DWD and disability–Part 1

The disability advocacy group Not Dead Yet (NDY) is unalterably opposed to Death With Dignity (DWD) laws.  I am unalterably opposed to anyone or any group that seeks to deny me the autonomy to choose when to exit this life using methods provided by those same DWD laws.  

All people follow their own values when it comes to DWD, whether that means living until natural death, or hastening death using the means provided by a DWD law or wholly through one’s own efforts where such a law is not available.  I spent my entire 40-year legal career representing or advocating for people with disabilities, even taking sign language classes so that I could better communicate with a young client who was deaf and emotionally disturbed.  

NDY’s position on DWD, as well as the similar views of ADAPT, the Center for Disability Rights, and other disability advocates have perplexed me.  They oppose all DWD laws, but as disability rights advocates, they insist on their autonomy to make their own life and death decisions, a position I support.  However, their position with regard to DWD laws denies me autonomy over my own life by preventing me from having the choice of a doctor’s prescription to hasten my own death, should the time come when I want to do so.

I realized recently, while reading an article in Theoretical Medicine and Bioethics as part of research I am doing on depression, that NDY activists do have a valid point that relates to the DWD laws that have been passed in Oregon, Washington, Vermont, the District of Columbia, Colorado, California, and Hawaii.  The author of the article, psychologist Carol J. Gill, made clear to me why it is important to make sure that DWD laws treat fairly those with long-term disabilities or irreversible illness:

People with disabilities, like everyone else, decide to die when life seems untenable.  However, disabilities do not render life untenable; rather, it is society’s treatment of people with disabilities that demoralizes them and spoils their quality of life.  Through discriminatory practices, neglect, social segregation, and impoverishment, society exhausts the spirits of people with disabilities and then, labeling their depression “rational,” lobbies for a legal mechanism to discard them.

While I don’t agree that anyone in the DWD movement (or the society at large) intends by their efforts to “discard” the disabled, Gill summarizes the way people with disabilities might feel about the effect of a DWD law, given the lack of resources available to the disabled in what many people think is one of the most advanced countries on earth.  Disability advocates do not help their cause, however, when they make specious arguments, such as that DWD laws create slippery slopes down which many (most) disabled people will eventually slide to early and unnecessary deaths.  

While slippery slope arguments are not always fallacies, it is essential that there be an actual causal connection between the first action taken and the undesired consequence.  Providing DWD to people who qualify under the narrow circumstances built into the laws does not inevitably lead to the abuse of the disabled.  So, in the case of the current DWD laws, the slippery slope argument is fallacious because there is no authoritative evidence of such abuse, including in Oregon, where the law has been in effect for more than twenty years.

Disability advocates denigrate the supporters of DWD by saying that pets are euthanized not because the pets are in pain, but because their owners can’t bear to see them suffering, implying that someone will want to end the life of a disabled person because she is believed to be suffering.  These advocates refer to pet euthanasia studies that show this phenomenon without giving the references so that others can see the evidence for themselves.  

In my experience, owners usually euthanize pets when the pets appear to be suffering without relief and their veterinarian concurs with the decision.  While veterinary literature does include reports of pet owners euthanizing pets for frivolous reasons–usually convenience, a reason that I find abhorrent–it would be incorrect to suggest that this is the norm.  And disability groups fail to mention that pets are considered the property of their owners, who legally are entitled to make a decision to euthanize them.  But no one owns the disabled, and no one but those disabled individuals can decide if it is time to end their own lives.  

Most important, it should be reiterated, is that all DWD laws are predicated on the independent decision of the applicant for such services, not on a decision by some coercive or abusive third party.

Diane Coleman, President of the Rochester (NY) chapter of NDY, claims that it is dangerous to put lethal drugs in the hands of the old or disabled because they could be coerced into taking them to end their lives against their will.  She would deny such people their right to privacy because she doesn’t trust the “safeguards” that are a part of all DWD laws.  She claims that elder abuse, coercion, and foul play are so rife in our society that these DWD laws cannot be trusted, yet I am not aware of any criminal prosecutions for people who have engaged in such illegal behaviors related to DWD laws.  

I find such views offensive personally because I nursed my 88-year old mother through her final illness, and we had morphine drops in our home (by a doctor’s prescription) to ease her pain, anxiety, and general discomfort when needed.  Apparently, Coleman thinks that my mother should have just suffered through her last days in lieu of having “lethal drugs” on hand.

The facts, as near as I have been able to determine them, are that all of the DWD laws now in force have sufficient safeguards to prevent such abuse, coercion, and foul play.  What is missing from the laws has nothing whatever to do with compelling the disabled to take their own lives.  What is missing is provision for adequate medical, social, and personal resources to aid everyone, including the disabled, to live independent lives of their own choosing.  But this was a problem long before the first DWD law went into effect in Oregon in 1997.

While I am aware that a few writers have proposed involuntary euthanasia for those in certain groups, including the severely mentally disabled, there is no DWD group of which I am aware in the United States that favors such proposals.  

One NDY intern, Sarah Cavar, claims that there are those whose purpose is to “cure the world” of people like her.  If so, I haven’t met them and I find the assertion outrageous.  Certainly, the Final Exit Network believes in no such thing.  The over-riding value to which Final Exit Network (FEN) members adhere is the autonomy of the individual, whether disabled or not.  We work for a right to a good death–a death of our own choosing.

There are some polling data on the attitudes of the disabled in the US about the right to die (RTD). Though I haven’t been able to find national data, I found polling results for a few states.  In 2014, polls in Massachusetts, Connecticut, and New Jersey showed that among the disabled, 74%, 65%, and 63%, respectively, favored Oregon-style DWD laws.  If these results are representative, NDY and the other disability advocacy groups that oppose the RTD are clearly out of touch with RTD opinion among their presumed constituents.

One point disability advocates often make is that most of us will become disabled at some point, many of us as we approach the end of our lives.  So the RTD when we are disabled potentially affects most of us.  I’ll have more to say in Part 2 about where we may be able to find some common ground with those disability advocates who oppose the right to die.