Frequently Asked Questions About Assisted Suicide

Responses by Rhonda Wiebe, Co-chair CCD Ending of Life Ethics Committee

Aren’t we subjecting people to unendurable suffering if we don’t allow doctors to help them commit suicide?
 

• Although intractable pain is often given as the primary reason for enacting assisted suicide laws, many studies indicate the reasons doctors actually report for issuing lethal prescriptions are the patient's "loss of autonomy" and "feelings of being a burden".
• The reasons Oregon physicians actually report for issuing lethal prescriptions are the patient's “loss of autonomy” (90%), “less able to engage in activities” (87%), “loss of dignity” (84%), and “feelings of being a burden” (38%).
• People with disabilities are concerned that these psychosocial factors have become widely accepted as sufficient justification for assisted suicide, with most physicians not requesting a psychological consultation (only 3% in 2008) or the intervention of a social worker familiar with home- and community-based services that might alleviate these feelings. That’s not a safeguard.
•  None of these reasons justify a lethal response.

What’s disability got to do with it? This is for people who are terminally ill.

• Virtually all end-of-life care issues such as access to competent health care, adequate pain relief, in-home personal care, peer counselling, family supports have been disability rights issues for decades.
• These issues can be successfully addressed. The disability community has already drawn that map.
• The emotions that arise when you are worried that these kinds of needs won’t be met are not resolved by, nor do they justify, a lethal response.
• Those who object to disability rights involvement have clearly not considered that people who are `terminal` based on a medical prediction of death within 6 months to a year are invariably disabled.

Aren’t there safeguards in place?
 

• The very fact that a law is proposed that applies different standards to some suicidal people than others is proof that there’s devaluation and discrimination. Nondisabled people are often offered suicide prevention.
• Two studies (by the National Council on Disability and the Council of Canadians with Disabilities) have shown that the safeguards necessary would make the procedure so onerous as to render the law unworkable.
• There’s a bright line in the law now because people have the right to refuse life-sustaining treatment but not the right to demand lethal measures.  If you take that bright line away, there’s no knowing where it stops. 
• The conditions for true equality don’t exist and aren’t foreseeable.
•  Data gathered by the Oregon Public Health Division, (OPHD) indicated that previous reports overreached their suppositions that patients who requested assisted suicide were receiving inadequate end-of-life, and these conclusions were drawn without substantial evidence from families who observed the pain or distress of their relatives who received end-of-life care. Furthermore, new surveys of nurses and doctors who cared for hospice patients do not support this contention.

Jurisdictions have legalized assisted suicide and put in safeguards that have been very successful. Why shouldn’t we just follow those models?
 

• The Canadian Medical Association Journal (CMAJ) published an article June 15, 2010 (CMAJ June 15, 2010, vol. 182 no. 9 895-901).  It looked at physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. The results are as follows:
• Of the 208 deaths involving physician assisted death, some 66 were without an explicit request and in those 66 deaths; the decision was not discussed in 77.9% of those patients.
• The data from Oregon and other places that supports physician assisted suicide is unreliable because it has hidden facts by doing the following:

• Assisted suicide deaths are not listed as suicides, but as due to the underlying illness.

• No data collected from doctors who refuse requests for assisted suicide (why they refused, what happened to the person afterwards).

• Though doctors are supposed to report writing lethal prescriptions, there’s no way to ensure they do.

• Drugs are not tracked after the prescription is dispensed.

• After annual statistical reports are produced, documentation is destroyed, preventing further analysis.

Aren’t we taking away autonomy and dignity by not allowing assisted suicide?

• In the Carter decision, the plaintiffs characterize the opposing view of the defendants as one where they take the social model of disability too far. The plaintiff said it is one thing to prevent Parliament from imposing burdens on the disabled that may be based on socially constructed limitations; it is entirely another matter to allow Parliament to impose burdens on the disabled because of a fear that socially constructed ideas or limitations can somehow overwhelm individual choice and decision making.
• So, in other words, if there’s someone with a disability who asks for help to commit suicide; and if we consider the possibility that their choice is based on discrimination, by considering that social factors may be at play, we are discriminating against them. 

