1. Aren’t we making people endure terrible pain and suffering if we don’t allow doctors to help them commit suicide?
- Although physical pain is often given as the main reason for allowing assisted suicide, pain is rarely an important factor when people ask to die. Only 22% of people who ask for assisted suicide in Oregon list “pain or the fear of pain” as the reason they want to die. In fact, physical pain can almost always be controlled.
- When people talk about “suffering” they sometimes mean the grief that comes with any major loss in life, such as losing the ability to walk, or the loss of a spouse or child. With encouragement and support, it’s possible to pass through this grief to feelings of peace and acceptance.
- Another kind of “suffering” has to do with becoming disabled. In Oregon, the reasons people give most often for asking for assisted suicide include: losing the ability to do favorite activities (87%), becoming dependent (90%), feeling like a burden (38%) or fear of losing their dignity because they need help with personal care (84%). Yet with architectural access and consumer-controlled home-based services, people with disabilities can stay active, integrated and in control of their lives.
- People with disabilities worry that these disability-related reasons have become widely accepted as good enough to allow assisted suicide.
All statistics taken from: Oregon Public Health Division, Center for Health Statistics, Oregon Health Authority (2012), Oregon Death with Dignity Act: data summary 2012, State of Oregon, Portland.
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2. What’s disability got to do with it? Isn’t assisted suicide only for people who are terminally ill?
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- Practically all people with “terminal illness” (six months or less to live) have disabilities.
- In every place where assisted suicide is supposed to be only for people who are “terminally ill,” people who are not “terminally ill” are routinely helped to die.
- It is very hard to predict how long someone will live, and doctors sometimes make incorrect diagnoses. We all know someone who has “beaten the odds” and lived much longer than doctors expected. In fact, reports from Oregon Public Health on that state’s “death with dignity” law show that during every year since the program began, people have outlived the six-month cut-off. See Oregon Public Health Division, Center for Health Statistics, Oregon Health Authority (2012), Oregon Death with Dignity Act: data summary 2012, State of Oregon, Portland.
- Under most assisted suicide laws, people with chronic illness and disability are also eligible for assisted suicide.
- In places where assisted suicide is legal, standards for who is eligible have grown more and more relaxed. For example, in the Netherlands, people who are old or simply “tired of life” can have a mobile euthanasia unit come to their home. In Belgium, two deaf men were given euthanasia in 2013 because they were losing their sight, and believed that being deaf/blind would be worse than dying. [Source: Huffington Post]
- People with disabilities are in a “high-risk” category because minor problems can – and often do – become life-threatening. In the hospital, people with disabilities are often badgered to sign “Do Not Resuscitate” orders or encouraged to refuse treatment.
- Nearly all end-of-life care issues – such as access to good health care and pain relief, in-home personal care, peer counseling, and family supports – have been disability rights issues for decades.
3. If only people who request assisted suicide and meet the criteria will be given assisted suicide, where is the danger?
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- Data from places where assisted suicide and euthanasia are legal show that people who are not eligible are often killed anyway. Recent examples in Belgium include Eddy and Mark Verbessen, 45-year-old deaf twins who asked for euthanasia because their vision was failing [source: Huffington Post], and a woman who was euthanized after being sexually assaulted by the psychiatrist who was treating her for anorexia [source: National Post]. In Oregon, annual reports show that at least one person outlives the six-month “terminal illness” cutoff each year. See, for example, the report from 2012: Oregon Public Health Division, Center for Health Statistics, Oregon Health Authority (2012), Oregon Death with Dignity Act: data summary 2012, State of Oregon, Portland.
- It is also dangerous to use the same standards for evaluating suicide requests submitted by someone with a disability as for a non-disabled person. Prejudices about quality of life with a disability shape the responses of medical staff and the general public when talking about these issues, and when responding to a disabled person who wants to kill himself. People assume that disabled people “need help” to kill themselves, that life with a disability is worse than death, and that having a disability means a life without happiness, love or satisfaction. Our lives include more than constant pain and suffering.
- Finally, the effects of discrimination on people with disabilities often go unrecognized. People with disabilities already have fewer choices regarding where and how they live, personal assistance and health care they will receive, and options for transportation and work. By refusing to acknowledge and correct this discrimination, society creates the miserable conditions that drive people with disabilities to want to kill themselves.
