Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder

This newly revised and updated edition of Forced Exit provides a gripping overview and analysis of the assisted suicide and euthanasia movement and the threat it poses to human dignity and human equality. Author Wesley J. Smith lays out the chilling intellectual underpinnings of a movement that asserts there is such a thing as human life unworthy of life--and that other humans or "experts" should be called upon to determine whose life satisfies the criteria for continued existence. Smith gives readers clear and straightforward analysis of the important issues at stake and the implications for the most vulnerable among us. Smith persuasively shows that he basic ideals that the assisted suicide/euthanasia movement hope to carve into federal and state laws through litigation and legislation are detrimental to the equality-of-life ethic that has long been recognized in this nation. In Forced Exit, Smith gives readers a strong defense of that important ethic. That ethic makes clear that the elderly, the sick and the disabled have as much importance, dignity, and worth than the young and the healthy. Importantly, Smith provides solutions to the dilemmas faced by patients at life's so-called margins. Steps must be taken to educate doctors about how to recognize depression in patients and that depression must be treated. Current medical practice must place greater emphasis upon pain control, since palliative measures can significantly reduce--if not eliminate--the physical pain felt by many patients who have serious injuries or illness. The false notion that assisted suicide somehow furthers patient autonomy is exploded by Smith. Through principled analysis and through countless concrete case studies, he demonstrates that the wishes of the sick, elderly, and disabled are all too often given short or ignored when it comes to important medical decisions. Smith describes the crucial distinction between the right to refuse unwanted life-saving medical procedures and the so-called "right to die"--proactive measures specifically intended to end life. Also, Smith deftly explains how administering food and water to patients is separate and distinct from medical measures. Forced Exit receives my strongest recommendation.

This is a revision and expansion of his earlier work of 1999. In it he brings up to date recent developments in the euthanasia wars. But the same concern for where society is heading, and the same call for action is found in this volume. Smith argues that modern medicine is undergoing a seismic shift, as is that of the surrounding culture. Whereas societies and their medical practitioners once believed that saving life and protecting life was our highest and most noble calling, they have now come to see that killing in the name of compassion is both justified and necessary. What has brought about such a radical shift in values and priorities? Smith argues that a number of inter-related causes can be mentioned. There is the "moral Balkanization" of Western culture, with a loss in moral absolutes and religious convictions. Then there is the elevation of personal autonomy as the highest virtue. Also there is a very sophisticated political machine pushing the euthanasia agenda. Backed with big bucks and extensive marketing research, it has become adept at selling euthanasia. With plenty of euphemisms, misinformation and scare tactics, it is managing to convince many that death is desirable, and life is not. And then there is the bottom line of money. The huge blowout in medical costs for the elderly makes the euthanasia alternative seem very tempting indeed. It is a major savings to bump off the elderly instead of treating them. The hazards of legalizing euthanasia are many. Suffering would increase, not decrease. For example, the funding and research on problems like AIDS could easily be cut, with the idea that it would be better for these people simply to die. Pain relief, hospice work, and palliative care would also face major cutbacks and social undermining. Why bother, after all, when a quick lethal injection would be much cheaper and easier? Smith examines some of the recent decisions made concerning end of life care, noting a slippery slope in action. In March of 1986 an ethical advisory panel of the American Medical Association declared that food and fluids provided by feeding tubes were no longer to be considered basic humane care, but medical treatment, and could therefore be withheld. Previously hydration and nutrition, even by means of tubes, were considered to be mandatory and necessary care. This led to another momentous decision in 1994, when the AMA declared that foods and fluids could be withdrawn even if a patient was not terminally ill nor permanently unconscious, something that before was a requirement. Smith points out that such steps along a slippery slope are not new, with a very similar incremental approach occurring in Germany early last century, leading to the final solution of the Nazis. A 1920 book written by two German professors, Permitting the Destruction of Life Not Worth Life became the cornerstone of Nazi practice which saw 200,000 helpless people deliberated killed by German doctors and nurses between 1939

This is the first book I have read that deals exclusively with the subject of euthanasia but Wesley J. Smith's compelling arguments have ensured that it will not be the last. The statistics in this book about the Netherlands alone are horrifying and yet, unfortunately, not especially surprising. Once you have crossed the line between forbidding and permitting physicians to kill, how can you prevent them from believing that they know best regardless of the guidelines that are supposed to prevent them from ending their patients' lives even against the explicit wishes and fears of those patients? As euthanasia enthusiasts push their agenda in the media, it is important that people like Smith reveal the true nature and consequences of their arguments. In spite of assurances to the contrary, even cautiously starting down the path to the death culture will lead to inevitable nightmare consequences like those seen in the Netherlands. To the "death fundamentalists" there is nothing particularly troubling about that; to the rest of us this horrifying example should be enough to halt us all in our tracks.

I am currently investigating several different ethical/public policy issues: homosexuality (i.e. advocating the behavior in schools, marriage), abortion, and euthanasia.The author of this book is the lead lawyer of the International Task Force on Euthanasia and Assisted Suicide, an organization that opposes all forms of euthanasia and assisted suicide.One of the changes that has made this discussion meaningful is the discussion between humane care and medical treatment. Humane care would include food, heat, washing etc; the basics, if you will. Medical treatment would be drugs, surgery and so on. In some recent US Supreme Court case, certain types of humane treatment has been reclassified as medical treatment (e.g. water and food). The significance of the change is this; patients cannot refuse humane treatment but they can refuse medical treatments, at a certain point (or have others refuse medical treatments on their behalf). There are sections that document the development of euthanasia in the United States through court cases and attempted legislation (in the 1930's and the present). There are sections on the Holland called, "Dutch Treat," is particularly good. Holland is the only country that where euthanasia is widely available (Holland made it totally legal on November 28, 2000). Smith shows the progression in Holland, how the guidelines are routinely violated and so on. One of the scary problems is INvoluntary euthanasia: 1,040 people (an average of 3 per day) died from involuntary euthanasia, meaning that doctors actively killed these patients without the patients' knowledge or consent.Smith shows that the euthanasia agenda would endanger the disabled, the ill, the elderly, those with low education, minorities etc... In Holland, there is universal health care for all paid for through taxes, in the United States it is partially private and partially public.Smith shows the two philosophies that at conflict in the current debate. The anti-euthanasia proponents hold to the equality-of-human-life ethics: "that each of us be considered of each inherent moral worth, and it makes the preservation and protection of human life society's first priority." (page xxi) This is contrasted with the quality-of-human-life ethic, which gives human beings value (protection etc...) not because they are human but only if they possess certain qualities. I think that Smith wisely chooses to examine Peter Singer as the principal philosopher of the movement; one of the interesting things was the reaction of critics to the book. In America and Britain, the book was warmly welcomed and highly praised. However, in Germany, "... Singer has... been severely criticized and demonstrated against in Germany, a country with an acute memory of the horrors can result from adopting such values as his." (page 23).The book also exposes the myth that all persons who oppose euthanasia are religious fanatics, from atheist Nat Hentoff, "I can't base my opposition to euthanasia on rel

Smith presents a passionate and intelligent argument against physician-assisted suicide. He places the debate in both an historical and a cultural context, and argues cogently why our doctors should not be in the business of killing. This book should be required reading for doctors and anyone on a hospital ethics board. I recommend it to anyone considering these difficult and important questions.