The Olympian: “Physician-assisted suicide symptom of a broken system,” by Joelle Brouner

I received news of this excellent op-ed by disability activist Joelle Brouner late yesterday. I reserve my comments for the end of the article.

Published September 28, 2007
Physician-assisted suicide symptom of broken system

Washington state is no place for the Oregon-style legalization of physician-assisted suicide. Many people with whom I frequently see eye to eye disagree with me on this point. They view the issue simply as one of personal choice. They are mistaken because, for many, the only real choice would be death.

When so many people are uninsured or have inadequate access to medical care, who can choose to receive preventive health care? How many can choose to be diagnosed in time to undergo life-saving treatments? It is cruel to beat the drum of choice when so many are effectively left to choose between death and death.

Then there is the matter of pain. Nobody wants to be in pain and nobody should have to be. Advocating death as a solution to pain is extreme and betrays a lack of ingenuity. Pain does not have to be uncontrollable; it can be effectively managed. By enacting progressive drug policy, we would make more effective pain management strategies available to doctors and their patients and assuage their fear of prosecution. Rather than pave the expressway to death, the Legislature could provide incentives for researchers who expedite the development of innovative drugs and pain-management tools.

Physician-assisted suicide is less about choice or pain management than power. If legalized, physician-assisted suicide will inevitably align the power of the state, big money interests and a broken medical system. If the state sanctions the participation of medical professionals in the killing of patients, the matter transcends the individual who dies. We cannot divorce ourselves from policy decisions made in our name. As citizens, we would all be complicit, by extension, in these deliberate deaths.

Even under the best circumstances, people face disadvantages in navigating state and medical systems. Is it reasonable to expect a person to negotiate with these powerful interests at a time when he or she is likely to have the least energy or emotional reserve? These circumstances are ripe for abuse.

Some who support physician-assisted suicide argue that Oregon- style safeguards will prevent abuses. But in Oregon, the records regarding implementation of physician-assisted suicide are destroyed. There is no way to independently audit them. We are left to trust that the records were accurate and the people who recorded them were truthful.

The American medical system has a long record of bias. Disparities in access to care based on race, class and gender are well documented. Is it so great a leap to think that a system with a record of perpetuating bias could abuse its power to promote death as a management strategy to achieve cost savings?

As a person with a life-long disability, I am all too familiar with the institutional power of the modern medical industry. Like many, I have experienced the consequences of being objectified and discredited within that system. Those who are considered inconvenient, who require too many resources, or who fail to meet an arbitrary health standard, are too likely to be the casualties if death passes for compassionate health policy. I fear that death will become the logical expectation of a system that prizes cost savings above people.

Joelle Brouner, a member of The Olympian’s Diversity Panel, is a disability rights activist.

This blog has already addressed multiple examples of the lack of accountability for medical professional professionals in both California and Oregon, something Joelle expresses concerns about in this piece.

I was digging through old articles and found that Joelle might have hit an important point in the State of Washington. There is evidence in her state that an overwhelming number of people wanting to die due to the very pressures she talks about.

In 1997, Joe Shapiro, then an editor of U.S News & World Report, published a long article on what things looked like in the Netherlands and what it might mean for the U.S. in “Euthanasia’s Home.” He shared this interesting factoid about American motivations, specifically citizens of Washington State:

Most Dutch patients–56 percent–seek euthanasia to avoid “useless suffering.” On the other hand, Americans say they are motivated by the fear of burdening their spouses and families: In a study in Washington State, that reason was cited by 75 percent of those who asked physicians to help them die. No wonder. In the United States, hospitalization and nursing home costs can impoverish. The Dutch face virtually no out-of-pocket expenses at the end of life.

Don’t take that to mean that Shapiro didn’t find any problems with euthanasia practices in the Netherlands. His balanced article found several reasons for concern – such as the light hand with which the courts in the Netherlands have used in dealing with the handful of doctors charged with violating euthanasia and assisted suicide protocols.

Read it. The only way to learn from the past is to actually know something about it. –Stephen Drake