AIDS Crisis Pushes Euthanasia Initiative Towards Ballot

California Assembly Speaker Willie Brown predicts that an initiative to legalize euthanasia will qualify for the ballot in November and be passed by voters, even though he believes the prospect of such a referendum is the mark of a political process gone “crazy.”

An ethicist opposed to legalizing euthanasia calls the launching into formal deliberation on legalizing mercy killing an ethically dangerous and premature endeavor, yet adds there appears little doubt that the debate is beginning in earnest.

“The questions we are addressing now (in California),” USC law professor Alexander Capron, director of a presidential biomedical ethics commission, said, “are questions we are going to all face. (People want) the ultimate magic bullet.”

The observations by Brown and Capron, at a biennial conference of the World Federation of Right-to-Die Societies over the weekend, appear to indicate that a wrenching debate over the issue of legalized mercy killing is now moving from the theoretical to the practical.

To their voices were added the comments of Dr. George Lundberg, editor of the Journal of the American Medical Assn., who said he believes euthanasia has emerged as an issue that may play a dominant role in consideration of medicine and ethics for the rest of the century

Lundberg, an ardent euthanasia opponent, flatly predicted in an editorial published last Friday that Californians would vote on legalizing euthanasia in November.

But backers of the referendum here said they are still lacking 200,000 signatures to qualify for the ballot.

Sponsors of the Human and Dignified Death Act, as the initiative is called, said they have slightly more than 200,000 signatures with less than a month remaining in their drive. Though momentum has begun to build in the Bay Area, San Diego, Riverside and Palm Springs, they added, the petition campaign is falling far short of its mark in the Los Angeles area.

While many factors influence what a cross section of experts perceive as a developing trend toward serious consideration of euthanasia in America, many observers said the situation may be powerfully influenced by the AIDS crisis.

Capron and Robert Risley, the Los Angeles attorney who organized the ballot initiative drive, both said the desperation of AIDS patients is focusing attention on euthanasia as an increasingly attractive solution to terminal suffering.

Dr. Stephen Yarnell, a San Francisco psychiatrist who has AIDS and was brought to his address at the convention here in a wheelchair, observed offhandedly that if the ballot initiative had already passed, “I think I would have been seriously discussing with my physician whether to wrap it up.”

Yarnell said he keeps an overdose of pills at his home and that he seriously considered suicide one day a couple of weeks ago. But he realized he couldn’t bring it off because “I couldn’t even hold down a sip of water.”

“I began to appreciate,” Yarnell said in a thin, weak voice, “the notion of people who shoot themselves in the head.”

Yarnell appealed to the 400 delegates at the international convention for the legalization of euthanasia.

A New York researcher who did a study of the increase in suicide risk among AIDS patients warned against using the hopelessness and suffering aspects of AIDS as an excuse to enact legal procedures under which patients could be killed.

Dr. Peter Marzuk found in a study of suicides in New York City that the suicide rate of AIDS patients was 66 times higher than that of the general population.

In a telephone interview, Marzuk said the growing link between AIDS and euthanasia “is no surprise.”

“It’s hard to predict whether AIDS will force the issue (that will make us) drift toward policies of euthanasia,” he said. “I would hope we wouldn’t but it may well force the issue. We have not been confronted with such a terrible disease like AIDS that produces such emaciation, disfigurement and pain so rapidly.”

In his keynote address at the conference, which ended Saturday, Brown said the euthanasia debate typifies a type of issue that politicians are generally inclined to avoid because “of the impact on the survivability of those who would have had to vote for it.”

But he said the idea of introducing a referendum to legalize euthanasia disturbs him even more. “I would prefer to see it in the halls of the Legislature,” Brown said, adding that because no one in the Assembly or the Senate was likely to introduce such a measure, “my guess is the initiative in California will qualify and I suspect that it will pass.”

However, he characterized as “crazy” the situation in which the general electorate would make a decision on such an emotionally charged issue based on such comparatively limited debate.

Anonymous Essay

The medical journal that carried Lundberg’s observations about the crossroads nature of the euthanasia debate also included two commentary articles and five pages of letters to the editor focusing on the controversy sparked by the publication in January of an anonymous essay by a doctor who claimed he or she killed a dying 20-year-old cancer patient with an overdose of morphine.

The essay, titled “It’s Over, Debbie,” precipitated an international protest. Lundberg was subsequently served with a subpoena by a Chicago prosecutor demanding that he reveal the author’s identity, but a judge threw the subpoena out and Cook County States Atty. Richard M. Daley has not announced whether he intends to pursue the matter further.

Lundberg and Capron agreed that the emergence of euthanasia as a serious political issue in California may have the effect of changing the geographic focus on the international controversy.

Until now, the Netherlands has been the main focus of euthanasia activism because doctors there have long been permitted to perform euthanasia if they can satisfy prosecutors that they have met a complex series of preconditions.

Euthanasia remains technically illegal in the Netherlands but prosecutions are rare and the Dutch parliament is expected to vote this year on two pending proposals that would bring about outright legalization.