For years, Democrats have supported assisted suicide legislation, also referred to as “medical aid in dying”, under the notion that it is a bodily autonomy issue akin to abortion. Leading assisted suicide proponent organizations like Compassion and Choices and Death with Dignity have expertly oversimplified assisted suicide into a “my body, my choice” issue, and have spent millions of dollars per year peddling that messaging to legislators across the country. But if we take a closer look at the true meaning of bodily autonomy, the key differences between a policy of legal abortion and a policy of assisted suicide, and the systemic injustices that pervade both issues, it becomes very clear that conflating abortion and assisted suicide is not only inaccurate, but incredibly dangerous. 

What is bodily autonomy?

Let’s start with the basics of bodily autonomy. Put very simply, bodily autonomy is the ability to make choices about what does or does not happen to one’s own body. We often think about bodily autonomy in the context of abortion, but it has a wide variety of applications from seatbelt laws to gender identity and expression. It is a phrase that became popular in the feminist movements of the 1970s to combat the idea that women and others who can give birth are the collective property of a patriarchal system who have a duty to reproduce and conform to narrow gender norms regardless of circumstance. Importantly, for someone to have true bodily autonomy, they need to be able to make choices about their body without coercion. Coercion can be active or passive; while someone actively threatening to harm a person if they get an abortion is certainly coercion, so is the lack of options for safe abortions that resulted in many people having to choose between carrying a pregnancy to term or having an unsafe abortion in a non-clinical setting, which sometimes led to their death. A decision made under the threat of harm is not truly a choice– it is a surrender to the more personally tolerable of two hardships.

How do a policy of legal abortion and a policy of assisted suicide differ in terms of their relationship to bodily autonomy?

A policy of legal abortion– meaning that the law allows for all people to access it regardless of who they are– protects the most marginalized people in our country. It has been proven that countries and states with abortion bans see higher maternal mortality rates than in countries where abortion is legal. This is largely because when safe, medically supervised abortion is illegal, people will resort to other methods that endanger, and, in many cases, kill them. The people who are most likely to need an abortion due to complications with a pregnancy are those who have the least access to quality health care. The maternal mortality rate for Black people is almost three times as high as it is for white people in part because Black people are twice as likely as white people to receive late-term prenatal care or none at all. Many Black people go through their entire pregnancy without seeing a single doctor due to lack of healthcare access. This means that fatal problems go undiagnosed, and problems that could be prevented via abortion care result in unnecessary maternal death. Even Black pregnant people with access to prenatal care are more likely to face socioeconomic barriers that result in negative health outcomes. In this sense, abortion is a critical form of healthcare that saves lives, and though the decision to have an abortion is often difficult, a policy of legal abortion means that more pregnant people can survive pregnancy-related complications even if they do not have access to other forms of pregnancy care. To summarize: a policy of legal abortion protects bodily autonomy by mitigating the active and passive coercion of pregnant people so they can make independent choices to save and improve their own lives. 

On the other hand, a policy of assisted suicide– meaning that the law provides a mechanism by which people can die via a lethal prescription– threatens the most marginalized people in our country and limits the exercise of true bodily autonomy to those with the most resources. This is primarily because our healthcare system punishes people for being poor. Poor people are simultaneously more likely to have health problems and less likely to have access to treatment for those problems. So if someone is significantly sick and/or disabled and unable to afford or access appropriate health care, their only other options are to hope they magically get better, adjust to life with their illness and go into insurmountable medical debt, or find a way to die faster than nature would allow them to. There’s no winning. 

A policy of legal assisted suicide and its social normalization disincentivizes institutions from increasing access to true health care. It’s a convenient escape from institutional responsibility. This is already happening in Canada, where proponents are rejoicing over the saved healthcare costs that legal assisted suicide and euthanasia bring, while simultaneously Canadians living in poverty feel that they are running out of options and pursuing assisted suicide and euthanasia. Proponents of assisted suicide in the U.S. argue that American policies are only for terminally ill people predicted to have six months or less to live, so no one else needs to worry. Canada’s legislation started with similar restrictions and has rapidly expanded to the point where people with non-terminal disabilities are eligible, and even those with a mental illness, in the absence of any condition that causes physical pain, could qualify starting in March 2023 though the mental health expansion has been delayed. 

Leading proponents of assisted suicide in the US predict our policy will see similar changes in the coming years. It is apparent in bills being considered this legislative session, where states with legal assisted suicide are proposing amendments that would significantly loosen eligibility requirements for both patients and providers. Bills that would legalize assisted suicide for the first time in a given state contain far fewer safeguards than they did even five years ago. The only assisted suicide policy that is guaranteed not to harm our most vulnerable community members is the assisted suicide policy that does not pass.

