In my first-ever anti-euthanasia article, published in Newsweek in 1993, I described the suicide of my friend Frances, who killed herself under the influence of the euthanasia-promoting Hemlock Society (since rechristened Compassion and Choices). Toward the end of the piece, I predicted what would happen should assisted suicide become legal and normalized:

The descent to depravity is reached by small steps. First, suicide is promoted as a virtue. Vulnerable people like Frances become early casualties. Then follows mercy killing of the terminally ill. From there, it’s a hop, skip and a jump to killing people who don’t have a good “quality” of life, perhaps with the prospect of organ harvesting thrown in as a plum to society.¹

I believed my conclusion would be uncontroversial. After all, it was only logical. Once the act of eliminating suffering by eliminating the sufferer is redefined from a crime to a beneficent medical intervention, there is no limiting principle. Terminal illness might be the gateway excuse for legalization, but since the real issue is the best response to suffering, I could not see how access would not expand continually over time. After all, many people who are not dying suffer more intensely and for a longer period than those who are. Moreover, once the law accepts the premise that some people are better off dead, a utilitarian calculus naturally follows that sees hastening deaths as beneficial—a “plum to society,” as I put it.

Boy, was I wrong! I received more than 150 letters reacting to the column. Most were hateful screeds. (Remember, this was before email, when my detractors had to pay the price of a stamp to wish me a slow and painful death from cancer.) Beyond the hate, almost all of my correspondents accused me of engaging in alarmist slippery slope argumentation. Even those who agreed that assisted suicide should not be legalized blithely assured me that it would never come to organ harvesting or mercy killing of those without a good “quality of life.”

Now, more than 30 years later, the facts are in. Euthanasia and/or assisted suicide has been legalized throughout the Western world—including in Australia, New Zealand, Colombia, Netherlands, Belgium, Spain, Portugal, Germany (by court ruling), Austria (by court ruling), and (most worrying of all to us in the United States) Canada. In the United States, assisted suicide is now legal in nine states and the District of Columbia. Tens of thousands of people throughout the world have had their deaths facilitated. And—just as I predicted—the practice of what death activists euphemistically call “medical aid in dying” (MAiD) has not only increased in numbers but expanded exponentially in scope, in some places including the instrumental use of those whose deaths have been facilitated. Indeed and alas, rather than being alarmist, my long-ago warning proved prophetic.

Euthanasia without Brakes

Most of the media are euthanasia-friendly, preferring to report on the issue in the glowing, uncritical language of empowered patients “dying peacefully on their own terms,” supported by loving family who are grateful that grandma is no longer suffering.² In contrast, euthanasia abuses and horror stories—an ever-growing list—generally receive little focused media attention and remain outside the notice of people not engaged with the issue. But we now have enough experience with euthanasia/assisted suicide to demonstrate that the “slippery slope” is not only real but has become an avalanche of abuse and abandonment.

Space does not permit a complete recitation of the known examples of abuse or neglect associated with legalized euthanasia. But the following recitation demonstrates the danger:

Euthanasia “Patients” as “Organ Farms”: People killed by euthanasia are increasingly being looked upon by doctors and society as splendid sources of organs. Not only that, but the phenomenon of conjoining euthanasia with organ harvesting—becoming relatively common now in the Netherlands, Belgium, and Canada—is celebrated in the media. Thus, the Ottawa Citizen recently depicted the practice as “a growing boon to organ donation,” sighing:

Ontarians who opt for medically assisted deaths (MAiD) are increasingly saving or improving other people’s lives by also including organ and tissue donation as part of their final wishes. According to Trillium Gift of Life Network, which oversees organ and tissue donation in Ontario, the 113 MAiD-related donations in 2019 accounted for five per cent of overall donations in Ontario, a share that has also been increasing.³

Some readers might be asking, “What’s the problem? These are people who want to die, so why not allow them to donate their organs?”

