How Assisted Suicide Laws Endanger People With Disabilities and Chronic Conditions
A disabled or chronically ill person who depends on life-sustaining treatment, even basic medications, would be able to qualify for assisted suicide if they lived where assisted suicide is legal. Oregon’s “Death With Dignity” law is the model for all U.S. states. As an Oregon official has clarified in writing, any person who becomes terminal because they do not receive treatment, for any reason, would qualify for assisted suicide under an Oregon type law.[1]If the reason they could not get treatment were an inability to afford insurance co-pays, they would be eligible for assisted suicide.
Anyone could ask for assisted suicide, but doctors are the gatekeepers with the power to decide who’s eligible. Since early 2020, the COVID pandemic has revealed that people with disabilities have been denied treatment for the virus due to their disabilities and pervasive healthcare provider biases about “quality of life.”
Assisted Suicide Laws Violate the Americans with Disabilities Act
By denying equal suicide prevention and other supports to people deemed “terminal”, assisted suicide laws are inherently discriminatory against older, ill and disabled people. The discrimination of state licensed health professionals denying equal suicide prevention and instead providing suicide assistance is a fundamental violation of the Americans with Disabilities Act.
The Oregon Assisted Suicide Data Substantiates Disability Concerns
Oregon’s assisted suicide law, the oldest in the U.S., is held up as the model for other states. One of the most frequently repeated claims by proponents of assisted suicide laws is that there is “no evidence or data” to support any claim that these laws are subject to abuse, and that there has not been “a single documented case of abuse or misuse” in the 25 reported years. Based on the Oregon state assisted suicide reports, these claims are demonstrably false.
Non-Terminal Disabled Individuals Are Receiving Lethal Prescriptions In Oregon
The Oregon Public Health Division assisted suicide reports show that non-terminal people received lethal prescriptions every year except the first. Prior to the 2020 report, the online state reports did not reveal how many people outlived the 6-month or 180-day terminal prognosis. In 2019, at least one person lived 1503 days. The 2020 – 2022 reports revisit this “terminal” survival issue and state that 4 percent of individuals outlived their 6-month prognosis[5] in 2020, 3.8% in 2021[6] and 5.8% in 2022.[7] This does not take into account the individuals who took the drugs quickly but may have survived if they had waited longer. There is no requirement that the doctor consider the likely impact of medical treatment in terms of survival.
Oregon reports [show] that non-cancer conditions found eligible for assisted suicide have grown over the years. The addition of anorexia as a condition some physicians have viewed as warranting assisted suicide demonstrates how empty the law’s purported “safeguards” are.
The Only Certifiers of Non-Coercion And Capability Need Not Know the Person
Four people are required to certify that the person is not being coerced to sign the assisted suicide request form, and appears capable: the prescribing doctor, second-opinion doctor, and two witnesses.
In many cases over the years, the prescribing doctor is a doctor referred by assisted suicide proponent organizations. The Oregon state reports say that the median duration of the physician patient relationship was 5 weeks in 2021 and 2022, and 11 weeks over all years (2021 Report, page 13). Thus, lack of coercion is not usually determined by a physician with a longstanding relationship with the patient. This is significant in light of well-documented elder abuse-identification and reporting problems among professionals in a society where an estimated one in ten elders is abused, mostly by family and caregivers. (Lachs, et al., New England Journal of Medicine, Elder Abuse.[8])
The witnesses on the Oregon request form[9] need not know the person either. So neither doctors nor witnesses need know the person well enough to certify that they are not being coerced. What might be an example of coercion? Many elder and disabled people would say the threat of being put in a nursing home.
No Evidence of Consent or Self-Administration At Time of Death
In less than half the reported cases, the Oregon Public Health Division reports state that no health care provider was present at the time of ingestion of the lethal drugs or that it is “unknown” whether a provider was present (2022 Report, page 14). Without requiring an independent witness, there is no way to confirm whether the lethal dose was self-administered and consensual.
Pain Is Not the Issue, Unaddressed Disability Concerns Are
The top five reasons doctors give for their patients’ assisted suicide requests over all reported years are not pain or fear of future pain, but psycho-social issues that are well understood by the disability community: “losing autonomy” (90%), “less able to engage in activities” (90%), “loss of dignity” (72%), “burden on others” (48%) and “losing control of bodily functions” (44%) (2022 Report, page 14). These reasons for requesting assisted suicide pertain to disability and indicate that over 90% of the reported individuals, possibly as many as 100%, are disabled at the time of their assisted suicide request.
Three of these reasons (loss of autonomy, loss of dignity, feelings of being a burden) could be addressed by consumer-directed in-home long-term care services, but no disclosures about or provision of such services is required. Moreover, only 3% of patients who request assisted suicide were referred for a psychiatric or psychological evaluation (and only 3 patients in 2022), despite studies showing the prevalence of depression in such patients.
Conclusion
The Oregon assisted suicide data demonstrates that people who were not actually terminal received lethal prescriptions in all 25 reported years except the first, and that there is little or no substantive protection against coercion and abuse. Moreover, reasons for requesting assisted suicide that sound like a “cry for help” with disability-related concerns are apparently ignored. For all these reasons, assisted suicide laws should be rejected and repealed.
[For a slightly more detailed version of this analysis, go HERE.]
1 thought on “Oregon Assisted Suicide Data Analysis”
We’re repeating the mistakes Germany made in the 1930’s and 40’s.
We must successfully do today what Germany failed to do.
Will we succeed? Yes, we will, but at what cost in human lives? This analysis is superb and rigorous. I certainly hope Oregon legislators take note and come to their senses.
We’re repeating the mistakes Germany made in the 1930’s and 40’s.
We must successfully do today what Germany failed to do.
Will we succeed? Yes, we will, but at what cost in human lives? This analysis is superb and rigorous. I certainly hope Oregon legislators take note and come to their senses.