Who Gets to Choose?

by Jean Nandi

On the face of it, Dion Aroner's "Death with Dignity Act," A.B. 1592 seemed like a good idea. Why not give dying folks the right to choose a dignified, early end to hopeless suffering? But close examination reveals the dangers lurking in this apparent liberty.

1. Not everyone will get to choose.

You may choose suicide only if two physicians have attested to your mental "competence." If you are depressed (surely a likelihood if contemplating suicide), you might be counseled by a psychiatrist, but only if your physician thinks you are mentally unbalanced. And if you are too sick or disabled to take a whopping dose of poison on your own, you will not be eligible for the opportunity to kill yourself with your doctor's help.

2. Your choice may be cost driven.

Inadequate home health services may force you into a nursing home, and the quality of your life is likely to deteriorate immediately. Your health plan may deny services which could prolong your life and ease your suffering, and your physician may not be adept at managing your pain. If you are compelled to choose suicide because adequate medical treatment and care is likely to result in your family's financial ruin, is this free choice?

3. Doctors are not omniscient.

Two physicians must agree that you are "likely" to die within six months. But how often have you heard of "miraculous" recoveries? Physicians are not always right, and many of us with disabilities are alive in spite of dire predictions--and some of us in spite of our physicians! I have lived 45 years beyond the first time doctors pronounced my cancer "terminal"--45 rich, full years that I might have needlessly discarded. A.B. 1592 mistakenly presumes that doctors can predict your death with scientific certainty.

4. Few doctors are truly knowledgable about alternatives.

Your physician must inform you about other options prior to prescribing a fatal dose. But those of us living with disabilities know only too well that doctors often undervalue our lives, are too frequently unaware of resources within ourselves and our communities which make our lives meaningful and even happy. In hospitals, persons with disabilities are frequently tricked or subtly pressured into signing "Do Not Resuscitate" orders. Managed care reviews deny potentially costly care that appears "futile" or wasteful of money or resources. It is in this setting that you will need to make your choice.

5. We have choices today.

New legislation is not necessary to provide painkilling drugs to ease one's suffering, even opiates adequate to end one's life "early" if they are prescribed for the purpose of ending pain. New legislation is not needed to allow one to request that treatment or even nutrition be withdrawn, nor is it needed to give one the choice of refusal of treatments that one feels too onerous to bear. The proposed new legislation is bound to harm many, and to help almost none, and we find it unsupportable despite the public's uninformed enthusiasm.

We believe that A.B. 1592--or any similar bill legalizing physician assisted suicide in any form--cannot bring wisdom to our medical profession or protections to our uninsured or underinsured frail and vulnerable seniors, disabled and poor. Rather let us re-educate our caregivers and provide quality health care for all. Let us have Life, not Death, with Dignity!
---Jean Nandi, California Disability Alliance