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Abandoning the Most Vulnerable

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Wesley J. Smith has written an interesting article about assisted suicide at The Weekly Standard called “Abandoning the Most Vulnerable.” The article is about the true story of Myrna Lebov who committed suicide at the age of 52 in her Manhattan apartment with the aid of her husband George Delury. According to Smith, Lebov had been suffering with progressive multiple sclerosis. The fallout:

Delury became an instant celebrity. He was acclaimed as a dedicated husband willing to risk jail to help his beloved wife achieve her desired end. The assisted-suicide movement set up a defense fund and renewed calls for legalization. Delury made numerous television appearances and was invited to speak to a convention of the American Psychiatric Association. He signed a deal for a book, later published under the title But What If She Wants to Die? Delury soon copped a plea to attempted manslaughter and served a few months in jail.

However, the story is more sordid than Delury’s public persona revealed. It turns out that he kept a diary, in which he explained what a burden Lebov was to him, and how he encouraged her to die only to free himself from the responsibility of caring for her. Excerpts:

I have work to do, people to see, places to travel. But no one asks about my needs. I have fallen prey to the tyranny of a victim. You are sucking my life out of my [sic] like a vampire and nobody cares. In fact, it would appear that I am about to be cast in the role of villain because I no longer believe in you…

Smith explains that “On July 3, 1995, the day before Myrna’s death, Delury wrote:”

Myrna is now questioning the efficacy of solution, a sure sign that she will not take [the overdose] tonight and doesn’t want to. So, confusion and hesitation strike again. If she changes her mind tonight and does decide to go ahead, I will be surprised.

Smith explains how Delury planned on helping her with her suicide:

He researched her antidepressant medication to see if it could kill her, and when she took less than the prescribed amount, which in itself could cause depression, he stashed the surplus until he had enough for a poisonous brew.

Obviously taking less than the prescribed amount of anti-depressant medication can cause depression in itself. Saving the surplus for an overdose doesn’t seem like the proper solution. As to Lebov’s mental state, Smith explains:

The diary showed that Lebov did not have an unwavering and long-stated desire to die, as Delury had claimed. Rather, as often happens with people struggling with debilitating illnesses, her mood waxed and waned. One day she would be suicidal–but the next day she was engaged in life. Delury, moreover, encouraged his wife to kill herself, or as he put it, “to decide to quit.”

On July 4th Lebov swallowed Delury’s prepared mixture of anti-depressants and died. But there’s more to the story yet:

In But What If She Wants to Die?–published after double jeopardy prevented another prosecution–Delury wrote that he hadn’t just mixed -Lebov’s drugs, but also smothered her with a plastic bag because he was worried that the amount she ingested might not be sufficient to kill her. Thus, Myrna Lebov didn’t really die by suicide: She was killed by her husband. (Delury died by his own hand in 2007, at the age of 74.)

Smith explains the state of affairs concerning assisted suicide in Great Britain:

Had Delury acted in England or Wales today–rather than in New York in 1995–he almost surely would not have been prosecuted. Even though assisted suicide remains a crime in the U.K., newly published British guidelines have effectively decriminalized some categories of assisted suicide by instructing local prosecutors when bringing charges in such deaths is to be deemed “not in the public interest.”

The guidelines were developed in response to a ruling by the U.K.’s highest court. A woman named Debbie Purdy–who like Lebov has progressive multiple sclerosis–plans to kill herself in one of Switzerland’s suicide clinics if her suffering becomes too much to bear. Wanting to be accompanied by her husband, but fearful he could be prosecuted, she sued, demanding to be told by law enforcement ahead of time whether he would face charges.

Purdy won the day. Noting that other recent cases of “suicide tourism” (as such trips taken to Switzerland to die are called) had not been prosecuted, Britain’s Law Lords ordered the head prosecutor to define the facts and circumstances under which the law would–and would not–be enforced.

The resulting guidelines declared that assisted suicides of people with a “terminal illness,” a “severe and incurable disability,” or “a severe degenerative physical condition”–whether occurring overseas or at home–should not be prosecuted if the assister was a close friend or relative of the deceased, was motivated by compassion, and the victim “had a clear, settled, and informed wish to commit suicide,” among other criteria–exactly the circumstances Delury said motivated him to facilitate Lebov’s death.

