Marlowe's Shade

Wednesday, May 25, 2005

Euthanasia Hall of Shame: Rev. Ralph Mero

Universalist Unitarian minister Reverend Ralph Mero has made a career out of political activism. In the early '70's he pushed for the legalization of abortion with the approval of his denomination, with politically like-minded religious leaders he opposed President Bush's faith-based initiatives, but he is best know for being an executive director of the Hemlock Society and a co-founder and former director of its spinoff, Compassion in Dying.

The tale of a patient in Seattle named Louise best characterizes Rev. Mero's ministry:

An article featured on the cover of the New York Times Magazine in the fall of 1993 also used a case description to try to prove the value of assisted suicide to an American audience. (4) The article described the assisted suicide of Louise, a Seattle woman whose death was arranged by her doctor and the Reverend Ralph Mero, head of Compassion in Dying, a group that champions legalizing assisted suicide. Members of the group counsel the terminally ill, offer advice on lethal doses, convince cautious doctors to become involved, and are present during the death. Mero and his followers do not provide the means for suicide (the patients obtain such help from their doctors) and claim not to encourage the patients to seek suicide.

Mero arranged for a Times reporter to interview Louise in the last weeks of her life, offering Louise’s death as an illustration of the beneficial effects of the organization’s work. Yet the account serves equally to illustrate how assisted suicide made both life and death miserable for Louise.

Louise, who was referred to Mero by her doctor, had been ill with an unnamed, degenerative neurological disease. The reporter tells us that "Louise had mentioned suicide periodically during her six years of illness, but the subject came into sudden focus in May during a somber visit to her doctor’s office." As Louise recounted it, "I really wasn’t having any different symptom; I just knew something had changed. I looked the doctor right in the eye and said, ‘I’m starting to die.’ And she said, ‘I’ve had the same impression for a couple of days.’" An MRI scan confirmed that the frontal lobes of Louise’s brain had begun to deteriorate, a sign that led her doctor to warn Louise that her life would most likely be measured in months, perhaps weeks. Louise said her doctor explained that "she didn’t want to scare me… she just wanted to be honest. She told me that once the disease becomes active, it progresses very fast, that I would become mentally incapacitated and wouldn’t be myself, couldn’t care for myself anymore. She would have to look into hospice care, or the hospital, or some other facility where I would stay until I died."

In this atmosphere of anxiety and fear, her doctor confirms what Louise believes is her only other option:

We are told that Louise did not hesitate with her answer. "I can’t do that… I don’t want that." The reporter continues, "Her doctor, Louise thought, looked both sad and relieved. ‘I know, I know,’ the doctor said. ‘But it has to come from you.’" Louise makes sure that they are both talking about suicide and says, "That’s what I’d like to do, go for as long as I can and then end it."

What has happened between Louise and her doctor? The doctor’s quick affirmation that Louise is starting to die, even before the MRI scan confirms her decline, is disturbing. She prefaces a grim description of Louise’s prognosis with assurance that she does not want to scare her. The doctor’s relief when Louise indicates that she is choosing suicide gives us some feeling about her attitudes toward patients in Louise’s condition.

Enter Rev. Mero:

As the account continues, the doctor indicates that she would be willing to help, had recently helped another patient whom Louise knew, and said she would prescribe enough barbiturates to kill Louise. To avoid legal trouble, she would not be there when Louise committed suicide. They exchanged several hugs and Louise went home. The doctor called Compassion in Dying for advice. The reporter quotes the doctor as saying about contacting Mero, "I was ecstatic to find someone who’s doing what he’s doing…. I loved the fact that there were guidelines."

On the phone, Mero advises the doctor on the medication to prescribe and then visits Louise, suggesting that he is prepared to help Louise die before knowing or even meeting her or in any way determining whether she meets any guidelines. When he does meet Louise, she asks him at once if he will help her with her suicide and be there when she does it and she is almost tearfully grateful when he says yes. He repeats many times that it has to be her choice. Louise affirms that it is, saying that all she wants "these next few weeks is to live as peacefully as possible." Louise seems concerned with being close to others during her final time and with spending what is left of her life in an environment of loving leave-taking.