The question itself demonstrates the danger. Imagine a healthy suicidal person asking to be killed and organ-harvested because he doesn’t believe his life to be worth living and hopes that through his death others—who want to live—can be saved. Would we allow that? No! (At least not yet.) Rather, the humane response would be to offer the person mental health support and suicide prevention to get past the darkness.

Now, notice the difference when a patient qualifies for euthanasia. Not only is suicide prevention not engaged, but in Ontario, once the patient is accepted for a lethal injection, the death doctor informs Trillium Gift of Life Network. In turn, Trillium contacts the soon-to-be-killed person to ask for their heart, liver, lungs, and kidneys. Again, from the Ottawa Citizen story:

“As part of high-quality end-of life care, we make sure that all patients and families are provided with the information they need and the opportunity to make a decision on whether they wish to make a donation,” Gavsie says. “That just follows the logical protocol under the law and the humane approach for those who are undergoing medical assistance in dying. And it’s the right thing to do for those on the wait list.”⁴

This is the opposite of “high-quality end-of-life care.” Canada does not restrict euthanasia to the terminally ill, but may include people with disabilities, chronic illnesses—and, beginning this year, the physically healthy experiencing mental illness. (The mentally ill are already eligible for euthanasia in Belgium and the Netherlands.) Thus, many euthanized organ donors would not be dying but for being lethally injected. Indeed, some might live indefinitely.

But because they are qualified to be killed under the law, their organs come to the forefront of policy. An article in the Canadian Medical Association Journal recently updated the Association’s “guidelines” for conjoining euthanasia and organ harvesting when the patient is not terminally ill—these are called “Track 2” patients.5 (There are even more relaxed standards for “Track 1” patients, those whose deaths are “reasonably foreseeable.” Due to space considerations, I focus below primarily on Track 2 patients.) From “Deceased Organ and Tissue Donation After Medical Assistance in Dying” (my emphasis):

All Track 2 patients who are potentially eligible for organ donation should be approached for first-person consent for donation after MAiD once MAiD eligibility has been confirmed, regardless of when their eligibility for MAiD is confirmed within the 90-day assessment period.

This means that the death doctor is to contact the organ-donation association, which in turn will contact the suicidal patient and ask for his or her organs (which, as we have seen, already happens in Ontario).

The recommendations also suggest allowing a soon-to-be-euthanized patient to determine who receives organs:

Organ donation organizations and transplantation programs should develop a policy on directed deceased donation for patients pursuing MAiD, in alignment with the directed donation principles and practices that are in place for living donation in their jurisdiction  . . . Directed donation should not proceed if there is indication of monetary exchange or similar valuable consideration or coercion involved in the decision to pursue directed donation. The intended recipient in a directed deceased donation case should be a family member or “close friend”—an individual with whom the donor or donor’s family has had a long-standing emotional relationship.  . . . The intended recipient must be on the current transplant waiting list or meet criteria for the same  . . . Transplantation will proceed only if the donor organ is medically compatible with the intended recipient.

Do you see the danger? The need for a transplant by a medically compatible loved one could become the motive for asking for euthanasia.

The article grouses that waiting for the patient to initiate organ donation conversations means “missed opportunities”:

Given the variation in practices relating to both MAiD and donation after MAiD across Canada, some jurisdictions may be unable to apply the updated guidance. Specifically, in jurisdictions reliant on patient initiation of donation after MAiD, lack of awareness of the option may result in missed opportunities. Jurisdictions without central coordination of MAiD may experience similar challenges. There are also jurisdictional variations in the education, training and support provided to coordinators who facilitate donation after MAiD.

Now, we can see that once the patient is accepted for medicalized homicide, his or her intrinsic human dignity is diminished—in at least some sense—from that of an equally valuable person into that of a mere natural resource usable for the benefit of others. In other words, the life, wellbeing, and future potential of the patient become secondary considerations to the potential benefit of garnering organs for other patients who want to live.

