Cover Interview: Hemlock President Calls for Control Over Death

Jeanne Grunwell, Village Life's moderator, recently interviewed Dr. John Westover, president of the Hemlock Society on the subject of assisted suicide.

Westover earned a doctorate in history at the University of Missouri and has taught at universities in the United States and abroad. He is co-founder of Hemlock of Southern Arizona, and he has been a member of Hemlock USA since 1981. He is serving as the organization's president for the second time, having also held that office from 1990-1992.

Westover began the interview with an opening statement. A transcript of the interview follows:

Westover: As an American, you have the right to live wherever you want, to worship any way you wish, and to determine your own destiny. These rights are at the very core of your personal liberty. They give you freedom of choice. They give you control over your life, but not over your death. Right now, people in America are dying from terminal illness, and they are denied the fundamental right to choose a peaceful, dignified way to end their lives. While the law does not allow terminally ill people to choose a peaceful, painless death, their doctors could easily provide one. Right now in America, we've got to change the law, and Hemlock stands for a change in law by the process of making it possible for qualified, terminally ill individuals to seek medical assistance to die in dignity at a time of their own choosing.

Grunwell: Based on what you just said, how would you identify "qualified, terminally ill individuals?"

Westover: At the present time, all of the official actions are talking about individuals who have been stated by medical opinion to have less than six months to live -- the illness will normally take its course in less than six months. There is a good deal of debate within the organization and in the movement expanding that to those people who are hopelessly ill -- not terminally ill. That would include such people as quadriplegics, and so on. At this time, the official position is with the terminally ill -- those who are within six months of death.

Grunwell: And what is your opinion?

Westover: Well -- I'm going to go for the hopelessly ill. I think that it is not equal justice to say that those people who are in the process of dying can secure medical assistance, and those people who are facing an impossible future which cannot be relieved by medicine -- quadriplegics, and so on -- if they so desire, [do not] have the right. But that's a personal opinion and not the position of the organization which I represent.

Grunwell: It could be argued that we're all going to die someday, so in some sense we're all terminal.

Westover: I don't think that's an argument. . , I think we're all going to die someday.

Grunwell: Right. Exactly. But how do you draw the line between, for example, people who are depressed? Hemlock does not support assisted suicide for people who are depressed, but why not?

Westover: That is a medical decision, and a psychologist or psychiatrist can rule. It's an imperfect plan, but at the same time, we feel that people who are clinically depressed need to have treatment for their depression -- for the reasons, and so on. They may not be able to ultimately secure a pleasant life, but at least we are not working in that particular direction.

Grunwell: But as you said, it is an imperfect science. Do you think there's a danger that if you promote ways for people to die comfortably that people who are depressed might use them, and therefore, do you feel any sense of responsibility?

Westover: There will always be errors made. We make them every day, and we will continue to make them. But I think that if we leave it up to trained medical personnel to make a determination on this, that will keep the number of errors low. I'm talking about deciding whether a person is clinically depressed or not. Is that the question?

Grunwell: That's one part of the question. I'm sorry, I don't think I phrased it clearly. I've read of cases where people who were clinically depressed were found with a copy of Final Exit on their nightstand.

Westover: Everyone has the right to take their own life. It's not illegal. And we will have individuals who decide for whatever reason that they're going to opt out. And Final Exit [describes] ways in which it is possible to do that.

Grunwell: Right. But I'm asking -- do you feel any sense of responsibility in possibly hastening someone's death, or offering them a means to die that they might not have had otherwise?

Westover: No, I really don't. My personal feeling is that each individual is the judge of his or her own conduct, and what they decide is their decision. The information which is contained in Final Exit and in other volumes is all in the public domain, and it's brought together for convenience rather than the person having to go through many medical volumes to find the information. It also strongly urges people not to use methods which are inhumane and undignified, like shooting yourself or jumping off a bridge or running your car into a bridge abutment. And in that sense, if the individual is determined to end their life, isn't it better to give them the information that they can use in such manner as to reduce the danger to society? By that I mean if you take people who sometimes decide to take their life, get liquored up and drive in traffic and kill themselves... That's a long-odd case, but there are a number of others -- and they endanger society. If the individual is determined to take their life, they'll take it, period. And it doesn't matter whether Final Exit tells them the prescriptions and so on.

Grunwell: Why don't you talk a little bit about the other things that Hemlock does, aside from working on changing laws?

Westover: Basically, we're interested in education. We have a lot of misconceptions of what we do. I was giving a talk in Decatur, Georgia, and a woman came up and said her mother wanted her to bring back a bottle of hemlock. Well, obviously, this isn't one of the things that is used medically these days at all. So I think it needs to be understood that what we are doing is trying to help people find answers to their very personal problems. When I get a call from somebody who says they're terminally ill, I tell them first of all I'm not a doctor, I'm not a pharmacist, I'm not going to recommend anything. I ask them if they've consulted with hospice; if they're not terminally ill, if they have consulted with a suicide prevention organization (of which most communities have such an organization). We're not interested in influencing people to do this. What we want to do is make an option available for certain qualified individuals. And in the process, we set up support groups of people who are ill, who are hurting, who have difficulty coping with life. We do many things other than direct the attention of public individuals toward the changing of the law. Even a man like Kevorkian probably turns down 25 people for every one that he handles. I'm not advocating Kevorkian's approach, but we need to understand that it's not simply a rush out and help people and suggest to them here's what they ought to do. I never suggest anything to anybody.

