Slippery Slopes, Political Realities and Comparing British Apples with American Oranges in Assisted Suicide Debate

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On Friday, July 18, the British House of Lords will be considering Lord Falconer’s bill to legalize assisted suicide yet again.  Naturally, this has resulted in a real uptick in public debate on the topic, some of which we’ll share and discuss here later.

Right now, I want to focus on a strategy being used by pro-assisted suicide advocates in the UK.   Very aware that one major criticism of legalization of assisted suicide is expansion or “slippery slope” into making nonterminally ill, old and disabled people targets of the legislation.  Naturally, this has meant that advocates try to steer clear of discussing the Benelux countries, which have embraced the euthanasia of nonterminally ill people, people with depression, old people who say they’re tired of living and the euthanasia of “severely disabled” infants – in the Netherlands, children with Spina Bifida have been the main target of medical killing according to reports.  And of course most people are aware of the group Dignitas in Switzerland, whose eligibility criteria involves mostly the ability to pay hefty fees rather than any concern about the medical diagnosis of an individual.

Instead, UK assisted suicide advocates have taken to pointing to the United States as a shining example of how assisted suicide can be contained and safeguarded.  I found a very recent example from Tom Shakespeare. a disability scholar who has written some pretty unscholarly things about assisted suicide before.  He left a comment on Neil Crowther’s “Making Rights Make Sense” most recent post “Signal Failure,” which I recommend people go and read in its entirety.  Crowther notes that while the bill attempts to rigidly define the health status and prognosis in terms of “eligibility,” there is no concern regarding the motivations for one’s wish to commit suicide.  As he notes, they are NOT medical reasons for the most part:

If an objective of ‘assisted dying’ is – as Dignity in Dying argue – to relieve suffering, the suffering most cited relates to what people feel able to be or do and to their sense of self, rather than physical pain.  As such we must conclude that their motivations are not wholly intrinsic in nature.

People should be worried about this, he says:

It is true to say as did the recent British Medical Journal editorial in support of the Bill  that ‘That much mentioned victim—the elderly lady who believes she has become a burden to others and offers herself up for assisted dying—will not qualify’ under the Assisted Dying Bill.  But one does not need to be concerned that the Bill’s internal safeguards would fail to be worried about where the motivations to end ones life come from, the signal this Bill would send in the current context, accepting as it does that feeling a burden is sufficient reason to ask to be helped to end ones life, and the potential for the laws scope to expand to encompass such a scenario in future.

None of this is of concern to Shakespeare, who submitted a reply, which concluded this way:

And the example of Oregon is a counter-example to the slippery slope fear. There has been no widening. A tiny % of people choose to take advantage of the law. People are not pressured. It seems to work fine. Even militant pro-lifers cannot find much by way of “abuses” to criticise. Of course some people want a much wider law. But I cannot see them ever succeeding, you only have to look at the opposition to this Bill to realise how difficult it would be. There have been many attempts to pass this very limited assisted dying provision. I would oppose voluntary euthanasia for people who are not dying, and so would the majority, and I am confident that it would not happen in UK.

It’s not just “some people” who want a wider law – it’s the majority of “right to die” activists.  Without going into great detail here, you can find great material regarding problems with Oregon’s assisted suicide law in the policy section at DREDF under “assisted suicide.”  Check out “Spurious Safeguards,” Flimsy Reporting, No Regulation,” and “Pro-Suicide Doctors.”

Shakespeare, when looking to Oregon and the two other states in the US with laws legalizing assisted suicide, wants people to compare apples and oranges.  Remember that there are 50 states in the US, all of them with self-governing and autonomy separate from the federal Government.  You need to get a large number of states legalizing assisted suicide before having a chance for legalization on a national scale.  In contrast, if the UK legalizes assisted suicide, then the whole country is subject to the law in one fell swoop.

That’s an important difference when trying to predict what will happen in the UK.  When other whole countries – like the Netherlands and Belgium – have legalized assisted suicide and/or euthanasia, expansion of “eligibility” has proceeded pretty rapidly.

While US groups want expansion, they’ve left the model assisted suicide statutes alone for now, until that statute or ones like it are implemented in most of the states.  There’s still expansion though.  The Final Exit Network engages in underground vigilante “help” with assisted suicide for just about anyone who wants to end their lives. Compassion and Choices is aggressively marketing VSED – voluntary stopping eating and drinking – as a “peaceful” way for even nonterminally ill people to kill themselves.

I’m not just guessing at the agenda of assisted suicide groups.

