How assisted suicide discriminates against the poor and disabled

Washington D.C., Feb 28, 2017 / 14:01 pm

While physician-assisted suicide is promoted as empowering terminally-ill patients, it could result in the poor being coerced to take their lives, experts warned at an event this week.

"When you deal with the issue of poverty, this immediately rises up – care is expensive, assisted suicide is not," Sen. James Lankford (R-Okla.) said at a Monday panel on physician-assisted suicide at the Heritage Foundation in Washington, D.C.

The elderly sick may also be taken advantage of, the senator added. They may be told by their families that they are a "burden" on others, or they may simply feel that way. Then "this becomes a guilt issue" as they consider requesting a lethal prescription, he said.

Physician-assisted suicide is currently legal in the District of Columbia and in six states – Washington, Oregon, California, Vermont, and Colorado via state laws, and in Montana through a state supreme court ruling.

Some 24 states are considering legalizing it, according to the group Death with Dignity that promotes these laws around the country. These so-called "Death with Dignity laws" allow patients diagnosed with a terminal illness with six months or less to live to request a lethal prescription from a doctor.

These laws have "otherwise been rejected by the people," noted Ryan Anderson, the William E. Simon senior research fellow in American principles and public policy at the Heritage Foundation. The "vast majority of the states have considered" the laws already and rejected them, he added.

Critics have also warned about loopholes in the laws that provide room for dangerous abuses to take place.

Patients may "doctor-shop" until they find a physician who approves their request for a lethal prescription, even though the doctor may barely know their medical history. Or one witness for the patient's decision to request a prescription may be a financial beneficiary of their death.

However, groups like Compassion and Choices and Death with Dignity are pushing for these laws to be introduced in state legislatures. And if legalized, physician-assisted suicide could prove especially dangerous to vulnerable populations like the poor, the elderly, and the disabled whose health care costs are seen by some as burdensome.

"Already because so many coverage decisions are based on financial considerations, people with disabilities have difficulty accessing the care we need," Lindsay Baran, a policy analyst at The National Council on Independent Living, said in a written statement read at Monday's panel.

In Oregon, she said, "we have several stories from people who have had doctor-recommended treatments denied only to be offered the assisted suicide drug as one of their covered alternatives" by insurance providers.

Physician-assisted suicide can indeed be "promoted" as a "cost-effective treatment," Dr. G. Kevin Donovan, M.D. M.A., professor at Georgetown University Medical Center,  warned at the panel.

Modern palliative care is capable of limiting the physical pain of terminally-ill patients, he added, answering one of the chief arguments of assisted suicide proponents about patients suffering pain for months on end as they prepare to die.

Palliative care is still "underrepresented in the practice of medicine right now," Donovan said, yet "with additional funding" it could become more commonplace.

"Will palliative care be made more accessible when physician-assisted suicide is a legal option? Those who provide funding for health care know that death is always cost-effective," he cautioned.

In California, Catholic opponents of assisted suicide were "told repeatedly by legislators" that "this will never be a publicly-funded benefit," said Kathleen Buckley Domingo, associate director of life ministry for the Archdiocese of Los Angeles.

Yet $2 million was set aside for these drugs by the state of California while 13 million people on the state's Medicare fund are not covered for palliative care, she noted.

"Especially in our immigrant communities…especially in our poor inner city communities, there's a huge disparity in the kind of health care that people are receiving," she said. "They're on MediCal, and this is now the cheapest and easiest option."

The drugs are cheap and also easily available, she said, noting that they can be shipped directly to people's homes.

One woman, Stephanie Packer in Orange, Calif., reported being denied chemotherapy treatment by her insurer while being offered cheap coverage for a lethal prescription, in a documentary produced by the Center for Bioethics and Culture Network.

The elderly sick are also vulnerable to such laws because they may be told by their families that they are a "burden" on others or they may simply feel that way.  

In fact, in 2014 the State of Washington reported that of those who died in the state's Death With Dignity program, almost 60 percent said they were concerned about being a "burden on family, friends/caregivers."

"We have privileged assisted suicide over good medical care," Donovan said, so much so that in California, by law if a hospitalized psychiatric patient has a terminal medical diagnosis, they "have to be released" if they request a lethal prescription.

"This is somebody who isn't entitled to make decisions for themselves. That's why they're in a psychiatric hospital," Donovan said.

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Ultimately, assisted suicide laws are not about empowerment but rather about special interests, the panel said.

Legalizing it "doesn't really give patients any new rights or protections," Donovan insisted, as suicide is currently "legal in all 50 states," but "it's just not legal to help someone or promote it." Rather, "it's a physician-protection law," he said.

The laws are supported by "very few people" who tend to be more well-educated and wealthier, but "those who are put at risk" are many, especially the elderly and those in lower-income brackets.

"I think those are usually called special interest bills," he said.

The bills are also based on a "false reasoning" of autonomy, he added.

"If these bills wanted to honor choice, free choice," he continued, "then how do we justify restricting this to people who are going to be dead in 6 months?" Why not those with nine or 12 month diagnoses, he asked, or the chronically ill or emotionally ill.

Even though proponents of assisted suicide argue that it saves patients from enduring months of painful suffering at the end of their lives, Donovan explained that many physicians may offer incomplete or even incorrect terminal diagnoses.

Two acts physicians do not perform well, he argued, are to "prognosticate the end of someone's life" and "overdose our patients, lethally."