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.