In 2002, The Hastings Center Report published an article by Martin Gunderson and David J Mayo titled “Restricting Physician-Assisted Death to the Terminally Ill.” (article is scanned PDF and not accessible to those using screen readers)

David Mayo, the second author, isn’t just some disinterested researcher. At the time of the article’s publication, he was on the board of directors of the Hemlock Society.  Currently, he’s on the board of directors of both Death With Dignity National Center, and their related political fund.  You can read the organization’s mini-bio of Mayo here.

Mayo comes at this topic as someone with long years of significant involvement in national groups promoting assisted suicide in the US.  When he talks about an incrementalist approach, it’s something worth paying attention to.  From the Hastings Center article:

In light of the current paucity of evidence, however, it is reasonable to proceed incrementally and extend physician- assisted death initially only to terminally ill patients. Doing so will grant its benefits to those who as a group are most likely to benefit and for whom it would involve no more risk than do current medical practices at the end of life, while withholding it from those less apt to benefit and about whom there is greater controversy over potential risk. Finally, opting for the incremental approach will generate further data that can subsequently make possible a more reasonable assessment of the risk.

Without using the exact wording that’s used earlier in this article, the authors assert that many – including the authors – don’t believe assisted suicide eligibility to be limited to the “terminally ill,” but it’s a good place to start, and as part of an incrementalist approach to legalization. Their conclusion:

Thus the restriction of physician-assisted death to terminally ill patients should not necessarily be regarded as a permanent restriction. Our defense of the terminal illness requirement is based not on deep principle, but rather on risk assessment in the face of uncertainty. If physician-assisted death were extended to terminally ill patients, we could decide to stop there, retreat, or advance, depending on what we found out.

Considering that assisted suicide advocates in the US are claiming that assisted suicide laws have performed spectacularly, it’s clear they’ll start working to expand the laws as soon as they reach a critical mass of states legalizing assisted suicide. One of our jobs is to stop them from reaching that critical mass.

NDY Articles and Letters Published in NJ Press Kick Butt

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I don’t usually say “kick butt” and I’m pretty sure I’ve never written it before, but I couldn’t resist.  This blog is to catch you up on NDY articles and letters published recently in the New Jersey press.

You last heard from our hero John Kelly in our blog on June 19th, which featured John’s letter to the Times of Trenton, responding to a column in favor of the NJ assisted suicide bill.

We had been concerned that John’s letter might not be published, so I had fired one off too, figuring that more letters increase the likelihood that at least one will be published.  As things turned out, my letter was also published on June 22nd, but with a very objectionable title:

Introduce patient safeguards into assisted suicide bill

George Amick’s column about the New Jersey assisted suicide bill mentions the bill’s vaunted safeguards, but a closer look shows they are hollow. For example, Mr. Amick says that the form to request assisted suicide requires “two witnesses, at least one of them a nonrelative, attesting that the applicant is competent and acting voluntarily.” What he doesn’t mention is that the witnesses don’t actually have to know you, but can simply verify your I.D. How does a stranger know if you are being coerced behind closed doors?

Mr. Amick also says that the doctor writes “a prescription for a lethal dose of barbiturates for the patient to self-administer when — and if — he or she decided to do so.” But the bill doesn’t have any safeguards after the doctor writes the lethal prescription. From that point forward, the greedy heir or stressed-out caregiver can pick up the script and administer it with or without consent. With no witness required at the death, there’s no way to know whether it was self-administered.

Competent lawyers wrote this law, and the emptiness of the safeguards is no accident. It was never meant to protect the patient, just the doctors and other participants in the death.

Diane Coleman, J.D., 
Rochester, N.Y.
The writer is president/CEO of Not Dead Yet

To be clear, I do not believe that assisted suicide safeguards can be crafted that would protect individuals (“patients”) from the risks these laws pose.

Back to our hero, John.  We had learned about online sites that tend to be followed by liberal and progressive legislators in New Jersey, so on June 25th John posted what is called a “diary” in bluejersey.com called “Assisted Suicide Is Not Progressive”.

John made several key points, such as:

Supporters of A2270 say that it is all about “autonomy,” but in reality the bill would limit choice, because it incentivizes insurers to restrict, or even deny, coverage. In today’s cost-cutting environment, where health-care options are limited, many people already struggle. A2270 would make it worse.

That same afternoon, we got the surprise announcement that the bill would be brought up on the Assembly floor for a vote the next day.  John had been working on a longer op-ed for a couple days, so he moved into high gear and submitted it to politickernj.com.  John’s piece de resistance was published the next day!  So, the very day of the vote, legislators saw it in one of their main news resource outlets.  Then, just to be sure, people on our side of the issue copied and distributed it to all legislators.

