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Friday, January 8, 2010

Death Better than Disability?

If assisted suicide is legalised most of the people who will die are disabled. And American disability advocates take a very dim view of it. This is the theme of a hard-hitting series of articles in the latest issue of the Disability and Health Journal.


The editor, Suzanne McDermott, writes that she changed her own mind after studying the issue. At first she believed that assisted suicide was solely a personal autonomy issue. But eventually she was persuaded that it is at the heart of the movement for disability rights: "Almost all people at the end of life can be included in the definition of 'disability'. Thus, the practice of assisted suicide results in death for people with disabilities."

The special issue is a response to a controversial 2008 decision by the American Public Health Association (APHA) to back "aid in dying" (ie, assisted suicide). Several themes emerge from the articles.

First, the very existence of legalised assisted suicide threatens disabled people. It will lead to an expectation that the disabled, elderly and infirm should shuffle off their mortal coil a bit early to relieve the burden on their carers. This fear has been ridiculed by supporters, who contend that all they want is choice at the end of life. Dream on, says Diane Coleman, of the lobby group Not Dead Yet. "Proponents of legalized assisted suicide are willing to treat lives ended through abuses of the practice as 'acceptable losses' when balanced against their wish for a pleasant way out and their unwillingness to accept disability, or responsibility for their own suicide. We disagree."

Second, the danger is not mandated euthanasia, as in Nazi Germany. Rather, it is a subtle and widespread expectation that death is better than disability. "If the legalization of assisted suicide continues, I believe the rank and file will some day see nothing wrong with hastening the deaths of many people," writes Dr Carol J. Gill. "They will stand by and do nothing to stop it and will endorse the policies and institutions that advance it-not because they are evil people but because it will no longer be evil in our culture to do so. It will be compassionate, respectful, routine."

Third, several authors argue forcefully that Oregon's Death with Dignity Act, which is the model for assisted suicide in the US, is deeply flawed. After about 15 years, several intractable problems have emerged. The authors claim that there is very little patient control; that statistics are incomplete; that oversight is minimal and secretive; that safeguards are easily circumvented; and that negligent doctors cannot be prosecuted. Allegations that in Oregon and in the neighbouring state of Washington, which has also legalised assisted suicide, the circumstances of deaths are routinely falsified are especially disturbing. In fact, Washington actually requires that doctors falsify the death certificate by listing the terminal disease as the cause of death rather than the lethal dose of barbiturates. ~ Disability and Health Journal, January

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