When Insurance Companies Refuse Treatment “Assisted Suicide” Is No Choice At All

January 24, 2017

Helena Berger, President and CEO of AAPD
Clyde Terry, Chairperson of the National Council on Disability

Just weeks after California legalized physician-assisted suicide in 2015, Stephanie Packer was informed by her insurance company that the chemotherapy she requested to treat terminal Scleroderma was not an option they were willing to provide, but medication to aid in physician assisted suicide (PAS) was. Packer’s insurer then offered a $1.20 co-pay for a handful of life-ending prescription drugs.

While it is no doubt true that by offering to aid in dying rather than assist in living, insurance companies can save millions of dollars each year, the high cost of physician assisted suicide only begins there.

Stephanie Packer’s story is but one example. The bulk of existing assisted suicide laws in the United States are based on the assumption that the terminally ill person seeking PAS has less than six months to live. At age 29, Packer was told that she has three years to live. Four years later, she has outlived the fatal prognosis.

As Packer’s experience illustrates, even to trained professionals accurately predicting a patient’s demise can be nearly impossible.

This should come as no surprise to people with disabilities who routinely face down ardently pronounced, but inaccurate predictions by medical professionals. Countless disabled people have been told that they or their children would not survive, they would not regain consciousness, etc. At worst, these predictions have turned out to be dangerously inaccurate and, at best, guesswork.

Where assisted suicide is legal, anyone who stands to inherit from the patient may steer a person towards assisted suicide, witness the request, pick up the lethal dose, or even administer the drug. The same would be true for an abusive caregiver. No witnesses are required at the time of death. There are no checks and balances to determine if any abuse took place.

In addition to people with disabilities, senior citizens, poor people, and minorities are particularly prone to mistreatment and abuse, especially if family members view them as a financial burden. In these cases, what proponents describe as a compassionate choice becomes more like a duty to die.

According to a 2015 report from the Oregon Health Department, the percentage of Oregon deaths attributed to a patients’ reluctance to “burden” their families has risen from 12% in 1998 to 40% in 2014, essentially making the right to die “option” for some vulnerable populations more like a duty to die. The lethal drugs used for assisted suicide can be as inexpensive as $100 – making assisted suicide the “cheapest treatment option” and an option that saves insurance companies money.

Assisted suicide laws make it legal for physicians to knowingly and intentionally facilitate suicide, including counselling about, prescribing, or supplying lethal drugs. Data on the frequency of assisted suicide cases is difficult, if not impossible to track.  States that have legalized assisted suicide do not require doctors to record the lethal drugs as the cause of death. Rather, the cause of death is listed as terminal illness.

Mistakes by health care professionals, widespread misinformation, coercion, and abuse limit the opportunity for people with disabilities to make informed and independent decisions. As such, the legalization of assisted suicide devalues the lives of people with disabilities and creates a double standard in our society by providing suicide assistance to individuals with disabilities and health conditions, and suicide prevention services to non-disabled individuals.

There are no federal laws on assisted suicide. Currently, six states – California, Montana, Oregon, Vermont, Washington and Colorado – have legalized assisted suicide. Assisted suicide remains illegal in forty-four states at present, however laws are under review in Maryland, New Mexico, New Jersey, New York, and Tennessee. Just last month, the District of Columbia gave the go-ahead for PAS in the District pending approval by the Mayor and by Congress.

The proponents of physician assisted suicide laws like to assert that they support the right to what they call “death with dignity.” What voters don’t often realize until later is that they are also giving insurance companies and physicians new rights too – the legal means to deny treatment.  The romantic notion of assisted suicide as something individuals do at the end of life to make their death more comfortable becomes tainted because without the means to live, the “right-to-die” becomes the dangerous default.

Under such grave circumstances, choosing to die is no choice at all.  Given these concerns, states are wise to proceed with caution.

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The National Council on Disability (NCD) is an independent federal agency charged with advising the President, Congress, and other federal agencies regarding policies, programs, practices, and procedures that affect people with disabilities. NCD is comprised of a team of Presidential and Congressional appointees, an Executive Director appointed by the Chair, and a full-time professional staff.

The American Association of People with Disabilities (AAPD) is a convener, connector, and catalyst for change, increasing the political and economic power of people with disabilities. As a national cross-disability rights organization, AAPD advocates for full civil rights for the 50+ million Americans with disabilities by promoting equal opportunity, economic power, independent living, and political participation.

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