national consensus on the issue. Authorities in Michigan have been notoriously unsuccessful in persuading juries to convict Jack Kevorkian, the most extreme and flamboyant of the "assisters." And public-opinion polls consistently show large majorities favoring assisted suicide. One state, Oregon, has already voted to legalize the practice in a popular referendum.

Wesley J. Smith's Forced Exit shows why the public should reject Kevorkianism in all its forms. Laying out his case with clarity and restraint, Smith blends reasoned argument with blood-curdling anecdotes, proving beyond a reasonable doubt that legalizing assisted suicide would be a sure step on the road to bureaucratized euthanasia. Smith also recognizes that the current controversies over assisted suicide are just one manifestation of the forces pushing us toward legalized murder, and that avoiding the slippery slope may require a serious reorientation of our public policies and attitudes.

Smith's most straightforward and compelling argument is that legalizing assisted suicide would create terrible perverse incentives. Proponents of the practice emphasize the apparent injustice of denying fully competent people who are near death the opportunity to make a rational choice to avoid the expensive, painful, and degrading treatments that modern medicine offers many of us at the end of life. But the grim prospect of an over-medicalized death (which probably explains the popularity of assisted suicide in polls) is a demonstrably foolish basis for public policy. First, patients already have the legal right to refuse unwanted treatments. Second, and much more important, most real patients simply do not fit the abstract model of the rational, autonomous chooser. On the contrary, people near the end of fatal illnesses typically suffer from maladies ranging from clinical depression to terrifying loneliness to feelings of guilt about the burdens they impose on others. In these circumstances, patients are highly vulnerable to manipulation by their families and, especially, their doctors. Families and doctors will often have strong incentives to prefer that the patient die sooner rather than later and thus to become subtly manipulative, even without realizing it.

Anyone who doubts that such incentives operate on family members should read a few of Smith's well-documented horror stories. But even those who believe that families are generally immune to the low dictates of self- interest should at least acknowledge that physicians are not. Besides the fact that caring for the incurable is tough on a doctor's patience and pride, brute financial incentives created by our emerging system of managed care guarantee that physicians will increasingly be encouraged to promote the inexpensive alternative of a hastened death in place of more expensive life- prolonging options. Doctors have already perfected the art of offering " options" designed to ensure that the patient chooses what the physician wants.