Wednesday, March 21, 2007

Death With Dignity... Or Death of Cruelty?

In November 1994, Oregon voters narrowly passed Measure 16, or the "Death With Dignity Act". And despite all the controversy and legal challenges that have plagued this law since winning the popular vote in 1994, the law still stands... And 246 terminally ill people have so far used the law to decide themselves when their lives would end.

And now, California may be the next state to allow "death with dignity". Assemblymember Patty Berg is reintroducing the "California Compassionate Choices Act", and already Assembly Speaker Fabian Nunez has signed on in support. The Legislature may now be ready to approve this law, but is California ready for legalized physician-assisted suicide? And is physician-assisted suicide really a "choice" that gravely ill people want? Is this "death with dignity"... Or just another death of cruelty?

Follow me down below for more on the controversy swirling around AB 374, the "California Compassionate Choices Act"...

(Cross-posted at Calitics)

So what is AB 374 all about? For Assemblymember Berg, it's about choice... And about our right to choose when and how we die:

The Compassionate Choices Act is about autonomy, privacy and the very unique rights of terminally ill Californians. We think people who will soon die from an untreatable disease should be able to decide how much pain they are willing to endure. And if they choose, they should be able to control their dying.

We know that nearly 7 out of 10 Californians want this right. Hardly any of them will ever need to control their own dying, and yet the vast majority of your friends and neighbors say the choice should be theirs to make.

Californians want to be able to discuss ALL their options with their physician if they are terminally ill. They need to know about hospice care, and about pain management. They want to be able to have these conversations in a way that respects their fundamental right to privacy – a civil right.

OK, so most Californians seem ready for this. After all, who doesn't like choice? But wait, is this really a "choice" that's being offered?

Marilyn Golden, a policy analyst for the Disability Rights Education and Defense Fund in Berkeley, recently wrote an op-ed article for The San Jose Mercury News about what she sees as the hidden problems and loaded "choices" of physician-assisted suicide. Here it is:

One major reason for the diverse opposition is the deadly mix between assisted suicide and profit-driven managed health care. The cost of the lethal prescription generally used for assisted suicide is about $100. That's far cheaper than the cost of treatment for most prolonged illnesses. The incentive to save money by denying treatment already poses a significant danger. Again and again, HMOs and managed care bureaucrats have overruled doctors' treatment decisions, sometimes hastening patients' deaths. This danger would be far greater if assisted suicide were legal. Denying patients access to life-sustaining treatments while offering them the "choice" of assisted suicide would subtly but coercively steer them toward death. While the proponents of legalization argue that it would guarantee choice, assisted suicide would actually result in deaths due to a lack of choice.

So is this really a choice that people can make, or is it a choice that people will be forced to make out of "financial necessity"? Supporters of AB 374 insist that the law is modeled after Oregon's Measure 16, and that like Measure 16, there are strong safeguards against coercion. Advocacy group Death With Dignity argues that the Oregon law does not allow for such coercion, and that the poor and disabled are not "encouraged" to use the law:

The law specifically requires that if there is any evidence of coercion, the process is immediately stopped. Moreover, physicians who work regularly and closely with terminally ill patients ensure that the law’s second physician’s opinion requirement alone ensures against coercion. Further, the State of Oregon reports of no evidence of coercion since the law’s enactment. [...]

To equate a disability with death is insulting, and no one can be encouraged to use the law. The Oregon Death with Dignity Law exists only for dying patients whose mental, physical and emotional suffering has become intolerable and who wish a peaceful and dignified passing. There are many in the disabled community who support the Oregon law – not because they are disabled, but because they are people. [...]

No one is encouraged to use the law. To date, persons who have chosen to use the law have been well educated, have had excellent health care, have had good insurance, have had access to hospice and have been well supported financially, emotionally and physically. Absolutely no HMO or insurance company participates in this process.

OK, so financially secure people use this law. And yes, it looks like no one is being "coerced", or even "encouraged", to use this law. But wait, how closely is Oregon REALLY looking? Marilyn Golden weighs in again:

Assisted suicide advocates tout the example of Oregon, which legalized the practice in 1997. But Oregon shines only if you don't look too closely. Each year, Oregon publishes a statistical report that leaves out more than it reveals. In fact, several of these reports have admitted, "We cannot determine whether assisted suicide is being practiced outside the framework of the law.'' The reports provide only general statistics, no details of individual cases. The statute gives the state neither the resources nor the authority to investigate violations. All of the information comes from doctors who prescribed the lethal drugs. Yet doctors who fail to report face no penalty. Autopsies are not required, so there's no way to ascertain the person was terminally ill. The state has never reported on several prominent cases at variance with the law -- these cases came to light only via the Oregon news media. Moreover, the state destroys the paperwork after each annual report, so it's impossible to independently verify the conclusions. The Oregonian, the state's major newspaper, complained in 2005 that the law's reporting system "seems rigged to avoid finding" the answers. Yet the California bill contains the same serious flaws as the Oregon statute on which it is modeled.

So what is the truth about this law? Will patients be dying with dignity... Or will they truly be dying a death of cruelty? Is this depriving people of their "right to end-of-life care" by just giving them a "loaded option" of killing themselves when they really don't have to? Is this "bringing the practice of hastening death under the light of the law" that will allow terminally ill people to avoid a longer and more painful death than necessary?

Is there an easy way to answer these tough questions?

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