By Jennifer Popik, JD, Robert Powell Center for Medical Ethics
A 43 percent rise in doctor-prescribed suicides in Washington State in 2013 was motivated not by pain, but by feared loss of autonomy and “dignity,” according to the official state government report.
Washington State’s annual report covering 2013 states that 91 percent reported to their health care provider concerns about loss of autonomy, 79 percent reported to their health care provider concerns about loss of dignity, and 89 percent reported to their health care provider concerns about loss of the ability to participate in activities that make life enjoyable.
Pain did not even appear on the list of motivations for doctor-prescribed suicide.
The language in the Washington law, developed initially for Oregon, purports to “safeguard” the practice of doctor-prescribed suicide by restricting it to the terminally ill and the competent. At the time of the referendum debate, the principal suicide advocacy group, Compassion and Choices (formerly the Hemlock Society), promoted adoption of the Washington law largely on the basis of the claim that it would be used for dying patients with unbearable pain and suffering.
However, in fact, it promotes death as the “solution” for any whose “quality of life,” in their stated opinion, makes their life not worth living. It has adopted the strategy of legalizing assisted suicide with so-called “safeguards,” and then works to erode these over time.
For one example, after trumpeting “safeguards” in Oregon and Washington laws, in Vermont Compassion and Choices successfully promoted a bill that ultimately has virtually none. For another example, after a Montana court decision held that “consent” is a defense to the crime of homicide, Compassion and Choices issued a factsheet for legislators that said, “The Legislature should affirm the Court’s guidelines, and not place obstacles in patients’ way. The Legislature should affirm that physician participation is voluntary, and enact protections from civil liability and professional sanctions for physicians who practice within the court’s guidelines.”
But the court, while setting a few vague boundaries, never actually issued guidelines. Compassion and Choices does not really advocate for guidelines, so much as employ them to give voters and legislators a false sense of security that people will not be abused under these laws.
Even if the safeguards were legally meaningful, which they are not, how would one go about enforcing them?
Suppose that a cancer patient who has recently moved to Washington requests doctor-prescribed suicide and is given the lethal drugs. Then her daughter, who lives out of state, only finds out about it once her mother has committed suicide. Suppose the daughter knew her mother was being treated for early dementia in a nearby state. Not only would there be no legal requirement to notify the daughter, she also would have a very difficult time seeking legal recourse.
Under the Washington State law, the standard of care doctors are required to meet is lowered far below the regular standard of care in malpractice lawsuits. In addition, the law requires that the death certificates must be falsified, listing an underlying condition as the cause of death, not suicide. One effect is that the real number of suicides can be obscured. So-called safeguards end up protecting all the wrong parties.
Although assisting suicide is only legal for a small fraction of the world’s population, advocates remain focused on promoting this dangerous legislation. Currently, doctor-prescribed suicide is legal in Oregon, Washington, and Vermont –and may have some legal protection in the state of Montana, due to a court decision. Also, an appeal is pending of a Second District court decision in New Mexico that struck that state’s decades-old law protecting against assisting suicide. Most recently, New Jersey is in the crosshairs, with a law like Washington’s bill passing out of the Assembly Health Committee only last week, and Maryland will be a prime target in 2014
In seeking to head off the organized, well-funded lobby that advocates legalization of assisting suicide, it is crucial to expose the inaccuracy of the claim that “safeguards” can effectively prevent abuse.
More information on how the safeguards are an illusion is available here.