This week William Melchert-Dinkel, a former nurse from Faribault, Minnesota appeared in court on charges of assisting the suicide of a British man and Canadian woman. He stands accused of instructing and coaxing these young people and others in Internet suicide chat rooms to kill themselves.
Reporters have been calling Compassion & Choices for comment, perhaps with the expectation that we would not condemn the alleged behavior. Nothing could be further from the truth.
Let's be clear. Our movement for end-of-life choice does not condone assisted suicide, and it never has. When we drafted the Oregon Death with Dignity Act in 1994 we were careful to preserve and maintain the felony of assisting a suicide. That law protects Oregonians with poor mental health and disordered thinking from anyone who would encourage and facilitate their attempts to harm themselves. Laws against assisted suicide are good laws that should stay on the books in every state where they appear.
History of assisted suicide laws is instructive. A wave of reform legislation passed through the United States in the 1970's to repeal ancient statutes making suicide and attempted suicide a crime. Those misguided laws hearkened back to feudal England, where citizens were deemed to "belong" to the king, and killing oneself amounted to destruction of property obligated to the crown. By the twentieth century, advances in psychiatry demonstrated that self-destructive thoughts called for mental health intervention, not criminal prosecution. So legislatures transformed the crime of "suicide" into the crime of "assisting a suicide" to punish the aiding and abetting of harmful behavior of the mentally ill. It's a crime to shout "jump, jump" to a distressed person clinging to a high window ledge. It's a crime to goad depressed teenagers into playing Russian roulette, or pretend to join them in a suicide pact. People who commit these crimes should be tried and punished accordingly for assisting, or attempting to assist a suicide.
These laws do have a problem, however. The problem is lawyers, doctors and other people have made overly broad assumptions about them. People have assumed assisted suicide laws prevent dying patients from asking their doctors for life-ending medication they could take if the suffering in their dying became unbearable. They assume the physician would be "assisting a suicide" even though rational dying patients are not "suicidal" and no American physician has ever been successfully prosecuted for empowering a dying patient with the means to humane and peaceful passing. Doctors who acknowledge their patients' imminent death and accede to their thoughtful request are providing aid in dying, not assisted suicide.
The contrast between aid in dying, in which a knowledgeable, merciful physician gives his elderly, dying patient the means to halt end-of-life suffering --- and assisted suicide, in which a malicious predator seeks out and victimizes physically healthy, mentally ill teens --- could not be more clear.
Consider the stark opposites outlined by Dr. James Lieberman in Psychiatric News, a publication of the American Psychiatric Association:
• The suicidal patient has no terminal illness but wants to die; the aid in dying patient has a terminal illness and wants to live.
• Suicides bring shock and tragedy to families and friends; Aid in dying deaths are peaceful and supported by loved ones.
• Suicides are secretive and often impulsive and violent. Aid in Dying is planned; it changes only the timing of imminent death in a minor way, but adds control in a major and socially approved way.
• Suicide is an expression of despair and futility; Aid in dying is an affirmation of a person's dignity and rational self-determination.
In short, suicide is the self destructive impulse of a person who has every reason and ability to live. Aid in dying is the self-affirming decision of a person who cannot choose to live, and can only choose the manner of an imminent death.
The charges against Melchart-Dinkel relate to the suicides of Mark Drybrough , 32, who hanged himself at his home in Coventry, England in 2005, and Nadia Kajouji , an 18-year-old from Brampton, Ontario who drowned in a river in Ottawa where she was studying at Carleton University. According to the charges, Melchert-Dinkel used Yahoo and Google chats to instruct the victims how to tie and hang a noose. He allegedly encouraged them to use a webcam so he could witness the suicides. He admitted to enticing 10 or 11 individuals into suicide pacts, and assisting several more than the two for which he is charged, in killing themselves.
Who can read these charges without feeling shock and disgust and knowing a crime has been committed?
Contrast these horrors with the elderly cancer patient, who gallantly fights the disease for years and finally acknowledges the approaching end, as cancer continues to ravage and degrade the ailing body. This person's doctor thoroughly assesses the dismal prognosis and the rational nature of his patient's request. After a period of waiting, watching and weighing the magnitude and course of suffering, this patient asks his loved ones to support his wish and be with him at his passing. At an appointed time they gather at his bedside, singing, praying and affirming their love as he drinks the life-ending medication his doctor has prescribed.
Who can read this description without feeling sympathy and knowing, somewhere deep inside where our humanity longs for freedom and dignity, that such a death is sad, as all death is, but it is not criminal?
The two situations are so different, it is impossible to use the same phrase to name them. Indeed, the crime is assisted suicide. The kindness is aid in dying.