Entitled “Assisted Suicide:  Just Too Dangerous”, it begins:

No matter how many amendments get added to the assisted suicide bill, A2270, whether for a prettier name  (out goes “Death With Dignity,” in comes “Aid in Dying for the Terminally Ill”) or for a changed-then-changed-back-again definition of “terminal illness,” the bill is too dangerous.

(It’s well worth a full read.)  As a result of tremendous work done by the broad coalition of groups in the New Jersey Alliance Against Doctor Prescribed Suicide, the sponsor stated that he was two votes short of the number needed for passage, so he withdrew the bill and no vote was taken.

In interviews, the sponsor also claimed that the bill’s opponents were being emotional rather than looking at the “facts of the bill” (‘Aid in Dying’ bill, lacking enough votes, pulled from NJ Assembly agenda), a theme picked up by the Star Ledger’s editorial, which absurdly claimed that the sponsor “pulled the bill before a vote so he could soothe opponents’ fears — which he said were ‘genuine’ but fueled by emotion.”

If I had a nickel for every time that proponents of assisted suicide bills attributed our opposition to fear of death or other forms of emotionality, NDY would be able to attend all those fancy conferences that proponents use to hob nob with influential professionals and policy makers.  I was just a teensy bit irritated by yet another such accusation, especially coming from an editorial board of a prominent paper, so I pushed back with a letter to the editor to provide some “clarification.”

My letter was published July 1st.  It appeared under a photo of a patient and medical professional, accurately captioned “The writer argues that New Jersey legislators have a duty to set aside emotion and think about seriously ill people who need the law to protect them. (Denis Farrell/Associated Press).”  Here is my letter:

Too many loopholes on NJ’s assisted-suicide bill

When it comes to emotion as a barrier to reason, assisted suicide’s proponents have a much bigger problem than opponents (“Wise to wait on assisted suicide,” editorial, June 30). But that’s understandable.

Based on their hearing testimony, many saw a loved one die in pain. I was angry, too, when my father’s oncologist left him in pain, until he finally turned to hospice and got the palliative care he needed. But whether his doctor was guilty of ignorance, carelessness or arrogance, that’s not a reason to change the law on assisted suicide.

Recent amendments to Assemblyman John Burzichelli’s “Aid in Dying” bill have not changed the primary reasons to oppose it. Terminal predictions are still unreliable. Treatable depression is still not addressed. One witness to the form can be an heir, and neither need to actually know the patient. Nothing stops any form of coercion or caregiver abuse outside the doctor’s office. There’s no independent witness at the time of death, so self-administration is still not assured. And there are still no enforcement provisions.

The bill doesn’t prevent abuse; it hides it. Legislators have a duty to set aside emotion and think about seriously ill people who don’t have a loving family and need the law to protect them.

Diane Coleman, president and CEO, Not Dead Yet, Rochester, N.Y.

New Jersey’s bill can be brought up for a vote again in the fall, so our work is not done, but at least we can pause and celebrate that our message got out there.

Would You Rather Die Than Go To A Nursing Facility? Time For the Community Integration Act!

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One of the issues that we have with The Conversation Project is that the online materials suggest that a nursing facility is the only alternative to being “independent”.  (The notion seems to be to ask, “If you had to go to a nursing facility, wouldn’t you rather have an advance directive that declines life-sustaining treatment?”)

It’s very disturbing that they don’t seem to have heard about Olmstead and home and community based services.  Why don’t they ask, “If you could get long term services and supports (LTSS) to stay in your own home, would you choose to live with a disability?”  (You can read more about our issues with The Conversation Project in our recent blog about our comment letter to New York’s Dept. of Health.)

Admittedly, it’s a long haul.  ADAPT has been working the LTSS issue for 24 years.  Every state had some type of Olmstead activity by now, but no state gives everyone the choice to receive long term care services at home, so we have more work to do.  Here’s a press release about the next step, led by ADAPT and Senator Tom Harkin.

06/30/2014 ADAPT PRESS ALERT:                               

WHO:       ADAPT and Senator Tom Harkin

WHAT:    ADAPT and Senator Harking Announce the Introduction of the Community Integration Act (CIA)

WHEN:   Wednesday, June 25, 2014

On June 25, 2014 Senator Tom Harkin, a long-time disability rights champion, introduced the long-awaited Community Integration Act. This legislation, if passed, will codify in law the Supreme Court’s 1999 Olmstead decision in which the court found that persons with disabilities have a right to live in least restrictive—community settings. Last year Senator Harking commissioned an important study that found that most states are falling far short of the promise and obligation that is implicit in the Olmstead decision. Accordingly, this legislation:
Amends the requirements for the Medicaid State Plan so that any individual who is at the institutional level of care must be provided equal opportunity to receive home and community based services. The state also needs to meet new requirements for providing home and community based services. The legislation has a section that defines and strengthens key terms including the definition of “home and community based”.

