From Chapter 1, “Death Fundamentalism”
WESLEY J. SMITH
this excerpt from his newly revised book, Forced Exit:The
Slippery Slope from Assisted Suicide to Legalized Murder,
Wesley J. Smith analyses an article published in the New York
Times Magazine and exposes some of the many ways in which
journalists lead the public to a false understanding of the
and exploitation inherent in the euthanasia consciousness are rarely
discussed explicitly but are often readily apparent, even in pieces that
promote the practice. A prominent article published in a major magazine
typifies the kind of euthanasia promotion that is so depressingly common
throughout the media.
On November 14, 1993, the cover story of the New York Times Magazine
was “There’s No Such Thing as a Simple Suicide.” It is the sad saga of a
dying woman, “Louise,” who killed herself with the active assistance and
moral support of Ralph Mero, a Unitarian minister and the cofounder of
the pro-euthanasia group Compassion in Dying.
An offshoot of the Hemlock Society at the time, Compassion in Dying
actively counseled dying people who expressed a desire to commit suicide
and assisted in their self-killing. Its founder and former director,
Mero insisted that he eschewed publicity and acted only out of selfless
compassion. Yet he and his “work” somehow managed to be featured in an
Ann Landers advice column, complete with mailing address, in the major
article in the New York Times Magazine, and in many national
print and television newsmagazine pieces and documentaries.
Lisa Belkin, a former New York Times reporter and author of the
book First Do No Harm, about medicine and ethics, wrote the “No
Simple Suicide” story. This excellently written piece presents Louise’s
story as melodrama, taking the reader on an emotionally wrenching
roller-coaster ride of her assisted suicide, complete with a cast of
heroes and villains and a gripping life-and-death plot. To make matters
more compelling, we are told that the tale is true, with only the dying
woman’s name changed to protect her family’s privacy.
“No Simple Suicide” chronicles the last few months of Louise’s life. We
learn early on that Louise suffers from an unidentified degenerative
brain condition. Her doctor, described as “a warm, down-to-earth woman,”
informs Louise that she has only months, perhaps weeks, to live. Louise
is afraid of dying in a hospital, hospice, or other “facility,” a
scenario her doctor bluntly tells her is quite likely to occur. Louise
tells her doctor that rather than die in a cold, impersonal facility,
she would rather kill herself. The doctor almost leaps at the chance to
prescribe the drugs for Louise to take.
We are told that the doctor had previously “cooperated” with another
patient’s suicide, but that there had been difficulties, so she contacts
Ralph Mero at Compassion in Dying to solicit his help and active
assistance in facilitating Louise’s death. The doctor later tells Belkin,
“I was ecstatic to find someone who’s doing what [Mero is] doing. I
loved the fact that there were guidelines. It made so much sense. This
was a human being who could help, not some book.”
A few days later Mero visits Louise, who lives with her mother. He tells
Belkin that Louise appeared relieved when he didn’t flinch or judge her
desire to kill herself and that she asked Mero to be with her when she
died. He agreed, stating that the decision was hers.
Louise has asked her friends to attend her suicide, but none will. When
a medical assistant of one of her doctors hears that Louise’s “trusted
friends” have refused to sanction her suicide, she befriends the ill
woman and supports her in her self-destruction.
Mero, the medical assistant, Louise, and Louise’s mother become a
cohesive group with one firm goal: Louise’s assisted suicide. They meet
to discuss how the self-termination will be performed. The deadly drugs
will be mixed with a small amount of food and anti-nausea medication so
that they can be kept down. Louise is to be monitored as she dies, and
the assistant is to administer anti-pain medication if Louise seems to
be suffering. After the death, the doctor will report to the authorities
that the deceased was terminally ill and that the death was from natural
causes after a prolonged illness, so no autopsy will be conducted. The
doctor is also to falsify the death certificate as to the actual cause
Weeks pass. Louise grows ever weaker. Yet the frail woman does not kill
herself. Mero becomes alarmed. He calls Belkin to inform her that he and
the group have been told by the doctor that Louise is running out of
time to kill herself. It is feared that the disease may soon render
Louise mentally incompetent. Mero worries that Louise’s “window of
opportunity will slam shut” because Compassion in Dying will assist
suicides only for persons who are mentally competent. He also worries
that if Louise waits much longer she will be unable to self-administer
the deadly drugs.