The impact of this dehumanizing force of gravity became blaringly clear in a recent case out of Belgium. A story in Le Soir recounted what happened when a 16-year-old girl with a brain tumor asked to be euthanized and have her organs harvested.6 Doctors agreed. At that point, she mattered less than the donation. The girl was sedated and intubated in an ICU for 36 hours before being euthanized and harvested.

The story lauds the girl as selfless. But it seems to me there is a terrible dark side to the tragedy. First, this was a minor terrified of decline who stated that by donating organs she believed she could do some good. But for that option, she might not have asked to die. Second, as far as we know, the girl wasn’t provided with suicide prevention nor assured that palliative care could alleviate her symptoms. Finally, the lengthy sedation to which she was subjected was primarily administered to allow her organs to be tested and to allow time to find compatible recipients. In other words, at least in some sense, once the girl asked to donate her organs, they became the paramount consideration.

Euthanasia as a Substitute for Care: When I first began my work against euthanasia and assisted suicide in 1993, both euthanasia and assisted suicide were permitted in the Netherlands under a decriminalized system that allowed doctors to end the lives of patients so long as there was (supposedly) no other means of preventing suffering and the death doctor reported the details to the authorities.7 (That system is now defunct. The Netherlands formally legalized euthanasia in 2003.)

When researching my first book on the issue, I came across data demonstrating that hospice was virtually unknown in the Netherlands. One reason for this deficiency was the Dutch medical system, which depends on general practitioners making house calls and has fewer specialists than the American system. But, I wrote, that might not have been the only reason:

The widespread availability of euthanasia in the Netherlands may be another reason for the stunted growth of the Dutch hospice movement. As one Dutch doctor is reported to have said, “Why should I worry about palliation when I have euthanasia?”⁸

In other words, once medicalized killing becomes normalized, it could eventually become a measure of first resort rather than last.

That abandoning paradigm can be seen playing out increasingly in Canada in recent years:

• A VA counselor suggested euthanasia to a military veteran burdened by PTSD.⁹

• A disabled woman with quadriplegia plans to be euthanized because she is destitute and it is easier and quicker to receive euthanasia than obtain disability benefits.¹⁰

• A man with serious disabilities—refused coverage for independent living services—was told that Canadian Medicare would cover the costs of obtaining a lethal jab.¹¹

• A cancer patient decided to be euthanized because he couldn’t obtain the chemotherapy that would extend his life.¹²

• Another cancer patient was offered euthanasia by her surgeon and told it would take months before she could see an oncologist. She chose instead to be treated in the USA.¹³

• An elderly woman opted for euthanasia rather than be isolated from her family during a Covid lockdown. Her family was allowed to be with her when she died but would not have been allowed to visit her room if she continued living.¹⁴

Canada isn’t alone in this. A report out of the Netherlands finds that autistic people are being euthanized in lieu of being provided proper care. From the AP story:

Several people with autism and intellectual disabilities have been legally euthanized in the Netherlands in recent years because they said they could not lead normal lives, researchers have found. The cases included five people younger than 30 who cited autism as either the only reason or a major contributing factor for euthanasia, setting an uneasy precedent that some experts say stretches the limits of what the law originally intended Eight said the only causes of their suffering were factors linked to their intellectual disability or autism—social isolation, a lack of coping strategies or an inability to adjust their thinking.¹⁵

The same paradigm is seen in Belgium, where a healthy elderly couple received joint euthanasia deaths out of fear of future loneliness caused by widowhood—a killing arranged by the couple’s own children.¹⁶ A suicidal anorexia patient, despairing over being the object of sexual predation by her former psychiatrist, was euthanized by her new psychiatrist.¹⁷ A transgendered patient despairing over the adverse results of transition surgery was killed rather than helped to go on living.¹⁸ These kinds of cases are becoming ubiquitous.

Enough. The unintended cruelty of legalized euthanasia is now quite clear. It is about “choice,” they say. It is about compassion, they say. Bah. That is just a veneer. Medicalized killing eventually becomes a form of abandonment.

Future Concerns

The societal damage done by euthanasia expands exponentially as time passes and a nation’s population accepts doctor-hastened death as normal. Here are a few of the unfolding harms that have emerged recently.