4. Aren’t there safeguards in place?
Many safeguards have been suggested and tried. In general, there is not enough oversight before the person dies, and almost no oversight after the person dies. Typical safeguards include:
1. Voluntary request – Requests for assisted suicide are supposed to be made free of influence.
- Discrimination and barriers, rather than the person’s disability, can create the conditions that lead someone to make a request. They may lack the services and supports necessary to be integrated and productive members of the community.
- The person may face pressure because of economic hardship or family stress.
- Comments from family, friends or medical staff may lead someone to feel they are a burden, less valuable because of their illness or disability, or that they’d be “better off dead.”
- Disputes over an inheritance can lead to family members putting direct or indirect pressure on someone to choose death.
- People with disabilities and elders suffer very high rates of abuse both at home and in institutions.
- Undue influence and coercion usually happen behind closed doors and are hard to detect. Most people are too embarrassed to report abuse. Sometimes the abuser is the only caregiver, so reporting the abuse would put the person at risk of living in an institution.
2. Assisted suicide is only supposed to be available to competent adults.
- Many people who ask to die have depression or other mental health issues that interfere with their ability to make clear choices. When these conditions are treated, people often change their minds and want to live.
- Many disabling conditions cause cognitive problems that make it impossible for a person to make an informed choice. General practitioners are neither trained nor qualified to detect these problems.
- Suicidal feelings are treated as legal evidence that a non-disabled person is “a danger to himself,” and can be committed to a psychiatric hospital against his will. This standard does not seem to be applied to disabled people who ask to die. This creates another form of discrimination.
- Deciding if someone is competent is not the same as knowing if they are depressed and treating them for it. Many people with depression don’t appear depressed to someone who doesn’t have any experience in treating depression.
- The standard for competence – who judges and what are the criteria – varies from one place to another. The process and standards may not reflect the seriousness of the life-or-death decision the person is making.
- Most assisted suicide and euthanasia programs do not require an screening by a mental health professional to detect and treat depression or other causes of suicidal feelings.
- Some places allow teenagers to be given assisted suicide and euthanasia, and parents can authorize it on behalf of their children.
3. The person is supposed to provide informed, written consent.
- Information about prognosis and options given by doctors is often biased because of prejudice about the quality of life with a disability.
- Providing information about alternatives to assisted suicide or euthanasia is not the same as making sure the person gets the necessary services to make those options a reality.
- Few laws require doctors to tell the person about home care to help with activities of daily living like dressing, bathing, transfers and using the toilet.
- Information is rarely made available in accessible formats or by unbiased interpreters.
- No laws require that the person asking to die talk to people living happily with that disability.
4. Assisted suicide must be prescribed by a physician
- There’s no requirement that the person have a long-term relationship with the doctor.
- If the doctor says ‘no,’ the person or their family can find another doctor until they find one who will say ‘yes.’ This is called “doctor shopping.”
- Family doctors are not trained to detect mental illness or cognitive problems that could interfere with a clear and informed choice.
- Doctors may not know enough about the person’s living situation or be able to detect abuse.
- Doctors don’t usually know about community supports and services that can help people live independently, or even much about palliative care.
- Doctors face pressure to cut costs.
5. The request for assisted suicide must be approved by a second doctor.
- When a doctor asks another doctor to consult, he will often ask someone he knows will agree with him.
- The second opinion is based only on a short visit and the notes of the first doctor. This is not enough information to make a life-and-death judgment.
- The second doctor is probably also not trained to detect mental illness or abuse.
6. Psychological evaluation.
- These are not usually required.
- Mental health workers have the same prejudices and biases about life with a disability as medical doctors.
- The opinion is based only on a short visit and the notes and opinions of the referring doctor. The psychologist or psychiatrist doesn’t have enough information to make a clear and complete decision
- Mental Health professionals don’t know about community supports and services that can help people live independently.
- In Oregon, doctors rarely ask for a psychological consultation (only 3% in 2008 and only once in 2011) to check for mental health problems that might cause suicidal feelings. Nor do they consult with a social worker who could help put home- and community-based services or peer counseling in place to deal with these feelings.
7. When the method is self-administration …
- No witness is required when the drugs are taken. There’s no way to ensure that it’s voluntary.
- If something goes wrong, there’s no way to help the person.
- A lethal dose of drugs may sit around the house for weeks or months.
8. When the method is euthanasia …
- Doctors sometimes leave it to other staff, like nurses or attendants, to perform the euthanasia, or these staff take it upon themselves.
- Doctors are trained to heal, not kill. Many doctors will not want to perform euthanasia, and people who want the service will have to go to a doctor they don’t know.
