Euthanasia for the Insane?


Dr. Jack Kevorkian

A moment’s reflection is all that should be necessary to convince anybody that our passions are not necessarily engaged by public controversies in proportion to the numerical or statistical importance of the question in hand. The debate over euthanasia and physician assisted suicide (PAS) is deeply impassioned everywhere; but not even the most enthusiastic advocate of euthanasia supposes – at least not yet supposes – that the question will ever affect other than a very tiny percentage of people.


The fact is that man is an animal that quarrels over symbols, and euthanasia is as much a matter of symbolic as of practical importance. How else are we to explain the fact, cited in an article in a recent edition of The Lancet about the new Belgian law extending the benefits of euthanasia to children, that there have been dozens of bills before the Belgian parliament desiring either to extend or to limit the scope of the current euthanasia legislation?

Reading the article and the articles to which it was linked, I came across two statements, one startling and the other importantly revealing. The starting fact was the following:

Recent studies have shown that the proportion of deaths that are the result of euthanasia or PAS in Oregon, USA as a whole, and The Netherlands, are 0.09%, 0.4%, and 3.4%, respectively.

Assuming this to be no misprint, why should the rate of physician-assisted suicide be more than four times higher in the United States as a whole than in Oregon, which is one of only four states (with a total of only 5 percent of the U.S. population between them) to permit it? Is it under-reported in Oregon? Is it carried out surreptitiously and illegally elsewhere? Are all the figures so inexact as to be virtually bogus? And if they are bogus, what does that tell us about the whole matter?


Another question is why there should be nearly forty times as many deaths by euthanasia and PAS as there are in Oregon. Is unbearable end-of-life suffering forty times more frequent in Amsterdam than in Portland? This is prima facie most unlikely. The pattern of disease in most western countries in very similar, and both in Oregon and the Netherlands cancer is by far the most common cause of requests for easeful death. Is there something sinister in the disparity?


The importantly revealing statement in the article about the extension to children in Belgium of the right to euthanasia was that suffering caused by psychiatric disorder was excluded as grounds for it (as it was excluded also for adults). This is very revealing because it is an implicit recognition of the truth of what is elsewhere often denied: namely that there is a fundamental difference between physical and psychiatric disease. The deeply corrupt and corrupting Anglo-American tort system pretends that the two are the same, to be dealt with and compensated equally; when in reality everybody – including even the most liberal legislator in Belgium – knows that there is a fundamental difference between them. Clearly if that difference were recognized by the courts there would be less work for lawyers.


It is obvious that if psychiatric disorder were recognized as grounds for euthanasia or PAS, the latter would become more or less death on demand. And if there is a right to death on demand, there must be a corresponding duty for someone to provide it. The slippery slope, the principal argument of those opposed to euthanasia and PAS, would become a very steep one, impossible not to slide down.

Nevertheless, many people persist in the lie that mental illness is no different from any other.


vulture image via shutterstock / Stacey Ann Alberts

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