Marylanders need health care, not assisted suicide

This article was published by the Frederick News Post on February 17, 2020.

By Katie Collins-Ihrke is the executive director of Accessible Resources for Independence, the Center for Independent Living in Anne Arundel and Howard counties.

The Maryland Legislature is expected to again consider an “end-of-life option” bill in its new session. Once again, disability activists will be a prominent part of the coalition to oppose the bill as a discriminatory overlay to a beleaguered and inequitable health care system.
The bill, an assisted-suicide bill, authorizes health care providers to write lethal prescriptions for people who are considered terminally ill, and grants broad legal immunity to everyone involved in their deaths. It does not provide medical and palliative alternatives. The only course of action it facilitates is death.

People have every right to say no to treatment they don’t want. However, there is a sharp distinction between a patient deciding when not to have life-prolonging treatment and a doctor actively prescribing lethal drugs for the purpose of directly causing the patient’s death. As Dr. Joseph Marine, professor at Johns Hopkins University School of Medicine, has stated, assisted suicide:

“is not medical care. It has no basis in medical science or medical tradition ... the drug concoctions used to end patients’ lives … come from the euthanasia movement and not from the medical profession or medical research.”

Physician-assisted suicide is depicted by its supporters as a choice for patients who have tried everything; however, many Marylanders do not have access to “everything.” The medical system is focused on reducing costs as it remains profit-driven. Many people struggle to obtain basic care. Yet there still are “quality of life” prejudices against elders and people with disabilities, and people of color still cope with deadly health disparities. Survival rates for cystic fibrosis, for example, vary depending on the type of insurance a person has available. With the system so broken and no consensus about solutions either on the state or federal level, it is inherently dangerous to legalize assisted suicide for any class of patients.

Data from Oregon indicates that the leading reasons people request lethal prescriptions are unrelated to pain or unbearable suffering, but rather to factors such as perceived lessening of autonomy or dignity. These issues are difficult but they can be addressed by programs promoting greater access to consumer-directed home aide support and respite care, and a change in attitudes about human interdependence. The disability community has shown that severe physical limitations can be managed to maintain one’s enjoyment of life.

It is telling that supporters of last year’s assisted-suicide bill were critical to the point of abandoning the bill when quite minimal patient protections were added to it. Their concern seemed to be not in avoiding needless premature deaths, but in preventing delays and expenditure of resources. For example, a desire to die may be fueled by depression or other psychosocial factors causing suicidal ideation. But some proponents objected to a requirement that a person get a psychiatric evaluation before being given a lethal prescription because “There is a severe shortage of mental health professionals in Maryland,…[especially] in rural areas.” This seems like a tacit admission that Maryland residents may be underserved in their mental health needs at a time when they need services the most.

“End-of-life option” bills are consistently marketed to the public as applying only to people who are expected to die within six months, not to people with chronic illnesses or disabilities. But buyer, beware! Apart from the fact there is no way to prevent mistakes in diagnosis, even when more than one doctor is involved, the term “terminal illness” can be surprisingly elastic. An Oregon health official has written that conditions can be deemed terminal even if there is lifesaving treatment, but the person is uninsured or cannot afford it. This includes diabetes and other serious conditions which can be medically managed.

Curiously, last year’s proponents of the Maryland bill opposed an amendment to add terms like “irreversible” and “progressive” to the definition of terminal illness. Moreover, a recent medical commenter in the Baltimore Sun has urged that Maryland follow not Oregon, but Canada, which allows both assisted suicide and active euthanasia and which is dropping any requirement that death be “reasonably foreseeable,” thus offering assisted death to anyone with a significant health problem or permanent disability.

Disability advocacy organizations are against giving doctors the authority to write lethal prescriptions, regardless of how an assisted suicide bill is written. Catchphrases can’t change the fact that mistakes, coercion and abuses will occur. We aim for a more equitable and supportive health system which gives people true options so they can live as well as they can for as much time as they naturally have.