The National Council on Disability (NCD) released a new report highlighting the dangers of legalizing assisted suicide for the disability community. The NCD also issued a series of recommendations for departments across the government while reaffirming its stance that assisted suicide should not be legal in the United States.
On Wednesday, the NCD published Assisted Suicide Laws and their Danger to People with Disabilities, the second report in its Bioethics and Disability Series. NDC looked at assisted suicide in the state of Oregon, where it has been legal for 20 years. Assisted suicide, which is legal in just under 10 states, is typically available to patients diagnosed with a terminal illness who have six months or less to live. Other regulations, requirements and restrictions vary by state.
In its most recent report, NCD found that most often disabled patients requested assisted suicide because of unmet service and support needs, especially when insurers deny expensive medical treatment and care but pay for lethal drugs. This issue is compounded because people in the disability community are more likely to be unemployed and qualify as low income, which means less access to financial resources for health care.
“Assisted suicide laws are premised on the notion of additional choice for people at the end of their lives,” NCD Chairman Neil Romano said in a press release. “However, in practice, they often remove choices when the low-cost option is ending one’s life versus providing treatments to lengthen it or services and supports to improve it.”
— NCD.gov (@NatCounDis) October 9, 2019
While assisted suicide laws include regulations, there are not any provisions to evaluate whether patients had access to a standard of care that adequately met their needs before considering assisted suicide. That care can be expensive and financially unattractive to insurance companies compared to assisted suicide. Disability advocate Ben Mattlin wrote about this for Vox in 2017.
“Legalization of assisted suicide unduly threatens people with severe disabilities and health care costs, like us,” Mattlin wrote, adding:
In a country where the right to receive health care is under attack and medical costs continue to rise, offering the option of legal suicide is the last thing we need. … A better option, for me, is to ensure that people with ongoing conditions are as welcome and valued as anyone else, and indeed that they are assisted in living their lives to the fullest. Shouldn’t that be the first priority?
The medical community often fails to see the value of disabled lives. The NDC found people with disabilities who requested assisted suicide had internalized oppression, believing negative disability attitudes. They were more likely to see needing supportive care is “undignified,” “burdensome” or “an inherent impediment to quality of life.” This can be reinforced by assisted suicide advocates, medical professionals and society at large.
“Some right-to-die activists have written about assisted dying as an antidote for indignity that occurs at the end of life, such as needing help to dress or use the bathroom,” Carol Gill, Ph.D., professor of disability and human development at the University of Illinois at Chicago, told the American Psychological Association (APA). “If you’re a person with functional limitations, that’s a real slap in the face.”
The NDC’s report found that medical professionals responsible for signing off on assisted suicide under right-to-die laws have very little legal responsibility or accountability, which makes it too easy for bad actors to abuse the system. The NDC also said “that assisted suicide laws require no evidence of consent when the lethal drugs are administered.” The safeguards designed to protect patients are failing.
“I think the cause of this glorifying and accepting euthanasia and physician-assisted suicide is caused by the misconception that people with disabilities cannot live ‘normal,’ happy lives,” wrote Mighty contributor Sarah Todd Hammer. “I have a disability, and I don’t believe my life is any less valuable because of that.”
In its report, the NDC highlighted a handful of studies that suggest states where assisted suicide is legal also have higher rates of suicide overall. One cited study, for example, suggested since assisted suicide was legalized in Oregon in 1997, its overall suicide rate increased 42% above the national average by 2012. And research suggests assisted suicide — and the attention it gets in the media — can also contribute to suicide contagion.
If people in the disability community are told or believe their lives are not as valuable or they are a burden, there may be no difference between wishing to die by assisted suicide and die by suicide. Mainstream suicide prevention initiatives are also not inclusive of people with disabilities. The NDC, therefore, recommended federal and state governments increase their suicide prevention efforts before legalizing assisted suicide to ensure people with disabilities receive appropriate medical and mental health care.
“On days when every breath is a monumental struggle, it can be tempting to give up,” Mattlin wrote for Vox. “I don’t want that option to be too easy. Those of us who may be closer to death have as much right to protection from suicidal wishes as anyone else.”
The NDC raised concern that people with disabilities requesting assisted suicide make a financial or moral decision connected to negative disability attitudes rather than “freedom of choice,” which is typically how advocates frame assisted suicide. “The risks of abuse are significant under assisted suicide laws and safeguards are not effective,” the NDC concluded. Safeguards designed to protect people under current assisted suicide laws are insufficient to protect the disability community from abuse.
“The Patients Rights Action Fund applauds the National Council on Disability for their thorough research that documents how assisted suicide laws and practice are a direct assault on the dignity and lives of people with disabilities,” wrote the Patients Rights Action Fund’s (PRAF) in a statement, adding:
In both the practice and the public policy itself, assisted suicide is inherently discriminatory against people with disabilities, making the struggle to gain equal access to health care even more difficult, resulting in death for the devalued protected class. … We encourage Congress, HHS, and providers alike to act on NCD’s recommendations because assisted suicide not only puts the lives of vulnerable people at risk, but is a pressing threat to equal protection.
NCD, an independent organization tasked with advising the president and Congress on disability issues, recommended additional mental health services in the disability community. The report called for better funding and access to long-term services and supports for people with disabilities and more robust research on the impact of assisted suicide. The NDC also suggested states stop allowing assisted suicide until better safeguards can be put in place to protect the lives of people with disabilities while respecting individual freedoms for end-of-life decisions.
“Having a meaningful life doesn’t necessarily mean that life needs to be pain-free or without physical impairment or functional limitations,” Gill wrote for the APA. “What it means is to remain engaged humanly, and get enough support from others or technology to engage in the activities that matter, that make life meaningful.”