How can discrimination based on disability be “wiped clean” because the person asking for death is disabled?

Question of inequality: aren’t people who cannot commit suicide because they are physically incapable denied choices by criminalizing the act of assistance?
 

• This speaks to a societal double standard. Are we then saying that suicide is some kind of inalienable right? Why then does everybody else gets suicide prevention? 
• Assisted suicide advocates use the term “death with dignity” to justify assisted suicide, but when asked what “indignities” concern them, they invariably describe the need for assistance in daily activities like bathing and toileting.
• These are disability realities, for many people with disabilities.  These routines are as much a regular part of their day as going to work or brushing your teeth.
• Equating disability with indignity is able-ist.
• Not surprisingly, we often hear that attitude from people who have recently acquired a disability.
• Studies show that if they get adequate supports, many people with disabilities rate their own quality of life as high as, or higher, than members of the general public rates their own lives. 
• In 2001 a study of 32 patients with HIV or AIDS indicated requests for Physician Assisted Suicide were determined by three factors: firstly, deterioration of the loss of functions and an increase of symptoms; and secondly was the “loss of community. These two factors together led to the third factor, the patient’s loss of self...” This is clearly a choice that arises not only  from the disease itself but from the societal pressures that press upon the individual. (Page 26 of Royal Society Report)

Wouldn’t legalizing assisted suicide help some people to live longer?
 

• Again, we are assuming there’s a class of people who shouldn’t benefit from the suicide prevention efforts that apply to the rest of society.
   

Isn’t assisted suicide a psychological comfort? Some people may never ask for help to kill themselves, but at least they have the comfort of knowing they have an option.

• This comfort stems from a discriminatory attitude. Just because it is a comfort to some  does not make it right.

If people can choose the time of their own death, they can have the comfort of dying peacefully with their families and friends. If they can’t choose that time, they may not have that comfort.
 

• How is the devaluation of a person a comfort? It stems from a sense that it is better to be dead than disabled and as such, when I become disabled I do not have to live this way – this is discrimination plain and simple.

People who assist loved ones to commit suicide may be prosecuted. These people aren’t criminals.
 

• How do we know that is their only motive? This is a recipe for abuse. Elders especially need to be vigilant to this.
• A study out of Oregon and Washington asked “Who is present with the person committing suicide when the barbiturates are ingested?” The 2011-12 stats out of the Oregon Public Health District indicate that of the 71 people that were prescribed a lethal does. For 57 of those, it is unknown  who was with them.
• Oregon
  • Loss of Autonomy - 93.8 %
  • Deceasing ability to participate in activities that make life enjoyable - 93.8%
  • Loss of Dignity - 78.5 %
• Washington
  • Loss of Autonomy - 90%
  • Loss of dignity - 64%
  • Deceasing ability to participate in activities that make life enjoyable - 87%

Isn’t opposition to physician assisted suicide contrary to public opinion? The majority of Canadians believe the law should be changed.
 

• The best answer is public opinion shouldn’t ever be the prevailing basis for law or policy.
• How is the polling question asked? Many don’t provide true alternatives. For example, a recent poll asked, ““If you were suffering from incurable pain, would you like your physician to assist you to die?” The question didn’t ask, “Should we invest more in improving pain management?”
• Angus Reid Poll, February 2010, relied upon by supporters, does not define euthanasia nor mention assisted suicide. In fact, when you look at the question asked “do you think people who help a person to commit suicide should be prosecuted?” only 41% of those surveyed indicated that they should not be prosecuted (The February 2010 Survey).
• In December 2010 survey, pain, while not being defined, was a key motivating factor for people agreeing with euthanasia. The survey did not ask the question of “if it could be controlled would you still want assisted suicide or euthanasia?”
• The survey results of the December 2010 poll also makes clear that if a person had a lifelong condition like quadriplegia, 55% oppose that a doctor should help end that person’s life. It would have been a much more informative poll if the only respondents had been people living with quadriplegia rather than able-bodied people trying to presuppose what they would want.