Grunwell: How did you get involved in Hemlock, and why is it that you feel so passionately about this issue?

Westover: I got involved in it as a matter of seeing individuals in my family who went through long periods of decline, and some who went through very difficult, painful deaths. I just simply don't want that for myself, and I don't think that anybody ought to be forced to go through that kind of situation. So what happened is when I first heard of the organization, the Hemlock Society, I joined. And when Derek Humphry came to Tucson, I attended a meeting, and was instrumental in setting up the first of the local chapters within the country. But it's the right of the individual to make this determination. We think it's humane -- a needed response to the development of technology. This is what brought me into it.

Grunwell: You're in your late seventies; you've been married for 55 years. There are people who say that if assisted suicide is legalized, it will lead to coercion of people who are marginalized in our society -- the elderly, the disabled. Do you have plans for what you would like to do if you are ever in a situation where you are incapacitated?

Westover: Of course I do. If I reach a point where I, myself, want out, I have the medication with which to do it. On the other hand, and I've given considerable thought -- I'm not morbid. I simply am a person who thinks and plans ahead about life. I've been very successful in doing this in terms of setting up a life which has been most pleasant for me, and I think this has helped the community. But you come down to this question of people who are marginal and are they likely to be pushed out? I don't think so. We have some pressures on people today. As a matter of fact, what I'm fearful of is that the direction of medicine in setting up the HMO's, hence to reduce the cost of Medicare and Medicaid and so on, will set up a large number of limitations about a person's choices. There, I think, is where it's more likely to come than through any movement in which we are currently involved.

Grunwell: What do you feel are the most morally compelling arguments against assisted suicide, and how do you respond to them?

Westover: What I think are morally persuasive issues -- I see none that persuade me morally to be opposed to it. If you're talking about what ones do we get most often, it is the argument that only God can give life, and only God can take life. Well, this is an interesting argument. But by the same token, if it is true that taking your life is wrong because it interferes with God's plan, why isn't the medical treatment -- say a heart transplant or lung transplant, or even the removal of your appendix -- violating God's plan, if that's what we're talking about. I can't see this as a moral issue. I think that it is overly simplistic. The other argument that we frequently get against euthanasia is the concept of the 'slippery slope' -- that once you allow physicians to assist people do die who are terminally ill, then there will come other kinds of categories that will be put into it, etc. This is a society of law. I don't think that this is likely to happen. True, it did happen in Germany, but it was on a totally different basis, in a totally different society. Anything could happen, but I see that not as a great likelihood.

Grunwell: Speaking of law, we know that the U.S. Supreme Court is going to address the constitutionality of a person's right to die. I just read in the paper -- I believe it was yesterday -- that Justice Scalia had made some comments that he did not believe that this was a constitutional right. How do you feel about that?

Westover: The argument that I heard him make, although I'm sure that that was not the total bit of it, was that assisted suicide wasn't legal in the days of the establishment of the Constitution, and therefore, it wouldn't be legal in the present time. But that's such a transparently thin argument. Judicial oversight wasn't allowed in those days, either. This argument, I think, is completely irrelevant. However, I think he has other attitudes that have not been reported. And of course, I think it obviously an unjudicial act to announce an attitude or a decision on a case which has not yet even been heard.

Grunwell: So do you have any predictions about how this is going to turn out?

Westover: Well, I've been saying that my guess is that we will find that the Supreme Court will not go on the blanket injunction that you get in the Second and Ninth Circuit Court. What you'll probably get is a Cruzan-type of decision. The courts will say that the states may not arbitrarily ban physician assistance in dying, but each state will probably be granted the right to set the terms, the conditions, and so forth. That's why we are working very much to educate the legislature about the issues involved and to provide model bills on which they can work. I may mis-guess entirely, but I don't see that the court will turn it down. In margin, I think what they are going to do is to put certain restrictions on the assisted suicide laws that now exist and then leave it up to the states to define how they want to handle it. This is what happened, essentially, in the Cruzan case.

Grunwell: Do you feel that there are any things that are not really being said in the public debate about assisted suicide?

Westover: Now, that one, I don't know how to answer. The arguments get to be pretty pro and con. I think there are certain individuals who, because of their religious or other traditions, may never agree with the proposition that a physician should be allowed to assist under controlled circumstances. And I think in that sense, it will be like other largely moral issues which come forward and take a long time to be accepted. Even an issue such as slavery, which was a moral issue on the minds of many individuals, eventually everybody came to accept [its abolishment]. And I think that this will be true in the case of abortion and the case of physician-assisted suicide, etc. These are matters of personal rights, and I think it sometimes takes a while to sink in, but eventually, this society does accept. . .

Grunwell: Do you have any thoughts that you might like to offer to people who haven't made up their minds about where they stand on this issue?

Westover: I think that they need to consider the matter of personal rights of human beings. We do not advocate that anyone seek medical assistance to die. But we feel that those individuals who feel it is necessary or proper should have that legal right to secure assistance. Suicide is not a do-it-yourself proposition, and as a result, we feel that those people who qualify should be allowed to make the decision and to receive help to die in dignity.

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