Lisa Belkin drops everything and flies to Seattle to speak with Louise,
who tells the reporter that she wishes to conclude some business and
spend some more time with her mother before killing herself. This upsets
Belkin, who blurts out the doctor’s prognosis: Louise does not have much
time within which she will be capable of killing herself.
Yet, for all of her stated desire to commit assisted suicide, Louise
still does not act. Some time later, the medical assistant-turned-friend
tells the group she will talk to Louise to see if she can get the
suicide back on track. She asks the dying woman, “I kind of want to get
an idea of what your time line is. Where do we stand?” Louise’s eyes
brim with tears, and she tells the medical assistant that she does not
want to talk about it. The woman apologizes. Louise justifies her delay
by saying that she wants to wait until Mero returns from out of town to
get his opinion of her condition. The medical assistant replies that is
a “bad idea” because Mero might not notice subtle changes in her
Still Louise does not kill herself. Mero withdraws, checking in by phone
but keeping the conversations short. He tells Belkin that he wants to
remain in the background so as not to influence the outcome.
Then Mero gets a message: Louise is finally ready. The group assembles.
Louise eats poisoned ice cream and applesauce that has been prepared
according to Mero’s instructions and immediately falls asleep on the
couch clutching a teddy bear. Hours pass as Louise sleeps. The group
waits for her to die. She does not. Mero worries that he might have to
accelerate the process with a plastic bag. Finally, Louise’s breathing
slows, and she expires. Mero contacts the funeral director and leaves.
As the article concludes, we are informed that Louise’s death was not
listed as a suicide and that her friends and relatives were told that
she “died in her sleep with her mother at her side, as she had wanted.”
Every drama is supposed to elicit a response from the audience. “No
Simple Suicide” is no exception. On its face, the article appears to be
an objective piece of journalism: Belkin does not praise or criticize
the people involved or the events, nor does she give her personal
opinion on the merits of Mero’s cause. Scratch the surface, however, and
the piece can be seen as an advertisement for legalizing and
legitimizing assisted suicide and euthanasia.
What leads to this conclusion? First is the manner in which the article
came to be written. Belkin didn’t find the story; the story found her.
As Belkin appropriately reveals, the board of directors of Compassion in
Dying, who invited her to observe their usually secret suicide
assistance activities, contacted her.
There is nothing illegal, immoral, or unusual about a reporter being
contacted about a story. Stories are often found in this manner. It is
safe to assume that nevertheless Mero and the board had more in mind
than merely illustrating the emotional difficulties surrounding terminal
illness. Surely they hoped to further their cause through the article.
That being so, it is likely they would carefully choose a writer in the
hope of finding one who could be expected to take a positive view of
their work. In fact, in her story Belkin exhibits an uncritical
acceptance of the methods and motives of Mero, the doctor, and the
Whether Belkin approached her work with a pro-assisted suicide bias, a
more important matter is the powerful message communicated by “No Simple
Suicide.” Bluntly stated, whether Belkin intended it, the article
promotes euthanasia by seeking to persuade the reader that assisted
suicide is acceptable. Proponents of legalizing assisted suicide and
euthanasia are ever about the task of proselytizing. The more we are
exposed to depictions of assisted suicide, the more commonplace it will
seem and, then, the more acceptable. Through this process we become
desensitized. Practices that we once found abhorrent begin to seem like
a normal part of life — or, more precisely, death. “No Simple Suicide”
serves this purpose in several ways.
- “No Simple Suicide” presents a
false dilemma. One of the tools used by
pro-euthanasia advocates when arguing for legalization is to create
a false premise: Either we provide “deliverance” to suffering
people, or they will be forced into cruel and unnecessary anguish.
Either they die peacefully and painlessly now, or in agony later.
“No Simple Suicide” similarly casts Louise’s plight as a forced
choice between two horrible options: assisted suicide or an
out-of-control death at a “facility.” Not once is the reader (or
Louise, as far as we know) informed that hospice and palliative care
could probably have mitigated most, if not all, of her pain and
discomfort. As reported, not once is the reader told that the
hospice experience is designed to provide love, comfort, and support
for the patient and the family, supplied by medical and
mental-health professionals and volunteers. Not once is the reader
told that hospice care can be supplied in the home—clearly a major
issue for the dying woman. Not once is the reader told that the very
purpose of hospice care is to facilitate a gentle and peaceful
transition from life to whatever comes next. The fact that the truly
compassionate option, from what is reported, was virtually
unexplored speaks volumes about the doctor’s agenda, and that of
Mero and perhaps the friend.