- If euthanasia is performed by doctors in hospitals, people may not want to go to the hospital for care, fearing they might be killed.
9. Informing family members
- Some laws require that family members be informed, while others do not.
- Sometimes it’s important to tell family members, so they can provide support or help the person to avoid suicide.
- Sometimes it can cause problems to tell family members, if the family is threatening or abusing the person who wants to die to avoid the risk that what may look like an assisted suicide is actually a homicide.
10. Reporting of assisted suicides/sanctions for not reporting.
- Even when the law requires doctors to report assisted suicides or euthanasia, they don’t always do so:
- If they didn’t follow the correct procedure
- If they don’t consider it an assisted suicide or euthanasia under the law
- If something went wrong
- For any other reason
- There are rarely penalties for doctors who don’t report assisted suicides or euthanasia. Even when there are, doctors are not punished.
- Assisted suicide and euthanasia cannot be counted if they’re not reported.
- Assisted suicides may not be counted as suicides, as in Oregon.
- Doctors won’t report when nurses and other medical staff euthanize some or help them commit suicide.
11. Investigations/prosecutions for violations of the law.
- Government agencies may not have power or funds to investigate problems or abuses.
- Agencies or professional associations who work closely with doctors may have a conflict of interest and not want to investigate.
- After a person is dead, there is rarely anyone who will come forward to say there was a problem.
- The standard of proof that a doctor acted properly may be very low.
The very fact that society considers adopting assisted suicide or euthanasia means that the lives of people who ask to die – mostly the disabled – are considered less important. Others are prevented from killing themselves. When governments legalize these practices, they endorse this devaluation and discrimination.
People with and without disabilities should get the same kind of suicide prevention services.
Social inequality and discrimination against people with disabilities make all safeguards ineffective. The only real safeguard would be true equality, which does not exist and isn’t likely to happen soon.
The people who are most vulnerable under these laws – elders and people with disabilities – suffer much higher rates of abuse than the general public. This law would make it possible for family or friends (including heirs) to pressure, trick or even force someone to accept assisted suicide. Interested parties can help make the assisted suicide request, witness the signature of the form, pick up the prescription and administer the lethal dose.
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5. Assisted suicide has been legalized around the world without any problems. Why shouldn’t we just follow those models?
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- The High Court of Ireland did not agree. In a 2013 decision, the court examined the same evidence used by the British Columbia court in the Carter case. The judges found proof that elders and people with disabilities are at risk of abuse under euthanasia and assisted suicide laws. See the High Court’s judgment here.
- In June 2010, the Canadian Medical Association Journal (CMAJ) published an article exploring physician-assisted deaths under the euthanasia law in Belgium. The researchers found:
- Of the 208 deaths involving physician assisted death, some 66 were without an explicit request
- Of those 66 deaths; the decision was not discussed with 77.9% of those patients.
(Source: Chambaere, K., Bilsen, J., Cohen, J., Onwuteaka-Philipsen, B. D., Mortier, F., & Deliens, L. (2010). Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. Canadian Medical Association Journal,182(9), 895-901. doi:10.1503/cmaj.091876)
- Data from jurisdictions that have legalized physician-assisted suicide) are unreliable. In Washington:
- Assisted suicide deaths are not listed as suicides, but as resulting from the person’s illness.
- No data is collected from doctors who refuse requests for assisted suicide (e.g. why they refused, what happened to the person after the refusal).
- Drugs are not tracked after the prescription is dispensed.
(Source: Washington’s Death With Dignity Act (RCW 70.245.010-903))
- In Oregon:
- There is no way to ensure that a doctor reports writing lethal prescriptions.
- After annual statistical reports are produced, documentation is destroyed, preventing further analysis.(Source: Oregon’s Death with Dignity Act (ORS 127.800-995))
6. Won’t legalizing and regulating assisted suicide reduce the number of wrongful deaths?
There is no evidence to show this has happened, or will happen. If we’ve learned anything, it’s that abuses continue where assisted suicide is legal. We’ve also seen that the eligibility criteria are applied more and more loosely, as in the case of Marc and Eddy Verbessem in Belgium. [Source: Huffington Post] That is called a “slippery slope.”
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7. We know assisted suicide already happens. If we don’t regulate it, won’t we end up with a “macabre specialty” of assisted suicides with no safeguards at all?
Regulations often don’t make a difference in assisted suicide practices.
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- A majority of deaths in Oregon are “guided” by people from Compassion & Choices. This organization bases their physician referrals on the doctors’ willingness to prescribe lethal drugs, rather than their relationship with a patient or expertise. See Dr. Kenneth Stevens’ 2015 report, provided by the Physicians for Compassionate Care Educational Foundation.
