A Primer on Assisted Suicide Laws Presented by Patients Rights Action Fund and Disability Rights Education & Defense Fund 1 Introduction 2 National Disability Rights Organizations Tat Oppose Assisted Suicide Laws 3 Key Objections 6 Article: Assisted Suicide Drives Decisions Based on Cost 7 Article: Who’s Really Hurt By Assisted Suicide? 9 Who’s Behind Assisted Suicide Laws? 10 Resources Appendix A Appendix F 11 Article: Sen. Ted Kennedy’s Widow, 23 Depression and the Wish to Die Victoria Kennedy, Explains Her Opposition to an Assisted Suicide Law Appendix G 24 Appendix B Illness Prognosis 13 Article: Terminally Ill Mom Denied Treatment Coverage - But Gets Suicide Appendix H Drug Approved 25 Assisted Suicide Abuses and Complications from Oregon, Washington Appendix C State and California 15 Article: Lawmakers Rush to Reintroduce End-of-Life Options Act, But Haste Appendix I Makes Bad Policy 30 30 States Have Rejected the Legalization of Assisted Suicide Appendix D 17 Article: Aid in Living, Not Dying Appendix J 33 Appendix E Suicide: For the Right to End-of-Life 19 Testimony of Dr. Gregory Hamilton Care Introduction Disability, illness, dying and death can be complex issues to discuss and think about – especially as it Consider these points: impacts ourselves or our loved ones. All of these • The deadly mix between assisted suicide Assisted Suicide. What is Assisted Suicide? W Assisted Suicide as: “suicide committed by •HMO’s and managed care bureaucracies someone with assistance from another person.” have overruled physicians’ treatment decisions,sometimes hastening patient Practically speaking, Assisted Suicide is the act death; in which a person is prescribed, by a physician, a lethal overdose that they will ingest at some time • The cost of lethal medication generally in the future to end his or her life. While some used for assisted suicide is far cheaper than current laws include provisions like a prognosis the cost of treatment for most long-term of six months or less to live, or that this overdose medical treatments; must be self-administered, legislation has been proposed to remove these minimal protections for • The incentive to save money by denying vulnerable people. danger. This danger could be far greater if issue of Assisted Suicide, we ask that you separate assisted suicide is legal; and private wishes or experiences and, rather, focus on the signifcant risks of legalizing Assisted Suicide in a diverse society – including other treatment options by their insurance, individuals with chronic illness and disability that they are, in effect, being steered toward is not terminal if managed, non-English speaking assisted suicide. y, and limited healthcare specialist access. • While proponents claim there has never been a problem or abuse where assisted We have created this brief issue primer for anyone suicide is legal, there are many well- who wants to look deeper, beyond the simplistic documented problems and abuses; see mantras of choice and “right to die,” or religion. Appendix H, page 25. 1 National Medical, Disability Rights and Other Progressive Organizations That Oppose Assisted Suicide Laws American Academy of Neurology Disability Section of the American AAN Public Health American College of Medical Quality League of United Latin American Citizens ACMQ LULAC American Association of People National Council on Disability with Disabilities NCD AAPD National Council American Disabled for Attendant Programs Today on Independent Living ADAPT NCIL American College of Physicians National Hospice & Palliative Care Organization – American Society of Internal Medicine NHPCO ACP – ACIM National Organization of Nurses American Medical Association with Disabilities AMA NOND American Medical Directors Association National Spinal Cord Injury Association AMDA Not Dead Yet NDY American Nurses Association Patients Rights Action Fund Patients Rights Council Association of Programs for Rural Independent Living Association for Persons with Severe Handicaps APRIL TASH Autistic Self-Advocacy Network United Spinal Association ASAN USA Disability Rights Center World Association of Persons with Disabilities Disability Rights Education & Defense Fund WAPD DREDF 2 Key Objections To the Legalization of Assisted Suicide Financial pressures already play far too great a role in many, if not most, health care decisions. Direct coercion is not even necessary. If insurers deny, or even merely delay, approval of expensive, life-giving treatments that For example, patients Barbara Wagner and Randy Stroup, Oregonians with cancer, were both informed by the Oregon Health Plan that the Plan won’t pay for their chemotherapy, but will pay for their assisted suicide. In California, Stephanie Packer and two patients of Dr. Brian Callister have encountered the same kind of circumstances. As only one example, people with mental illness and depression are given lethal drugs in Oregon, despite the claims of proponents that these conditions disqualify a person. (Read testimony by Dr. Gregory Hamilton, focusing on problems posed by assisted suicide in Oregon for people with psychiatric disabilities, online or turn to Appendix E on page 19.) fewer protections. 3. Most people do so because they fear burdening their families or becoming disabled or dependent, as detailed by the Disability Rights Education & Defense Fund. (See Appendix F on page 23.) Anyone dying in discomfort that is not otherwise relievable, may legally today, in all 50 states, receive palliative sedation, wherein the patient is sedated to the point where the discomfort is relieved while the dying process takes place. Tus, today there is a legal solution to any remaining painful and uncomfortable deaths; one that does not raise the very serious difculties of legalizing assisted suicide. 4. The supposed safeguards included in the handful of states where assisted suicide is permitted don’t really protect patients for many reasons, including these: a. If a doctor refuses lethal drugs because the doctor believes the patient is not eligible under the law, the patient or family simply can – and does – fnd another, willing doctor to fll the deadly script (“doctor shopping”). 3 b. “Six months to live” is ofen wildly misdiagnosed, opening the dangers of assisted suicide to many who are not terminally ill. (See the DREDF statement on Te Fundamental Loophole of Terminal Illness Prognosis online or turn to Appendix G on page 24.) c. Nothing in the Oregon-style law will protect patients when there are family pressures, whether fnancial or emotional, which distort patient choice. d. An article from Michigan Law Review, June 2008, showed how the State of Oregon undermines all the safeguards in the law. Authors Dr. Herbert Hendin and Dr. Kathleen Foley noted, “OPHD does not collect the information it would need to efectively monitor the law and in its actions and publications acts as the defender of the law rather than as the protector of the welfare of terminally ill patients.”1 5. Problems with assisted suicide data collection and data soundness, and the lack of any investigations of abuse or meaningful oversight, are so signifcant as to render conclusions based on those data to be critically fawed. No one is held accountable for failing to report assisting in a suicide, and there is no investigation to see if they have done so. Oregon ofcials have admitted this problem; “We cannot determine whether physician assisted suicide is being practiced outside the framework of the Death with Dignity Act.” Te state has also acknowledged actually destroying the underlying data after each annual report. Regarding abuses that have come to light in Oregon, see handout on Oregon abuses. (See Appendix H on page 25.) 6. Some 30 states have rejected the legalization of assisted suicide (see Appendix I on page 30), contained in roughly 175 different proposals, since Oregon frst passed its law. Many are familiar with the few locations that have assisted suicide laws (See Appendix I). But the truth about legalization eforts is far more telling, as approximately 30 states have consistently rejected legalization. Despite what proponents say, there is signifcant, widespread, bipartisan opposition to assisted suicide. 7. Many key organizations oppose the legalization of assisted suicide. Including, but not limited to the American Medical Association; the National Hospice and Palliative Care Organization; many prominent Democrats and progressives, many disability rights organizations and thenation’s oldest Latino civil rights group the League of United Latin American Citizens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uicide requests from people with terminal illness are usually based on fear and depression. As Herbert Hendin, Chief Executive Ofcer of Suicide Prevention Initiatives (SPI) and Professor of Psychiatry at New York Medical College, stated in Congressional testimony in 1996, “a request for assisted suicide is …usually made with as much ambivalence as are