When the person who supposedly commits suicide does so privately, without any physician’s supervision and in the company of only a close friend or relative, they can’t exactly speak for themselves as to whether they were murdered or committed suicide. They’re dead. Short of any honest diary implicating someone in the event of a murder, it appears to end up, in the last resort, as one person’s word against another person’s silence; as if the scrutiny applied to determining assisted suicide or murder relies on the honor system. And one cannot, in most cases, tell clearly another person’s motivations. Someone’s motivation might be compassion, and supposing it is, there is the danger of having too much compassion; like the mother who obsesses over her daughter’s good health to the point that she keeps her indoors under constant care until she really does develop an illness. Compassion, like many other virtues, can be perverted by excess, and become harmful. It is a touchy subject, to be sure, and should be approached with the gravity that it warrants. It is, after all, a matter of life and death.

Assuming Seversky is correct about the UK system, it is at least a dual payer system. So if you think your health is more important than the government does, you have options. That's the critical thing that is missing in Canada. O'Leary
Which is preferable? Owning your home rather than living in a council house. And are there 1.5 million families homeless in the U.S? Well, the National Coalition for the Homeless --- an advocacy group expected to put the worst spin on things -- estimates the total number of PEOPLE to be between 1.6 million and 3.5 million and being unable to cover health cost is obviously not a factor. tribune7
In the United States healthcare is provided by a largely private multi--payer system. One published article estimated that 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs. In the United Kingdom healthcare is available to all through the National Health Service augmented by a private sector for those who can afford it. Nobody loses their home or goes bankrupt in the UK because they are unable to pay their medical costs. Which is preferable? Seversky
Lamarck, I think you have a point. The big problem - in my experience - is that fixing broken bones or poison ivy rash is comparatively cheap, or should be. A St. John Ambulance volunteer might set a simple fracture for a teenager. I usually counsel poison ivy sufferers to apply a kettle full of boiling water - not to themselves but to the ivy. Many anti-itch meds work fairly well to relieve the symptoms. Note: Scratching the itch is a bad idea because it actually spreads the toxin. The big health care problem comes with late life expenses when people have complex problems that can either be remedied or palliated, but only at considerable technical expertise, which means considerable financial expense. All those people must, quite properly, be paid their wages. That is why I think a multi payer system will probably work better than a single payer system, because it allows more players on the field. The Canadian blogger, Blazing Cat Fur, wrote a moving account in the National Post of his troubles getting care for his mother at a downtown Toronto hospital. Some others here might understand. O'Leary
I heard on a radio show recently one guy talking about what actually drives health care costs up. He said if health care insurers only covered severe life threatening stuff, be it chronic or acute, then the rest could be paid for with cash, e.g. broken bones. I think he was focusing on the big ticket items although he didn't say this. It's the broken bones, psychotropics, rash medication stuff that gives insurance companies the excuse (and maybe valid excuse? No idea) to make insurance so high. lamarck
So, if I understand you correctly, there are no formal proposals for some kind of compulsory euthanasia in Canada. You are afraid that, because there is insufficient funding for the healthcare system overall, resources could be redeployed from care of the elderly to areas that are assessed as more cost-effective? Do you have any evidence for that? Are there any statistics to show that older people are being allowed to die from conditions that are easily managed because money is not available for the treatment? Seversky
Mark Frank, to judge from advertising at my local shopping centre, you can get boob jobs and tummy tucks in Canada privately. But core health services are, in general, a government monopoly. The core services will save your life, though maybe not your love life. In my experience, our hospital staff are excellent, but exhaustively overworked and desperately underfunded. One health care worker remarked to me recently in passing that if his hospital added 100 beds, the staff could fill them immediately. Of course. That's because hundreds of people are waiting for treatment for core illnesses now. But the beds won't happen because most people are not sick most of the time, so tax funding goes to stuff like Olympic bids and building a soccer bubble around the corner from me. I personally think that a multi payer system makes more sense because it allows more payer options. Maybe you don't care whether my spinster aunt lives or dies or in what condition, but maybe I do. Maybe she has an insurance policy. Maybe a foundation recognizes her work in World War II. Maybe she saved her money, and her nieces and nephews say: "Just use it to help yourself and don't worry about us. Leave what you don't need to the female veterans' foundation." But a system like ours drifts into "lock." We see what needs to be done but can't do it because only government can pay for this stuff. Yo soccer bubble. So bad stuff happens, and good stuff doesn't. I suppose this is far off the ID controversy, but it may help someone somewhere. O'Leary