It is also notable that Louise’s doctor treats her patient’s
suicidal desire as expected, rather than as a cry for help. Yet
studies prove that the vast majority of dying people do not exhibit
suicidal tendencies. When dying patients do ask for suicide, they
are almost always clinically depressed, just as are suicidal people
who are not terminally ill. Depression is a treatable condition.
Unfortunately, most doctors are not adept at recognizing depression
in their dying patients. Thus, whether through ignorance or
arrogance, Louise’s doctor probably abandoned her patient to the
throes of depression which could well have been overcome.
It is also assumed by all involved in the young woman’s assisted
suicide that she will not change her mind. Yet medical studies have
shown that this is often not true. Indeed, the “will to live” among
terminally ill people “shows substantial fluctuation.” In other
words, one day a patient may request suicide but the next week be
very glad they are still alive. And that seems to have been the case
here. Louise did not have an unremitting desire to self-destruct.
The only people with that unyielding death agenda were those who
- “No Simple Suicide” creates the
impression that euthanasia is a loving rather than a violent act.
The suspicion that there was an unspoken agenda behind “No
Simple Suicide” is supported by the striking artwork that
illustrates many of the scenes described in the text. While Belkin
undoubtedly had little or nothing to do with their creation, the
pictures, which appear to be oil or watercolor paintings, are
powerful and moving. The article doesn’t tell us Louise’s actual age
or what she looked like, but the pictures depict Louise as a woman
in her late twenties, her youth and delicate beauty adding to the
tragedy of her condition. In one picture, Louise is curled up
peacefully asleep on a couch after eating the poisoned ice cream.
She is holding a teddy bear as her gray-haired mother sits beside
her, the older woman’s hand resting lightly upon her dying
daughter’s leg. In another picture, we see Louise and Mero in a
counseling session. He is a strong presence, solid and dependable
with his white beard and black suit, a striking contrast to the
frail Louise, who has a blanket wrapped around her shoulders. In
another picture, Louise’s mother is pictured leaning over her
daughter, who is so weak the older woman can barely hear her speak.
The paintings have been created in the warm colors of autumn to
invite us in, to linger as if we were standing in front of a
crackling fire, indeed, to enter and become intimate participants in
the unfolding drama. The paintings grab our hearts and rivet our
attention solely on the suffering of the dying woman. In that way we
are less likely to think critically, to look beyond Louise’s
personal tragedy to the broader implications of what is being done
to her. Also, by making the scenes seem gentle and warm, we are far
less likely to recoil in horror at the actual events.
- “No Simple Suicide” creates the
impression that Louise’s assisted suicide was a necessary choice.
The article supports the merit of Louise’s assisted suicide on
several levels. Belkin’s prose creates the impression that Mero and
the others are compassionate pioneers leading the country toward an
enlightened view of facing and overcoming the ravages of terminal
illness. In fact, according to Belkin, that is how the group viewed
themselves, writing that each saw Louise’s pending assisted suicide
as a “poetic expression of control, a triumph over the indignities
of disease.” That is a typical view held by death fundamentalists
and no doubt is the view Mero hoped Belkin’s readers would accept.
Belkin came to a less romantic but equally erroneous conclusion
about the affair. The only time she expresses a personal opinion in
the article, she describes Louise’s assisted suicide as a “second
choice” to not being sick, and as the “most acceptable” of the dying
woman’s “unacceptable options.” But that is a distinction without a
difference. Whether euthanasia is pushed as a heroic statement of
control or a rational choice between the lesser of two evils, the
result is the same: legitimization of that which is ultimately
profoundly destructive to individuals, the healthcare system, and
Whether motivated by the death-fundamentalist notions of Mero, the
“pragmatic choice” view of Belkin, the participants’ genuine desire
to serve Louise, or a combination of these factors, Louise was
pushed by those around her into suicide because that was the death
they wanted her to have. As the psychiatrist Dr. Herbert Hendin,
former director of the American Foundation for Suicide Prevention,
has written about the case, “Like many people in extreme situations,
Louise . . . expressed two conflicting wishes — to live and to die —
and found support only for the latter.” One wonders what the outcome
would have been had someone — anyone — supported Louise’s often
expressed desire to live and had stayed with her to the natural end
of her life. Perhaps, then, her friends would have surrounded her in
her final days. Perhaps Louise and her mother would have had a more
meaningful time together, spared the undignified and excruciating
dilemma over when and whether Louise would kill herself. Perhaps
Louise could have truly died in peace.
