Lisa Blumberg: Promoting the Better Dead Than Disabled Ethos to Kids

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Photo of Lisa Blumberg, head and shoulders shot of a smiling woman with short gray hair and a dark blue blouse seated with a desk of files and books in the background.
Lisa Blumberg

Canada has the broadest euthanasia law in the world. Both people who are ill and people who have disabilities deemed to cause them to suffer may request that a doctor or nurse practitioner provide them with a drug induced death. (1) Alan Nichols, a 61-year-old man with a history of depression was euthanized, over the strong objections of his family, after he listed hearing loss (which he acquired at twelve) as the medical reason for his request.

His euthanasia implies nothing about what it is like to have hearing loss – people with impaired hearing, like everyone else, lead varied lives – but it speaks volumes about the failure of Canada’s safety net. “Alan was basically put to death,” his brother said.  (2)

There were more than 10,000 deaths in Canada by euthanasia last year, an increase of about a third from the previous year. The association of Canadian health professionals who provide euthanasia advises physicians and nurses to inform patients if they might qualify to be killed, as one of their possible “clinical care options.” (3) Indeed, people with disabilities who have been hospitalized and their families have reported instances where hospital staff have brought up euthanasia even though the individuals had not indicated a bit of interest in it. (4) Canada is a textbook example of how society’s thinking “evolves,” to use Prime Minister Justin Trudeau’s term (5), once assisted suicide and euthanasia is legalized.

Into this milieu, the Canadian Virtual Hospice has produced a colorful, soothing activity book for kids ages six and up to help them cope with the euthanasia of someone they know. (6) Whether intentional or not, the book encourages the youngest members of the public to think that in some or many instances it is better to be dead than disabled and it is reasonable for medical providers to act accordingly. This 26 page book refers to disability twelve times. (7)

Entitled Medical Assistance in Dying (MAID) Activity Book, the book calls the death inducing drugs “medicine” and never uses the term euthanasia. Yet it is candid in stating that “A doctor or nurse practitioner (a nurse with special training) uses medicines to stop the person’s body from working.” The person is given three drugs by IV. The first calms them. The second puts them in a coma. The third is what does it. The book states, ‘the third medicine makes the person’s lungs stop breathing and then their heart stops beating…When their heart and lungs stop working, their body dies. It will not start working again.” (8)

As for the end of the process, “once the MAID provider has checked everything and they are sure that the person has died, they will leave the room to fill out some papers. Then they will pack up their supplies and leave….” (9)  It all seems so ordinary and mundane, almost as if a visiting nurse has given grandpa a blood pressure check, chatted a bit and then gone to the next house.

Kids are asked to make their choices. Do they want to be in the room where it happens, in the next room or somewhere else? If they are not there, how do they want to be notified? Do they want to see the body or get a photo? (10)

They are assured that euthanasia does not hurt. (11) There seems to be no conclusive evidence though either way as to whether it may involve pain. Brain and heart monitors are not used and since the person is given paralyzing agents, distress may be masked. (12)

The book makes the dubious statement that “no one can cause another person to have so much pain and suffering that they choose MAiD.” (13) No indication is given that some people can be made to feel like a burden, or steered or coerced towards this awful decision. The authors seem not to have heard of elder abuse. Their view is perversely Pollyannaish. Kids are encouraged to talk about their feelings about an impending euthanasia, but missing is any suggestion that if the child truly thinks the person is being bullied or steered, they should take their concerns to someone on the outside like a trusted teacher.

It would, of course, be wrong to place on a six-year-old the responsibility to talk an adult down from dying by euthanasia. Yet kids can be told that some people get quite sad when they are very worried about how to manage things in their daily lives or thinking about expenses and that there is much other people and the community can do to help.

The nub of the book for me and what I think underlies its biased nature are the authors’ explanation as to why an ill or disabled person would gravitate towards euthanasia. According to the book, “people might ask for MAID if their illness or disability will not cause their body to die, but it causes too much pain or suffering for them to keep living with it, and there is no way to make the illness or disability get better or go away…some things still cannot be cured, and some pain and suffering cannot be taken away. This is no one’s fault.” (14)

The language may be simplified for the audience but this is just the medically oriented better dead than disabled viewpoint taken to its logical conclusion. It reflects the tired idea that a disability in and of itself defines and perverts a person’s life. If a person’s disability is permanent, they are up a creek without a paddle as long as they are in this world. Voluntary euthanasia is seen to offer them a way out. However, this doesn’t explain the euthanasia of Sean Tagert, a 41-year-old with ALS, who was quite explicit that he was “choosing” this path because he could not obtain the funding for a few extra hours of daily aide support that he needed to be able to stay at home and continue to participate in the raising of his beloved young son. (15)  

To put it charitably, this is an egregious failure of the imagination on the part of the Canadian Virtual Hospice.

