The Danger of Assisted Suicide Laws

Part of the Bioethics and Disability Series

National Council on Disability, October 9, 2019 (excerpts)

Executive Summary

Purpose

As one part of a report series on bioethics, this report presents information on how assisted suicide laws may impact policies and practices related to the delivery of medical interventions and life-saving medical care for people with disabilities.

The purpose of this report is to provide an update to the previous NCD analysis of such laws, to examine whether the NCD predictions about the effect of these laws were correct, and to learn more about the relationship between assisted suicide laws and the provision of life-sustaining medical care and palliative care to people with disabilities. Do misunderstandings about the quality of life and the value of the lives of people with disabilities affect the development and operation of such laws? Are there ways to reduce or eliminate harms, and improve the understanding of policy makers, the medical community, and society in general?

Background

Promoted as a way to relieve suffering at the end of life, assisted suicide laws, as they have developed in the United States, generally allow physicians to prescribe lethal drugs to patients diagnosed with terminal illness and with a prognosis of 6 months or less to live, if certain procedural steps are followed. Many national disability organizations have taken positions opposing these laws, due to concerns regarding their impact on people with disabilities.

Key Findings

Safeguards and Their Limitations

Assisted suicide laws contain provisions intended to safeguard patients from problems or abuse. However, research for this report showed that these provisions are ineffective, and often fail to protect patients in a variety of ways, including:

■ Insurers have denied expensive, life-sustaining medical treatment but offered to subsidize lethal drugs, potentially leading patients toward hastening their own deaths.

■ Misdiagnoses of terminal disease can also cause frightened patients to hasten their deaths.

■ People with the disability of depression are subject to harm where assisted suicide is legal.

■ Demoralization in people with disabilities is often based on internalized oppression, such as being conditioned to regard help as undignified and burdensome, or to regard disability as an inherent impediment to quality of life. Demoralization can also result from the lack of options that people depend on. These problems can lead patients toward hastening their deaths—and doctors who conflate disability with terminal illness or poor quality of life are ready to help them. Moreover, most health professionals lack training and experience in working with people with disabilities, so they don’t know how to recognize and intervene in this type of demoralization.

■ Financial and emotional pressures can distort patient choice.

■ Assisted suicide laws apply the lowest culpability standard possible to doctors, medical staff, and all other involved parties, that of a good-faith belief that the law is being followed, which creates the potential for abuse. Lack of Data Collection, Oversight, and Investigation of Mistakes and Abuse

■ There is a substantial lack of data about assisted suicide, due not to lack of research, but to unnecessarily strict privacy and confidentiality provisions in assisted suicide laws.

■ Where assisted suicide is legal, states have no means of investigating mistakes and abuse, nor even a complaint mechanism or similar way for the public to report suspected problems.

■ Nevertheless, a few important conclusions can be gleaned from the minimal available data, including that assisted suicide laws require no evidence of consent when the lethal drugs are administered.

■ Trends show that the minimal amount of data collection that was mandated by earlier state laws is decreasing over time as some newer states adopt less restrictive assisted suicide laws.

How Are Assisted Suicide Laws Viewed by Disability Organizations?

As with many issues and social movements, individuals are not always in complete unison. Many national disability rights organizations oppose the legalization of assisted suicide. All national groups that have taken a position are opposed. NCD respects the rights of individuals to their opinions and acknowledges that some people with disabilities support, or are not opposed to, assisted suicide laws, but NCD, for the reasons described in this report, maintains its position opposing them. Recent Issues and Events: Bringing the NCD Position Up to Date

■ A Sense of Congress resolution, H.Con.Res.80, was introduced in the 115th Congress to express that assisted suicide puts those most vulnerable at risk of deadly harm. It garnered both Democrat and Republican cosponsors.

■ The risks of abuse are significant under assisted suicide laws and safeguards are not effective.

