Lisa Blumberg: Assisted Suicide California Style

John L’Heureux was a prolific writer and former Stanford professor who died April 22nd in California. His wife, Joan L’Heureux, initially told the New York Times that the cause was complications of Parkinson’s disease (1). Within a few days, though, the New Yorker published an essay by L’Heureux on why he would die by assisted suicide (2).

The piece, which was somewhat unimaginatively entitled “On Death and Dignity”, may have omitted salient facts. It is conceivable that he may have mischaracterized his wife’s stance. I have even considered the possibility that it was a hoax – one of L’Heureux’s more bizarre bits of fiction – but that seems unlikely since he did die when he said he planned to. The bottom line is that if L’Heureux’s death went down as he recounted, it is almost a textbook study on how these laws in and of themselves encourage suicide.

L’Heureux seems to have been a suggestible guy. He started college intent on becoming an actor but then his roommate out of nowhere said, “Why don’t you become a priest. You’re smart enough.” (3) L’Heureux became a Jesuit priest.

Some years later, he left the priesthood – not because he had problems with doctrine or with the Jesuits – but because he felt it was too hard to be the type of priest he wanted to be. Shortly thereafter, he married Joan, a former nun (4).

When L’Heureux acquired Parkinson’s disease (PD) as an older man, he was understandably concerned because his father had PD and ended up with cognitive decline and in a nursing home, fates that L’Heureux deemed inevitable. He referred to himself and his father as “parkies”. Yet, his literary career flourished. He continued to write novels and his short fiction appeared regularly in the New Yorker which he took as reassurance that he “was still compos mentis.” He obtained a contract to publish his new and selected stories as a collection subtitled “And Maketh Many Wild Leaps.” L’Heureux said that “my heart indeed made many wild leaps.” (5)

This all sounds like things were pretty good. Yet L’Heureux wrote that after another of his works was published, “I first looked into California’s death-with-dignity law. I found it hard to believe that the state was sanctioning a kind of suicide. Suicide? No, death with dignity.” (6) His focus on the law (which arguably did not even apply to him), the state and buzz words is telling. At another point in his essay, he said he was invoking the law as “justification” for his suicide. My guess is that the law whispered to him suggestively. Instead of “why don’t you become a priest”, it was “why don’t you kill yourself?”

L’Heureux discussed things with Joan and “we came to agree that, in this case, death sooner was better than death delayed.” (7) He did not say that Joan accepted or became resigned to his decision. Instead, they both agreed, he should die. Perhaps you could call it a unilateral suicide pact.

Next came a talk between L’Heureux and his doctor. “I reviewed for him my progress—I liked the irony of the term—from my half-assed stumbling walk to reliance on a cane, and then that sobering moment when I was forced to use a walker. That was where I was now. Next would come the wheelchair…” (8) The doctor told him that he still had enough brain matter to be of sound mind. L’Heureux took this as a compliment, although the practical effect of what the doctor said was that the doctor was not going to request a mental health evaluation.

“Thus my suicide began,” L’Heureux wrote dramatically. “Three home visits by two doctors—my primary physician and my neurologist—officially established my decision to die with dignity… I signed a formal document attesting to my decision, and it was co-signed and witnessed, according to the law.” (9) L’Heureux received his lethal prescription.

What’s wrong with this picture?

The main criteria of California’s assisted suicide law is that a person have a terminal illness which will, within reasonable medical judgment, result in death within six months. Yet, there is no mention in L’Heureux’s essay of his being at all close to death. He was just seemingly a man with a slowly progressive condition who like many people his age – he was 82 – used a walker and had some anxiety about the future. However, there is no clear mechanism in the law for enforcing the requirement that doctors determine that a person be in the end stage of an illness. It is sort of the honor system.

There is also the requirement that a person’s request must not arise from the undue influence of another. However, the doctor must only ascertain if the person “is feeling” unduly influenced. A person who is being influenced may not be aware of it. That is the nature of influence.

It is chilling to read of L’Heureux’s belief – a belief that apparently went unchallenged – that his suicide was “an agreed – upon act of love.” (10)

Many studies have established that people with PD have a higher suicidal ideation rate than the general population. In one study, suicidal ideation was present in 31% of participants with PD, compared with 16% of patients with psoriasis, and 2% of healthy controls. The authors recommended that “clinical assessment of PD patients should include a psychiatric evaluation investigating suicidal ideation and perceived disability”. (11) As with other groups, suicide among people with PD is a preventable tragedy.

Once L’Heureux had his lethal prescription, he and Joan discussed the date for what he called the Event. “Given the strain that all of this put on us…we chose sooner, rather than later. April 22nd, three weeks away.”

John L’Heureux died on that date. There may not have been anyone around with enough sway with him to suggest otherwise.

Footnotes

1. https://www.nytimes.com/2019/04/25/obituaries/john-lheureux-dead.html
2. https://www.newyorker.com/books/this-week-in-fiction/john-lheureux-05-06-19
3. https://www.bostonglobe.com/metro/obituaries/2019/05/01/and-thus-suicide-began-prolific-author-john-heureux-wrote-his-final-essay-death-and-dignity/m4yqp88Bfb7RqSc1bFX0cM/story.html
4. https://www.nytimes.com/2019/04/25/obituaries/john-lheureux-dead.html
5. https://www.newyorker.com/books/this-week-in-fiction/john-lheureux-05-06-19
6. Ibid.
7. Ibid.
8. Ibid.
9. Ibid.
10. Ibid.
11. https://www.psychiatryadvisor.com/home/topics/neurocognitive-disorders/parkinsons-disease/correlates-of-increased-suicidal-ideation-in-parkinson-disease/
12. New Yorker essay