Organized Obfuscation: Advocacy for Physician-Assisted Suicide

An ancient but evergreen practice with controversial political and ethical issues is to manipulate ideas and language, spinning them to serve one's ends. My example will be the current physician-assisted suicide debate, now being played out with a ballot initiative in the state of Washington. The advocates for physician-assisted suicide make use of a favorite method from the spin tool box, that of obfuscation, defined in dictionaries as an effort to render something unclear, evasive, or confusing. I believe that in recent years, many (though hardly all) advocates of euthanasia and physician-assisted suicide have used organized obfuscation as a political tactic, and Washington is no exception.

The seeds of this interpretation were planted in my mind in the late 1980s. In the January-February 1989 issue of the Hastings Center Report we published an article by a Dutch cardiologist, Richard Fenigsen, titled "A Case against Dutch Euthanasia." ¹ We did so with considerable trepidation. The article seemed extreme in its accusations, the only available footnotes were in Dutch, and we had no good way of independently verifying his critique. In brief, he charged that there were far more instances of euthanasia than reported, that regulations promulgated by Dutch courts to control the practice were widely ignored, and that euthanasia without informed consent of patients (called "non-voluntary euthanasia") was common. We decided to take a chance and published the article.

We were almost instantly assaulted with a remarkable (and obviously orchestrated) deluge of complaints from Dutch health authorities and organizations, as well as euthanasia advocacy groups. They included, among others, the Dutch Society of Health Law, twenty-five prominent medical and health care figures who joined to send us a letter, and the Dutch Society for Voluntary Euthanasia.² Their message was uniform and unsparing: we should not have published such an irresponsible article, filled with unverifiable charges and baseless accusations and displaying a gross misunderstanding of the practice of euthanasia in the Netherlands. (We Americans just didn't get it!)

A few lines from those letters became memorable. One of them was that the Dutch meaning of euthanasia was that of "a deliberate life-ending action . . . [as the result of ] an enduring [patient] request. 'Euthanasia,' therefore, is by necessity, voluntary."³ Another letter asserted that "it is impossible for people who do not want euthanasia to be forced or maneuvered into it because that would violate the definition of euthanasia."⁴ The notion that one could not be forced into something because it would violate a definition is surely imaginative (and philosophers of language should take note). The letters evaded the question of whether nonvoluntary euthanasia (now turned into an oxymoron) actually took place.

As it turned out, however, Fenigsen was shortly proved strikingly right, even if not in all details. In a series of confidential interviews with physicians and an examination of death certificates, three surveys in 1990, 1995, and 2001 found that approximately two percent of all Dutch deaths (3,500 or so) came from euthanasia and physician-assisted suicide, about 1,000 of which were without the patient's explicit request.⁵ Fewer than 45 percent were reported, as required by law.

But the apologists were not giving up on spin. Yes, those figures are probably correct, they seemed to say, but they did not mean what they seemed (to outsiders) to mean. Foreigners just don't understand that the Dutch doctor-patient relationship is far more intimate than in other countries. Their doctors know what their patients would want even if they have never said anything; and, besides, it is a physician's ethical duty to judge the patient's quality of life and to act accordingly, even without consent. In sum, to call the survey results evidence of "abuse" was to misunderstand the special and compassionate culture of Dutch medicine.

If the Dutch advocates cut the template for organized obscurantism, many American euthanasia/ physician-assisted suicide advocates were quick to make use of it. Consider the phrase "death with dignity," the title of the Oregon physician-assisted suicide legislation in 1997, and now the title of the...