It is speculative whether the book might impact a child’s perception of a person with a disability or illness they meet in daily life. It is speculative whether the book might motivate a child to suggest “MAID” to grandma when she complains about her knees. It is speculative whether the book would influence a child who feels hopeless to give up or would make a child who identifies with having a disability herself feel devalued. Also speculative is what effect it might have on the healthcare consumers and policymakers of tomorrow.

It can be asserted though that the better dead than disabled ethic is inimical to inclusion, respect for diversity, problem solving in dealing with adversity, and horror at taking lives – values 21st century kids need to succeed.

The Canadian Virtual Hospice has produced some constructive resources on dealing with illness but the Medical Assistance in Dying (MAID) Activity Book seems little more than propaganda that may even sway adults. The organization needs to do some hard thinking on the precepts they want to promote.

They should be aware that even though euthanasia is allowed under Canadian law, United Nations Human Rights experts have raised serious questions on whether the law has a discriminatory impact on disabled people and is inconsistent with Canada’s obligations to uphold international human rights standards. (16)

FOOTNOTES

  1. https://apnews.com/article/covid-science-health-toronto-7c631558a457188d2bd2b5cfd360a867

  2. Ibid.

  3. Ibid.

  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882029/

  5. https://nationalpost.com/pmn/news-pmn/canada-news-pmn/trudeau-defends-use-of-two-planes-calls-tory-criticism-a-far-right-tactic

  6. https://www.virtualhospice.ca/maid

  7. https://www.virtualhospice.ca/maid/media/3bdlkrve/maid-activity-book.pdf

  8. Ibid., pg. 1,4

  9. Ibid.,pg. 23

  10. Ibid., pp. 12-14

  11. Ibid., pg. 4

  12. https://nationalpost.com/news/canada/medical-assistance-in-dying-how-do-people-die-from-maid

  13. https://www.virtualhospice.ca/maid/media/3bdlkrve/maid-activity-book.pdf 5

  14. https://www.virtualhospice.ca/maid/media/3bdlkrve/maid-activity-book.pdf 5-6

  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882029/

  16. https://spcommreports.ohchr.org/TMResultsBase/DownLoadPublicCommunicationFile?gId=26002 https://apnews.com/article/covid-science-health-toronto-7c631558a457188d2bd2b5cfd360a867

Media Advisory: Disability Rights Advocates Gather at SJC to Defend Disabled Lives

"death with dignity", aid in dying, assisted suicide, court cases, court decisions, john kelly, Jules Good, Our News & Commentary Blog, press release, protests, Second Thoughts, , , ,

***MEDIA ADVISORY***

Disability Rights Advocates Gather at SJC to Defend Disabled Lives

Boston, MA – Thursday, October 13 at 12 PM, Second Thoughts MA: Disability Rights Advocates Against Assisted Suicide and Not Dead Yet will gather outside the Supreme Judicial Court at the John Adams Courthouse to remind the SJC and the public that the issue of assisted suicide belongs in the legislature, just as the Suffolk Superior Court recommended in its dismissal in Kligler vs. Mass.

Second Thoughts Director John B. Kelly said, “Neither the U.S. Supreme Court nor any state high court has found a constitutional right to assisted suicide. The prohibition against assisted suicide protects the lives of disabled people.”

Not Dead Yet Director of Minority Outreach Anita Cameron said, “Black people overwhelmingly oppose assisted suicide and don’t use it. As doctor assisted suicide laws become normalized across the country, racial disparities put Blacks at risk of denial of care and early death.”

Not Dead Yet Assistant Director Jules Good said, “After Canada’s Supreme Court ruled that assisted death is a fundamental right, legislation and more court decisions have led to the euthanizing of disabled people who lack care, safe housing, and social supports. The Court must not legalize a practice that further endangers people who are already vulnerable.”

