Would Legalizing Physician-Assisted Suicide Endanger Minorities?
The New York State Task Force on Life and the Law wrote in its 1994 report, When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context:
"It must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care. Those who will be most vulnerable to abuse, error, or indifference are the poor, minorities, and those who are least educated and least empowered. This risk does not reflect a judgment that physicians are more prejudiced or influenced by race and class than the rest of society - only that they are not exempt from the prejudices manifest in other areas of our collective life.
While our society aspires to eradicate discrimination and the most punishing effects of poverty in employment practices, housing, education, and law enforcement, we consistently fall short of our goals. The costs of this failure with assisted suicide and euthanasia would be extreme. Nor is there any reason to believe that the practices, whatever safeguards are erected, will be unaffected by the broader social and medical context in which they will be operating. This assumption is naive and unsupportable."
Robert Beezer, 9th Circuit Judge, wrote in his 1996 dissent in Compassion in Dying v. Washington:
"Constitutional protection for a right to assisted suicide might spawn pressure on the elderly and infirm--but still happily alive--to 'die and get out of the way.' Also at risk are the poor and minorities, who have been shown to suffer more pain (i.e. they receive less treatment for their pain) than other groups… Further, like the elderly and infirm, they, as well as the handicapped, are at risk of being unwanted and subjected to pressure to choose physician-assisted suicide rather than continued treatment...
The poor, the elderly, the disabled and minorities are all at risk from undue pressure to commit physician-assisted suicide, either through direct pressure or through inadequate treatment of their pain and suffering. They cannot be adequately protected by procedural safeguards, if the Dutch experience is any indication. The only way to achieve adequate protection for these groups is to maintain a bright-line rule against physician-assisted suicide."
Patricia King, JD, Professor of Law, Medicine, Ethics, and Public Policy at Georgetown University and and Leslie Wolf, JD, MPH, Assistant Adjunct Professor of Medicine, University of California, San Francisco, wrote in their chapter "Lessons for Physician-Assisted Suicide from the African-American Experience," that appeared in the 1998 book Physician-Assisted Suicide: Expanding the Debate:
"Historically minorities and the poor have been abused and have had their preferences ignored, if indeed, their preferences were solicited at all...
Studies show that blacks are substantially less likely than whites to support legalization of physician-assisted suicide...
Specifically, these differences in attitude towards PAS [physician-assisted suicide] may reflect differences in black expresion of health and illness as well as concerns about death. Not only have African-Americans experienced disrespect for their autonomy, they have suffered injustice in medicine as well as in the broader society. As a group, blacks have been abused, neglected and exploited. They have reason to believe that their lives are not valued in the same way as whites' and rationally perceive that, in their encounters with the healthcare system, they are frequently treated differently solely because of their race...
This perception of racial disparities in the healthcare system is supported by a host of studies demonstrating racial differences in health status, access to healthcare and quality of health across a variety of conditions and healthcare settings."
Linda Ganzini, MD, Professor of Psychiatry and Medicine at Oregon Health & Science University wrote in her chapter, "The Oregon Experience," that appeared in the 2004 book Physician-Assisted Dying: The Case for Palliative Care and Patient Choice:
"One concern has been that disadvantaged populations would be disproportionately represented among patients who chose assisted suicide. Experience in Oregon suggests this has not been the case. In the United States, socially disadvantaged groups have variably included ethinic minorities, the poor, women, and the elderly. Compared with all Oregon residents who died between January 1998 and December 2002, those who died by physician-assisted suicide were more likely to be college graduates, more likely to be Asian, somewhat younger, more likely to be divorced, and more likely to have cancer or amytrophic lateral sclerosis... Moreover, although 2.6 percent of Oregonians are African American, no African American patients have chosen assisted suicide."
In Compassion in Dying v. Washington (1996), the United States 9th Circuit Court of Appeals, in a decision delivered by Circuit Judge Stephen Reinhardt, stated:
"One of the majority's prime arguments is that the statute is necessary to protect 'the poor and minorities from exploitation,'-- in other words, to protect the disadvantaged from becoming the victims of assisted suicide. This rationale simply recycles one of the more disingenuous and fallacious arguments raised in opposition to the legalization of abortion. It is equally meretricious here. In fact, as with abortion, there is far more reason to raise the opposite concern: the concern that the poor and the minorities, who have historically received the least adequate health care, will not be afforded a fair opportunity to obtain the medical assistance to which they are entitled -- the assistance that would allow them to end their lives with a measure of dignity. The argument that disadvantaged persons will receive more medical services than the remainder of the population in one, and only one, area -- assisted suicide -- is ludicrous on its face. So, too, is the argument that the poor and the minorities will rush to volunteer for physician-assisted suicide because of their inability to secure adequate medical treatment."
Michael White, JD, Member of the Board of Directors of the Death With Dignity National Center, wrote in his Apr. 22, 1997 "Yes" column to the question "Should Physician-Assisted Suicide Be Legalized?," that appeared on the website for Before I Die: Medical Care and Personal Choices:
"In a workable system, the option of physician-assisted suicide would arise only after all treatment options are exhausted, the best of hospice and palliative care has failed to relieve unbearable suffering, and if a mentally competent patient continues to request assistance in dying. Then, with outside opinion concurring, a physician would be permitted to prescribe medication that the patient could use to hasten death at a time of the patient's choice.
These safeguards would preclude abuse of the handicapped, the incompetent, minorities, the elderly, or other vulnerable populations."