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Posted on Thu, Mar. 01, 2007, San Jose Mercury News

Assisted suicide bill puts pressure on patients to die sooner
By Marilyn Golden


For the third time in as many years, a bill to legalize assisted suicide has been introduced in the California Legislature.


At first glance, it seems like a merciful policy. But a closer look uncovers many reasons legalization would be a dangerous mistake. For this reason, it is opposed by a broad coalition that includes many disability rights organizations, the American Medical Association and other medical groups, the American Cancer Society, the League of United Latin American Citizens, the Coalition of Concerned Medical Professionals (which does anti-poverty work in poor communities) and many other organizations. While religious groups are in the mix, the opposition to assisted suicide is a broad coalition of left, right and center. Why such a spectrum of resistance to something that seems so humane?


Supporters of assisted suicide often talk superficially about choice and self-determination. It is crucial to look deeper. We need to think about how assisted suicide would actually function in our medical system and our society. Once legalized, assisted suicide would have many unintended consequences. It would especially affect many people in vulnerable circumstances.


One major reason for the diverse opposition is the deadly mix between assisted suicide and profit-driven managed health care. The cost of the lethal prescription generally used for assisted suicide is about $100. That's far cheaper than the cost of treatment for most prolonged illnesses. The incentive to save money by denying treatment already poses a significant danger. Again and again, HMOs and managed care bureaucrats have overruled doctors' treatment decisions, sometimes hastening patients' deaths. This danger would be far greater if assisted suicide were legal. Denying patients access to life-sustaining treatments while offering them the "choice" of assisted suicide would subtly but coercively steer them toward death. While the proponents of legalization argue that it would guarantee choice, assisted suicide would actually result in deaths due to a lack of choice.


A 1998 study from Georgetown University's Center for Clinical Bioethics underscores the link between profit-driven managed health care and assisted suicide. The research found that the greater the cost-cutting pressure, the greater the willingness to prescribe lethal drugs, if such prescriptions were legal. The study called for "a sobering degree of caution in legalizing [assisted suicide] in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care."


Assisted suicide advocates tout the example of Oregon, which legalized the practice in 1997. But Oregon shines only if you don't look too closely. Each year, Oregon publishes a statistical report that leaves out more than it reveals. In fact, several of these reports have admitted, "We cannot determine whether assisted suicide is being practiced outside the framework of the law.'' The reports provide only general statistics, no details of individual cases. The statute gives the state neither the resources nor the authority to investigate violations. All of the information comes from doctors who prescribed the lethal drugs. Yet doctors who fail to report face no penalty. Autopsies are not required, so there's no way to ascertain the person was terminally ill. The state has never reported on several prominent cases at variance with the law -- these cases came to light only via the Oregon news media. Moreover, the state destroys the paperwork after each annual report, so it's impossible to independently verify the conclusions. The Oregonian, the state's major newspaper, complained in 2005 that the law's reporting system "seems rigged to avoid finding" the answers. Yet the California bill contains the same serious flaws as the Oregon statute on which it is modeled.


The bill's absence of genuine oversight and its weak penalties will allow it to be stretched, as has occurred in the Netherlands. Over the past 25 years, the Dutch approach to "death with dignity" for people with terminal illness has expanded into full-blown euthanasia (lethal injections administered by doctors) for people with chronic illness, people with mental health distress, and even depressed teenagers and infants with disabilities.


We should reject this bill as bad medicine for California.


MARILYN GOLDEN is a policy analyst for the Disability Rights Education and Defense Fund in Berkeley. She wrote this article for the Mercury News.