Second Thoughts member Ellen Leigh said, “I supported assisted suicide until I learned that it is all about disability – the top five reasons in Oregon involve depending on others, feeling like a burden, and shame – ‘loss of dignity.’ We all have inherent dignity and do not lose that when we become ill and disabled. Bringing ‘dignity’ into this only increases feelings of shame and burden for choosing to live.”

Speakers will show:

  • Assisted suicide, as leading proponent bioethicist Thaddeus Pope conceded, “is all about disability.”

  • Well-educated upper class white people are the drivers of assisted suicide. Marginalized people in MA and across the US oppose assisted suicide, and legalizing it ignores our perspectives and needs.

  • Palliative care, including palliative sedation when necessary, is already legal to relieve pain and other suffering in a way that does not pose such a risk to vulnerable people. Assisted suicide isn’t needed.

WHEN: Thursday, October 13, 12 PM-1 PM
WHERE: 1 Pemberton Square, outside the John Adams Courthouse, intersection of Somerset Street and Ashburton Place.

VIRTUAL: Facebook Live Link will start streaming at 12 PM noon.

Second Thoughts MA organized in 2012 to contest the 2012 Ballot Question 2 for the legalization of assisted suicide, which we helped defeat. We have successfully lobbied against every assisted suicide bill since.

Not Dead Yet is the leading national disability organization opposing assisted suicide laws, futility judgments, and “better dead than disabled” policies. The group organized in 1996 to help stop Kevorkian, whose victims were overwhelmingly disabled and not terminal.

For more information, please contact Jules Good (mailto:JGood@NotDeadYet.org) or John Kelly at mailto:SecondThoughtsKelly@Gmail.com. 617-952-3302 

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Mourning the Loss of Paul Spooner, ED of MetroWest CIL

assisted suicide, better dead than disabled, national council on independent living, Our News & Commentary Blog, paul spooner, Second Thoughts
Head and shoulder photo of Paul Spooner, a smiling brown haired white man with a moustache, wire-rimmed glasses, an oxygen nasal canula and a gray fleece jacket.
Paul Spooner

Disability advocates around the country are mourning the loss and remembering the leadership of Paul Spooner who died unexpectedly Saturday. In Not Dead Yet’s early years in the late 1990s, Paul was President of the National Council on Independent Living and helped ensure that our message against the “better dead than disabled” mindset was heard by disability advocates at hundreds of CILs. This led to the NCIL membership’s adoption of a formal Resolution Opposing the Legalization of Assisted Suicide in 1997. Under Paul’s leadership, the MetroWest CIL hosted the early NDY website for several years. More recently, his Center has been hosting Second Thoughts Massachusetts’ website.

Paul’s decades of dedication to disability rights will not be forgotten. Below is a brief description of some of his many contributions to the disability rights movement that appeared October 11 in the Framingham Source:

FRAMINGHAM – The Boston Center for Independent Living announced the sudden death of Paul Spooner.

“We are most saddened to share the news that Paul Spooner, a disability rights leader for four decades, passed unexpectedly over the weekend,” wrote the organization in an email. “Paul was Executive Director of the Metrowest Center for Independent Living in Framingham since the early 1990s, a past president of the National Council of Independent Living, and always a fierce advocate for independent living, equal access, and the dignity of people with disabilities.”

Spooner spoke out for “affordable and accessible housing, and accessible transportation, and demanded compliance with the ADA and the state’s Architectural Access Board rules,” said the Boston organization.

Spooner “courted legislators and worked closely with the Metrowest delegation in the state legislature, able to consider Senate President Karen Spilka both a friend and ally. Photos in his office from an earlier time showed Paul with Senator Ted Kennedy, among others,” wrote the Boston organization. “Just last week Paul reveled in the expansion of the CommonHealth program he’d championed with MassHealth that was approved by federal officials. His fingerprints were on too many bills, programs, civil rights complaints, and other advances for people with disabilities to count.”

“Paul Spooner passionately lived disability rights. It defined him and he helped define the cause. He’s totally irreplaceable,” wrote the organization.