If the government is the only legal provider of core health services, and chooses not to provide them, then nature takes its course. Are private health services illegal in Canada? That is radical! Mark Frank
Seversky and all, There is no need for compulsory euthanasia in a compulsory single-payer health system like Canada's. Yes, there is a euthanasia lobby, but the heavy lifting is done by the single-payer system itself. If the government is the only legal provider of core health services, and chooses not to provide them, then nature takes its course. Lots of people are more interested in a new hockey arena than in whether Granny gets a stent. And Granny is NOT allowed to just pay for a stent, even if she has an insurance plan or savings. Some of us are not even interested in the question of voluntary euthanasia (VE), because we haven't even settled the question of what to do when people do NOT want to die. It is sad to see people pass from Stage 2 of a cancer to Stage 3 while awaiting treatment in a system where you cannot just flash an insurance card or, at worst, a credit card. Note: I totally oppose VE (in part because, given modern palliative care, I suspect it is about as voluntary as suttee most of the time). O'Leary
O'Leary @ 1
It’s something else to say Granny should be voted off the Island to save money. I’ve heard more of that here in Canada than I care to discuss.
You seem to be alluding to Canadian proposals for compulsory euthanasia. Can you be more specific? Seversky
A few comments on the article as they relate to the UK guidelines. * The UK guidelines have not been accepted. They have been published for consultation with a view to implementation next year if accepted. * This is nothing to do with the "crumbling of the rule of law". It has always been the case that the DPP may decide not to prosecute for any crime based on "public interest". This is an essential flexibility. If anything this guideline firms up exactly how the rule of law should apply in this case. * Wesley Smith talks about but does not list "other criteria" for not prosecuting. Two important ones are: - The victim asked personally on his or her own initiative for the assistance of the suspect; - The actions of the suspect, although sufficient to come within the definition of the offence, were of only minor assistance or influence, or the assistance which the suspect provided was as a consequence of their usual lawful employment. He also left out a vital word in one of the other guidelines. - The suspect was wholly motivated by compassion; It seems to me obvious that George Delury's case did not meet any of these criteria and would have been prosecuted under the proposed guidelines had all the facts come to light. Of course it is necessary to discover all the facts. But that is true of any crime. Mark Frank
Nakashima may not understand the allusive way in which I often write. But he has no business asking me to just stop. I've had experience with attempts to vote Granny off the Island. My point is - too bad I must spell it out - government has no business helping people end their lives because it amounts to capital punishment without even the explanation of a criminal offense. There is a whole science of palliative care today, and people who mean any good for society should be promoting that, not methods of death or protection for them. Death comes anyway. No need to roll out the Red Carpet for death. O'Leary
Nakashima: You're here at our generostiy. So stop with the stopping. William Dembski
Mr Hayden, Thank you for bringing this issue to our attention. I think Mr Smith goes a little off the rails when he starts talking about fear of disability, that is nowwhere in the new standards, as he notes in the next sentence. But overall, it is clear that if society is not going to use prosecution to protect this group, it needs to come up with something else. Perhaps you have found such a method by focusing on the problems of privacy and inconstancy. Here is my thought: in order to obtain a waiver of prosecution against an assistant, the person who wishes to die should have to register that desire for several periods of time, not as a matter of public record, but with some counseling agency. The wish should be difficult to register and yet easy to revoke. And the death itself should be attended by a witness, not just the assistant. I realize there are many other difficult and painful issues, my thoughts are those motivated by the fact pattern Mr Smith brings forward. Mrs O'Leary - please stop. Please. Nakashima
I've fought this battle most of my adult life. People want to off Granny for her own good. What exactly is "her own good"? Granny might fulfill a cherished dream if she visits Graceland before she dies. I don't get Graceland, but then I ain't nothin' but a houn' dog anyway, so why ask me? If a government decides to sponsor charters to Graceland, well, that might not be a wise use of public funds, but why riot in the streets about it? There are worse uses of public funds. It's something else to say Granny should be voted off the Island to save money. I've heard more of that here in Canada than I care to discuss. O'Leary

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