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the Semantics of Suicide Aid in Dying

Cardinal Roger Mahony (Reuters/Lucas Jackson)

Cardinal Roger Mahony (Reuters/Lucas Jackson)

Ben Dolin sighs deeply as he recalls the promise he made his wife, Eva, on her deathbed. “I told her I wouldn’t let her suffer,” he says, pausing to collect himself. A thoughtful man of 77, with pale-blue eyes and a powerful, resonant voice that belies his age, Ben has hardly any regrets from his 45 years of marriage to Eva. Just one: “To this day I feel that I failed her. She asked me to end her suffering, and I couldn’t.”

(Illustration by Mr. Fish)Eva had seen enough suffering in her lifetime. As a 19-year-old Jew in Nazi-occupied Greece, she stood and watched as her parents were herded onto a train bound for the German death camps. She herself managed to escape, sneaking her way to the Italian Consulate in Salonika. A gifted linguist, fluent in five languages, Eva managed, in a perfect Venetian dialect, to convince Italian officials to keep her safe. She was so persuasive that she was able to stay hidden in the consulate of an occupying power for the duration of the war.

“She was an amazing woman with an incredible thirst for life,” says Ben. “This was a tough cookie.”

After the war, Eva moved to California, where she eventually met Ben, who was 10 years her junior. The couple married in 1955 and moved to Encino, where Ben worked as a corporate director for Security Pacific Bank and Eva as a language instructor. “French tutor to the stars,” says Ben, laughing. “Everybody knew her. She was practically a celebrity herself.” The couple had three daughters and enjoyed traveling the world whenever they had the chance. “I was a lucky man to have had such a life,” Ben says.

Then in 2000, while on a Tahitian cruise, Eva found herself nearly crippled by intense abdominal pain, which turned out to be colon cancer. Initial surgery to remove the tumor went poorly, and chemotherapy and radiation proved ineffective in containing the spread of the disease. Eva’s condition was terminal. “She couldn’t walk, she couldn’t go to the bathroom by herself,” says Ben. “When she wasn’t sleeping, she was either sedated or in excruciating pain. What kind of life is that?”

After more than two years of fighting the disease, trapped in a hospice bed with no prospects for recovery, Eva pleaded with her husband to help her end her life. He agreed, telling her he would do all he could. Privately, Ben pulled one of Eva’s doctors aside and asked if there was anything he could do to help her “accelerate the process.” But the doctor brushed Ben’s questions off without responding. Despite repeated legislative attempts to legalize the procedure, assisting suicide was and remains against the law in California, punishable by jail time. Ben and Eva’s pleas were ignored. Shortly thereafter, hospice officials began scrutinizing the application of Eva’s pain medication to make sure Ben wasn’t stockpiling to give her an overdose. “If I did anything, I was going to be charged with manslaughter,” says Ben. “It was Kafkaesque. This was my wife, and there wasn’t a damn thing I could do to help her.”

Eva’s suffering continued for weeks, until she eventually began to refuse food and water. Her doctors began to institute the legal practice of terminal sedation — in which she was essentially medicated into a coma and was to be kept that way until she died of “natural” causes. Days later, Eva began wheezing severely. “I asked the doctor what was wrong,” says Ben, “and he told me, ‘Oh, that’s normal. She’s drowning from the fluid in her lungs.’ ”

Ben slept beside her that night. When he awoke the next morning, Eva was silent. She had died in her sleep. “This is humane? Letting my wife drown to death?”

Experiences like the Dolins’ are common in California, and for the past three years, as state legislators have attempted to legalize assisted suicide, these stories have dominated the discourse in the right-to-die debate.

A Nobel laureate in chemistry in 1997, former UCLA professor Paul Boyer lost his adult son Douglas to kidney cancer in 2001. A true advocate, Douglas Boyer fought to obtain the legal right to die peacefully up until his last breath. Moved by his son’s efforts, Paul Boyer took up the fight where his son left off. “It was terrible watching him suffer,” says Boyer. “I think Nobel Prize winners have an obligation to help smooth the interface between science and society, and this was an issue I wanted to get involved with.”

In June of 2006, Boyer went to Sacramento to lobby lawmakers in support of Assembly Bill 651 — a right-to-die measure for terminally ill patients. Boyer spoke at length to legislators and the media and even wrote a personal plea to Santa Ana state Senator Joe Dunn, whose committee vote would determine whether the bill would go to the floor in the Senate. But despite those efforts and the support of roughly 70 percent of Californians, AB 651 never made it out of Senate committee — failing by one vote. Catholic lobbying against the bill was fierce, and after consulting with his bishop, Joe Dunn refused to give his support.