- “No Simple Suicide” suggests that
it should be easier to help people die.
Louise’s assisted suicide took place in the underground,
amid people who lied and broke the law in order to facilitate her
so-called death with dignity. The attitude of the article is
implicitly critical of the fact that this subterfuge was necessary.
The reader is given a subliminal message, often voiced out loud by
assisted-suicide advocates, that goes something like this:
Unreasonable people who refuse to allow others to control their own
destiny are insensitive, thoughtless, and cruel. They force dying
people to endure unnecessary suffering. Such judgmental attitudes
caused Louise’s friends to abandon her when all she wanted to do was
control the time and place of her own death. Her caring doctor was
prevented from actively participating in her patient’s final
“treatment” because euthanasia by lethal injection is forbidden.
Mero, a compassionate clergyman, was forced to risk imprisonment in
his pursuit of providing care and comfort to the suffering.
The Other Side of the Story
The irony is that the members of the little group surrounding Louise
were the ones who were thoughtless, insensitive, and cruel, for they
took from Louise, in Dr. Hendin’s words, “her own death.”
- Louise was unable to give informed
consent to her suicide because she was denied information about
hospice care. The story indicates that both the
doctor and Mero allowed Louise to believe that she would have to
either die in a “facility” or kill herself at home. Apparently,
neither discussed hospice care with Louise or described the
palliative care that could have reduced her discomfort. It appears
they presented Louise with a false dilemma.
- The medical assistant pushed Louise
into going forward with the assisted suicide. The
medical assistant who suddenly embraced Louise as a friend is
suspect. Was she part of a pro-euthanasia group? Did she have an
agenda? We are not told. Was not Belkin even a little curious about
this? Regardless of her motives, the assistant is a powerful actor
throughout the drama, urging Louise on to self-destruction. Recall
that when it became clear that Louise was delaying her
self-destruction and appeared not to want to go forward, the medical
assistant grew impatient and confronted the ill woman, saying, “I
kind of want to get an idea of what your time line is. Where do we
stand?” When Louise says she doesn’t want to talk about it but would
rather wait for Mero to return to give his opinion of her medical
condition, the friend tells her it is a “bad idea” and urges her not
to wait because Mero may not be able to notice “subtle changes in
Louise’s temperament and thus might give the wrong advice.” That is
pressure disguised as advice.
- Ralph Mero’s “compassion” was
available to Louise only if she carried out her designated role.
This is the most insidious part of the story. It is important to
remember how emotionally vulnerable most terminally ill people are
as the end of life approaches. Louise was certainly no exception.
Then, along comes “compassionate” Ralph Mero — a minister, no less —
who tells Louise, “I’ll be with you and I’ll support you.” From that
point on it is quite clear that Louise has become dependent on the
moral judgment and emotional support of Mero, to the extent that she
even wanted to rely on him for medical advice as to how far her
decline had progressed.
Note that throughout the early part of the process, Mero was there
for Louise. He held her hand. He patiently and gently went over the
guidelines for the assisted suicide. He presented himself as a
source of strength, a nonjudgmental rock to lean on in this
difficult time. But when Louise hesitated and refused to be
pressured into suicide, what did this altruistic man of compassion
do? Did he hold her hand and discuss alternatives to killing, such
as hospice care? Did he pray with Louise so that together they could
seek God’s guidance? (He is a minister, after all.) Did he assure
her that whatever her choice might be, he was her friend and would
be there to the end? No. He withdrew: “Over the next few days, Mero
checked in with Louise and her mother by telephone, but kept the
conversation short. ‘I was measuring my phone calls,’ he says. He
wanted to remain in the background and allow Louise to control the
timing and pace. Her growing dependence on him was making him
uncomfortable, and he needed to keep it clear in her mind, and his,
that she was the driver and he was just along for the ride.” But
when she seemed to be choosing a different course, his absence made
it clear that Louise was on her own if she chose a natural death.
Imagine how painful it must have been for Louise when her minister,
the man she was leaning on for strength and guidance, was suddenly
holding her at arm’s length, especially after being so intensely a
part of her life over the previous weeks. This certainly looks like
emotional manipulation on Mero’s part, communicating a harsh and
powerful message to the dying woman: kill yourself and I am your
man; stick it out to the end and I am out of here. That is not
compassion. That is cruel abandonment.