The legislation includes a section that addressed the ways that states limit or restrict access to home and community based services, including a requirement that states address the needs for affordable, accessible, and integrated housing.

The legislation incorporates the remedies and procedures of the Americans with Disabilities Act into the Medicaid law and creates a new enforcement mechanism where the Secretary of Health and Human Services can reduce the federal Medicaid match for a state that fails to comply with the law.

The legislation adds a new requirement that states needs to report on their progress in providing community integration.

The legislation ends institutional bias by including home and community based services as a mandatory service for all states.

And finally, it includes a clause that provides states with the time they need to amend state law to comply with these new requirements.

Our thanks to Senator Harkin for this crowning legislation that marks decades of selfless commitment to the cause of the right of persons with disabilities to live in the community.

Press Release: Not Dead Yet Applauds Disability Rights Advocates for Key Role in Stalling New Jersey Assisted Suicide Bill

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[Editor’s Note:  The PRWeb version of this release in pdf format with a photo of John Kelly is available here.]

In a stunning defeat today for proponents of assisted suicide, the New Jersey assisted suicide bill A2270 was pulled from the floor and tabled until September for lack of votes. Not Dead Yet applauded New Jersey disability advocates as press reports credited disability rights opposition for the defeat.

“The bill was shown to be extremely controversial,” said Marilyn Golden of the Disability Rights Education and Defense Fund. “It has bipartisan opposition and is widely opposed by a diversity of groups, including the disability community.”

In the June 26, 2014 Star-Ledger postmortem, Statehouse reporter Susan K Livio reported that disability advocates “turned out in force” to testify at the bill’s hearing.

“We have a lot of reasons for concern about legalizing assisted suicide,” said Diane Coleman of Not Dead Yet. “One of our biggest concerns, given the rising tide of abuse of elders and people with disabilities, is that no law can prevent assisted suicide coercion behind closed doors.”

Reports from the state house had sponsors two votes short of a majority. The bill has been shelved until September, when Assemblyman John Burzichelli hopes to bring it back.

“The more legislators learn about the details, the more they turn against an assisted suicide bill,” said Not Dead Yet regional director John Kelly, a New Jersey native. Kelly is also director of Second Thoughts Massachusetts.

“We are 4 for 4 this session – New Jersey joins New Hampshire, Massachusetts, and Connecticut in having ‘second thoughts’ about assisted suicide,” Kelly added. “We also know that we need to be prepared for ongoing advocacy, and we’re ready for that.”

Kelly joined disability rights advocates from New Jersey along with the Medical Society of New Jersey and faith-based groups in bringing the opposition to the legislature.

UK: Assisted Suicide/Euthanasia Appeal Dismissed By Court

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From www.politics.co.uk:

Supreme court judges have dismissed a bid to effectively make euthanasia legal in the UK, after months of deliberating behind the scenes.

A majority of the panel of nine judges upheld the decision of the high court that existing laws preventing doctors from assisting with suicides do not infringe the rights to privacy or a family life under the European Convention of Human Rights.

The decision will be a hammer-blow for Paul Lamb, who was near-paralysed in a traffic accident 20 years ago and wants to end his life legally.

It follows the death of Tony Nicklinson, who suffered from ‘locked-in syndrome’, after losing his high court bid last year. His widow Jane had pursued the appeal alongside Lamb.

Not Dead Yet UK issued the following reaction:

Naturally we sympathise deeply with the disabled people who brought this legal case and their families but there is much truth in the adage that ‘hard cases make bad law’.
Euthanasia and assisted suicide is profoundly dangerous, irrespective of such hard cases, not least because they pose a very grave risk to thousands disabled people who have been made vulnerable by cuts in health and social care services and welfare benefits, making some feel they would be better off dead and no longer a burden on their family and friends.

We very much welcome, therefore, the ruling by the Supreme Court today because it protects the many whilst compassionately responding to the few by rarely prosecuting those who assist them with their wishes to die. Without this bright line we risk sleepwalking into state sanctioned killing.

Founder of Not Dead Yet UK Baroness Jane Campbell said “We can only hope that Parliament will heed the wisdom of the court by rejecting Lord Falconer’s very dangerous Assisted Dying Bill.”

Notes:
The new Bill comes to the House of Lords for its second reading 18 July 2014
Disabled people are almost universally against this Bill
Some small number of ‘hard cases’ do not make opposition to this Bill any less urgent.
Contact Dr Kevin Fitzpatrick, Spokesperson/Researcher for Not Dead Yet UK for further information at kevin@inclusion21.org or 07816671185