Even after working on an issue for decades, you can come across one thing that shifts your perception of what it’s about.
That happened to me recently on the issue of physician-assisted suicide, thanks to an intrepid Swedish investigator named Fabian Stahle.
Stahle saw support growing in his country for a law like Oregon’s, allowing doctors to prescribe a lethal overdose to patients diagnosed as terminally ill. He knew the Oregon law defines a “terminal disease” as “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.”
He wondered if this means only people who will likely die in six months even if they receive treatment, which is what most of us mean by the term. So, he raised this question by email with the Oregon Health Authority. An Oregon official’s answer was that, in determining whether a disease is “terminal,” the question is: “Should the disease be allowed to take its course, absent further treatment, is the patient likely to die in six months?”
Stahle followed up and received further candid answers, which are receiving media attention now that he has posted his email exchange on the internet.
To illustrate what “terminal” means in Oregon, here are three scenarios of people who would be eligible to receive drugs for suicide.
First, a young man with well-controlled juvenile diabetes, who could live for decades, loses his job or is rejected by the woman he loves. Despondent, he stops taking his insulin, then applies for the lethal drugs to finish the job.
What makes his illness “terminal” is his depression. (Oregon’s annual reports say that 96 percent of those obtaining the drugs are not evaluated for depression.)
Second, a man with a spinal cord injury who needs an electric wheelchair and a ventilator to live and work finds that his ventilator no longer works correctly and he can’t afford to fix it. His disability is now terminal and he can obtain suicide drugs.
Disability rights groups like “Not Dead Yet” that have long argued that assisted-suicide laws pose a threat to their members are absolutely right.
Third, a woman with chronic heart and lung conditions common in her age group stays active by taking several medications every day. Her state health plan stops paying for the more expensive ones to save money, and she will likely enter a slow decline toward an earlier death.
Her terminal diseases are old age and lack of wealth. (Oregon’s annual reports show that most people getting the drugs have no or only governmental health insurance, and most are above 65 years old.)
The proponents of such laws have won legislative battles and voter referenda by claiming they affect only those who are dying from conditions that cannot be cured or alleviated.
The officials applying Oregon’s law now say they have always used a more expansive view — you are terminally ill if you can be made terminal by circumstances or the decisions of others. The policy involves not so much a “slippery slope” as misdirection from the outset.
Thus, assisted suicide more clearly emerges as violating our entire vision of social justice. It nudges people toward death who are not “terminal” in any ordinary sense but are elderly, disabled or financially challenged. The class of people treated as “disposable,” to quote Pope Francis, is very broad.
The threat posed by such deadly discrimination should be alarming to all of us — because we must speak for those who cannot fight for their own lives, and because the life we save may be our own.
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