- The Final Exit Network has faced criminal charges in situations where “exit guides” held people’s hands down to prevent them from tearing the plastic bag off of their head to stop their “assisted suicides.” [Source: Riverfront Times of St. Louis]
- Clients of the infamous Dignitas clinic in Switzerland do not have to be residents of that country. People from France [source: the Atlantic], the United Kingdom and Germany [source: the Guardian] have traveled to Switzerland seeking assisted suicide. In 2012, the Dutch government launched mobile euthanasia units to make house calls [source: Huffington Post]. Whether or not you can get home care to make your life easier, you can certainly get assistance to die.
8. These suicide requests do not arise from mental illness. These are fully informed, competent people who are not under anyone’s control or influence. They are making a rational choice to avoid tortuous pain and suffering. Shouldn’t we treat them differently from those with “mental illness?”
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- The concept of “rational suicide” has been promoted by a very small but vocal group of researchers, but has not been accepted by any of the major mental health associations. Of 27 scholarly articles found on the topic of “rational suicide and the American Psychological Association,” 12 were written by either James Werth or James Rogers in support of “rational suicide.” Surveys that show support for “Rational Suicide” may, in fact, reveal more about disability bias among mental health professionals.
(Source: Gill, C. J. (2000). Health professionals, disability, and assisted suicide: An examination of relevant empirical evidence and reply to Batavia (2000). Psychology, Public Policy, and Law, 6(2), 526-545. http://dx.doi.org/10.1037/1076-89188.8.131.526)
- In the latest version of the Diagnostic and Statistical Manual (DSM V) released by the American Psychiatric Association in 2012, assessments for suicidality factor in whether a person has a disabling condition as a potential cause. In other words, the presence of a disability is a reason to offer suicide prevention services. (Source: Oquendo, M. A., & Baca-Garcia, E. (2014). Suicidal behavior disorder as a diagnostic entity in the DSM-5 classification system: advantages outweigh limitations. World Psychiatry, 13(2), 128-130. doi:10.1002/wps.20116)
- A variety of social factors can cause suicidal feelings: isolation, bullying, violence, devaluation by society, institutionalization, identity issues, culture and language deprivation, substance abuse, and more. These are all associated with the discrimination of people with disabilities, as well as other groups such as First Nations people, LGBT people, and veterans. In addition, people with disabilities and elders are subject to high rates of abuse and domestic violence, another factor that contributes to suicide.
- Finally, studies done of requests for assisted suicide found that the reasons given by people requesting assisted suicide are the same as those given by other suicidal people. As well, people asking for assisted suicide are likely to be influenced by the same suicide prevention measures which are effective for non-disabled suicidal people.
9. Aren’t we taking away autonomy and dignity by not allowing assisted suicide?
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- For assisted suicide to happen, a third party must step in and take action on your behalf. (True autonomy would mean committing suicide on your own).
- Eligibility for assisted suicide is determined by a third party, according to government standards, decided by a doctor. That’s even more interference.
- The diagnosis and treatment for the underlying illness will be influenced by wait times, access to services adapted to the person’s needs, and the limits of one’s insurance. It can be influenced by many outside factors.
- In an interdependent society “autonomy” is an illusion. We are all dependent on the infrastructure for utilities and transportation, the agricultural, manufacturing and shipping industries for food and other necessities, and a health care and social benefit system for our health and welfare.
10. Aren’t people who cannot commit suicide because they are physically incapable denied choices by making it a crime to help them?
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- Anyone is able to commit suicide. If nothing else, they can refuse to eat or drink. (Many cultures have a tradition of this form of suicide).
- Most often when someone asks to die, it is a cry for help. We should help people live, not die.
11. We euthanize our pets. Why is assisted suicide different?
About 4 million companion animals are euthanized each year, mostly because.
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- They are abandoned.
- They have personality or behavior problems.
- They have costly medical conditions.
- People no longer want to care for them.
- They’re old, incontinent or unsightly.
- They have a terminal illness, or for no reason at all.
12. Isn’t assisted suicide a personal issue? It’s not as if the state is killing people.
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- Public policies for, and the public nature of, suicide prevention makes this a political issue.
- If doctors can prescribe or administer deadly drugs while:
- employed by the health service
- using facilities, and equipment funded by the government
- operating under a programme developed, implemented and operated by the government
…that makes the government directly responsible.