NDY Submits Public Comment On Proposed ACA Rule 1557 Change

Our News & Commentary Blog

Background:

The Department of Health and Human Services recently allowed a comment period for organizations and individuals to share their thoughts on proposed changes to Section 1557 of the Affordable Care Act (ACA). Section 1557  prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. There are many proposed changes to the rule, but the two most significant changes are that Medicare Part B will formally be considered federal financial assistance under the ACA, and that language will be added to prohibit discrimination on the basis of gender identity and sexuality. You can view a more in-depth summary of the proposed changes here.

Our Public Comment:

Not Dead Yet is a grassroots disability organization that opposes assisted suicide and euthanasia as deadly forms of discrimination against disabled and chronically ill people. We are pleased to see the proposed amendments to Rule 1557, which will have a tangible, positive impact on disabled people in healthcare settings. As you continue in the rulemaking process, we ask that you consider the following barriers to equitable healthcare for disabled people, particularly discrimination related to clinical algorithms in healthcare decision making, organ transplantation and suicide prevention.

 

Quality of Life Assumptions and the Use of Clinical Algorithms

Involuntary withdrawal of life-sustaining medical treatment (LSMT) is a practice that has prematurely ended the lives of disabled and chronically ill people without the consent of patients or their surrogate decision makers. It is difficult to fully discern who is most at risk of involuntary treatment withdrawal since the data we have available is primarily from cases that went to court, and families of deceased people without the resources to pursue legal action are not a part of this data. The available data shows that older adults, especially those with chronic conditions, comprise a significant number of these cases [1]. BIPOC patients are also at higher risk of having LSMT withdrawn because, at least in part due to healthcare disparities, they are more likely to develop health conditions that necessitate the use of LSMT [2]. 

 

When a patient or their surrogate objects to a futility judgment, it’s important to examine the power dynamics at play. Because doctors have more institutional power than patients or their families do, it is vital that they prescribe care that embodies a combination of medical best practice and respect for the wishes of the patient and, if appropriate, surrogate decision makers. The use of clinical algorithms that are based on the notion that having a disability inherently reduces one’s quality of life biases care provision in a way that deprioritizes disabled people [3]. This quite literally has life-or-death consequences in decisions about the withdrawal of LSMT, as well as in situations where Crisis Standards of Care are employed. 

 

A key example is the use of the Sequential Organ Failure Assessment (SOFA) throughout the COVID-19 pandemic as a way to determine who would receive care during shortages. As our colleagues at DREDF have pointed out, myriad factors related to communication disabilities and chronic illness could cause someone to receive a lower SOFA score, putting them at risk of being denied care during a shortage [4]. QALYs are another algorithm based on false assumptions about the quality of life among disabled people. We oppose the use of these discriminatory algorithms and support a more patient-centered approach that considers the needs and desires of patients, as well as more consideration of the perspectives of others who have undergone treatments that are the subject of these discussions. 

 

Discrimination in the Organ Transplantation Process

There is a history of discrimination against disabled people who wish to receive organ transplants. Though organ donation is facilitated through a national program, each health center has its own policies and procedures on referring candidates for transplant. In a 2019 report, the National Council on Disability found that “the assumption that people with disabilities will not be able to comply with postoperative care has caused disability to be considered a contraindication to organ transplant at many transplant centers.”[5] This results in disabled people being denied transplant not because of current or reasonably foreseeable health problems, but because of the ableist idea that disabled people cannot follow instructions as well as nondisabled people. While some people may need more support in following postoperative procedures, this should not be the deciding factor in organ transplant candidacy evaluations. 

 

Standardized nondiscrimination policies for transplant candidates, such as those introduced in the Charlotte Woodward Organ Transplant Discrimination Prevention Act (H.R. 1235), should be integrated into the policies and procedures that healthcare centers create to comply with Rule 1557. 

 

Discrimination in Suicide Prevention Care

When a disabled person presents with suicidal behavior, their desire to end their life may be validated or even encouraged by medical professionals in places where assisted suicide is legal, especially if they have a serious or advanced chronic condition [6]. Assisted suicide, also referred to as medical aid in dying (MAiD), is death by lethal drugs requested by a person and prescribed by a medical professional. A person can die by assisted suicide if they feel that the physical pain and/or emotional struggles of living with a serious illness or disability are too much to live through. If their doctor agrees with this concern, the doctor can write a prescription for a medication that will kill the person quickly. 