How can we actually protect everyone’s bodily autonomy, including marginalized peoples?

There are so many ways we can foster comfort and choice at the end of life without threatening the lives of people who aren’t ready to die. Advocating for full-spectrum palliative care with adequate pain relief, nutrition, and emotional care is of utmost importance. Modern medicine has advanced to a point where no one needs to die in severe pain. The issue is not that appropriate end-of-life care does not exist, it’s that it isn’t accessible to everyone. Good palliative care gives people a range of options about what curative treatments they wish to continue or discontinue, whether they want to be at home or in a medical setting, and what comfort measures they want to use. Giving everyone access to this range of options is a genuine example of bodily autonomy. 

As Anita Cameron, celebrated disability justice activist and Director of Minority Outreach at Not Dead Yet has written, we need to “provide people with disabilities supports to live, not tools to die”. Disabled peoples’ bodily autonomy is constantly under threat as we are denied access to home and community based care, institutionalized against our will, forced to live in congregate settings because of a severe lack of accessible affordable housing, forcibly sterilized, disproportionately incarcerated, made to endure electroshock torture, denied access to oral and dental care, and killed by our caregivers. It is unsafe and unjust to pass a policy that makes it easier for vulnerable people to die while making it harder to hold medical practitioners accountable when there are so many systemic issues that put disabled people at greater risk of significant illness and death. If state governments are truly interested in protecting bodily autonomy, they should start with addressing at least one of the previously mentioned issues– not with legalizing assisted suicide.

The policies we pass reflect the values of our governments. As such, it is crucial to consider the impact a given policy will have not only on the privileged person or even the “average person”, but on those living on the margins. While people with adequate access to quality health care, needed home care services, loving families, and a strong support system may not be harmed by a policy of assisted suicide, people without such privileges will be. It is unconscionable and inequitable to only concern ourselves with the bodily autonomy of a select few. If we truly want to promote bodily autonomy for everyone, we cannot allow assisted suicide to be legalized.

From the New Haven Register, 4/2

Can Conn. live with aid-in-dying being law?

Proponents of legalizing assisted suicide insist that the practice would be tightly controlled. Doctors would only be able to write lethal prescriptions for state residents with a six months prognosis who are mentally competent and who have made two requests at least 15 days apart. The drugs must be self-administered. As Dr. Diane Meier, a palliative care specialist has said, hoever, “the entire heartfelt adherence to restrictions that are announced when you first get the public to vote in favor of this go up in smoke once the practice is validated.”

Proponents seem to feel that it is a good strategy. J.M. Sorrell of Massachusetts Death with Dignity in referring to “the hoops you have to go through” under the bill Massachusetts is considering has stated, “Once you get something passed, you can always work on amendments later.”

Almost all of the few states that have legalized assisted suicide are considering loosening eligibility requirements. California has reduced the reflection time between requests to 48 hours. Bills introduced in Hawaii, New Jersey, Oregon and Washington would do likewise.

Following New Mexico’s approach, Hawaii, Oregon and Washington are considering bills allowing nurse practitioners and, in the case of Washington, physician’s assistants to determine eligibility for assisted suicide and write death causing prescriptions. This belies the complexity in judging life expectancy and implies that assisted suicide is an ordinary medical procedure like wrapping a sprain.

Mistakes in prognosis occur regularly. 12-15 percent of hospice patients outlive their prognosis by six months or more. Sometimes a pessimistic prognosis may be based on the assumption, erroneous or not, that the person will not receive the in-home support needed to stay alive.

What constitutes “terminal illness” is elastic. An Oregon health official has opined that conditions can be deemed terminal even if there is lifesaving treatment but the person does not want it, is uninsured or cannot afford it. This viewpoint sweeps in any chronic condition that might turn fatal if not medically managed. This is not a theoretical concern. Among the persons who died in Oregon in 2021 under its assisted suicide law were people with conditions such as arthritis and anorexia.

Indeed, a Colorado doctor has written of helping thirtysomethings with anorexia obtain so-called “aid in dying” drugs. Anorexic persons do not meet eligibility requirements. As Dr. Angela Guarda, director of the eating disorders program at Johns Hopkins University, said, “Anorexia is treatable, not terminal … it is impossible to disentangle this request (to die) from the effects of the disorder on reasoning, and especially so in the chronically ill, demoralized patient who is likely to feel a failure.

