Why Progressives Should Oppose Assisted Suicide

By Marilyn Golden, Policy Analyst Disability Rights, Education and Defense Fund.

April 12, 2005

In January the California State Senate begins hearings on AB 651, which would legalize assisted suicide in California. A similar bill presented in the State Assembly last year but didn't even come to a vote because of overwhelming Democrat and Republican opposition. There is a widespread public perception that those opposed to legalization are religious conservatives, and the logical position for a liberal is in support.

But the coalition that's formed to oppose the bill, Californians Against Assisted Suicide shows a diversity of political opinion that may be surprising to those who have not looked closely at the issue. In opposition are numerous disability rights organizations, generally seen as liberal-leaning; the Southern California Cancer Pain Initiative, a group associated with the American Cancer Society; the California Medical Association; and the League of United Latin American Citizens the oldest civil rights group in California. Catholic organizations are in the mix, but no person would consider this a coalition of religious conservatives. This is a diverse coalition representing many groups coming together across the political spectrum. Why?

Perhaps the most significant reason is the deadly mix between assisted suicide and profit-driven managed health care. Again and again, health maintenance organizations (HMOs) and managed care bureaucracies have overruled physicians' treatment decisions, sometimes hastening patients' deaths. The cost of the lethal medication generally used for assisted suicide is about $35 to $50, far cheaper than the cost of treatment for most long-term medical conditions. The incentive to save money by denying treatment already poses a significant danger. This danger would be far greater if assisted suicide is legal.

If patients with limited finances are denied other treatment options by their insurance, they are, in effect, being steered toward assisted death. It is no coincidence that the author of Oregon's assisted suicide law, Barbara Coombs Lee, was an HMO executive when she drafted it.

A 1998 study from Georgetown University's Center for Clinical Bioethics underscores the link between profit-driven managed health care and assisted suicide. The research found a strong link between cost-cutting pressure and a willingness to prescribe lethal drugs to patients, were it legal to do so. The study warns that there must be "a sobering degree of caution in legalizing [assisted suicide] in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care."

The California bill is modeled after a nearly identical law that went into effect in Oregon in 1997. A closer look at Oregon highlights the many flaws.

Each year, Oregon publishes a statistical report that leaves out more than it states. For example, several of these reports have included language such as "We cannot determine whether assisted suicide is being practiced outside the framework of the law." The statute provided no resources or even authority to detect violations. All we know comes from doctors who prescribed the drugs, not family members or friends who probably have additional information about the patients. Doctors that fail to report their lethal prescriptions face no penalty. The state doesn't even talk to doctors who refused to assist the very same patients other physicians later helped to die, though these doctors who first said "no" may have viewed the patients as not meeting legal requirements, important information if one wishes to evaluate the law's outcomes. Autopsies are not required, so there's no way to ascertain the deceased was actually terminally ill, opening the door to another Dr. Kevorkian. The state's research has never reported on several prominent cases inconsistent with the law – these cases came to light only via the media. Last March, an editorial in The Oregonian complained that the law's reporting system "seems rigged to avoid finding" the answers.

We must separate our private wishes for what we each may hope to have available for ourselves someday and, rather, focus on the significant dangers of legalizing assisted suicide in this society as it operates today. This column is sure to bring howls from those already ideologically supportive of legalization, but anyone who wants to look deeper, beyond the simplistic mantras of choice and "right to die," are encouraged to read other articles and testimony that can be found in these locations:

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