Testimony, California Assembly Judiciary Committee
March 27, 2007
Marilyn Golden, Policy Analyst, Disability Rights Education and Defense Fund and California Disability Alliance
I am Marilyn Golden, Policy Analyst with the Disability Rights Education and Defense Fund.
A few days ago, the Vermont House of Representatives soundly defeated an assisted suicide bill very similar to AB 374. They did not do it because they are religious conservatives. Democrats, and progressives from smaller parties, out-number Republicans in that body by a far larger margin than in the California Assembly. I do not mean to suggest that you [a California legislator] should do something just because a Vermont legislator did. But the themes heard during their floor debate were the same ones that always echo whenever thoughtful people dig beneath the surface of this issue. Heard over and over were:
• Assisted suicide is bad public policy;
• The safeguards are inadequate;
• There are too many unanswered questions.
“Too many unanswered questions” is a good way to describe what AB 374 would bring to California, just as the Oregon law has brought to that state.
Let’s look at the supposed safeguards to see if California’s 8 million uninsured and masses of underinsured would be safe.
• Two doctors must agree the person meets the law’s criteria. But there’s considerable evidence that in Oregon, if your doctor tells you no, you can shop for a doctor who will say yes. An overwhelming number of Oregon’s suicides were facilitated via the organization Compassion and Choices.[i] How often do these referred physicians say no? We don’t know. The reports don’t tell us.
• The person must be terminally ill with 6 months or less to live. Are depressed persons who are misdiagnosed as terminal given lethal drugs? We don’t know. In Oregon last year, only two people were sent for a psychological assessment, according to Oregon’s own figures, yet depression is the most common cause of a request for death. Under this bill, psychological assessments may be as brief as one visit; is this enough time to assess whether depression or coercion is affecting a person? Not according to a substantial majority of psychiatrists. But contrary to this fact, the Oregon guidebook for assisted suicide states the presence of a mental disorder does not necessarily mean the patient is incompetent to make this judgment. Have people whose depression could have been successfully treated, died in Oregon? We can’t know.
• The law has no controls over the lethal drugs once it’s prescribed. Since Oregon’s own figures show many people who get lethal drugs die before they take them, what happens to the deadly drugs that remain? We don’t know.
• There is evidence that sometimes the vaunted “safeguards” have been disregarded in Oregon, such as too few witnesses, or prescribing the lethal drugs without waiting the 15 days the law requires, but no one has been disciplined or penalized. How often have the on-paper safeguards been violated in practice? We don’t know.
Now let’s look closer at the annual statistical reports mandated by Oregon’s law and this bill. Do they really show us the full picture?
• Oregon statistics are based solely on self-reporting by doctors. Reporting is required on paper, but there are no penalties if doctors don’t. How many have failed to report? We don’t know. The law authorizes no investigations; nor does this bill.
• How many people who died under the Oregon law, first asked their own doctors and were told “no?” We don’t know – this isn’t counted.
• How accurate and comprehensive are the Oregon statistics? We don’t know because the state actually destroys its data once each annual report is published, making independent verification impossible.[ii]
• Have people with disabilities used assisted suicide in Oregon? We can’t know – the statistics don’t report that. Have people used assisted suicide that could have lived many happy years if treated? We can’t know. The numbers don’t talk about that, either yes or no.
• How many doctors wrote lethal prescriptions for multiple people last year? We don’t know – starting last year, the Oregon reports stopped reporting on this. Why? We don’t know.
• How many people actually used assisted suicide for pain, rather than depression or fear of the future? Before last year, it was very low. But now, we can no longer know, because starting last year, the report combines “inadequate pain control” with “fear of future inadequate pain control.” If this continues, Oregon will have successfully kept hidden how few people actually use lethal drugs due to pain. Why? We don’t know.
• The “good faith” standard in the Oregon law renders all its safeguards unenforceable because under the law, no practitioner will be liable if they practice in good faith. Has there been negligence by doctors under the Oregon law? We can’t know – the law authorizes no investigations. Since censure – that is, public criticism – is banned, doctors cannot practice their ordinary peer review, which requires criticism of poor practice. Is there malpractice under the Oregon law? We don’t know.
• How many assisted suicides were based on financial concerns? We don’t really know, because doctors don’t always know their patients’ motivations. More than one-third were on either Medicare or Medicaid up through the 8th year, but the Oregon reports don’t tell us whether Medicaid (for poor people) or Medicare. Why not? We don’t know.
Is this the model California really wants to use for something this important? We urge your “no” vote on AB 374.
Responses to Questions
Why do so many disability rights organizations oppose legalizing assisted suicide?
Disability rights organizations overwhelmingly oppose assisted suicide because we see it as worsening the damaging stereotypes society has about disability. The widespread view that disability as a fate worse than death – which is a stereotype that most people with actual disabilities do not agree with – has justified making a deadly exception to public policy on suicide. Most people are given suicide prevention – but people like us would receive suicide assistance, due solely to our disability or health status.[iii] People with disabilities in the hospital are often urged to sign Do Not Resuscitate Orders, even when they actively want aggressive medical treatment. And let’s not forget that Derek Humphry, who founded the Hemlock Society, has written clearly that this change is needed to save resources for society – as if we are expendable.
Why are the opponents imposing their personal values on everyone else?
We are not imposing a personal view. We are taking a broader perspective – we’re saying that this issue is bigger than personal choice. Assisted suicide poses significant dangers – for a great many people, and for society as a whole. On this issue, choice for a few comes at too high a cost for the many.
[i] Dr. Peter Goodwin, the group’s former medical director said that about 75% of those who died using Oregon’s assisted-suicide law through the end of 2002 did so with the organization’s assistance. (Transcript of tape of Peter Goodwin, “Oregon” Jan. 11, 2003, presented at 13th National Hemlock Biennial Conference, “Charting a New Course, Building on a Solid Foundation, Imagining a Brighter Future for America’s Terminally Ill,” Jan. 9-12, 2003, Bahia Resort Hotel, San Diego California.)
During the 2003 calendar year, the organization was involved in 79% of assisted-suicide deaths. (“Compassion in Dying of Oregon Summary of Hastened Deaths,” Data attached to Compassion in Dying of Oregon’s IRS Form 990 for 2003.)
According to Dr. Elizabeth Goy of OHSU, Compassion in Dying (now called Compassion and Choices) sees “almost 90 percent of requesting Oregonians….” (Testimony of Elizabeth Goy, p. 291, question 768. (Goy is an assistant professor, Dept. of Psychiatry, School of Medicine, OHSU, and has worked with Linda Ganzini in formulating results of surveys dealing with Oregon’s law.))
[ii] House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, Assisted Dying for the Terminally Ill Bill [HL] Volume II: Evidence. Apr. 4, 2005.Testimony of Katrina Hedberg, p. 262, question 592.
[iii] Diane Coleman, “Not Dead Yet,” in Kathleen Foley, MD, and Herbert Hendin, MD, (eds.), The Case Against Assisted Suicide: For the Right to End of Life Care, (2002, Johns Hopkins University Press, Baltimore, MD), p. 221.