I write as Director of Public Policy of the Autistic Self Advocacy Network (ASAN), and a member of the Board of Not Dead Yet, to oppose the Death with Dignity Act.
Physician-assisted suicide legislation endangers people with disabilities, including disabilities resultIng from illness. Supporters frequently focus on the “indignity” of needing help to eat, move, or take medications. In Oregon, which passed nearly identical legislation, 93% of those who died from physician-assisted suicide in 2013 cited “loss of autonomy,” or disability, as a motivation. Less than 28% cited concerns about pain control.
This mindset perpetuates stigma, isolation, and depression among people with disabilities, including disabilities related to illness. It also increases already heightened vulnerability to medical discrimination, abuse, isolation, and discrimination.
Instead of addressing these risks, legislation like this bill actively exacerbates them. As we’ve seen in Oregon, which has a similar law, there is no data indicating that the safeguards in this legislation are effective. Although advocates for assisted suicide claim that there is no evidence of abuse in Oregon, the data and individual stories indicate numerous points of concern.
In 2013, only two of the 71 Oregonians who died from physician-assisted suicide were even referred for formal psychiatric or psychological evaluation. Even when physicians did express concerns that an individual was experiencing depression or being pressured by family members, patients have nevertheless received lethal prescriptions through “doctor shopping.” Compassion and Choices facilitates the large majority of physician-assisted suicides in Oregon, according to their own public statements. Unfortunately, Oregon does not collect data on whether or not people who request physician assisted suicide have been previously turned down by doctors.
Oregon also does not officially document cases in which concerns about abuse have been raised, even though there have been numerous such cases. For example, Wendy Melcher, an Oregonian who was dying of cancer, was administered a lethal dose of barbiturates by a nurse, following a plan developed with Melcher’s partner. The nurse, who claimed that she was participating in an assisted suicide plan, had not documented unmanageable pain. No doctor prescribed the lethal dose, Melcher did not self administer the medications, and there were no neutral witnesses to verify the nurses story. The event wasn’t reported to the Oregon Health Authority. Yet no criminal charges were brought, and the case is not even mentioned in any of Oregon’s official records of assisted suicide.
Finally, although this legislation claims to limit its scope to people who have a terminal illness, doctors typically cannot make six-month prognoses with an acceptable level of certainty. The disability community is full of people who have outlived “six-month” prognoses by decades. There is every reason to believe that legalized physician-assisted suicide in California would shorten the lives of many people by months, years, or decades.
When people are offered the option of suicide but not the option of affordable home care, they do not have any meaningful choice. People with significant disabilities due to illness should not have to die in order to have dignity. Instead, they need access to the things that help them make the most of their remaining time: quality palliative care, respectful in-home supports, counseling, and assistive technology to maximize autonomy. Let’s focus on aid in living, not “aid in dying.”