Source: Syracuse.com
By Stephanie Woodward
In 2019, the New York Legislature will once again consider a bill to permit healthcare providers to give lethal prescriptions to adults who are deemed terminally ill and ask to die. Despite lack of success in the past, proponents will use myths in arguing that legalizing assisted suicide enhances patient choice without compromising patient safety.
Myth #1 is that the bill concerns “aid in dying” and “end of life options” rather than enabling suicide. These are marketing terms. As Dr. Ira Byock, a palliative care specialist has written, “’aid in dying’ makes it sound like giving someone a lethal drug is an extension of hospice and palliative care. It is not.” New York’s highest court has drawn a sharp distinction 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. If the latter was a medical practice, as proponents have stated, there would be no reason for laws to immunize medical professionals from what would otherwise be unlawful behavior, i.e. assisting and abetting suicides.
Myth #2 is that people seek to end their lives because they are in unbearable pain. Oregon data indicates that the leading reasons people request lethal prescriptions are unrelated to pain but are instead related to factors such as perceived lessening of autonomy or dignity. Scant attention is paid to the social forces that may magnify these feelings, such as a society that is grudging about providing needed supports such as consumer-directed in-home care.
Myth #3 is that criteria written into the law will prevent abuses. The healthcare system’s present emphasis on cost cutting makes legalizing assisted suicide inherently dangerous. There have been instances, for example, where insurers have denied payments for treatments that might be helpful but have offered to pay for lethal drugs. Moreover, nothing can prevent erroneous medical predictions and or dilute the influence of the quality of life assumptions of others.
The minimal criteria written into the laws apply only to the prescribing of lethal drugs, and not to their use. Any mental health evaluation to determine if the person has impaired decisional capacity is made when he requests the drugs. In Oregon, evaluations only happen about 5 percent of the time. There is no requirement that a person be evaluated just prior to taking the drugs, although mental state can fluctuate widely over time. Disinterested parties need not be present to ensure the drugs are self-administered. With elder abuse rising, there are bound to be cases where a person is influenced or coerced into taking the pills by someone who has an emotional, practical or financial reason for having him or her die sooner rather than later. Yet, proponents assert there have been no abuses, while the law and medical confidentiality prevent discovery of abuses, and while proponents chafe against waiting periods and what they call “red tape.”
Myth #4 is that “aid in dying laws” only apply to people who are close to death. Byock has aptly observed, “When doctor-induced death becomes an accepted response to the suffering of dying people, logical extensions grease the slippery slope.” Oregon is a cautionary tale here. Most people would view terminal illness as one that will inevitably result in death regardless of treatment. An Oregon health official has opined though that conditions can be deemed terminal even if there is lifesaving treatment but the person is uninsured or cannot afford it. This includes diabetes and other serious conditions which can be medically managed.
Oregon is also considering changing its statutory definition of terminal illness to both eliminate the six-month time frame in which death is expected to occur and to allow ambiguity in the role the condition would play in causing the person’s death. The proposal would define terminal illness as “disease that will, within reasonable medical judgment, produce or substantially contribute to a patient’s death.” This is broad enough to potentially sweep in any chronic condition, disability or age-related ailment that may impact life expectancy in the future and sends a terrible societal message to millions of Americans.
Myth #5 is that the main opposition is faith-based. The staunchest and most credible opponents to legalizing assisted suicide are disability groups, which see how existing inequities in our health care system would be magnified.
As the New York Court of Appeals stated, “potential danger[s] of this dramatic change in public policy would outweigh any benefit that might be achieved.” New Yorkers should continue to say no.