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California’s proposed assisted-suicide bill does not require psychiatric evaluations which would rule-out depression, fear or anxiety as a primary motive for requesting assisted suicide, and does not provide adequate checks and balances to ensure that the disabled and elderly are protected. It could also lead to an increase in non-therapeutic suicides as it becomes socially acceptable. Since it costs only $35-50 for life-ending “medication” as opposed to hundreds of thousands of dollars for terminal healthcare the cost-saving incentive is significant.
For the seventh time since 1994, the California state legislature is considering a bill (SB 128) that would authorize mentally competent adults who are diagnosed with terminal diseases to request and receive life-ending “medication.” Although the language of the bill purports to include safeguards against insurance companies soliciting patients to obtain aid-in-dying information by requiring the request to come from the individual, physician, or designee, according to some experts the bill lacks key protections that could leave the elderly, disabled, or those suffering from anxiety or depression vulnerable.
According to University of Irvine Psychiatry Professor, Dr. Aaron Kheriaty, MD who wrote to members of the legislature on April 28, 2015. (http://noassistedsuicideca.org/images/KheriatyLettertoLegislatorsSB128.pdf), the bill “does not require physicians to refer patients for psychiatric consultation to rule-out common mental disorders or other causes that contribute to suicidal thinking and the wish to die.”
According to Dr. Kheriaty, the desire to commit suicide is “almost always a cry for help” and a “distress signal” which may relate to untreated clinical depression, fear, anxiety, under-treated pain, and other stressors. He points out that in Oregon, where psychiatric consultations are not required, only 5% of individuals who died by assisted suicide were seen for psychiatric evaluations before making the decision to end their lives.
Under the proposed legislation, doctors would only need to meet a minimal “good faith” legal standard which, according to Dr. Kheriaty, is much lower than the higher “medical standard of care” that is required in other medical situations, and the law seems to be designed more to protect doctors from liability than to ensure that patients receive proper medical treatment and evaluation before they are provided life-ending treatment.
The California bill is closely patterned after Oregon’s assisted suicide law was passed in 1997. After a decline in Oregon’s suicide rates in the 1990s, non-medical suicides began to rise between 2000 and 2010. Today, according to Dr. Kheriaty, Oregon now has a 35% higher suicide rate than the national average, and preliminary data in Washington state which also legalized physician-assisted suicide shows a similar trend. Nationally, suicide is currently the 3rd leading cause of death among adolescents and young adults.
Most major disability rights groups also oppose bills to legalize physician-assisted suicide. According to Marilyn Golden, a policy analyst for Disability Rights, Education, and Defense Fund, an organization that opposes the legalization of assisted suicide, there is a clear cost incentive for health insurance companies and HMOs to back assisted suicide. The cost of lethal medication is $35-50, which is not even comparable to the cost of treatment for most long-term medical conditions. Per Golden, there is already pressure on medical providers not to prolong life, and the legalization of assisted suicide would create a “significant danger.”‘
In an opinion piece published in the Syracuse Post-Standard, Diane Coleman, president and CEO of Not Dead Yet, a national disability organization that opposes legalization of assisted suicide, writes in the Syracuse Post-Standard that, “The 17 years of reports on medically assisted suicides from the Oregon department of health offer a clear window into motivations behind hastened deaths. The top five reasons doctors give for their patients’ suicides are not pain or fear of future pain, but psychological issues that are all-too-familiar to the disability community: “burden on others” (40 percent), “loss of autonomy” (91 percent) or “loss of dignity” (79 percent).”
“[S]o-called safeguards in assisted suicide bills are hollow,” writes Coleman. “An heir or abusive caregiver can suggest assisted suicide to an ill person, sign as witness to the request, and pick up the drugs. No independent witness is required at the death and in half of Oregon’s cases no such witness was present. So how would anyone know if the lethal dose was self-administered, or even if the person consented at the time? Oregon’s law looks the other way, with no evidence of what happened at the end.”
Coleman calls on state lawmakers to “consider the dangers to the many elders, ill and disabled people who are not safe from mistake, coercion and abuse.”
Unlike previous attempts at legalization, California SB 128 is well funded and has passed through several key committees. If the legislation fails, it will likely be place on the ballot as an initiative in the near future.