Suicide

Assisted Suicide: A Disability Perspective

Position Paper

National Council on Disability

March 24, 1997

Marca Bristo, Chairperson

Written for the National Council on Disability by Professor Robert L. Burgdorf Jr., University of the District of Columbia School of Law

TABLE OF CONTENTS

Executive Summary

I. INTRODUCTION

II. COMPLEXITY OF THE ISSUES

III. THE CASES UNDER CONSIDERATION BY THE SUPREME COURT

IV. PERSPECTIVES OF INDIVIDUALS WITH DISABILITIES

A. A Split of Opinion?

B. Insights from the Disability Experience

1. The Paramount Issue -- Rights, Services, and Options

2. The Reality and Prevalence of Discrimination

3. Deprivation of Choices and the Importance of Self-Determination

4. Others' Underestimation of Life Quality

5. Fallibility of Medical Predictions

6. Eschewing the Medical Model of Disabilities

7. The Impact of Onset of Disability Upon Emotional State and Decision-Making

8. The Reality of Living with Pain and Bodily Malfunction

9. Divergent Interests of Those Involved in Assisted Suicide Decisions

V. CONCLUSIONS

The Current Situation

Procedural Protections

Weighing the Dangers of Physician-Assisted Suicide Against its Benefits

Executive Summary

Physician-assisted suicide and related issues have garnered much judicial, media, and scholarly attention in recent months. Two cases presently pending before the United States Supreme Court raise the issue of the legality of state laws prohibiting physician-assisted suicide. As the principal agency within the federal government charged with the responsibility of providing cross-disability policy analysis and recommendations regarding government programs and policies that affect people with disabilities, the National Council on Disability is issuing this position paper in the hope of presenting a coherent and principled stance on these issues drawn from the input and viewpoints of individuals with disabilities.

In the body of this position paper, the Council examines a number of insights derived from the experiences of people with disabilities focusing on the following topics:

1. The Paramount Issue -- Rights, Services, and Options

2. The Reality and Prevalence of Discrimination

3. Deprivation of Choices and the Importance of Self-Determination

4. Others' Underestimation of Life Quality

5. Fallibility of Medical Predictions

6. Eschewing the Medical Model of Disabilities

7. The Impact of Onset of Disability Upon Emotional State and Decision-Making

8. The Reality of Living with Pain and Bodily Malfunction

9. Divergent Interests of Those Involved in Assisted Suicide Decisions

Based upon these insights from those who have experienced disabilities and upon the existing legal framework, the National Council on Disability has formulated its position on the issue of physician-assisted suicide for persons with imminently terminal conditions as follows:

The benefits of permitting physician-assisted suicide are substantial and should not be discounted; they include respect for individual autonomy, liberty, and the right to make one's own choices about matters concerning one's intimate personal welfare; affording the dignity of control and choice for a patient who otherwise has little control of her or his situation; allowing the patient to select the time and circumstances of death rather than being totally at the mercy of the terminal medical condition; safeguarding the doctor/patient relationship in making this final medical decision; giving the patient the option of dying in an alert condition rather than in a medicated haze during the last hours of life; and, most importantly, giving the patient the ability to avoid severe pain and suffering.

The Council finds, however, that at the present time such considerations are outweighed by other weighty countervailing realities. The benefits of physician-assisted suicide only apply to the small number of people who actually have an imminently terminal condition, are in severe, untreatable pain, wish to commit suicide, and are unable to do so without a doctor's involvement.

The dangers of permitting physician-assisted suicide are immense. The pressures upon people with disabilities to choose to end their lives, and the insidious appropriation by others of the right to make that choice for them are already prevalent and will continue to increase as managed health care and limitations upon health care resources precipitate increased "rationing" of health care services and health care financing.

People with disabilities are among society's most likely candidates for ending their lives, as society has frequently made it clear that it believes they would be better off dead, or better that they had not been born. The experience in the Netherlands demonstrates that legalizing assisted suicide generates strong pressures upon individuals and families to utilize that option, and leads very quickly to coercion and involuntary euthanasia. If assisted suicide were to become legal, the lives of people with any disability deemed too difficult to live with would be at risk, and persons with disabilities who are poor or members of racial minorities would likely be in the most jeopardy of all.

If