The August 13, 2012 edition of the New York Times contains a puff piece for assisted suicide that uses an anecdote about an Oregon physician to rehash the tattered argument that assisted suicide is safe because most of those who commit suicide where assistance is legal are affluent, insured, and well-educated. Because they could afford to pay for care, they are presumed not to be vulnerable to pressure.
Presumption is far from proof.
In an article published in November 2010 in the Journal of Medical Ethics, UK medical researchers I G Findlay and R. George go after the assumption that affluence equals invulnerability. That presumption, they write, sees “the concept of vulnerability from one perspective only”. They point out that many people, including some researchers, lack objectivity because “those who see a problem from within a set of values have difficulty imagining a view from elsewhere”. Findlay and George argue that it is entirely possible that the wealthy may in fact be more vulnerable than the poor to pressure to commit assisted suicide. The assumption that the poor are more vulnerable, they say, is based on a system of value judgments rather than solid research. An abstract and instructions for buying their article can be found at http://jme.bmj.com/content/37/3/171.abstract. We will be glad to share our copy of the article with individuals on request.
Findlay and George list the following reasons why the affluent may be vulnerable:
1. “…illness and potential dependence are more frightening to them or because they have fewer psychosocial supports”
2. “ …they are people who are familiar with the intricacies of the law and can argue more persuasively with their physicians”
3. “… they may be vulnerable to factors invisible to rigid demographic analysis.”
4. “…stigmatization of illness and disability” may exist among the affluent.
Findlay and George also assert that the continued rise in the number of assisted suicide deaths in Oregon points to the need to investigate a possible role of “media coverage and possible contagion” and “subliminal unintended coercive influence from proponents of PAS….especially in consumerist societies in which citizens may be more sensitive to fashion and the new” and “to feel…that not to conform to the new way is in some manner politically incorrect”.
While Findlay and George don’t limit the possibility of this cultural coercion to the affluent, True Dignity, recognizing that we have our own set of values, believes that wealth creates its own set of pressures to die that come into play the moment assisted suicide is made legal anywhere.
Every Oregon annual report shows that most people dying under Oregon assisted law are over 60 (http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year14-tbl-1.pdf). It is a truism that elder abuse in this country is a huge problem and that much of the abuse is for financial gain. One has only to remember the abuse suffered by Brooke Astor, the NY socialite, widely reported a few years ago (http://en.wikipedia.org/wiki/Brooke_Astor). If wealth did not protect her from being pressured to change her will or from its being changed without her knowledge, why would it have protected her from pressure or coercion to die sooner so that the same people who caused her to change the will could inherit her wealth sooner? Pressure and coercian are antithetical to choice. Attorney Margaret Dore calls assisted suicide “a recipe for elder abuse and the illusion of choice”; she provides much evidence to back up this assertion (http://www.margaretdore.com/vermont.cfm).
We know with certainty that the poor have already been pressured under Oregon’s assisted suicide laws. Two terminally ill Oregon Medicaid patients, Barbara Wagner and Randy Stroup, received letters from the state’s Medicaid program denying coverage for life-prolonging chemotherapy prescribed by their doctors and wanted by them and, in the same letter, offering coverage of assisted suicide (http://abcnews.go.com/Health/story?id=5517492&page=1#.UCkcpKOLUis, with Randy Stroup’s information on page 2). Stroup and Wagner perceived the letters as pressure to die, went public, and, in one case, got the decision overturned and in the other got free chemotherapy drugs from the company that made them. What we don’t know is how many patients received similar letters but did not go public and, whether they accepted the state’s offer of help in committing suicide or not, felt this pressure.
The doctor in the NY Times article (not linked here, but easy to find online) mouths the slogan of the national assisted suicide movement to the reporter: “…it is my life, it is my death, and it should be my choice.”
We say to him that what may (or may not) be his free choice may not be a free choice at all for another, whether that other is rich or poor, insured or not, educated or not. Our personal choices end where they threaten others.
Legal assisted suicide is and will always be a threat to some. We need to do everything possible to keep it from spreading in our country.