■ Loosening of the rules is increasing in various aspects of assisted suicide laws—in eligibility, in who can prescribe lethal drugs, in whether waiting periods are mandatory, and in how people with depression are treated—and in turn, each of these increases the risk of danger.

Evidence of suicide contagion in states where assisted suicide is legal has been found in several studies.

■ Improvement in palliative care in the last decade has the potential to reduce requests for assisted suicide, though palliative care should be more socially oriented and disability informed.

■ The criminalization of pain: Due to the opioid crisis, people who depend on opioids to manage pain often find themselves treated like criminals. It may become easier to obtain a prescription to die than one to relieve pain.

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Faulty prognoses pose considerable danger to people with new or progressive disabilities or diseases, who may often be misdiagnosed as terminally ill, but who, like Laurie Hoirup, could potentially outlive these prognoses by years or even decades. Research overwhelmingly shows that people with new disabilities frequently go through initial despondency and suicidal feelings, but later adapt well and find great satisfaction in their lives.25 However, adaptation takes considerably longer than the mere 15-day waiting period required by Oregon-model assisted  suicide laws. During an initial period after a new disability, and before one learns that a disability does not preclude a good quality of life, it can be too easy, where assisted suicide is legal, to make an irrevocable choice to die.

A counterexample was Dr. Richard Radtke, a well-known academic oceanographer in Hawaii for many years. Dr. Radtke had a very disabling form of muscular sclerosis for more than 35 years. In the early period after his diagnosis, with an extremely limiting disability, doctors often misclassified him as terminally ill, and he experienced severe depression for 2 years. Had the option for assisted suicide been available at that time, he later acknowledged that he would have chosen it and died many years earlier. Instead, Radtke went on to a successful academic career, and was a happily married father. After his retirement, he served as president of a charitable foundation, and was grateful for the length and scope of his life, until he finally died of natural causes in 2012….

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Another California example concerns a provision in the law characterized by Rita Marker, Executive Director of the Patients Rights Council, as “extremely dangerous.”

“443.19. (a) The State Department of Public Health shall collect and review the information submitted . . . The information collected shall be confidential and shall be collected in a manner that protects the privacy of the patient, the patient’s family, and any medical provider or pharmacist involved with the patient under the provisions of this part. The information shall not be disclosed, discoverable, or compelled to be produced in any civil, criminal, administrative, or other proceeding.” [Emphasis added.]

The first sentence . . . would protect the privacy of patients and individuals participating in doctor-prescribed suicide. However, the second sentence (highlighted in bold) is new. [It] could protect any person who causes a vulnerable patient’s death, even if the person’s actions were in violation of [California’s] End of Life Option Act.

For example, if a family member finds out that someone coerced a loved one into signing the written assisted-suicide request and then forced the loved one to take the lethal drugs after [they] were mailed to the patient’s home, [this] provision would actually prohibit any investigation into the loved one’s death.

This new wording sets the stage for massive patient abuse and complete protection for those engaged in criminal activity that culminates in a patient’s death. Absolutely no information related to the patient’s death could be disclosed to law enforcement or any other investigating body.

Nothing in any other state proposal [until this point in time] has ever contained this type of language.84

The later Hawaii law (2018) contains a similar provision.85

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Loosening of the Rules

Proposals to legalize assisted suicide are gradually growing less and less protective of public safety, and thus, their legalization would pose increased dangers. Loosening of the rules is occurring in a number of different ways.

Examples include…

A recent Hawaii bill had no requirement for a second doctor, often termed the consulting physician, to confirm the patient’s diagnosis or eligibility for assisted suicide. All actions could be carried out by a single attending physician. In the end, this bill failed to pass, though a bill passed the following year that did require a consulting physician’s concurrence.98 … And the Hawaii law, as originally proposed, would have permitted advanced practice registered nurses, as well as doctors, to be “attending provider[s]” who could diagnose a patient’s terminal disease and prescribe lethal drugs.102

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read … Full Report

FW: Scathing Report Shows Assisted Suicide Expansion Leading to Deaths of Treatable Patients