- The reporter also pushed Louise
toward killing herself. As if all of that isn’t
disturbing enough, what are we to make of the reporter, Lisa Belkin,
and her participation in these sad events? Recall when the doctor
informed Mero and the reporter that Louise was likely to slip
quickly and become mentally incompetent and therefore become unable
to kill herself or receive Mero’s assistance, Belkin immediately
flew to Seattle, unaware that Louise has not been told of this
prognosis. During an interview on that occasion, Louise tells Belkin
that she wants to wait a week or so before killing herself. Belkin
I was surprised, confused and extremely uncomfortable. . . . Without
thinking, I blurted out a question: “Your doctor feels that if you
don’t act by this weekend, you may not be able to . . .”
My words were met with a wrenching silence. Louise blanched, her
pale skin turned even paler. I was horrified with myself . . .
“She didn’t . . . she never . . . I didn’t know that,” Louise said,
sharply looking at her mother.
“That’s what she told me,” her mother offered gently.
Louise became silent. . . .
“It’s O.K. to be afraid,” her mother said.
“I’m not afraid. I just feel as if everyone is ganging up on me,
pressuring me,” Louise said. “I just want some time.”
Indeed, Louise was being pressured, now even by the reporter who at
that point crossed the line from an observer and chronicler of
events to a participant in them.
- There is no compassionate voice of
opposition. “No Simple Suicide” presents a one-sided
version of assisted suicide. Except for one brief passage, people
who resist legalizing euthanasia are not heard from, nor are the
many reasons given why opponents of the death culture are so devoted
in their resistance. Notice also that the one quotation selected for
use in the article by Belkin, presumably from a longer interview,
describes opponents to euthanasia as “harsh,” reinforces the false
stereotype that opposition is based primarily on religion, and does
not express any concern for the well-being of Louise.
Such short shrift was not accorded proponents of assisted suicide.
At one point in the article, Mero describes his work for Compassion
in Dying as an experiment to “show, demonstrate, prove, that when
people make a claim for humane treatment, it can be provided in a
way that does not jeopardize vulnerable people or pose a threat to
the social fabric.” Leaving aside the perversion of the word
“treatment” in that sentence, we can assume that Mero hoped that by
inviting Belkin to observe his work, his vision of a world where the
ill can be routinely euthanized would be accepted by readers.
But as this analysis of “No Simple Suicide” — an article typical of
this genre — demonstrates, what actually happened to Louise was just the
opposite of the impression the story sought to convey. Instead of
receiving compassion (literally, “suffering with”) from those she
trusted, a sick and vulnerable woman was pushed by them into suicide. In
Dr. Hendin’s words, Louise’s “death was virtually clocked by their
[Mero’s, the doctor’s, her mother’s, the medical assistant’s, Belkin’s]
anxiety that she might want to live. Mero and the doctor influence the
feelings of the mother and the friend so that the issue is not their
warm leave-taking . . . but whether they can get her to die according to
the time requirements of Mero, the doctor, the reporter, and the
disease. . . . Individually and collectively, those involved in
[Louise’s assisted suicide] engender a terror in Louise with which she
must struggle alone, while they reassure each other that they are
gratifying her last wishes.” Ralph Mero was unavailable for comment
about my criticisms.
Wesley J. Smith. "Death Fundamentalism." Excerpted from Chapter 1,
Forced Exit:The Slippery Slope from Assisted Suicide to Legalized Murder
(Dallas, Texas: Spence, 2003).
Reprinted by permission of Spence Publishing. All rights reserved.
Forced Exit:The Slippery Slope from Assisted Suicide to Legalized Murder
ISBN 1-890626-48-1 400 pages, can be purchased for $8.97 from the Spence
Publishing web site.
Through original reporting, exhaustive research, historical analysis,
and extensive interviews, Smith makes a compelling case against
legalizing assisted suicide. He explores the truly humane and
compassionate alternatives that can change a death wish into a desire to
Wesley J. Smith is a senior fellow at the
and an attorney and consultant for the
International Task Force on Euthanasia and Assisted Suicide. He is
an international lecturer and public speaker, appearing frequently at
political, university, medical, legal, bioethics, and community
gatherings across the United States, Canada, Great Britain, and
Australia. Wesley J. Smith is the author or co/author of 9 books.
Most recently his revised and updated
Forced Exit: The Slippery Slope From Assisted Suicide to Legalized
Culture of Death: The Assault of Medical Ethics in America, and
Power Over Pain.
Copyright © 2003