November 11, 2016
Dear American Medical Association Leadership:
I am writing on behalf of Not Dead Yet, a national disability organization, to urge you to maintain your longstanding opposition to legalization of assisted suicide bill.
Not Dead Yet is a national, grassroots disability group with activists in most U.S. states who oppose legalization of assisted suicide. Not Dead Yet’s opponents have long told the media that we should be dismissed as having unreasonable fears. But the reality is that we live on the front lines of the health care system, with long term health issues that give us a better informed perspective on the weaknesses of that system and the ways that it too often fails to meet its stated goals.
Many of us have spent a lifetime advocating for the rights of disabled people, young and old, to control our own lives and not have our choices dictated by others. So you might wonder why we oppose a bill that is widely portrayed as giving people choice and control over their own death.
But who actually has choice and control under assisted suicide laws? Who are the doctors who are giving lethal prescriptions? The public image is that one’s own doctor, someone who knows you and has taken care of you throughout your illness, will be the one who assists your suicide as a last resort. But in Oregon, the majority of assisted suicides involve a doctor referred by Compassion and Choices (C&C). [See references under “Doctor Shopping” section of article at http://dredf.org/public-policy/assisted-suicide/why-assisted-suicide-must-not-be-legalized/#marker45] The median duration of the doctor-patient relationship is 12 weeks according to the latest state report. The state does not interview doctors who said “no” to the person’s request, so we don’t know why so many people had to go doctor shopping at C&C.
The prescribing doctors also fill out a final report after the death, among other things stating the reasons for the request for assisted suicide. Among the top five reasons given are feelings of being a “burden on others” (41%) or feeling a “loss of autonomy” (92%) or “loss of dignity” (78%). These are not about pain from a terminal disease, but are psychological and social issues that cry out for meaningful supports and genuine care. Yet the assisted suicide law does not even require disclosures about consumer controlled home care options to address feelings of loss of autonomy or feelings of being a burden on family, much less require that those services be provided.
The bill specifically provides that depression is not a barrier to getting a lethal prescription. All that is required is that the depression is viewed as not impairing the person’s judgment. Psychiatrists and psychologists are not immune from prevailing social biases against people whose illnesses make them dependent on others for basic physical care. In some cases, they are just as likely as anyone to say, “If I were in your shoes, I might want to die,” and render an opinion that treatment for depression is not necessary, paving the way for a lethal solution.
Still, some might say, didn’t the person initiate the request for assisted suicide? Didn’t they have to self-administer the lethal dose?
Most people who have been reported to use assisted suicide in Oregon are ages 65-84, in a society where one in ten elders are abused [http://www.nejm.org/doi/full/10.1056/NEJMra1404688]. The abusers are usually family members. About half the people reported to use assisted suicide in Oregon did not have a health provider present at the time of death. With no independent witness required, there is no evidence that they self-administered the lethal drugs, or even that they consented at the time of death. These bills have to be considered in light of the sad reality that not all seriously ill people have loving family. Assisted suicide laws grant blanket immunity and effectively foreclose investigation of wrongdoing.
Moreover, as a person who has been disabled all of my life, I’ve learned that some of the health care that I’ve needed will not be covered by the available forms of insurance, because it won’t cure me and it “costs too much”, things that would have helped me maintain more physical function longer or reduced the help I needed from family. This is a common experience in the disability community. The idea of mixing a cost-cutting “treatment” such as assisted suicide into a cost-conscious health care system is dangerous to the thousands of people whose health care costs the most — mainly people living with a disability, the elderly and chronically ill. When push comes to shove over the health care needs of an ill or disabled New Jersey resident, will insurance approve the right care or the cheap care? These realities undermine the image of “choice” that is being sold by assisted suicide advocates.
Finally, although I’ve been disabled all my life, the majority of people with disabilities acquire their disabilities through traumatic injury or a medical event or illness, such as a stroke or multiple sclerosis. The practical losses associated with acquiring a disability are multiplied exponentially by the crushing social oppression and internalized stigma of disability. In the early and uncertain phase of a disabling event, many of our activists, friends and colleagues, have been viewed as potentially terminal. The impact of a public policy of assisted suicide that, like Oregon, accepts psycho-social reactions to disability as justification for medically assisted suicide, poses perhaps the gravest threat to the tens of thousands of persons who are newly disabled each year.
There are many more reasons that legalizing assisted suicide is bad public policy, too many to detail in one letter. We hope that when you examine how an AMA position of neutrality or support for assisted suicide bill would tip the political scales, leading to passages of bills in more states and consequent harm to the vast majority of people, you will see that maintaining your longstanding policy against assisted suicide is the best course for both doctors and patients.
Diane Coleman, JD