Euthanasia Deaths, Going Up!: Euthanasia/assisted suicide is sold to a wary public as a last-resort option—a safety valve, if you will—to be rarely applied, and then only in cases of extremis. But in real life, hastened death tends to increase exponentially year by year. For example, in 1998—the first full year that assisted suicide in Oregon became legally available—the state reported 16 deaths from assisted suicide. In 2022, that number had risen to 278, with 431 prescriptions written.¹⁹

The Netherlands has experienced an even more dramatic increase. In 2004, 1886 people were killed by doctors. In 2021, the number had risen to 7,666. Even more notably, that number increased by more than a thousand in one year, with 8,720 lethal injections in 2022.²⁰

Canada experienced the most startling death acceleration. The first year of full legalization, 2016, Canadian doctors killed 1,018 patients. The next year the total was 2,828. In 2018, it reached 4,493. In 2022, a horrifying 13,241 patients were killed.²¹ (If the same percentage of people were killed by doctors in the much more populous United States, that would amount to about 140,000 medical homicides annually.) And now that patients with clearly non-terminal conditions are killable in Canada, these numbers will undoubtedly rise to unprecedented levels going forward.

Follow the Money: There is a less visible but perhaps ultimately more dangerous force driving the euthanasia juggernaut: money. Whether in a socialized healthcare system like Canada’s, or one with free market elements and incentives as in the United States, once the most expensive-to-care-for patients can be killed—people with long-term chronic medical conditions, disabilities, or the frail elderly—it should become obvious that, over time, billions could be saved in the healthcare system.

This isn’t paranoia. Indeed, Derek Humphry, the co-founder of the Hemlock Society, made this point explicitly in his book (co-authored with Mary Clement) Freedom to Die: People, Politics and the Right to Die Movement. In a chapter entitled “The Unspoken Argument,” the euthanasia advocates write, “Elders or otherwise incurable people are often aware of the burdens—financial and otherwise—of their care.” They then get to the ultimate point:

A rational argument can be made for allowing PAS [physician-assisted suicide] in order to offset the amount society and family spend on the ill, as long as it is the voluntary wish of the mentally competent terminally ill and incurable adult. There will likely come a time when PAS becomes a commonplace occurrence for individuals who want to die and feel it is the right thing to do by their loved ones. There is no contradicting the fact that since the largest medical expenses are incurred in the final days and weeks of life, the hastened demise of people with only a short time left would free resources for others. Hundreds of billions of dollars could benefit those patients who not only can be cured but who also want to live.²²

Canadians have already noted the costs being saved for their socialized system from legalizing euthanasia. Back in 2017, a study projected that Canada’s socialized medical system could save up to C$138.8 million annually by not treating patients (less C$1.1 million for the costs associated with euthanasia). It is worth noting that the authors based their cost-savings projections on more conservative practice than the country’s actual experience. They assumed that “40% of Canadians who choose medical assistance in dying would have their lives shortened by 1 week, and 60% of patients will have their lives shortened by 1 month.”²³ In practice, many patients do not wait until the very end of their illnesses before being euthanized.

More recently, a 2020 projection found that if some 6,000 Canadians were to be euthanized under a proposed (and now in effect) expansion of death eligibility beyond “death being reasonably foreseeable,” the annual net savings would be C$149 million.²⁴ But more than twice as many Canadians died by euthanasia than was predicted in 2022, with the total cost savings currently unknown. Moreover, with the elderly, people with disabilities, and those with chronic and (soon) mental illnesses now being euthanized, the cost savings will undoubtedly increase, providing a potential incentive to further normalize killing as a “medical treatment.”

