Monday, June 1, 2015

What you don't know can kill you.

This article was posted by Careful on June 1, 2015.

Marilyn Golden
By Marilyn Golden - Senior Policy Analyst with the Disability Rights Education & Defense Fund

In a supplement to her testimony to the California Senate Health Committee on assisted suicide bill SB 128, disability rights expert Marilyn Golden looks at the supposed safeguards in the bill to see if the state’s remaining 3 or 4 million uninsured, and masses of underinsured, would be safe.

Under the bill:

* Two doctors must agree the person meets the law’s criteria. But there’s considerable evidence that in Oregon, if your doctor tells you no, you can shop for a doctor who will say yes. An overwhelming number of Oregon’s suicides were facilitated via the organization Compassion and Choices. How often do these referred physicians say no? We don’t know. The reports don’t tell us.
* The person must be terminally ill with 6 months or less to live. Are depressed persons who are misdiagnosed as terminal given lethal drugs? We don’t know. In Oregon over the last few years, only in 3% of reported cases were people were sent for a psychological assessment, according to Oregon’s own figures, yet depression is the most common cause of a request for death. Have people whose depression could have been successfully treated, died in Oregon? We can’t know.

Now let’s look closer at the annual statistical reports mandated by Oregon’s law and this bill. Do they really show us the full picture?
* Oregon statistics are based solely on self-reporting by doctors. Reporting is required on paper, but there are no penalties if doctors don’t. How many have failed to report? We don’t know. The law authorizes no investigations; nor does this bill.
* How many people who died under the Oregon law, first asked their own doctors and were told “no?” We don’t know – this isn’t counted. 
* How accurate and comprehensive are the Oregon statistics? We don’t know because the state actually destroys its data once each annual report is published, making independent verification impossible. 
* Have people used assisted suicide that could have lived many happy years if treated? We can’t know. 
* How many doctors wrote lethal prescriptions for multiple people last year? We don’t know – starting in approximately 2006, the Oregon reports stopped including this. Why? We don’t know. 
* How many people actually used assisted suicide for pain, rather than depression or fear of the future? Before, I believe, 2006, it was very low. But now, we can no longer know, because starting then, the report combines “inadequate pain control” with “fear of future inadequate pain control.” If this continues, Oregon will have successfully kept hidden how few people actually use lethal drugs due to pain. Why? We don’t know. 
* How many assisted suicides were based on financial concerns? We don’t really know, because doctors don’t always know their patients’ motivations. More than one-third were on either Medicare or Medicaid up through the 8th year, but the Oregon reports don’t tell us whether Medicaid (for poor people) or Medicare. Why not? We don’t know.
Is this the model California really wants to use for something this important?

Marilyn Golden is a Senior Policy Analyst with the Disability Rights Education & Defense Fund (DREDF), a leading US law and policy center on disability civil rights. The above article is supplementary to testimony submitted to the California State Senate Health Committee in March on the assisted suicide bill SB 128. The main part of her testimony is here.

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