The right-to-die movement, though, refuses to die, and another initiative — AB 374 — is currently working its way through the state Assembly, the third such bill in as many years and the fifth since 1992. Modeled after the 1994 Oregon Death With Dignity Act, the only existing right-to-die law in the country, the bill would provide legal immunity for doctors to prescribe a lethal dose of medication to “mentally fit” terminally ill adults diagnosed as having less than six months to live. Unlike euthanasia, in which a doctor performs the “mercy killing,” patients prescribed a fatal dose would have to physically take the pills themselves at a time of their choosing.

Now 88 and in failing health, Boyer probably won’t be able to lobby Assembly members on behalf of the new bill. For his own sake, he hopes he won’t have to. “Aging is not for sissies,” he says with a smile. “I don’t want my own life decisions purloined by the rule of a tyrannical minority.”

On a cool March morning, in downtown Los Angeles, a small congregation of protesters gathers in Pershing Square under the banner of “Californians Against Assisted Suicide.” Roughly 50 in number, and carrying probably twice as many signs, they’ve come to voice their opposition to Fabian Núñez and his support of what one sign calls the “Buchenwald Bill.” Mostly white and elderly, they shuffle about politely, smiling at one another and taking pictures, waiting for organizers to march them to the steps of Núñez’s office, several blocks away. The stale smell of urine wafts in the air, and a colony of homeless men and women, roughly equal in number to the marchers, are spread throughout the park, some watching with mild amusement and others dozing. Their presence is notable in that they appear to be the only ones present who actually reside, in one way or another, in Núñez’s district.

After an hour or so of milling in the square, organizer Bob Cielnicky grabs a megaphone and formally starts the protest. “Lord, we say a prayer for the souls of supporters of this bill,” he begins, seemingly setting the religious undertone for the rest of the day. But if religious condemnation of assisted suicide would seem the natural path to take after such an introduction, what follows is a complete surprise. After Cielnicky steps down, virtually all mention of religion, and especially Christianity, is abandoned. If Compassion and Choices has been conspicuously avoiding the use of the “S” word, the protesters are at pains to silence the “J” word: Jesus. Nor is there any formal presence from the Catholic Church. In its stead, a bizarre parade of “disability advocates” and “labor leaders” hop to the front of the pack to grab the megaphone and start shouting.

One such advocate repeatedly warns of “intense vomiting” for those who attempt to end their lives with a physician’s assistance. She’s referring to a recent report from Oregon, which revealed that four out of the 46 patients who took advantage of the Oregon law in 2006 regurgitated their fatal dose before finally succeeding. “How can it be called death with dignity if the patients are vomiting?” she concludes, seeming to forget the far more egregious suffering patients have likely endured.

The only overtly religious figure of authority present is a large, middle-aged mouth-breather calling himself Rabbi Lou Feldman. When his turn to take the megaphone comes, he indulges the crowd in a brief synopsis of the shared Judeo-Christian belief in the “sanctity of life,” before concluding his remarks with a rhetorical flourish. “The road to Auschwitz was paved with euthanasia programs,” he says, drawing the biggest applause of the day. Feldman’s speech doesn’t mark the first Holocaust reference of the day, nor will it be the last. Indeed, the slaughter of the Jews appears to be a bit of a motif, highlighted by several remarkably insensitive placards.

“Coming soon to your town — Auschwitz R US — You kill ’em we grill ’em.”

As the speeches wrap up, the protesters gather and march to Núñez’s office. Led by Cielnicky, the group forms a long line out front stretching the length of the block. Fliers are then passed out, and the line stutters through a series of slogans based on disability rights. Yet for all their issue-oriented incantations, the religious conviction among the group is unmistakable. Gold crosses hang from the necks of several protesters, and a boy no older than 12 wears a shirt that reads, “Pain is weakness leaving the body” — a presumed reference to John Paul II’s teachings.

As for Cielnicky, he’s a member of the Orange County Priority Life Network, and an Internet search of his name reveals public comments in opposition to any number of progressive social issues: gay marriage, abortion, stem-cell research — you name it. If the church doesn’t like it, neither does Cielnicky. Yet when asked about his religious preferences, Cielnicky plays coy. “I’m a man of God,” he says, before getting back to his talking points, “but today I’m here to lend my support to the disabled. This whole bill is ridiculous. The closest comparison I see is to Nazi Germany.”

Meanwhile, Rabbi Feldman gleefully repeats his prognostications of impending genocide into the doe eyes and open lens of a rather stunning female television reporter. She nods along professionally, wraps up the interview and power-walks away, leaving Feldman with a goofy smile that remains throughout the march.

