Diane Coleman, J.D., M.B.A.
Not Dead Yet
497 State Street
Rochester, New York 14608
February 15, 2013
Assisted Suicide a Dangerous Prescription in Today’s Climate
Not Dead Yet is a United States disability rights organization which opposes legalization of assisted suicide and euthanasia based on social justice concerns. Leading proponents of bills to legalize assisted suicide in the U.S. argue that this has nothing to do with disabled people, but only with the terminally ill. They often claim disability organizations shouldn’t be meddling in a policy that impacts the general public more broadly.
While it’s true that people with disabilities aren’t generally claiming to be terminally ill, we are claiming that the terminally ill are disabled. This is one of many reasons that our perspective may shed some light on this complex issue.
People with disabilities and chronic conditions live on the front lines of the health care system that serves (and too often underserves) dying people. Over the years, disability rights groups have been accused of paranoia and fear-mongering about assisted suicide and euthanasia, but it would be more accurate to view us as the proverbial “canaries in the coal mine” who are sounding the alarm.
In the U.S. state of Massachusetts where a ballot referendum to legalize assisted suicide was defeated last year, the disability advocates call their opposition group “Second Thoughts.” They say that assisted suicide may sound like a good idea at first, but on “second thought” the risks of mistake, coercion and abuse are too great to warrant legal immunity for doctors or others who assist suicide.
Disability advocates don’t fit the liberal vs. conservative script. Liberal supporters of assisted suicide ignore the dangers for elders and disabled people who rely on health care and public supports. Meanwhile, conservative politicians believe assisted suicide violates their principles, but see no contradiction in slashing budgets for health care and community services we need to survive, which is nothing less than “back door” euthanasia.
Assisted suicide supporters paint themselves as “compassionate progressives” fighting for freedom against the “religious right.” It’s a simple message, and it goes down well, if you ignore inconvenient truths, such as:
- Predictions that someone will die in six months or similar defined period are often wrong;
- People who want to die usually have treatable depression and/or need better palliative care;
- Pressures to cut health care costs in the current political and economic climate make this the wrong time to add doctor prescribed suicide to the options;
- Abuse of elders and people with disabilities is a growing but often undetected problem, making coercion virtually impossible to identify or prevent.
It’s not so easy or pleasant to talk about those things, but we must. It’s not the proponents’ good intentions but the language of the assisted suicide or euthanasia proposals that policy makers need to consider.
As one of countless disabled people who’s survived a terminal prediction, I can’t help but become concerned when the accuracy of a terminal prognosis determines whether someone gets suicide prevention versus suicide assistance.
The Oregon government reports themselves show that non-terminal people are getting lethal prescriptions – up to 1009 days have passed between the request for a lethal prescription and death. One of the many things the reports hide is specifically how many lived longer than 180 days (i.e. six months, which is defined as “terminal”), but we do know that there’s no consequence to the assisting doctors, no matter how many were not actually terminal. All of these people were disabled.
Proponents of assisted suicide also claim that 15 years of data from Oregon show that safeguards to ensure that it’s voluntary are working to prevent coercion. This is the claim also made in the Tasmanian consultation report. (http://www.premier.tas.gov.au/featured_releases/voluntary_assisted_dying ) How would they know? The Oregon reports only tell us what the prescribing doctors indicated were the patients’ reasons for wanting assisted suicide by checking off one or more of seven reasons on a multiple choice state government form.
One of the reasons is feelings of being a burden on others, checked in 39% of the cases. Yet there is no corresponding requirement that home care options be disclosed as part of informed consent under the law, home care that might alleviate pressures on family caregivers, much less that such home care be offered or funded. One of the disability community’s biggest social concerns is the failure of the state and federal government to enforce our civil and human right to home care. Though the Supreme Court has established that right, most are still waiting for this right to be realized in practical terms. We reject the idea that the solution to feelings of being a “burden” on others is to kill the patient and call it an act of “compassion.”
Other “safeguards” issues raise even more concerns. Although the Oregon reports admit that the government can’t assess compliance with the safeguards, some independent articles find that safeguards failed in individual cases (see, e.g., Hendin & Foley, MDs, “Physician-Assisted Suicide in Oregon: A Medical Perspective”, Michigan Law Review, June 2008, http://www.michiganlawreview.org/assets/pdfs/106/8/hendinfoley.pdf). But the law includes no authority for investigation or enforcement, so nothing happens as a result.
Pressure to choose assisted suicide or euthanasia can come in many forms, some hidden and private. A key problem is the law’s inability to protect individuals from unscrupulous family members. The two witnesses who attest to the absence of coercion under the Oregon law don’t actually have to know the person, although one of them can be an heir. So nothing in the law would stop a family member from suggesting or urging someone to “choose” assisted suicide, from taking them to the doctor to make the request, from witnessing the signature, or from picking up the prescription.
Elder abuse is notoriously undetected and underreported. Sure, some people are safe, but with 5.6 million estimated reported and unreported elder abuse cases in the United States annually, many are not. Once the lethal drugs are in the home, the drugs might be administered with or without the individual’s consent. Even if they struggled against it, who would know?
When we’re talking about changing public policy that impacts both the health care system that everyone depends on, and the real world of families that are not necessarily all loving and supportive, we have an obligation to think of everyone, not just those who are safe from the very real risks posed by assisted suicide and euthanasia legislation.