Electric EDGE
Web Edition of The Ragged Edge
January/February 1997
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What's wrong with
legalizing assisted suicide
for disabled people?

© Copyright 1996 by Cal Montgomery. All rights reserved.
Do not reproduce this story unless you include this information!

This important essay about assisted suicide was posted to recipients of the Not Dead Yet E-Mail list by Cal Montgomery.

Depression is treated differently if you're disabled
First, many disabled people will come to want to die as the result of depression. Some depressions appear to come about for purely biological reasons, and these are usually treatable by biological means. If the preferred course of action for people whose only disability is depression is anti-depressants, but the preferred course of action for people with other disabilities as well is death, then disabled people will needlessly die. Other depressions appear to come about as an interplay between life situations and the individual (although they may also require anti-depressants to alleviate them).

Disabled individuals, who may deal with discrimination, frustration, lack of access to basic arenas of human interaction, job disincentives, and the sense on the part of other people that they are needlessly taking up resources that other people should get, are more vulnerable than some other populations to reactive depressions.

If you're nondisabled, you get support ...
Particularly vulnerable are those whose disabilities are recently acquired. Again, if you have any disability other than this depression, you are far more likely to be supported in your desire to die rather than to have other people try to help you to find ways to alleviate both the depression and to alleviate or help you learn to live well within the situation in your life that brought it about. It is often *not* the disability, per se, which brought about the reaction, but those social response to disability -- the withdrawal of friends and family, the discovery that you are not as employable as others with your skills and abilities, the realisation that there are people who regard you as a threat merely for staying alive. And again, disabled people will die needlessly.

People euthanized without asking for it
Second, if we look to the Netherlands, where assisted suicide is already an option, we discover a frightening trend. Many doctors are euthanizing people who have not actually requested it. (I am getting this information from Dr. Herbert Hendin's recent book "Seduced By Death".) From believing that the desire to die is *a* reasonable option in certain cases, many doctors have come to believe that it is *the* reasonable option, and where they believe that the person would want to be assisted if only the problem that prevented them from doing so (mental retardation, Alzheimer's, Catholicism) were removed.

Euthanasia will become a preferred treatment
Where assisted suicide or euthanasia is considered a medical procedure, it may be more indicated on traditional terms than some other medical procedure. Assisted suicide or euthanasia is more likely than almost any other medical treatment for a serious disability to result in less future suffering, less need for future medical care, and less financial burden to whomever is paying your bills. With the rise of managed care organisations, many of whom already presure disabled people to sign Do Not Resuscitate orders (presumably in part because it's cheaper not to resuscitate), it is not unlikely that assisted suicide, if it ever becomes a medical treatment for disability, will become a preferred medical treatment in at least some cases. And again, people will die needlessly.

Doctors don't see quality of life, whereas disabled people do
Third, while the right to commit suicide may be present, it is not at all clear that doctors ought to be involved in this right. I will grant that a doctor is more likely than the average lay person to know how to do it successfully, but on the other hand there have been studies reported in the news recently that say that people with spinal cord injuries, several years post-accident, report much higher quality of life than the ER, ICU, or rehab doctors and nurses (who work with them in the first months post-accident, when they are most likely to want to die and to be offered that option) predict for them. Another study has reported that adolescents who were among those disabled infants considered for euthanasia report much higher quality of life than the neonatal ICU doctors and nurses (on whose shoulders much of the burden of advising parents whether to permit the infant to live lies) predict for them. In other words, physicians have absolutely no idea what life can be like or is like, and are responding instead to prejudices about disability.

What doctors have told me
In my own life, I have been informed by a doctor recently that disabled people cannot attend schools like normal people, and by another that I would be better off if I committed suicide. I have not sought these opinions -- one was announced during an office visit for no reason that I can discern and the other was mailed to me over the Internet. These are not people whom I want to have adjudicate whether I ought to be alive. If doctors are allowed to make the decisions based upon their own ideas of our quality of life, disabled people will needlessly die.

Self-determination for disabled people only
Many of those who are arguing on behalf of assisted suicide are saying that it is self-determination which is at issue. But if it really were self- determination at issue, then all people regardless of disability -- or at the very least all competent adults -- would be permitted to obtain a doctor's assistance in committing suicide. However, if you start talking to psychiatrists and psychologists, you will discover that in most cases, when someone begins to seriously discuss suicide as an option, that is taken as an indication that the person is depressed, in need of intervention (which the law encourages), and possibly not competent, at least for the moment. Only with disabled people (and for that matter, only with certain disabled people) is "That makes sense!" an appropriate response.

Pity versus compassion
Moreover, a number of assisted suicide advocates do not wish to restrict their assistance to competent people -- in fact, those who are not judged competent are even more likely to be assisted, on the grounds that their lives are not worth living. Rather, the issue seems to be one of pity. Pity is distinct from compassion. Compassion requires the ability to "feel with" the person -- and it's obvious from many studies that those who judge disabled people's lives not worth living are in many cases not grasping that those very people do regard their lives as worth living, and that in those cases where they do not, there is frequently some confusion as to why.

Are nursing homes inevitable?
The philosopher Daniel Callahan, most of whose arguments are persuasive (so long as you forget that there are any disabled people in the world) considers dementia, paraplegia, and being confined to a nursing home as three things that might happen to you no matter what you, your family, or community does to prevent them. In reality, dementia and paraplegia do sometimes occur no matter what is done, but if you truly have the necessary support from those around you (including financial support), nursing homes are far from inevitable. And pity is an insidious thing.

R.C. Smith, in "A Case About Amy", suggests that one of the most insidious things about prejudice against disabled people is that it is so often and so well cloaked even to the prejudiced person that he and those around him can regard him as a truly compassionate being, someone who has real concern for the disabled and attempts to help them, even as he proceeds to add insult to injury. Racism is more likely to be overt, and where it is not, it is still less likely to be camouflaged as great respect and compassion for the people of another race. The bigotry against disabled people that can lead to our deaths, then, can be cloaked as concern for our interests -- cloaked so well that even those who are urging our demise see themselves as acting in our interests.

There is a very real possibility that, if the Supreme Court rules in favour of assisted suicide for the disabled, many disabled people will die who could have (or perhaps were already) lived a good life, a full life, a life that they would have regarded as worth living. And once you are dead, equal opportunities in education, employment, housing, and access to leisure facilities just aren't that relevant anymore. ...

-- Cal Montgomery

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