 

Both assisted and unassisted suicide produce the same result: the intentional death of a person. One of the dangerous distinctions between assisted and unassisted suicide is that the former is deemed a rational response to illness or disability while the latter is usually seen for the tragedy it is. Therefore, when a disabled patient expresses suicidality, it is seen as rational. This puts disabled people at risk.

 

If a person meets the criteria for pursuing assisted suicide, they are disabled, whether they identify that way or not. One of the first steps in the process is that the doctor who prescribes lethal drugs determines “that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.” Based on reports about people who died by assisted suicide in Oregon, in only 3% of cases was this determination made by a psychological professional [7]. 

 

“Impaired judgment” is clearly a subjective criterion. If the doctor or professional evaluating the patient holds true the ableist notions pervasive in our society– that disabled people are suffering, are burdens, that our care needs or society’s failure to meet those needs make us unable to live meaningful or acceptable lives, that our conditions are humiliating – then when a patient gives those reasons for wanting to die, the typical doctor or professional will not consider that as evidence of “impaired judgment.” They will write suicidality off as a logical response to being disabled. 

 

Even when disabled people seek out healthcare for reasons unrelated to mental health, the American Psychiatric Association recommends that the patient should potentially undergo a suicide assessment [8]. They cite “functional impairments, pain, disfigurement, increased dependence on others, and decreases in sight and hearing” as risk factors for suicide. This is not a wholly unfounded assumption – a 2018 survey of more than 430,000 US adults found that respondents with disabilities were over 3 times more likely to experience “frequent mental distress” than respondents without disabilities [9].These studies problematically draw a surface-level correlation between having a disability and being suicidal, when in reality, the barriers disabled people face as a result of living in an ableist society often cause more emotional distress than the disability itself [10]. It is understandable that hospitals would see this data and want to perform a suicide assessment on disabled patients as a preventative measure since this population is much more likely to struggle with “mental distress.” However, there is a difference between using data trends to inform care decisions and reinforcing the assumption that disabled people must want to die because our lives are tragic and difficult, an assumption rooted in ableism. 

 

Conclusion

Not Dead Yet recommends that the requisite nondiscrimination training outlined in the proposed Rule changes include specific education on disability cultural competency and anti-ableism, using materials and expertise from leading disability justice organizations such as the American Association for People with Disabilities, the National Council on Disability, the Autistic Self Advocacy Network and others.

 

The proposed amendments to Rule 1557 can lay the foundation for a healthcare system that affirms the inherent value of all human lives and focuses on protecting vulnerable populations from discriminatory practices. Not Dead Yet strongly recommends that organizational policies and procedures to comply with Rule 1557 include training from disabled-led organizations on healthcare disparities and disability justice, cultural competency and accessibility best practices. 

 

Citations 

[1]: Pope, T. (2022). Thaddeus Mason Pope. Thaddeuspope.com. Retrieved 3 October 2022, from https://www.thaddeuspope.com/medicalfutility/futilitycases.html.

 

[2]: Bazargan, M., & Bazargan-Hejazi, S. (2020). Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. American Journal Of Hospice And Palliative Medicine®, 38(6), 688-718. https://doi.org/10.1177/1049909120966585

 

[3]: Bazargan, M., & Bazargan-Hejazi, S. (2020). Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. American Journal Of Hospice And Palliative Medicine®, 38(6), 688-718. https://doi.org/10.1177/1049909120966585

 

[4]: DREDF. (2020). Letter From DREDF and Additional Organizations Opposing California’s Health Care Rationing Guidelines – Disability Rights Education & Defense Fund. Disability Rights Education & Defense Fund. Retrieved 3 October 2022, from https://dredf.org/letter-opposing-californias-health-care-rationing-guidelines/.

 

[5]: National Council on Disability. (2019). Organ Transplant Discrimination Against People with Disabilities.

 

[6]: Stainton, T. (2019). Disability, vulnerability and assisted death: commentary on Tuffrey-Wijne, Curfs, Finlay and Hollins. BMC Medical Ethics, 20(1). https://doi.org/10.1186/s12910-019-0426-2

 

[7]: Oregon Health Authority. (2021). Oregon Death with Dignity Act 2020 Data Summary.

 

[8]: Jacobs, D. (2010). PRACTICE GUIDELINE FOR THE Assessment and Treatment of Patients With Suicidal Behaviors [Ebook]. Retrieved 3 October 2022, from https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf.