Note that this is before Oregon's Death with Dignity law was passed, and that the doctor alludes to guidelines long after they should have been applied. What Rev. Mero has in fact done is relieve the doctor of any consequences or accountability. And why is a minister advising a doctor on the deadly dose to prescribe? It get even more grotesque as the day draws near:

The doctor is concerned that Louise’s judgment might soon become impaired: "The question is, at what point is her will going to be affected, and, if suicide is what she wants, does she have the right to do it when she still has the will?" The doctor, like Mero, says she does not want to influence the patient, but worries that Louise might not act in time. "If she loses her mind and doesn’t do this, she’s going into the hospital. But the last thing I want to do is pressure her to do this."

Yet the closeness before dying that Louise seemed to want is lost in the flurry of activity and planning for her death as each of those involved with her dying pursues his or her own requirements. At a subsequent meeting of Mero and Louise, with Louise’s mother and her doctor also present, Mero gives Louise a checklist in which he reviews steps to be taken during the suicide from the food to be eaten to how the doctor would call the medical examiner.

The doctor indicates she will be out of town for the next week, but that she has told her partner of Louise’s plans. "You don’t have to wait for me to get back," she tells Louise, hinting, the reporter tells us, that it might be a good idea not to wait. The doctor was more direct when alone with Louise’s mother, telling her that she was afraid Louise might not be coherent enough to act if she waited past the coming weekend.

The doctor and Mero discuss how pointed they can be with Louise, wanting her to make an informed decision without frightening her into acting sooner than she was ready. They hoped, "she would read between the lines." Mero assures the reporter that he always wants to err on the side of caution. Nonetheless, a few days after the meeting, Mero called the reporter in New York, asking her to come to Seattle as soon as possible. He knew she was planning to come the following week, but he warned her not to wait that long.

The reporter leaves immediately for Seattle and finds Louise in a debilitated condition. She is in pain, getting weaker, and speaks of wanting to end her life while she can still be in control. She says she is almost ready, but not quite. She needs about a week, mainly to relax and be with her mother.

What Louise didn't count on was that once she put herself into Rev. Mero's care, the timetable was not her own. After a full court press by nearly all of the players involved, Louise finally accedes to her suicide. And in her final scene we see a glimpse of the true face of Rev Mero's ministry of death:

Over the next days she speaks with Mero by phone, but he tells the reporter he kept the conversations short because he was uncomfortable with her growing dependence on his opinion. Nevertheless, after a few such conversations, the contents of which are not revealed, Louise indicated she was ready; that evening Mero came and the assisted suicide was performed. A detailed description of the death scene provides the beginning, the end, and the drama of the published story. Louise did not die immediately but lingered for seven hours. Had she not died from the pills, Mero subsequently implied to the reporter, he would have used a plastic bag to suffocate her, although this violates the Compassion in Dying guidelines.

Rev Mero shows himself to be a skilled orchestrator of the simple and true goal of physician-assisted suicide: a corpse to be delivered to the medical examiner. In the end all the talk of a better end of life that the right-to-die movement touts as its mission gives way to a merciless timetable that is more rigorous than the disease itself. The tragic part is that Louise was never offered the kind of quality end-of-life care that would have addressed her fears and given her the time she so desperately needed. The poignancy of how Rev. Mero's agenda failed to address that is seen in Louise last attempt to express her longing for love and comfort:

The reporter blurted out, "Your doctor feels that if you don’t act by this weekend you may not be able to." Her words are met with a "wrenching silence" and Louise, looking sharply at her mother, indicates that she hadn’t been told that. Her mother says gently that is what the doctor had told her. Louise looks terrified and her mother tells her its OK to be afraid. "I’m not afraid. I just feel as if everyone is ganging up on me, pressuring me," Louise said, "I just want some time."

Louise’s mother was growing less certain that Louise would actually take her own life. When she tried to ask her directly, Louise replied, "I feel like it’s all we ever talk about."
papijoe 6:22 AM