If a state legalizes assisted suicide, there will be an assisted suicide industry, albeit probably a small one, seeking to pursue its interests. In Oregon, the requirement that only state residents be eligible for assisted suicide was challenged by a doctor in court and the state chose not to fight it. The state is amending its statute accordingly. Vermont is seeking to do so as well. It is not clear how lack of a residency requirement will play out in this day of teleconferencing.

Proponents scoff at any concern about assisted suicide morphing into “voluntary” euthanasia of the disabled, although this is what has happened in Canada and in other countries that legalized assisted suicide. In California, four doctors and two patients brought a federal lawsuit challenging the provision in the state’s law that patients self-administer the lethal drugs.Their argument was that this discriminated against people lacking functional ability to do it themselves. With major disability groups filing an amicus brief in strong opposition, the case was dismissed but assisted suicide laws may fuel more such cases.

A Connecticut legislator explaining why she is a proponent used a quote attributable to Nietzsche. “One should die proudly when it is no longer possible to live proudly.” Hopefully she did not intend the obvious implication behind the quote that some folks need to hurry and die.

Before you support the legalization of assisted suicide and view it as just “aid in dying,” think carefully about the values you want for the health care system and the type of society you want to live in.

Lisa Blumberg of West Hartford is a lawyer, writer and disability rights activist.

CW: suicide, assisted suicide, ableism

In this video, we take a closer look at the anatomy of an assisted suicide bill and how proposed expansion bills would change current statutes. There are expansion bills being heard in Vermont, Hawai’i, Washington, and Oregon.

Want to get involved with advocacy work to stop assisted suicide? Fill out this quick form and we’ll be in touch: https://secure.everyaction.com/8FDj6L…

Video link: https://youtu.be/bEreuFDEeQw

Note from Jules: My apologies for speaking so fast in this video! I must have been over-caffeinated when I recorded this. I’ll make a concerted effort to slow down for clarity in the future. Thanks for being patient with me!

Transcript

Hello and welcome back to the Not Dead Yet vlog. My name is Jules Good. I use they/them pronouns, and I’m the assistant director and policy analyst at Not Dead Yet. I’m a white person with short brown hair and today I have on a gray short sleeve T-shirt.

This week we’re taking a deeper dive into what we call assisted suicide expansion bills. If you saw our last video about legislative updates, you got a brief summary of some of these bills. Now we’re going to take a look at the anatomy of an assisted suicide bill to understand which parts are being changed in current proposed legislation and what risks those changes pose.

Part one, anatomy of an assisted suicide bill. We often use phrases like legalizing assisted suicide, but what exactly does that mean? What is being made legal that wasn’t legal before? What exactly changes in the law in medical facilities and in patient care when a state makes assisted suicide legal? Let’s break it down. Oregon was the first state to legalize assisted suicide back in 1997. Other assisted suicide bills in the years since have more or less copy and pasted Oregon’s bill language, so we’ll use Oregon’s law as it stands today as our model assisted suicide bill. There are five key pieces of information in every assisted suicide bill that detail rules and procedures for, one, eligibility, including prognostics and residency requirements. Two, making the request for lethal prescription and waiting periods. Three, evaluating the request for lethal prescription. Four, insurance. And five, immunities and liabilities.

Let’s start with eligibility. Oregon’s law says, quote, “An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease and who has voluntarily expressed his or her wish to die may make a written request for medication,” end quote. So, someone has to be deemed able to make decisions by a physician, be able to prove residency with appropriate forms of identification, and have a diagnosis from a physician indicating that they are expected to die within the next six months as a result of their condition. If someone meets these requirements, they can make a request for a lethal prescription. This requires two oral requests and one written request. The second oral request must be made no sooner than 15 days after the first oral request. The written request must be made using a special form, an example of which is provided in the last section of the statute.

In Oregon and a few other states, the 15-day waiting period can be waived if a physician medically confirms that the patient will likely die before the waiting period ends. The physician must make the patient aware of their ability to rescind their request after the second oral request is made. Once the request for lethal prescription is made, it has to be evaluated. The attending physician and a consulting physician have to review the patient’s medical records, examine the patient and verify that they do indeed have a terminal disease and are capable of making the request. If either physician is concerned that the patient may be, quote, “Suffering from a psychiatric or psychological disorder or depression causing impaired judgment,” end quote, they are are required to refer the patient for counseling, which basically just means a professional assessment and not necessarily ongoing mental health support. If the patient is cleared by both physicians and a psychological professional, if deemed necessary, their request for lethal prescription is approved.

