'In God's hands'

Ever since 59-year-old Laurie Hoirup was a year old, doctors have predicted she had only months to live. When she struggled to stand months after her first birthday, a doctor diagnosed her with Lou Gehrig’s disease. That day Hoirup’s mother placed her in her crib with a bottle, turned on the gas, and laid herself on the couch, waiting for both of them to die.

But within a few moments Hoirup’s mother realized the doctor could be wrong. She turned off the gas and resolved to face her daughter’s illness.

In the years following, doctors changed Hoirup’s diagnosis several times until at age 17 she learned she had spinal muscular atrophy, a condition that leaves her with little to no use of body parts except for her right hand. The Sacramento, Calif., woman relies on a ventilator and tempers pain with daily medication. She depends on family members and caregivers to feed, bathe, and groom her and to assist her with using the restroom.

Hoirup has seen many persons with a prognosis like hers sink into depression and contemplate suicide. Indeed, she has had moments over the past 59 years when she thought, “This is really hard. … Maybe it would be easier if I wasn’t here.”

Under California’s new assisted suicide law, beginning this spring doctors can prescribe lethal drugs to patients with terminal illnesses who want to kill themselves. The new law roughly triples access to physician-assisted suicide nationwide—1 in 7 Americans now has access to it—and proliferates what advocates call “death with dignity” and deem a worthy alternative to end-of-life suffering and dependency.

Hoirup has never attempted to take her own life. The author, disability advocate, and grandmother of four continues to outlive doctors’ predictions: “I’m still here. … Does this mean I don’t have dignity?”

Hoirup fears that as assisted suicide becomes widely accessible, the implications will stretch far beyond the terminally ill. She points to the burgeoning of euthanasia deaths in the Netherlands and Belgium and to Canada’s assisted suicide law that includes the disabled. She worries that some of her elderly, disabled, and cancer-stricken friends will be tempted to think they are better off dead: “The idea of being a burden to family is already scary for most people. This law may be reason enough for them to end their lives prematurely.”

Brittany Maynard drew national sympathy in 2014 when she championed “aid in dying” as a means of escape from her aggressive brain cancer. The 29-year-old newlywed told People, “I am choosing to suffer less.” She moved from California to Oregon to use that state’s 1997 “Death with Dignity” law, the first of its kind in the United States. She ended her life with doctor-prescribed lethal drugs and quickly became a beloved public face for assisted suicide—one more palatable than Dr. Jack Kevorkian, who elicited horror in the 1990s when he showcased homemade life-ending machines he named “Mercitron” and “Thanatron.”

Since Maynard’s death, public support for doctor-assisted suicide has risen 10 percent, with nearly 7 in 10 Americans and 81 percent of young adults (ages 18-34) supporting it, according to a recent Gallup poll. Nearly half of the states have recently introduced assisted suicide bills and ballot initiatives or have litigated the issue in court.

California activists made sure to leverage Maynard’s death. Last October, after five previous failed attempts, California lawmakers had enough momentum to legalize physician-assisted suicide for those with a prognosis of six months or less to live. The nation’s most populous state joined Oregon, Washington, Vermont, and Montana, where the practice is legal either by law or court order.

Gov. Jerry Brown, a former Jesuit seminary student, signed California’s “End of Life Act” with an unusually personal message: “I do not know what I would do if I were dying in prolonged and excruciating pain. … It would be a comfort to be able to consider the options afforded by this bill.” A California referendum effort failed to gather enough signatures to put the issue on the ballot. Now, a group of seniors, disability advocates and pro-life groups plans instead to file a lawsuit to stop the law.

The same day Brown signed California’s law, the Southern Medical Journal published a study connecting physician-assisted suicide with an increase in overall suicide rates. Two British scholars studied data from Washington and Oregon since assisted suicide became legal and found a 6 percent increase in overall suicides and a 14 percent increase for persons over 65.

Oregon’s suicide rate—which does not include its nearly 900 physician-assisted suicides—is now 41 percent higher than the national average. University of California, Irvine, medical ethicist Aaron Daniel Kheriaty explains that those around people who commit suicide have a much higher chance of also killing themselves: “Once you introduce suicide as a reasonable way out for some, that message is heard by everyone. … Restrictions become arbitrary and it becomes a slippery slope.”

Last March one Oregon lawmaker introduced a bill expanding eligibility for lethal drugs to include those with up to a year to live rather than six months. In European countries where assisted suicide and euthanasia are legal, more people are using it and for an expanding number of reasons:

• In 2002, the Netherlands became the first country since Nazi Germany to legalize euthanasia and assisted suicide. In the past five years, euthanasia deaths have doubled. In 2013 nearly 5,000 people were euthanized: Cancer is often the reason, but patients can be euthanized if they convince two doctors of their “unbearable” pain. That definition has expanded to include blindness, multiple sclerosis, depression, loneliness, or simply being over the age of 70 and “tired of living.” Doctors granted one woman her request to die in order to avoid living in a nursing home. Another dying patient was euthanized to free up a hospital bed.

• In the Dutch-speaking parts of Belgium, euthanasia and assisted suicide now account for nearly 5 percent of all deaths. Last year lawmakers broadened the law to include terminally ill children. In recent years Belgian doctors granted death requests from a healthy, 24-year-old “depressed” woman and from a transsexual after doctors botched her sex change operation.

• Six hundred suicide “tourists” from 31 countries traveled to Switzerland between 2008 and 2012 to die there, and the number is growing. One traveler, Jeffrey Spector, a British businessman and father of three, said it was in his family’s “best interests” that he end his life at a Swiss assisted suicide center rather than face paralysis from a spinal tumor. “I don’t want to take the chance of very high-risk surgery and find myself paralyzed,” Spector told the Blackpool (England) Gazette last May, shortly before he killed himself: “I want the privilege to have a cup of tea and hold the phone. … I want to be able to do it myself.”

‘Once you introduce suicide as a reasonable way out for some, that message is heard by everyone. ... Restrictions become arbitrary.’ —Aaron Daniel Kheriaty, medical ethicist at the University of California, Irvine

In Oregon and Switzerland, studies show patients less motivated by pain than by a desire to remain autonomous. Oregon’s assisted suicide patients have been mostly white, educated, and well-off, but California’s assisted suicide law reaches a more diverse and vulnerable population. Euthanasia opponents fear it will lead to widespread abuse and diminish palliative care and suicide prevention, endangering the state’s weakest members. “Dying isn’t dead yet—it’s a stage of living,” says Wesley J. Smith, a California lawyer and consultant for the International Task Force on Euthanasia and Assisted Suicide.

As for Oregon, Smith speaks of “plenty of abuses—we just don’t hear about them.” In 2008, Barbara Wagner and Randy Stroup received a letter from Oregon Medicaid officials after they sought treatment for her lung cancer and his prostate cancer. Officials denied the costly treatments, but listed assisted suicide as one of the recommended treatments the state would cover. Officials changed their minds only after the couple went public with their plight. Smith says Californians will see more of this: “The state will not pay to extend the lives of its citizens, but it will pay to end them sooner.”

Laurie Hoirup says she’s leaving her death “in God’s hands.” Since even a common cold can be deadly for her, she has learned to enjoy little things: long weekly drives with her husband, trips to the zoo with her grandsons, and family barbecues where one grandson enjoys stuffing her mouth with potato chips. She’s still waiting for a granddaughter: “I need to buy a tutu.”