- By allowing assisted suicide, the Canadian government demonstrates its belief that some people are less worthy of suicide prevention than others.
13. Isn’t this about choice?
A number of factors limit the choices available to a person:
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- They may not have access to effective palliative care.
- Their health care may be delayed or denied based on economic factors or accessibility.
- People who don’t have home care services are forced into institutions, or have to rely on family so much that they feel like a burden.
- Anyone could ask for assisted suicide, but government standards and a doctor’s judgment determine who gets it.
- People with disabilities face discrimination and lack adequate supports to live as equals in the community.
14. What’s the difference between withholding or withdrawal of treatment, and assisted suicide or euthanasia? Aren’t they the same thing?
There are several important differences.
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- When a person asks for medical treatment to be taken away (withdrawn) or not given (withheld) they are saying they don’t want to be touched, or want that “touching” to stop. The right not to be touched has been recognized by many courts as a most basic and important right.
- When a person asks for assisted suicide or euthanasia, they are saying they want something done to them. People can ask for a medical treatment, but there is no charter right to any and every medical treatment they ask for.
- Stopping a medical treatment doesn’t always mean the person will die, or that death is intended. The person’s condition could get better, and the person still has the chance to change her mind. Assisted suicide and euthanasia are intended to make the person die, and that is the most likely outcome because a poison is added to the person’s medical problems in order to kill her.
15. Many ethicists and scholars believe withholding treatment and assisted suicide are the same, so shouldn’t they be treated the same under the criminal law?
The opinions of ethicists are divided on whether withholding/withdrawing treatment is the same as assisted suicide. Courts and statutes, on the other hand, say that, for the reasons described above, they are different and should be treated differently under the law.
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16. We already allow withdrawal and withholding of treatment, and the informed consent process used for that seems to work OK. Isn’t that enough for assisted suicide?
In fact there are many problems with the system as it is
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- The use of Do Not Resuscitate (DNR) orders (also known as “no code” or “code zero”) often leads to problems. Studies have shown that:
- Medical staff often withhold other treatments besides CPR (such as dialysis, medications, tests, food and water, transfusions)
- People with disabilities are pressured to sign DNRs, or the orders are simply put on their charts without their knowledge or consent, or that of their families.
- Doctors sometimes give unclear or incorrect information about the medical outcome of signing or not signing a DNR.
- When a person asks that treatment be withheld or withdrawn, hospital protocols do not call for suicide prevention services, even though withholding treatment often leads to death.
- Doctors often wait too long to talk about end-of-life choices. When these conversations happen, the patient may be unconscious or otherwise unable to participate.
- Studies show that doctors sometimes make such decisions without the permission of the person or her family.
- The problems with informed consent that arise in assisted suicide are the same for withholding and withdrawal of treatment.
17. Doesn’t prohibiting assisted suicide discriminate against disabled people who cannot commit suicide on their own?
In a word, no.
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- Removing the criminal penalty from suicide did not make suicide into a program sponsored by the government. Laws that prohibit assisted suicide are applied equally to all people, and are part of a larger social policy to prevent suicides.
- Applying this policy equally to all people is an effort to recognize and address the discrimination that already happens to people with disabilities. Examples include putting “do not resuscitate” orders on the medical charts of disabled people, pressuring disabled people to refuse treatment, and lack of adequate accessibility, services, and supports to be fully integrated in their communities.
- Suicide prevention policies exist to protect many groups who are vulnerable, such as First Nations people, lesbian, gay, bisexual and transgender people, adolescents, veterans and people with disabilities. All of these groups are vulnerable to suicidal feelings because of discrimination, isolation, bullying, violence, devaluation by society, institutionalization, identity issues, culture and language deprivation, substance abuse, and many other social factors.
18. If people with disabilities are not allowed to have assisted suicide, aren’t you implying that they are weak-minded and don’t know what they want?
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- No. We are saying that everyone who says they want to kill themselves – for whatever reason – should get the same suicide prevention services, as well as supports to live (and die) while fully integrated in their communities. Only then will full equality & autonomy be achieved.
19. Prohibiting assisted suicide forces people to die earlier than they want. Doesn’t that deprive them of their charter right to (part of their) life?
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- If a person chooses to commit suicide, that is their decision. The loss of a few months for some people must be weighed against the potential loss of many others’ lives. Any legalized system of assisted suicide is susceptible to mistakes and abuses. By saying that disabled people are eligible to be killed while others are not, the government is giving these abuses a stamp of approval.