Separating myth and reality in aid in dying

The aid-in-dying issue has come before the legislature before and has been controversial each time.

The virus is surging and the death rate is increasing as the already overburdened health system is in crisis. Yet, there is talk of the legislature again considering a bill to permit doctors to provide lethal prescriptions to terminally ill adults requesting them. This is despite the fact that such bills have stalled in committee five times in the past and due to the pandemic, the legislature may meet virtually for much of the upcoming session. Proponents will be talking about choice and compassion. Let’s separate rhetoric from reality.

Rhetoric: The bill deals with “aid in dying.” Reality: This suggests that the bill would increase access to hospice and palliative care. It would not. It would just enable doctors to give patients a means to end it all. There is quite a difference between a patient deciding when not to have life- prolonging treatment and a doctor actively prescribing lethal drugs for the purpose of directly causing the patient’s death, i.e assisting in a suicide.

As Dr. Joseph Marine, professor at Johns Hopkins University School of Medicine has stated, assisted suicide “is not medical care. It has no basis in medical science or medical tradition… the drug concoctions used to end patients’ lives… come from the euthanasia movement and not from the medical profession or medical research.”  In the year after Washington, D.C passed an assisted suicide law, only two doctors signed up to participate.

Rhetoric: The bill is focused on choice and personal autonomy. Reality: Choice implies a level playing field. In our troubled health system where both costs and profits are soaring, a patient’s medical options usually depend on the quality of their insurance (if any).  Seniors and people with disabilities struggle with “quality of life” prejudices. People of color endure deadly health disparities, which has certainly made clear in the pandemic. Audrey Chapman, a professor of medical ethics at the University of Connecticut Health Center, supports assisted suicide but paradoxically admits that “One would not want a patient to make a decision because they can’t get appropriate medical care,” though that it precisely the situation many people face.

Rhetoric: People seek to end their lives due to pain. Reality: Oregon data indicates that the leading reasons people request lethal prescriptions are psychosocial factors such as perceived lessening of autonomy, or feeling they are a burden. People with disabilities have shown these issues can be addressed by appropriate social supports if the community has the will.

Rhetoric: The law has safeguards that will prevent abuses. Reality: This is wishful thinking. Nothing can prevent erroneous or vague medical predictions even when two doctors are involved. Moreover the minimal criteria written in to the laws apply only to the prescribing of the lethal drugs. Then the person is on their own. Any mental health evaluation to determine if a person has impaired decision-making capacity is only made when he requests the drugs. No evaluation will be done just prior to taking the drugs although mental state can swing wildly based on physical factors like oxygen level. Disinterested parties need not be present when the drugs are swallowed. The practical, financial and emotional difficulties created by the pandemic have caused both domestic abuse and depression to soar, leading people to do or say things they wouldn’t otherwise. Even in ordinary times, there are bound to be cases here or there where a person falls prey to the strong suggestion of another or is the victim of coercion, trickery or worse.

Rhetoric: Doctor-assisted suicide laws only apply to people who will die soon. Reality: Doctors cannot say conclusively when a person will die, especially when the measure is months. Moreover, what is terminal illness is capable of interpretation. For example, an Oregon health official has opined that conditions can be deemed terminal even if there is lifesaving treatment but the person  cannot afford it. This could include diabetes, and other potentially fatal conditions which can be medically managed. Indeed some assisted suicide supporters are advocating dropping any requirement that a “suffering” person’s death be foreseeable and allowing euthanasia as well.

Reality:  In-person testimony is an essential part of governmental decision-making. As Connecticut disability activist Cathy Ludlum has stated, especially with controversial issues, legislators must see their constituents in person and witness their passion. If live public hearings cannot be held this winter or if the people most concerned about an assisted suicide bill would not feel safe attending them even if they were held, the legislature must not consider assisted suicide. It’s that simple.

There are many reasons why assisted suicide bills have failed to pass five times in progressive Connecticut. Bringing up the bill again now should be a non-starter.

Lisa Blumberg is a Hartford area attorney, writer and disability activist.

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