In reading through my collection of news items, I found myself directed to an article in the Daily Mail referencing a new study published in the Canadian Medical Association Journal which reviewed the status of assisted suicide in Belgium.  The study raises some important questions about the policies necessary to allow for an effective assisted suicide program and may fundamentally challenge the idea that such a program can be administered at all.  With “death panels” still fresh in the minds of many Americans, this study is a sober reminder of what’s at stake when we begin to confront the wide expanse of issues related to end of life planning.

To clarify one point right up front: I do favor assisted suicide and would probably vote to legalize the practice if given the chance.  I say probably because I also believe that any acceptable assisted suicide program will require meaningful (state) government involvement to be implemented appropriately, including creating civil and criminal liability for medical professionals who stray too far in blurring the line between euthanasia and murder.

According to the study, of 208 physician-assisted deaths within their study group, 142 occurred with the explicit consent of the patient, while 66 were performed without patient consent.  The study noted that most of the deaths conducted without patient consent occurred in patients over 80 years old who were hospitalized, and the vast majority were patients who were either comatose or who had dementia.  In over 75% of all cases, the decision to end life was discussed with the patient’s family, and in only a few cases was the decision to end the patient’s life discussed with nobody.

The greatest concern has naturally gravitated toward the patients whose lives were ended without having given their express consent.   Such concerns all share in the same core belief that there is something wrong about other people deciding for us when it is time for us to die.  Without a strong principle of restraint, it is easy to see how lives my be ended for medical or political expediency, to help doctors meet bureaucratically imposed death quotas, or to pinch out a population with disfavored political views.

As assisted suicide continues to gain traction in the United States as an acceptable end of life practice, it is important for all of us to think about the practice in terms of our own end of life planning.  Just as we have grown accustomed to “advanced directives” which instruct hospitals and doctors on when to terminate life-saving care, Americans should begin to think about adding some “really advanced directives” concerning if and when it may be appropriate to medically terminate our lives.  For those without a legal directive on record, we should be able to fall back on the experience and policies which, so far, have been mostly successful at balancing the interests of individuals against their prognosis for life.

With a significant number of assisted suicides being performed in the absence of the patient’s consent, the Belgium study points out the need to be clear about our desires at the end of our lives, preferably long before we get there.  With appropriate protections and respect for patient wishes, there is no reason to think that assisted suicide will become a tool of murder against the unwilling.