 

[9]: Robyn, C. (2020). Frequent Mental Distress Among Adults, by Disability Status, Disability Type, and Selected Characteristics — United States, 2018. Morbidity And Mortality Weekly Report, 69(36). https://doi.org/https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a2.htm?s_cid=mm6936a2_w

 

[10]: Friedman, C. (2019). Most People Are Prejudiced Against People with Disabilities – The Council on Quality and Leadership. The Council on Quality and Leadership. Retrieved 3 October 2022, from https://www.c-q-l.org/resources/articles/most-people-are-prejudiced-against-people-with-disabilities/.

 

NDY Vlog Episode 2: Suicide Prevention and the Disability Double Standard

Our News & Commentary Blog

To view the video on YouTube , go here: https://youtu.be/B0z1XnuoSV0

CW: Suicide, ableism

In this vlog, we’ll explore the relationship between suicide prevention, disability, and assisted suicide, as well as the ways disabled people are endangered by policies that devalue our lives.

RESOURCES ON DEINSTITUTIONALIZATION WORK:

Project LETS: https://projectlets.org/advocacy

MindFreedom International: https://mindfreedom.org/about-mfi/

SOURCES:

1&2. APA Suicide Assessment Guidelines: https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf 3. CDC Frequent Mental Distress survey: https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a2.htm?s_cid=mm6936a2_w 4. Prejudice against disabled people: https://www.c-q-l.org/resources/articles/most-people-are-prejudiced-against-people-with-disabilities/ 5. Osteoarthritis stats: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920533/#:~:text=pain%20and%20disability.-,Osteoarthritis%20(OA)%20is%20the%20most%20common%20joint%20disorder%20in%20the,%25%20in%20women%20(2). 6. Disability, vulnerability, and assisted death: https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-019-0426-2 7. Oregon “Death With Dignity” Act 2020 Report: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year23.pdf

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. I wear black hearing aids with pink molds in them. And today, I have on a blue and white houndstooth pattern button down shirt.

September is Suicide Prevention Month. During this month, we share stories of loss, grief, survival, and resilience. We share resources about where to get help if a person is feeling suicidal. We talk about suicide so that people struggling with suicidal thoughts feel more comfortable sharing their stories and seeking help. But one thing we rarely see discussed during this month is the relationship between disability, suicidal ideation, and assisted suicide. That’s what we’re here to explore today.

Let’s explore two scenarios. The first will feature a non-disabled person, and the second will feature a disabled person. While other factors like race, gender, and size, among others, certainly impact the way patients are treated, let’s assume for the sake of this hypothetical scenario that the only difference between these two patients is their disability status.

In scenario one, we have a person who does not have disabilities other than mental health challenges. This person shows up to the hospital with an intent and plan to die by suicide. Maybe they’ve already made an attempt, and have been brought to the hospital by someone else. When this patient is admitted, they are evaluated by a medical professional. This evaluation includes several core components to learn more about the patient’s current state and prior history. These include current plans for suicide, current and previous diagnoses or presentations of psychiatric illness, history of prior suicidal behavior, potential external triggers for the current episode, and the strengths and vulnerabilities the patient has that will inform a treatment plan. Based on the information gathered from the evaluation, the medical professional will prescribe a treatment plan to the patient.

The treatment plan gives the patient instructions, and hopefully support for recovering after a suicide attempt. Sometimes, the patient may choose to stay in the hospital or another inpatient facility, but they should not be forced to do so. Other parts of a treatment plan could be medication interventions, types of psychotherapy, and management of external factors in the person’s life that could trigger future suicidal ideation. The treatment plan is enacted. If the person completes the plan, they can go back to their normal life, hopefully with more tools and resources for managing their mental health. Sometimes, a person may face additional challenges in completing the plan, so the plan is revised, and the person may continue receiving care.

People face many, many barriers in accessing appropriate care after a suicide attempt, including but not limited to forced institutionalization. We can’t cover all of that in this video, but we will link some resources down in the description so you can learn more about these issues and the amazing work being done to combat them.

