The broadening of eligibility under the Canada’s euthanasia law to include people who are deemed to suffer from “untreatable mental illnesses” has been delayed once again. The expansion had been scheduled to take effect in March. According to theNew York Times, the postponement occurred because a parliamentary committee concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so. The Canadian Health Minister Mark Holland stated that “the system is not ready, and we need more time.” He did not give any new effective date for the expansion, although a committee member expressed the hope that the delay would be indefinite.
Shortly before the delay was announced but when there were already signs that the Canadian Government was having “second thoughts”, the Editorial Board of the Washington Post wrote a sharply worded piece opposing voluntary euthanasia for psychiatric survivors in Canada and elsewhere. The importance of a major newspaper taking such a stand cannot be overestimated.
It is true that the editorial seems to assume that euthanasia and assisted suicide are more acceptable for those with life-threatening physical conditions than for psychiatric survivors. It does not attack the type of assisted suicide laws enacted in several states in this country. Yet, every argument that the editorial makes against legalizing euthanasia for psychiatric survivors also mitigates against permitting assisted suicide for any group. Indeed, down to its use of the phrase “second thoughts,” the editorial reverberates with arguments that disability rights advocates have made in opposing assisted suicide in general. (Note: The piece does use some terminology regarding psychiatric survivors that activists would avoid.)
The editorial states, “Many in the grips of psychiatric distress view, temporarily, suicide as their only way out, only to later be grateful they did not kill themselves in the depths of their suffering.” This is equally true of people initially demoralized by physical disabilities and illnesses struggling to get the support they need. The heart of the lawsuit brought by two disabled Californians (joined by several advocacy groups) challenging the constitutionality of the state’s assisted suicide law is the fear that if they become suicidal, they will not be given the suicide prevention services available to the general California public but instead be approved for a lethal drug prescription.
Disability rights activists have long pointed out that assisted suicide is less about patient choice and personal autonomy and more about what health care providers should or should not be able to do. Health care providers are the designated gatekeepers in the statutory scheme. They can make eligibility determinations based on incomplete knowledge of the patient, errors in prognosis or implicit bias. Along these lines, the editorial stated, “There might, indeed, be mentally ill patients suffering from symptoms so debilitating and intractable that their options are uniformly dismal. But designing a system to distinguish them reliably from others in mental distress, who would benefit from treatment, is at least extremely hard, if not impossible. Certainly, Canada’s system is not up to the task.” Health Minister Holland said virtually the same thing when he announced the postponement of the expansion.
The Canadian system is not up to the task. The American system is not up to the task. No health care system is up to the task because what a euthanasia or assisted suicide law expects health providers to do is to determine, based on health status, that a person’s continued existence is so irredeemable and lacking in value that they are eligible for state sanctioned death. No one has the capacity to do that. In Canada, finding eligibility seems to be the default position – only 3.5 percent of written requests for euthanasia were denied in 2022.
Lastly, the Post takes on the issue of “safeguards.” Noting that Quebec’s top end-of-life care regulator has decried rampant noncompliance with the rules in that province, the editorial states that although proponents may have “high confidence in the procedures they’ve developed to control psychiatric euthanasia. They need to remember that no procedural protections are perfect…Good intentions tend to have unintended consequences. In the United States, Americans need to keep a close eye on their neighbor’s experience and learn from it.”
We could not have said it better ourselves. Thank you, Washington Post! However, given all that you have said, you should join us in opposing assisted suicide in any iteration.
Alex Thompson (NY Assn. on Independent Living) and Max Rodriguez (Center for Disability Rights) had a ten minute interview with Capital Tonight’s Susan Arbetter. Detailing weaknesses of the purported “safeguards” in the state’s assisted suicide bill, they urged the legislature to reject it as too dangerous. Key concerns focused on insurance pressures to cut costs and the healthcare system’s failure to meet people’s needs for treatment, care and related supports.
The Capital Tonight broadcast video and article are HERE and excerpts from the accompanying article are also copied below.
Members of disability rights community urge N.Y. lawmakers to reject Medical Aid in Dying Act
By Susan Arbetter New York State PUBLISHED 7:30 PM ET Feb. 14, 2024
….[A]mong the 30% of voters who do not support the [assisted suicide] bill, there is one group that argues the bill’s safeguards are inadequate.
Advocates for people living with disabilities are concerned about people being pressured into the procedure.
“The biggest concern is, is this really a choice?” Alex Thompson, director of advocacy with the New York Association on Independent Living, told Capital Tonight. “We’ve seen in Canada and other places where this is legalized, where instead of people being offered support to be in the community and still have a level of autonomy, they are offered assisted suicide.”
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When asked if there are any additional safeguards that could be included in the bill that would make it more acceptable to the disability rights community, both Max Rodriguez, manager of government affairs with the Center for Disability Rights, and the New York Association on Independent Living’s Thompson said no.
“Really, there is nothing to add. To think there are final adequate safeguards is misleading,” Rodriguez said.
“I don’t think that we’re really in a place where we can support this bill. There are just too many concerns around this related to the way our for-profit health care system works,” Thompson reiterated.
The Association on Independent Living’s opposition memo to the bill states that the disability community is deeply concerned about coercion and abuse.
“A.995/S.2445 does not prevent a coercive family member or caregiver from doctor shopping with the individual to find a physician who will provide the fatal drug. There is nothing in the proposed legislation which would prevent an abusive caregiver or family member from steering the individual toward physician assisted suicide, witnessing the request form, picking up the lethal dose, and even administering the drug,” the memo states.
Rodriguez is also concerned about tracking the lethal medication once a prescription is filled by a pharmacy. A 2022 report from Oregon states that the “ingestion status” for over 100 patients was “unknown.”
