Wednesday, February 3, 2021

What the COVID Crisis Tells Us About the Dangers of Assisted Suicide

This article was published by the disability rights group, Not Dead Yet on February 2, 2021.

Diane Coleman, Not Dead Yet
By Diane Coleman

The COVID pandemic revealed that people with disabilities have been denied treatment for the virus due to their disabilities and pervasive biases about their “quality of life”. This denial of care raises the very real issue that persons with disabilities are and will face similar discrimination under assisted suicide laws.

Healthcare providers are the gatekeepers of assisted suicide in states where it’s legal, rendering a terminal prognosis, certifying lack of coercion, etc. Assisted suicide laws immunize providers (and other persons) from criminal and civil liability in the death of an individual. Careful examination of the language in these laws reveals the absence of meaningful safeguards. Nevertheless, public acceptance has largely depended on trust in medical providers’ willingness and ability to protect very ill individuals from mistakes, coercion and abuses, up to and including negligent or intentional homicide. The pandemic has demonstrated that such trust is misplaced.

Media Coverage of Discriminatory Denial of COVID Treatment

A recent article in The Hill (Is Oregon’s physician-assisted suicide law affecting disabled COVID-19 patients?, 12/25/2020) considered the possibility of a link between “Oregon’s decades-old physician-assisted suicide (PAS) law and recent efforts to deny life-saving care to COVID-19 patients with disabilities.”

National Public Radio reporter Joe Shapiro also covered examples of COVID treatment denials involving people with disabilities in Oregon: Oregon Hospitals Didn’t Have Shortages. So Why Were Disabled People Denied Care?, (12/21/2020) and As Hospitals Fear Being Overwhelmed By COVID-19, Do The Disabled Get The Same Access? (12/14/20). The latter article summarized a Harvard researcher:
A “vast majority” of doctors say people with a significant disability have a worse quality of life, according to a recent poll by Dr. Lisa Iezzoni, a Harvard Medical School professor and physician who studies health care disparities for people with disabilities. Her research […was] published in the journal Health Affairs in early 2021.
Unfortunately, discriminatory denial of COVID treatment is not unique to Oregon.

COVID Crisis Standards of Care Discriminate Unlawfully

In response to concerns about shortages of ventilators and other resources to treat COVID patients, many states, local authorities and medical facilities developed policies for allocating resources if there were shortages. These “crisis standards of care” included denial of treatment based on such criteria as:
  • loss of reserves in energy, physical ability, cognition and general health (WA) 
  • intellectual and cognitive disabilities (AL) 
  • cancer with a less than 10- year survival expectation (PA) 
  • individuals who use ventilators on a regular basis may have their ventilators removed and reallocated (KS).

In early 2020, disability advocates began filing formal discrimination complaints against these policies, which were serious enough for the Office for Civil Rights of the U.S. Dept. of Health & Human Services to issue a bulletin stating that:

[P]ersons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative “worth” based on the presence or absence of disabilities or age.
Settlements between the Office for Civil Rights and certain states have resulted in critical policy improvements, but other states have failed to change their policies to comply with federal laws prohibiting discrimination based on disability.

Racial Disparities in Healthcare Increase the Injustices and Risks

Last summer, leading disability rights organizations called for an investigation of an Austin Texas hospital’s conduct relating to Mr. Michael Hickson, a Black man with physical and cognitive disabilities caused by brain injury, who died at the hospital on June 11, 2020. A complaint to OCR stated, “[T]he hospital refused to provide him treatment for his COVID 19, because of his disabilities. One of the doctors, in response to Mrs. Hickson asking if the reason they would not treat him was because of his lack of quality of life due to his disabilities, responded yes.”

Racial disparities in denial of healthcare treatments also increase the dangers of assisted suicide. Leading Black Disabled activist Anita Cameron has explained:
“People of color and people from other marginalized communities are at risk from assisted suicide laws because racial disparities in healthcare:
  • Lead to limited health choices and poorer health outcomes.
  • Make it more likely that doctors will “write off” patients as terminal.
  • Make it less likely that patients can afford life-saving treatment.
  • Make it less likely that patients will receive adequate pain treatment.
With all this, it is clear that legalizing assisted suicide puts people of color, the elderly, people with disabilities and people of certain socioeconomic status at risk of death through mistakes, abuse and coercion.”
National Council on Disability Bioethics Series Documents Rampant Medical Discrimination Against People With Disabilities

The National Council on Disability issued a series of groundbreaking reports on medical discrimination against disabled people, stating:
Despite the growing understanding that disability is a normal part of the human experience, the lives of persons with disabilities continue to be devalued in medical decision-making. Negative biases and inaccurate assumptions about the quality of life of a person with a disability are pervasive in U.S. society and can result in the devaluation and disparate treatment of people with disabilities, and in the medical context, these biases can have serious and even deadly consequences.
These reports covered such topics as organ transplant eligibility, futility policies, “quality adjusted life years” value measures and assisted suicide. As “The Danger of Assisted Suicide Laws” states:
The idea that hastened death is a pathway to dignity for people facing physical decline reveals the public’s extreme disparagement of functional limitations and a perception that “dignity” is not possible for people who rely on supports, technology, or caregivers to be independent or alive. Many hold the attitude that a person with a disability may be better off dead than alive.

Advocacy organizations supporting assisted suicide laws have pushed for public acceptance based on a generalized trust that medical providers are both willing and able to protect very ill individuals from medical mistakes as well as coercion and abuse. But that trust is, in many cases, misplaced and, in all cases, unrealistic. Claims that there have been no abuses are patently false, but more cases would surface if these laws were not designed to hide them. Assisted suicide laws must be rejected. The so-called “safeguards” cannot protect older, ill and disabled people from the discriminatory attitudes that permeate society including, as COVID policies have shown us, the medical system on which all of us depend.

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