“Euthanasia And Arbitrary Institutionalization Are Both Immoral”

Meghan Schrader

By Meghan Schrader
Meghan is a disability activists and a member of the EPC-USA board.

As I’ve said, I think that one of the most effective ways to prevent euthanasia is for euthanasia opponents to be thinking about what kind of world we want people with disabilities to live in, and do what we can to link euthanasia prevention to creating a better world. 

Hence, I think it’s valuable for euthanasia opponents to be aware of the trend towards broad re-institutionalization that is happening in the United States right now, especially since we know that coerced institutionalization contributes to euthanasia.

Institutions often smell like pee. The odor of urine hangs in the air. If you live in an institution you might get the chance to do something fun once in a while, like make a craft or watch a TV show, but your options for recreation are limited. Your loved ones and friends might come visit you at designated hours. You eat whatever food the institution serves. Often if you want to go to the bathroom, an orderly will have to unlock the door for you. Maybe the person living in the room next to you screams constantly. Maybe your roommate died from a bedsore that became infected because there weren’t enough staff to take care of his needs. 

In many ways living in an institution is like living in prison, except the residents generally aren’t criminals.

So, as a euthanasia prevention advocate, I’m disturbed that apparently, that’s the world that Texas, Florida, Alaska, and the Department of Justice want for some disabled people.

As I’ve noted, a 1999 SCOTUS precedent called Olmstead LC. generally requires states to provide community supports to disabled people who would be unnecessarily institutionalized without them. Ie, SCOTUS held that there may be some people who do need institutionalization in a humane setting, like if they are homicidal, have no ability to care for themselves whatsoever or prefer to live in an institution. But within reason, states can't put disabled people in institutions because states prefer that to community support. This determination created Olmstead’s “community integration mandate,” which helps protect disabled people from living in institutions just because that’s where the supports are.

But now, Texas, Florida, Alaska and the DOJ are fighting to let states design their home and community support systems in a way that would make many disabled people unable to receive the support they need without living in an institution.

This would be the case even when the disabled people aren’t a threat to themselves or others.

Florida, Texas and Alaska are the three states still clinging to the aforementioned Texas vs. Kennedy lawsuit. The lawsuit threatens euthanasia-preventing healthcare protections for disabled people, but especially takes aim at simple, straightforward 2024 guidance about how to implement Olmstead’s mandate that disabled people who aren’t a threat to themselves or others be able to receive services in their communities.

These guidelines were also outlined by DOJ guidance in 2011 and 2020 and aren’t complicated: they define what community integration means and what states must do to achieve it. The regulations define what it means to be at risk of unnecessary institutionalization, and clarify that disabled people need not wait until they are unnecessarily institutionalized to invoke their right to community support. 

But the remaining Texas vs. Kennedy plaintiff states complain that implementing the updated community integration guidance will “add new regulatory burdens and imposes substantial costs on the state.”

(You know, like how the Canadian government sees disability services as a burden, so it’s incentivizing its disabled citizens to die by (MAiD) euthanasia?)

The Department of Justice has been conferring regularly with these states, and despite community integration being enforced by every administration since the Clinton administration, including the President’s first administration, the DOJ is apparently poised to give these states what they want and more.

Repealing the 2024 guidelines would be destructive enough, but the DOJ has now said that longstanding legal interpretations of Olmstead's community integration mandate are null and void: there is no community integration mandate; states don’t have to serve disabled people in the most integrated setting appropriate to their needs.

For instance, having declined to enforce Olmstead, the Department of Justice has asked the United States Court of Appeals for the 11th Circuit to vacate its ruling that Florida illegally withheld the community services necessary for medically fragile children to live at home with their families. A recent court judgment found that Texas violated the law by unnecessarily placing intellectually disabled adults in nursing homes, and the DOJ would like that ruling to be reversed. Alaska, the third state still pursuing the Texas vs. Kennedy lawsuit, was found by the previous administration’s DOJ to have unnecessarily withheld community services from emotionally disabled children. The DOJ will likely seek to nullify that judgment as well.

Hence, the DOJ is failing to protect the same vulnerable people whose flourishing mis being undermined by the euthanasia movement, because that’s what the states of Texas, Florida and Alaska want the DOJ to do.

Incentivizing disabled people to die by assisted suicide violates society’s moral duties to people with disabilities. The current government’s approach to institutionalization also violates those principles. Coercing disabled people into institutions to get your political allies out of a legal pickle is an amoral thing to do.

A lot of people in the current government make vocal appeals to family and moral values. Is forcing intellectually disabled adults to live in understaffed nursing homes that smell like pee, and depriving disabled children of the opportunity to grow up with their families, consistent with those values?

I’m not writing about this issue to shame or praise people for how they vote; my commentary on how other disability issues are related to euthanasia is meant to be nonpartisan. I’ve met people from accross the political spectrum who care about disabled persons.

But recent government choices take steps toward creating a more limited and painful world for people with disabilities. Regardless of anyone’s intentions, making it easier for disabled people to be unnecessarily institutionalized contributes to a culture in which disabled people are so marginalized that offering assisted suicide seems normal and appealing.

It’s unjust to medicalize disabled people’s suicides in order to ease burdens on the medical system.

It’s also immoral for disabled people to shoulder the burden of living in institutions to relieve “regulatory burdens” on the state.

Author Note 1: I did an interview with moral theologian Charlie Camosy about how coerced institutionalization and assisted suicide are connected to one another. It can be read here.

Author Note: Here are the details about the updated Community Integration Mandate that is under threat.