Politics & Policy

In D.C., a Deadly Experiment on the Poor

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The District of Columbia is considering legalizing physician-assisted suicide — here’s why it shouldn’t.

The Council of the District of Columbia plans to vote on “death with dignity” (physician-assisted suicide) legislation November 1. The council, and all of us, have some time to consider the consequences of authorizing lethal prescriptions for people thought to have six months or less to live.

I lived in Washington, D.C., for years and worked there for decades, but now live in Washington State — which has a seven-year record of allowing physician-assisted suicide in such cases.

The state initiative was marketed as a way to allow a free choice for a small number of desperately ill people suffering terrible pain, with safeguards against abuse. The reality has been different.

There is absolutely no reporting or scrutiny of possible abuses. The State of Washington does a statistical report, based entirely on what the prescribing physician says happened; no one can question that account. Original records are destroyed; physicians are legally required to falsify the death certificate, reporting a death from “natural causes.” Despite these obstacles, even the whitewashed state reports show disturbing trends.

First, 938 lethal prescriptions have been written and at least 751 patients have died from taking the drugs in seven years. No one knows what happened to the other nearly 200 lethal overdoses put out into the general population, or who used them for what purpose. Annual reported numbers of those dying from the drugs have tripled in this short time. The drugs are supposedly “self-administered,” but that is defined to mean only that it is the patient who swallows (“ingests”) them, others may feed them to the patient, and no witness is required to assess competency or prevent coercion.

Second, only about a third of the patients mention pain, or even a fear of future pain, as a reason for getting the drugs. Most say they feel they are a “burden” on others. They can hardly feel otherwise, when the State of Washington has exempted these citizens from the usual state program for suicide prevention and is offering them suicide assistance instead. A psychological evaluation to see whether the patient is acting from a treatable depression is optional; 96 percent of those obtaining the lethal drugs never get one.

Third, the great majority of those dying under the law (73 percent) are of age 65 or over. Most (53 percent) are widowed, divorced, or never married. Last year, 71 percent were completely dependent on Medicaid or Medicare for their health coverage, up from 57 percent the previous year. The picture that emerges is of lonely, older patients, dependent on the state for their health care, getting a message from that state that they are useless and should move on to make room for more valuable people. This profile — older, unmarried, dependent on others — matches the profile of those most at risk in our society of being victims of elder abuse, which public-health officials have called an epidemic.

Only about a third of the patients mention pain, or even a fear of future pain, as a reason for getting the drugs.

Finally, the six-month “terminal” diagnosis is guesswork. Last year 16 percent of the people who died after obtaining the drugs lived longer (up to almost two years, having received the drugs in previous years); most of the others, of course, died from the drugs before the six months were up, so no one knows how long they would have lived. The six-month prediction could be false in most cases. Such prognoses are notoriously unreliable at the best of times; with assisted suicide, doctors literally bury their mistakes.

This is happening in a state that is overwhelmingly white, educated, and middle-class. I think of how this agenda would combine with the terrible financial inequities in the District, with its largely African-American cadre of urban poor, and I shudder.

In 1994, the New York State Task Force on Life and the Law studied this issue. Convened by Democratic governor Mario Cuomo, the members were divided on whether assisted suicide could be ethical. But they unanimously opposed legalization, saying that assisted suicide would be practiced “through the prism of social inequality and bias” that characterizes the delivery of health care and other services in our society. They said legalization would “pose the greatest risks to those who are poor, elderly, members of a minority group, or without access to good medical care.”

Given the already troubling signs in states that legalized the practice, the council should have no interest in imposing this social experiment on the poor black citizens of the District of Columbia.


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