If the rally at Pershing Square gave any indication, Fabian Núñez didn’t seem to have to worry much about the political ramifications of his right-to-die stance. With “suicide” largely out of the mix and the Catholic Church staying out of the fray — relying on its PR wing, the California Catholic Conference, to do the political dirty work — right-to-die foes seemed to be grasping for new tactics. On March 21, a foothold appeared across the country when legislators in socially progressive Vermont struck down that state’s right-to-die measure, 82-63.

Buoyed by the Vermont defeat, AB 374 foes showed up en masse at the bill’s March 27 Assembly Judiciary Committee hearing in Sacramento. Unlike the march on Núñez’s office, the majority of the opposition at the hearing was organized and eloquent. Led by the California Medical Association’s unfortunately named president, Dr. Richard Frankenstein, they argued that frequently occurring misdiagnoses of terminal illnesses could lead to the unwarranted suicide of those with serious disabilities or with chronic, but nonterminal, illnesses. More insidiously, they suggested, profit-greedy HMOs would try to save money on providing end-of-life care by coercing the poor and the powerless into killing themselves.

“We are reminded of the injunction that we learned the first day in medical school,” said Dr. Frankenstein. “First, do no harm.” How the process of terminal sedation, the medically induced stupor that ended the life of Eva Dolin, fits into this creed was not addressed.

The most compelling argument against the bill was launched by registered nurse and California Hospice and Palliative Care Association board member Holly Swiger. Citing data collected in 2005 by the California Office of Statewide Health Planning and Development, Swiger noted that more than 3,100 patients admitted to hospices in California were later discharged because they were no longer terminally ill. “If this bill were to pass,” she insisted, “people could make a very wrong decision based on an inaccurate prognosis.”

These doomsday scenarios appeared to make a persuasive case against AB 374, but as Democratic committee chair Dave Jones pointed out in the hearing, “We now have nine years of hard data from Oregon. The opposition asserts that we would have a parade of horribles if this bill were to pass. In fact, that hasn’t been the case.”

Indeed, since the Oregon law was enacted in 1998, 298 people have ended their lives with a doctor-prescribed dose of medication. Four hundred sixty others applied for the fatal dose but elected not to follow through. “This sheds light on the issue of coercion,” said Jones, “and also indicates to me that the will to live is strong.”

Of the 46 people who ended their lives last year under the terms of the Oregon law, only one lacked health insurance. The vast majority of those who had aid in dying in Oregon were wealthier and significantly more educated than the state averages.

“There have been absolutely no incidents of coercion or malfeasance in Oregon,” Van Nuys Democratic Assemblyman Lloyd Levine tells me later. “Given the historic mistreatment of the disabled in this country, I can understand why some might have their concerns, but not one disabled person in Oregon has hastened their death because of this law.”

That doesn’t stand to change in California, where AB 374 has even more protections built into it. To get life-ending medication, a patient has to be in a hospice and must obtain the consent of two doctors. Patients who aren’t in a hospice need to be referred to a mental-health specialist to determine whether they are of sound mind. “The CMA is citing the supposed incompetence of its own doctors in diagnosing terminal illnesses as a reason this bill shouldn’t pass,” says Levine. “If incompetence is that much of a problem, give me a list of these doctors, because I don’t want to go to them.”

If the coherent arguments against AB 374 didn’t fare well at the hearing, things got even worse for opponents of the bill when elements of the anti-Núñez march resurfaced. Several attempts were made at establishing a rhetorical Holocaust beachhead, but were promptly shot down by Democratic Assemblyman and former Los Angeles City Councilman Mike Feuer. “To analogize what happened in the Holocaust to the choice of a competent patient to end his or her life is so profoundly insulting to those who perished in the Holocaust, I can’t begin to say.”

“There are two main camps in opposition to this bill,” says Levine. “There are those in the disability community who have genuine, but in my opinion misplaced, fears based on historical distrust of the medical community, and people who are Catholic that have moral objections they couch in other arguments.”

Perhaps sensing this crumbling façade, fire-and-brimstone Catholic opposition finally revealed itself at the hearing. In one of the more dramatic pieces of political theater on that day, an elderly man claiming to “represent the Roman Catholic Church,” stepped to the podium. After addressing the Assembly committee as a “kangaroo court,” he warned those who support the bill, “You’re not doing a service to God.” He then yelled, “These doctors who support this bill are going to hell!” The man was later joined in moral fervor by Republican Assemblyman Anthony Adams. “You better darn well believe that I want to impose my morality on these people,” a red-faced Adams railed.

Adams will have to wait to impose his morality — AB 374 easily passed through committee with a 7-3 vote. But the religious outrage that surfaced at the hearing appears to have foreshadowed the growing opposition to come.