Euthanasia Poisons a Nation’s Soul: Transforming killing from a negative into a beneficent means of eliminating suffering changes public morality. For example, when euthanasia began in the Netherlands, it was supposed to be strictly limited to cases of force majeure. But after decades of desensitizing the public to doctors causing death, the Dutch people now overwhelmingly support allowing euthanasia for what is known as a “completed life.” From the NL Times story:

A massive 80 percent of voters believe that people should be able to get help in dying when they feel they’ve come to the end of their life,Trouw reports based on a Kieskompas poll of almost 200,000 people. Only 10 percent of respondents disagreed with the statement that people who consider their lives complete should be able to end their lives with professional help. The other 10 percent of voters had no opinion on the matter.

The first focus of this idea are the elderly:

The [parliamentary] bill would allow people over 75 to decide when to die with professional help if they feel they’ve reached the end of a completed life. Added to the bill is a six-month process in which they have to meet with an “end-of-life counselor” at least three times.²⁵

Note well that the concept of the “completed life” need not involve any physical illness, disabling condition, or psychiatric malady at all. People could decide they have lived long enough due to loneliness, boredom, fear of future widowhood, death of an adult child, dissatisfaction with living conditions, worries about being unproductive, you name it. In other words, “completed life” euthanasia would allow the healthy elderly to be terminated.

Moreover, in principle, why should eligibility be age-dependent? Once the concept of the “completed life” is accepted, why shouldn’t the death option be available to younger people? Indeed, doesn’t every suicidal person believe their useful life is completed? Again, as with many aspects of euthanasia, there is no effective limiting principle.

Meanwhile, in Canada, shockingly large percentages of people now support euthanasia as a remedy for the suffering caused by adverse social conditions! According to a recent poll, 27 percent of respondents strongly or moderately agree that euthanasia is acceptable for suffering caused by “poverty,” and 28 percent strongly or moderately agree that killing by doctors is acceptable for suffering caused by “homelessness.”²⁶

Before the legalization of euthanasia, I’m confident that few Dutch would have supported allowing doctors to kill healthy geriatric patients—any more than (I hope) Americans would. But after decades of euthanasia normalization, only 10 percent think it would be wrong. And can we imagine more than one-quarter of Canadians supporting euthanasia as a remedy for homelessness if it had not already become widely accepted for the suffering caused by illness and disability? Do you see what I mean about how euthanasia is poisoning a nation’s soul?

“But Wesley,” some might say, “the same moral decay hasn’t happened in states that have legalized assisted suicide.” As a fact checker would put it, that’s partially true. People aren’t (yet) assisted in suicide for botched sex change surgeries or for having suffered sexual predation by their psychiatrist. But that shouldn’t make us sanguine. Almost every state that has legalized assisted suicide already has liberalized its regulations to allow easier access to doctor-prescribed death. Oregon and Vermont have done away with residency requirements, and some states even allow virtual assisted suicide, with doctors examining patients who want to die over the internet. Besides, the people of the United States have only nibbled at—but not yet swallowed— the snake’s proffered poison apple, which is why the death agenda has not yet swept the country. But if we ever do yield to the culture of death, the same tragic trajectory seen so vividly in the Netherlands, Belgium, and Canada will happen here. As I pointed out at the beginning of this essay, it’s only logical.

Conclusion

Euthanasia cannot ultimately be restricted only to the few for whom nothing but death can eliminate suffering. Once medicalized killing becomes normalized, the death agenda spreads, objectifies those who want to die, and corrupts public morality in ways that should shock the human conscience. The same progression will happen here too if we don’t change our current cultural trajectory. And many of those who dismiss the warnings contained in this article as alarmist will applaud when that dark time comes.

Those with eyes to see, let them see.

 

NOTES

 

1. Wesley J. Smith, “The Whispers of Strangers,” Newsweek, June 28, 1993. The Whispers of Strangers | Discovery Institute

2. Such articles are ubiquitous. See, for example, “Model Ali Tate Cutler’s Grandmother is Choosing to Die on Her Own Terms,” Yahoo News, May 25, 2023, Ali Tate Cutler grandmother dying by choice, MAID (yahoo.com).

3. Bruce Deachman, “Medically Assisted Deaths Prove a Growing Boon to Organ Donation in Ontario,” Ottawa Citizen, January 6, 2020.