Now, let’s talk about person two. Person two has a disability that significantly impacts their ability to independently perform activities of daily living, such as feeding themself and using the bathroom. They land in the hospital after a medical event unrelated to mental health. Even if they did not come into the hospital with psychiatric symptoms, the American Psychiatric Association recommends that the patient should potentially undergo a suicide assessment. They cite, quote, “Functional impairments, pain, disfigurement, increased dependence on others, and decreases in sight and hearing,” end quote, as a risk factors for suicide. Now, this is not a wholly unfounded assumption. A 2018 survey of more than 430,000 US adults found that respondents with disabilities were over three times more likely to experience, quote, “Frequent mental distress,” than respondents without disabilities. The problem with these studies is that they draw surface-level correlation between having a disability and being suicidal, when in reality, the barriers disabled people face as a result of living in an ableist society often cause more emotional distress than the disability itself. It is understandable that hospitals would see this data and want to perform a suicide assessment on disabled patients as a preventative measure, since we are much more likely to struggle with, quote, “mental distress”.

But there’s a big difference between using data trends to inform care decisions, and reinforcing the assumption that disabled people must want to die because our lives are so tragic and difficult, an assumption rooted in ableism. For example, osteoarthritis, a joint disorder, is more common in women than in men. But if a woman showed up to the hospital with zero symptoms of osteoarthritis, it would make no sense for doctors to start testing for it rather than managing the issue at hand. It takes time and attention away from the care the patient actually needs in that moment. The same can be said about assuming suicidality in disabled persons.

But what about when a disabled person actually does want to die by suicide? Since we have all this data showing that disabled people are more likely to struggle with mental distress, we should have excellent care measures in place for disabled people who present as suicidal. But in reality, a disabled person’s desires to end their life maybe validated or even encouraged by medical professionals in places where assisted suicide is legal, especially if they have a serious or advanced chronic condition. In short, assisted suicide is death by lethal drugs requested by a person, and prescribed by a medical professional. A person can die by assisted suicide if they feel that the physical pain and/or the emotional struggles of living with a serious illness or disability are too much to live through. If the doctor agrees, the doctor can write a prescription for a medication that will kill the person quickly.

Many proponents of assisted suicide say that it is not the same thing as traditional suicide because people who die this way want to live, but feel they can no longer endure their illness or disability. However, you could make the same argument for unassisted suicide. People who die by suicide don’t want to die for no reason, but rather, because they feel they can’t continue to live given their circumstances. Both assisted and unassisted suicide produce the same result, the intentional, self-inflicted death of a person. The actual and far more dangerous distinction between assisted and unassisted suicide is that the former is deemed a rational response to illness or disability, while the latter is usually seen for the tragedy it is. Therefore, when a disabled patient expresses suicidality, it is seen as rational.

Let’s examine how this puts disabled people at risk. First, we have to acknowledge that if a person meets the criteria for pursuing assisted suicide, they are disabled, whether they identify that way or not. We’ll get into the nitty gritty of the assisted suicide process in a future video, but for now, just bear that fact in mind. One of the first steps in the process is that the doctor who prescribes lethal drugs determines, quote, “That the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment,” end quote. Based on reports about people who died by assisted suicide in Oregon, in only 3% of cases was this determination made by a psychological professional.

We can see that quote, “impaired judgment” is a subjective criterion. If the doctor or professional evaluating the patient holds true the ableist notions pervasive in our society, that disabled people are burdens, that our care needs or society’s failure to meet those care needs makes us unable to live happy lives, that our conditions are humiliating, then when a patient gives those reasons for wanting to die, the doctor or professional will not consider that as evidence of impaired judgment. They will write suicidality off as a logical conclusion to being disabled.

The illustration by Toujours Vivant, or Not Dead Yet Canada, pointedly sums up the disability double standard in treatment of suicidality. Illustration is a cartoon drawing depicting a person using a power wheelchair. On their left is a set of stairs leading up to a door with a sign above it marked, “Suicide Prevention Program”. On their right is a ramp that is marked as wheelchair accessible, leading up to a door with a sign above it, marked “Assisted Suicide”. The person’s wheels on their wheelchair are pointed toward the ramp up to the door that says “Assisted Suicide”. It will always be easier to let us die than to give us the tools we need to live. It will always be more cost effective to prescribe us a lethal drug, than a course of treatment. And for these reasons, it will always be dangerous for disabled people to live in a society where assisted suicide is legal. Suicide does not have to be our fate. Thank you for watching. Please visit www.notdeadyet.org to learn more about our work. Bye.