For nearly two months after Fabian Núñez first announced his support for AB 374, California’s most powerful religious figure kept his mouth shut. Finally, on the Tuesday before Easter, the second anniversary of Pope John Paul II’s death, Cardinal Roger Mahony stepped to the pulpit to break his public silence. The timing was not coincidental. Allusions to Pope John Paul’s teachings on the sacrosanct nature of suffering were scattered throughout Mahony’s homily. Invoking the memory of the late pope, the cardinal insisted that AB 374 is “nothing more than an assisted-suicide bill” — later declaring, “If Pope John Paul were standing here right now, he would point out that euthanasia, which is the same thing as assisted suicide, is both senseless and inhumane.”

Of course, assisted suicide and euthanasia aren’t the same thing. Assisted suicide is the voluntary taking of one’s own life to end suffering, whereas euthanasia is commonly understood to entail someone else doing the killing — possibly without the recipient’s consent. “I’m pretty sure the cardinal knows that difference,” says Núñez. “He’s conflating the two to galvanize the masses. We do that all the time in politics. But this isn’t politics, this is religion we’re talking about.” (Archdiocese spokesman Tod Tamberg maintains that the difference between euthanasia and suicide is negligible. “The end result is the same,” he says, “the taking of a life.”)

Núñez has good reason to play close attention to Mahony’s words. During the same homily, the cardinal saved some of his strongest language for the speaker. “What really troubles me is Assembly Speaker Fabian Núñez’s support for AB 374,” Mahony said. “This cathedral is in his Assembly district. I live here. I’m one of his constituents. Many of you who live downtown are constituents of this Assembly district. And so we should be troubled that Fabian Núñez, who has worshipped here in this cathedral, has somehow not understood the culture of life but has allowed himself to get into this other direction, the culture of death.”

Núñez, who has worked closely with Mahony on immigration issues, was blindsided. “I expected him to say something,” says Núñez, “but nothing so visceral and dogmatic. I mean, ‘the culture of death’ — that’s horrific. My kids attended Catholic school all their lives. How am I going to explain this to them?”

Indeed, the ferocity of the attacks seems strange. After all, Núñez is both pro-choice and a supporter of gay marriage — if those positions allowed for cordial diplomacy in the past, why not assisted suicide now? Though Mahony’s homily briefly mentioned the same disability-rights arguments that have been largely disproved by the Oregon experience, the real answer appears to be no less than preserving the legacy of the pope himself. “This is a good opportunity to recommit ourselves to the ideals of John Paul II, but especially his culture of life,” said Mahony.

A culture of life that just happens to believe human suffering serves as redemption for the murder of Jesus Christ and for the sins of man. “The person who lives his suffering in the Lord grows more fully conformed to him and more closely associated with his redemptive work on behalf of the church and humanity.”

These are the words of Pope John Paul II’s “The Gospel of Life,” an apostolic letter that expands on his earlier “The Christian Meaning of Suffering.” In citing his objections to AB 374, Mahony quoted from this text freely and even said he gave a copy of the letter to Fabian Núñez, hoping it would change his position.

But Núñez has other ideas. “I was elected to represent the citizens of California, not the Catholic Church or the pope,” he says. “Even if I wanted to put my religious views into law, that would be completely irresponsible. That’s not who I am.”

Despite the prospect of a protracted battle with the church in his own backyard, Núñez vows not to be swayed. “If you look at my track record, when I want to get something done, it tends to happen. After these recent events, I’m now more committed to getting this bill through than ever before.”

It won't be easy.  On this past Wednesday, April 18, AB 374 was put on “suspense” in the Assembly Appropriations Committee, most likely meaning that its backers felt they lacked enough support to allow a vote on the Assembly floor. Essentially, it's a delay tactic, and once the bill is released from suspension it will go directly to a floor vote. Núñez has until May 30th to change a few minds.  If he's able to do so, the bill then needs to pass a floor vote by June 8th — the last day before the summer recess.  From there it would head to the Senate and then on to Governor Schwarzenegger — who, by the way, is Catholic.

On Easter morning inside the massive Cathedral of Our Lady of the Angels in downtown Los Angeles, Cardinal Mahony stands in full regalia and observes as a priest leads the congregation in the General Intercession — the prayer for humankind. It's Catholicism’s holiest day, the day of Christ’s resurrection and of the redemption of the sins of humanity through his suffering, the smell of incense hangs in the air as thousands of worshipers of all races stand before the altar, heads bowed and hands clasped in prayer.

“Lord, we pray for you to watch over all of our elected officials,” the priest says. “We pray for you to put an end to euthanasia.”

“Lord, hear our prayer,” the congregation replies in unison.