Assisted Suicide: Is It Really Suicide?

Posted by Michael Collins in Life After Paralysis on September 17, 2015 # Advocacy and Policy

The California State Assembly and Senate just passed, and forwarded to Governor Brown for his signature, a bill that that would make physician-assisted suicide legal in a state that apparently wants to keep up with its neighbors Oregon and Washington and three other states. Inclusion of this most populous state on the back of the "death with dignity" bandwagon, when or if it happens, assures that in time it will eventually be accepted as the law of the land in even more states. That will be a sad day in this supposed land of opportunity and equality.

This issue is an important one for all of us who are spinal cord injured or who have some other type of chronic disabling condition that will likely last throughout our lifetimes. In the eyes of those who are pushing these laws through state legislatures, our lives are too often seen as not worth living. Incontinence and inability to control our bodily functions are not terminal conditions, but they rank high on the list of reasons why people choose to seek out physician-assisted death. Are we rapidly approaching the acceptance of the type of institutionalized death as depicted in the 1973 movie Soylent Green? For society's sake, I hope not.

This concern is not new to the disability community. One of the earliest members of the Reeve Foundation blog squad was Laura Hershey, a Colorado advocate who championed the causes of disability rights worldwide. She was passionate about opposing a type of law that can be unfairly applied to people with disabilities who are not actually terminally ill, or even suffering from intractable pain. As a leader of Not Dead Yet, Laura traveled, testified and wrote extensively to warn that those of us whose healthcare opportunities are already limited due to the perception of our worth and the limited resources we have available to purchase quality healthcare would face a greater negative impact from these laws.

During this time of rapidly increasing healthcare costs and reductions in state budgets for public health programs like Medicaid, it is already difficult for many people with disabilities to obtain quality care. Insurance providers, including Medicare and Medicaid, routinely deny more expensive options if they are requested by someone whose quality of life is considered minimal or substandard. Some prescription drug formularies do not list the expensive (or experimental) medication used to treat cancers, expensive radiology treatments are available only after payment of huge deductibles, and both of those situations have a disproportionate impact on those who have been restricted to saving no more than $2,000 due to outdated Social Security Administration regulations.

Compassion & Choices and others who support these "physician-assisted suicide" laws prefer to use the term "aid in dying" to soften the image of a medical professional aiding an individual in taking their life. Proponents claim that these laws simply provide the terminally ill with a means of controlling the pain and avoiding the suffering that comes with the natural process of dying from a terminal illness. Not so.

The 2014 Death With Dignity Act annual report from Oregon, where this law has been in place for a few years, shows that pain is low on the list of reasons why patients sought to have their lives ended artificially. In fact, pain is not even one of the top reasons: Loss of autonomy; loss of dignity; a decreasing ability to participate in activities that made life enjoyable and an inability to control bodily functions were far more important reasons in the minds of those wanting to end their lives early.

So-called "death with dignity" laws appear to relieve physicians of the burden of the Hippocratic oath they took early in their careers, pledging to "First do no harm." The medical professionals who prescribe the medications that kill are absolved from any responsibility or the threat of future lawsuits related to their participation if states adopt these laws. These doctors also seem to prefer a hands-off role when it comes to the actual deaths, as the prescribing physicians in that 2014 report from Oregon were only present at about 13% of the 105 deaths. Worse yet, there is no record of who actually administered that final fatal dose to the suicidal patient. What use will be made of the prescriptions that were given to the other 50 individuals who apparently chose not to take the drugs during the time period of the annual report?

In my mind I find it difficult to separate that image from a similar one. What if a suicidal individual called a suicide prevention hotline and the hotline employee had a firearm delivered to their home to make it easier to take their life at that time? I doubt if society would be so quick to absolve that hotline employee of responsibility for the role they played in the death. No, we expect suicide counselors to convince callers that suicide is not a good option. Yet, here we are.

It seems likely that many of the people who choose this way to end their lives are dealing with depression, yet it is amazing to read that only three of the 105 Death with Dignity Act patients who died in Oregon in 2014 were referred for psychiatric or psychological evaluation. Our country has a pathetic track record when it comes to the quality and availability of mental health services. Many people who could benefit from counseling and treatment are instead left to wander the streets of our cities in a growing legion of the homeless. It would seem that an individual requesting to die at the hands of a physician would be the ideal candidate for some level of mental health evaluation by a qualified professional.

With assets exceeding $22 million in mid 2014, the last year for which reporting is available for this nonprofit organization, it is clear that Compassion & Choices has the resources to continue pushing state legislators to introduce bills legalizing physician-assisted suicide in multiple states. For those who may not be aware of the fact, that organization was originally called the Hemlock Society and had a very negative view of the quality of life of people with disabilities, even those who were not terminally ill. Some things haven't changed.

The juggernaut of additional assisted suicide laws can only be stopped, or at least slowed, by concerned citizens who demand to have a system in place that does not funnel individuals to seek out assisted suicide just because it is the only option available to them.

Those laws in place now, with no requirements for pre-suicide counseling, physician oversight throughout the process, nor lack of follow-up with those who requested the lethal prescriptions but decided not to take them are a poor excuse for what should be just an option when all other healthcare services have been made available and no longer work. Since there are so few controls on the current systems, why not just make the pills available over the counter and encourage anyone to take them who is facing struggle in their daily lives? I imagine that healthcare costs would see an immediate decline if those who make most use of the system were no longer beneficiaries of it. Absurd idea? Of course, but so is the manner in which end of life is being arbitrarily shortened by physician-assisted suicide laws.

If the requirement to obtain a prescription was removed, physicians could be left out of the picture altogether. That would allow them to remain faithful to their Hippocratic oaths while they go about the business of keeping people well or making them better.

As someone who works daily to remain in control of my life, I can sympathize with others who seek to control their lives to the last breath. I had friends who have made that choice; I respected and understood their choices at the time, and will remember them fondly for the good times that we shared. It is just a shame that they had so few other options available to them when making that decision.

© 2015 Michael Collins | Like Mike on Facebook