By Jennifer Popik, JD, Robert Powell Center for Medical Ethics
Editor’s note. My family will be on vacation through the end of this week. I will be posting an occasional new story, but for the most part we will be re-posting columns that ran over the last year. Many will be strictly educational while some will about remind us of notable victories this legislative cycle.
2015 has seen an unprecedented push by advocates of doctor-prescribed suicide to legalize the practice, with about 20 bills introduced in state after state. The organization behind these efforts is Compassion and Choices or C&C (formerly the Hemlock Society).
C&C has gained attention using the case of a California woman with a brain tumor, Brittany Maynard. Maynard moved to Oregon where it is legal to have a physician prescribe a lethal dose of barbiturates to end her life. Yet as disability rights advocate and President of Not Dead Yet Diane Coleman, stated, “Assisted suicide legalization isn’t about Brittany Maynard. It’s about the thousands of vulnerable ill, elderly and disabled people who will be harmed if assisted suicide is legalized.”
Although assisting suicide is only legal for a small fraction of the world’s population, advocates remain focused on promoting this dangerous legislation. Despite well over 140 well-funded attempts and numerous ballot initiatives, its U.S. proponents so far have managed to legalize doctor-prescribed suicide only in Oregon, Washington, and Vermont –and it may have some legal immunity 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 protective law against assisting suicide.
For bills introduced in other states, C&C typically has promoted essentially the same legislative language that currently governs both Oregon and Washington. The language, developed initially for Oregon, purports to “safeguard” the practice of doctor-prescribed suicide by restricting it to the terminally ill and the competent. The so-called safeguards have been widely criticized and the most recent versions of this already dangerous legislation contain even fewer.
These proposals play on many of our worst memories and potential fears – either having seen or dreading having to go through the experience of someone dying badly. Rather than focus attention on improving pain management, training physicians how to manage illness, or teaching doctors how to interact and communicate in a respectful manner with older patients and those with disabilities, who are often marginalized, C&C touts suicide as a “solution.”
Legislatures in multiple states have heard testimony against these bills from countless medical professionals, persons with disabilities, and those who have survived so-called “terminal” diagnosis. The testimony documents the mythical nature of four standard claims by suicide proponents.
1. Myth: You must be terminally ill.
How often does someone live past a doctor’s prognosis? Physicians, by and large, do not like making these kinds of predictions because they are difficult to make and often wrong. Under the laws being promoted, the patient is supposed to have six months to live or less. However, we know in Oregon that people receive lethal prescriptions and long outlive their prognosis. Further, this so-called safeguard has been made to apply to people who no one would think of as terminally ill such as diabetics, those with HIV, or those with hepatitis simply because they would die without treatment in six months—even though with treatment they could live much longer, even indefinitely. Assisting suicide legalization has led people to give up on treatment and unnecessarily lose years of their lives.
2. Myth: The lethal dose will ensure a peaceful death.
Barbiturates, the most commonly used method for doctor-prescribed suicide in Oregon and Washington, do not necessarily lead to a peaceful death. Under the law, the patient is prescribed dozens of pills and sent home to overdose. Overdosing on barbiturates has caused documented cases of persons vomiting while becoming unconscious and then aspirating the vomit. People have begun gasping for breath or begun to spasm. Overdosing on these drugs can cause feelings of panic, terror, and confusion. There have also been cases of the drugs taking days to kill the patient. This is hardly the peaceful death that advocates claim.
3. Myth: The patient must be free from mental illness and depression.
There is nothing in existing Oregon, Washington, or Vermont law that requires doctors to refer patients for evaluation by a psychologist or psychiatrist to screen for depression or mental illness. There is also no such requirement in any current proposal in any state. The doctors can make a referral, but nearly never do. In fact, according to the Oregon’s official state reports, in17 years of legalized doctor-prescribe suicide, a mere 5.5% of death candidates have been referred for psychological evaluation.
4. Myth: Everything is working in Oregon .
Barbara Wagner, an Oregon resident, was seeking a cancer treatment from her state health care plan. Astoundingly, she was sent a letter from the Department of Health telling her that her plan would not cover her cancer drugs (about $4,000 a month) but reminding her that she had the option to kill herself with a suicide prescription (about $100), for which the Department would pay. (Source: ABC News, Death Drugs Cause Uproar in Oregon, 8/6/08) She was not the only resident to receive such a letter.
While abuses ranging from a patient with dementia receiving a lethal dose, to numerous non-terminally ill people getting prescriptions, to pressure from the state health plans to utilize the cheaper suicide option have been documented and exposed, the real depth of abuses is difficult to know. The law relies on doctors to self-report. However, there is no penalty if they do not report statistics and complications. Furthermore, doctors are not held to the ordinary standard of medical malpractice in implementing the “safeguards,” but a far lower one. Under Oregon law, the death certificate is actually falsified so that it lists some other condition, not suicide, as the cause of death. And much to the dismay of many families who found this out too late, the law does not require families to be notified of a patient’s suicidal intent.