FORCED EXIT - The Slippery Slope From Assisted Suicide to Legalized Murder, by Wesley J Smith, Times Books, div of Random House, New York, 1997, xxvi, & 291 pp. ISBN: 1-8129-2790-7

Review by Del Meyer, MD

Wesley J Smith, author of No Contest: Corporate Lawyers and the Perversion of Justice in America, opens his prologue of Forced Exit with the story of a dear friend who spent years planning her suicide and after inviting friends to the event, none of whom came, exited this life quietly. Smith, an Oakland attorney, contacted the executrix and obtained her suicide file wherein he found newsletters and other scurrilous documents from the Hemlock Society that thoroughly sickened him.

This motivated Smith to research into death, the inventing of the right to die that is driving people to embrace the death culture, and euthanasia's betrayal of medicine. He finds that a society that believes in nothing can offer no argument even against death. Seen in this light, support for euthanasia is not a cause but rather a symptom of the broad breakdown of "community" and the ongoing unraveling of our mutual interconnectedness. The consequences of this moral Balkanization can be seen in the disintegration of family cohesiveness; in the growing nihilism among young people that has led to a rise in suicides, drug use, and other destructive behaviors; in the growing belief that the lives of sick, disabled, and dying people are so meaningless that helping them kill themselves can be countenanced and even encouraged.

Smith calls acceptance of euthanasia "terminal nonjudgmentalism." He finds a good example in A Chosen Death by Lonny Shavelson, an emergency physician, who describes "Gene" who has had strokes and depression but is not terminal. Sarah, from the Hemlock Society, is given the task of assisting in his death. Sarah found her first killing experience tremendously satisfying and powerful, "the most intimate experience you can share with a person... More than sex. More than birth." Sarah gives Gene the poisonous brew as if she were handing him a beer. Gene drinks the liquid, falls asleep on Sarah's lap who then places a plastic bag over his head and croons, "See the light. Go to the light." But Gene, suddenly faced with the prospect of immediate death, changes his mind and screams out . . . and tries to rip the bag off his face. Sarah won't allow it, catches Gene's wrist and holds it. Gene's body thrust upwards and Sarah lays across Gene's shoulders. . . pinning him down, twisting the bag to seal it tight. Gene's body stops moving.

Smith says what happened to Gene is murder. He further feels that the ethical thing for Dr Shavelson to have done was to knock Sarah off the helpless man and then dial 911 for an ambulance and the police. Shavelson describes his thoughts on whether to act or observe the death, and Smith calls this non-decision "terminal nonjudgmentalism," or TNJ. He feels that what Shavelson and other death fundamentalists miss is that so-called protective guidelines for the "hopelessly ill" are meaningless; they provide only a veneer of respectability. Once killing is deemed an appropriate response to suffering, the threshold dividing "acceptable" from "unacceptable" killing will be continually under siege. But the fiction of control, essential to the public's acceptance of euthanasia, will have to be maintained, so the definition of what will be seen as "legitimate" killing will be expanded continually.

I personally observed this attitude at the last international meeting of my professional society as I spoke with pulmonologists from The Netherlands, Belgium, and other Western European countries who admitted that "killing patients" occurs rather frequently--sometimes the sickest in the hospital is killed simply to open a bed for a new admission.

As we are beginning to comprehend the holocaust; as African Americans are searching for the relics of their slavery, like the neck irons with their torture springs and who say that this was the real holocaust; when doctors are able to kill thousands of the millions that lie on beds of mercy every day, we will see the epithet of Shindler's List, when doctors directed those whose lives weren't worth living into lines toward the chambers. What was thought to be the efficient killing by the nazis and the communist doesn't hold a candle to what a free misguided society can do as we open up pandora's box for doctors to kill patients whose only crime was being ill, or alive with a life not thought to be worth living, We must act before it is too late. Otherwise those who do act, will be considered alive, but will not be after their first accident or illness that brings them in contact with ruthless bureaucratic state controlled doctors, a horror we can't imagine, or a thrill, that not even Stalin or Hitler could envision.