4. Ibid.

5. Kim Wiebe MD, et. al., “Deceased Organ and Tissue Donation After Medical Assistance in Dying: 2023 Updated Guidance for Policy:” Canadian Medical Association Journal, CMAJ 2023 June 26;195:E870-8. doi: 10.1503/cmaj.230108: Deceased organ and tissue donation after medical assistance in dying: 2023 updated guidance for policy (cmaj.ca)

6. Alain Lallemand, “Euthanasia: I’ve Had Enough. I Want to Die Helping People,” Le Soir, October 16, 2023 (Google translation).

7. For details on how this now-repealed system worked—and the abuses that resulted—see Wesley J. Smith, Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (New York, Times Books, 1997).

8. Ibid, p. 231.

9. Michael Lee, “Canadian Soldier Suffering with PTSD Offered Euthanasia by Veterans Affairs,” Fox News, August 22, 2022. Canadian soldier suffering with PTSD offered euthanasia by Veterans Affairs (foxnews.com)

10. Tyler Cheese, “Quadriplegic Ontario Woman Considers Medically Assisted Dying Because of Long ODSP Wait Times,” CBC News, June 22, 2023.

11. CTV CA, “The Solution is Assisted Life: Offered Death, Terminally Ill Ontario Man Files Lawsuit,” March 15, 2018.

12. Katie DeRosa, “B.C. Man Opts for Medically Assisted Death After Cancer Treatment Delayed,” National Post, December 5, 2023.

13. Amy Judd and Kylie Stanton, “B.C. Woman Gets Surgery in U.S., Says Wait Times at Home Could Have Cost Her Life,” Global News, November 27, 2023.

14. CTV News, “Facing Another Retirement Home Lockdown, 90-Year-Old Woman Chooses Medically Assisted Death,” November 19, 2020.

15. Maria Cheng, “Some Dutch People Seeking Euthanasia Cite Autism or Intellectual Disabilities, Researchers Say,” Associated Press, June 28, 2023.

16. Simon Caldwell, “Elderly Couple to Die Together by Assisted Suicide Even Though They Are Not Ill,” Daily Mail, September 25, 2014.

17. Michael Cook, “Another Speedbump for Belgian Euthanasia,” Bioedge, February 8, 2013.

18. Damian Gayle, “Transsexual, 44, Elects to Die by Euthanasia After Botched Sex-Change Operation Turned Him Into a ‘Monster’,” Daily Mail, October 1, 2013.

19. Oregon Health Authority, Oregon Death with Dignity Act, 2022 Data Summary, March 8, 2023. DWDA 2022 Data Summary Report (oregon.gov)

20. Statista, “Number of Euthanasia Deaths Reported in the Netherlands from 2000 to 2022.” Netherlands: euthanasia 2000-2022 | Statista

21. Government of Canada, “Fourth Annual Report on Medical Assistance in Dying in Canada 2022.”

22. Derek Humphry and Mary Clement, Freedom to Die: People, Politics and The Right to Die Movement (New York: St. Martin’s Press, 1998), p. 333.

23. Aaron J. Trachtenberg and Braden Manns, “Cost Analysis of Medically Assisted Dying in Canada,” Canadian Medical Association Journal, January 23, 2017.

24. Office of the Canadian Budget Office, “Cost Estimate for Bill C-7 ‘Medical Assistance in Dying’,” October 20, 2020.

25. Anne-Marijke Podt, “Widespread Public Support for Assisted Suicide at End of Completed Life,” NL Times, November 8, 2923.

26. Research Co., “Poll on Medically Assisted Dying in Canada,” May 5, 2023. Tables_MAiD_ CAN_05May2023.xlsx Group (researchco.ca)

 

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Original Bio:

Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council. In May 2004, Smith was named one of the nation’s premier thinkers in bioengineering by the National Journal because of his work in bioethics. In 2008, the Human Life Foundation named him a Great Defender of Life.