The fourth main part of an assisted suicide bill is language about insurance. We talked more in depth about insurance policies and the relationship to assisted suicide in our video about the Kligler case, so check that out if you want a deeper explanation of this. But basically, most life insurance policies withhold payout of benefits if the policy holder dies by suicide. Assisted suicide legislation clearly states that an insurance company may not do that if the patient dies by assisted suicide, and many laws say that the death certificate must list the underlying illness as the cause of death so as to avoid complications with this or other issues. Lastly, assisted suicide legislation details the immunities of medical professionals and others involved in the death of the patient. The immunities are the most significant part of assisted suicide laws. If someone claims to act in, quote, “good faith compliance with the law,” they cannot be legally or professionally penalized. The exception to this is that if a facility or provider chooses not to provide assisted suicide and one of their staff does it anyway, that staff member can be punished or sanctioned by the facility. If a person alters or forges a request for lethal medication or interferes in the process with the intent of causing the death of the patient, that person can be convicted of a class A felony.

Every statute and bill has its own quirks, but I’m hoping this rundown gave you some insight into what a given assisted suicide bill actually does if it passes. Now that we have a baseline, let’s take a look at some current proposed expansion bills and the impacts they would have in relation to current assisted suicide statutes.

Part two, understanding current expansion bills. This legislative session, there are expansion bills being heard in Oregon, Washington, Vermont, and Hawaii. Vermont’s bill deals primarily with abolishing the residency requirement while Washington and Hawaii’s bills aim to expand the definition of, quote, “what a qualified medical professional is” so that healthcare providers other than physicians can evaluate patient’s eligibility for assisted suicide and to reduce the waiting period between a request for lethal drugs and getting the prescription. Oregon’s bill aims to do all three of those things. Let’s talk through what this means and the threats these forms of expansion pose to vulnerable patients. In Oregon, non-residents are already able to pursue assisted suicide due to a settlement in a court case last year. The Oregon Health Authority and the Oregon Medical Board voluntarily agreed to stop enforcing the residency requirement and asked the legislature to remove it from the law, which is part of what this bill, SB891, would do. Removing the residency requirement undermines the authority of other states that have decided assisted suicide is unsafe for their residents. It expands the pool for doctor shopping where people who want to pursue assisted suicide switch doctors until they find one who will help them die that way. This is especially dangerous because someone could be under the care of a doctor for only a few short weeks before they really have a chance to get to know the person and accurately gauge their decision-making capacity and any external pressures on them to die.

Vermont is considering two similar bills, HB2 and SB26, which would remove the residency requirement from its bill. The House bill passed through committee and the Senate bill is still awaiting a hearing. The situation in Vermont has recently been complicated by the settlement reached in Bluestein versus Scott in mid-March, which allows the plaintiff, a Connecticut resident, to die by assisted suicide in Vermont when she becomes eligible. Unfortunately, this means the Vermont bill is even more likely to pass.

Hawaii, Oregon and Washington are considering bills that would increase the pool of healthcare providers who are eligible to assist in a patient’s suicide. Currently, in these states, only physicians are able to evaluate a patient’s eligibility. The bills would extend this ability to physician assistance and advanced practice registered nurses, APRNs, which means that people with less diagnostic experience and often less experienced practicing medicine in general would be determining patient eligibility under requirements that already have a lot of room for error given the imprecise nature of prognostics. Research has shown that 12 to 15% of people outlive a six-month prognosis, and rushing to pursue assisted suicide toward the beginning of this period is especially risky because people could have several more months or even years of life left. Jeanette Hall, an Oregonian diagnosed with terminal cancer, sought out assisted suicide, but was encouraged by her doctor to try other treatment options before going that route. She has now lived more than 20 years post-diagnosis. In an article for the Boston Globe she said, quote, “If my doctor had believed in assisted suicide, I would be dead.”

Equally concerning is the reduction of the waiting periods between requesting and receiving lethal drugs. Research shows that depression is a common reaction to a terminal prognosis, obviously, especially at the early stages. It takes weeks or months for antidepressants to work. Insufficient palliative care and in-home personal care services, an unfortunate reality for most disabled people, can also lead to despair. Official data shows that concerns about loss of autonomy and feelings of being a burden on others are major factors in requests for assisted suicide, but it takes time to put in-home services in place. There is no excuse for abandoning people with advanced illnesses by hastening their deaths rather than addressing their needs. When this happens, it’s not compassion, it’s disposal.

These expansion bills are indicative of a dangerous trend in assisted suicide advocacy. The safeguards that aided in getting the legalization bills passed initially are now being reframed as barriers to accessing end of life care. The less stringent the process is, the more room there is for error, abuse and coercion. Thanks for watching. If you want to get involved in advocating against assisted suicide, fill out the quick form in the video description below and we’ll be in touch with you. To learn more about us and our work, please visit www.notdeadyet.org. See you next time.