On February 8, the Maryland Senate’s Judicial Proceedings Committee held a public hearing on a proposed assisted suicide bill (SB0443). That morning prior to the hearing, the Patients Rights Action Fund organized a press conference of opponents. Anita Cameron represented Not Dead Yet and made the following compelling arguments against the bill.
Anita Cameron’s Press Conference Remarks
I’m Anita Cameron, Director of Minority Outreach for Not Dead Yet, a national disability organization opposed to medical discrimination, healthcare rationing, euthanasia and assisted suicide.
SB 0443 will put sick people, seniors and disabled people, especially, at risk due to the view of doctors that disabled people have a lower quality of life, therefore leading them to devalue our lives.
In 2021, Lisa Iezzoni, a professor of medicine at Harvard University, conducted a survey of 714 doctors around the country as part of a study. She found “82.4 percent reported that people with significant disability have worse quality of life than nondisabled people. Only 40.7 percent of physicians were very confident about their ability to provide the same quality of care to patients with disability, just 56.5 percent strongly agreed that they welcomed patients with disability into their practices, and 18.1 percent strongly agreed that the health care system often treats these patients unfairly.”
Now add race and racial disparities in healthcare to this. Blacks, in particular, receive inferior health care compared to whites in the areas of cardiac care, diabetes, cancer and pain management. Doctors are more likely to write us off as terminal, making us eligible for assisted suicide.
COVID, in particular, has laid bare racial disparities and disability discrimination in healthcare that leads to medical rationing and futility decisions that can end a person’s life. Michael Hickson’s case is a clear case of discrimination against disabled people.
Michael Hickson was a 46-year-old Black man from Texas, the father of 5 children. Mr. Hickson was a quadriplegic, the result of a brain injury caused by a heart attack. He was placed in a nursing home, where he contracted COVID. He was sent to St. David Hospital, in Austin, Texas. However, due to his disability, the doctors decided not to treat him, stating that he had no quality of life, though family videos show him laughing and singing with his wife and children. He was placed in hospice and allowed to die.
I, too, have personal experience with racial discrimination and disparities in healthcare. The most blatant example of this was when I went to the emergency department last year in intractable pain. A white woman, also in pain, was next to me in the hallway because it was very busy that day. We had the same ER doctor caring for us. She, without asking, got Dilaudid, a potent pain medication, while I got a pat on the shoulder and sent home.
As long as disability discrimination and racial disparities in healthcare exist and as long our broken, profit-driven healthcare system limits people’s access to treatment, services and supports, assisted suicide laws like SB 0443 have no place in Maryland.
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The House committees will hear the bill on February 16. I testified last week and must say that Maryland has unusually complex steps and deadlines for allowing witnesses to testify (oral or written). The process is detailed by each committee, such as in these Health and Government Operations Committee Guidelines. They are hearing the bill Friday and the deadline to sign up is Wednesday.
Today, Anita Cameron testified via online access to oppose Minnesota’s assisted suicide bill while John Kelly and Diane Coleman submitted written testimony to the MN House of Representatives Health Finance and Policy Committee.
Below are excerpts from each and their names links to their full testimonies.
Research has documented Black, Asian, and Hispanic persons regularly experience barriers to palliative/hospice care utilization. …Although Black people and other people of color request assisted suicide less than white people at this point, as the practice is normalized, they are more at risk of pressure to do so. First, racial disparities in healthcare lead to limited health choices and poorer health outcomes including death. Economic disparities make it less likely that patients can afford life-saving treatment and more likely that doctors will “write off” patients as terminal and thus eligible for assisted suicide…
There is no way to contain eligibility to a narrow set of people. Especially when thousands of disabled Americans now live with conditions that in some states are seen as “worse than death.” Anorexia nervosa and diabetes can now qualify as terminal conditions. Once death is accepted as a positive outcome of medical care, it inevitably gets offered to more and more people.
The problem for us disabled people is that we are already treated badly in the medical system. As medicine has focused increasingly on patient “quality-of-life” as a barometer of life-worthiness, death has been recharacterized as a benefit to an ill or disabled individual. Most physicians (82%, a 2020 Harvard study found) view our “quality-of-life” as worse than nondisabled people.
Data from states where assisted suicide is legal show that all people who request assisted suicide have disabilities, even if some don’t think of their impairments that way, and that unmet disability related needs are their reasons for wanting to die….
We are deeply concerned that the proposed delete-all amendment requires providers to offer physician assisted suicide along with other treatment and palliative care options when a patient receives a terminal diagnosis. Doctors and other providers are in a position that carries status and authority. Bringing up assisted suicide to a patient who has not raised the issue themselves conveys a dangerous and demoralizing message by its very nature and could even be taken as an implicit endorsement.
The Patients Rights Action Fund (PRAF), led by Matt Vallière, coordinates diverse coalitions of advocates against assisted suicide laws. Matt and his expert team have respected and supported a strong disability role in these state coalitions from early on. They have also been crucial to taking into federal court my longstanding assertion that assisted suicide laws are a deadly form of discrimination and violate the Americans with Disabilities Act.
This month, Matt looked back on the victories of 2023 in an op-ed carried by The Hill. I was thrilled by that because it’s a publication described as “a top US political website, read by the White House and more lawmakers than any other site — vital for policy, politics and election campaigns.”
Regarding the ADA lawsuit in which United Spinal, NDY and others are also plaintiffs, Matt asserted that “California law creates even more unequal treatment for people with disabilities, puts us at greater risk of coercion, and makes us more vulnerable to a system preventing access to the care we need. It effectively funnels us toward death too soon. That’s not equal protection — it’s eugenics.” (Emphasis added.)
The op-ed also highlighted some key policy victories among health related organizations. For example, “Last year also saw the American Medical Association (AMA) reject a proposal to soften its longstanding opposition to assisted suicide.”
