The facts debunk the I-1000 supporters' claims
I-1000's supporters have made claims regarding the veracity of our statements. We invite voters to decide for themselves about the dangers of I-1000. For each issue we provide "their claims," all of which are from their web-site, www.deathwithdignityfacts.com (unless otherwise noted), followed by the facts. You decide who is telling the truth.
Issue: I-1000 Would Hurt the Poor and the Disabled Because It Would Make Them More Vulnerable to Coercion.
Their claim: Disability is irrelevant under I-1000. Only terminally ill patients - not people with disabilities - are eligible to use the law.
Facts: As one justification for the "need" for assisted suicide, I-1000 supporters cite the "indignity" dying persons may experience of being dependent on others for help with daily needs. Severely disabled people may live their whole lives with the very same daily difficulties -- depending on others for transportation, hygiene assistance and so forth. Yet most disabled would say that their lives are very much worth living. I-1000 would devalue the lives of all disabled people by giving them the message that their living conditions make their lives not worth living. People with life-limiting and serious illness are indeed vulnerable to coercion. Link to Not Dead Yet/DREDF materials on CAAS web site.
Their claim: We can look to 10 years of experience in Oregon to see that there has been no pressure on vulnerable groups.
Facts: Oregon resident Barbara Wagner is a prime example of the pressure that would be put on poor and vulnerable people. She was unable to pay for the cost of her care, and received a letter from the Oregon Health Plan telling her that the treatment her doctor prescribed would not be paid for, but assisted suicide would. http://abcnews.go.com/Health/story?id=5517492&page=1 (last accessed October 23, 2008). Oregon resident Randy Stroup had a similar experience (http://foxnews.com/story/0,2933,392962,00.html). These are not isolated cases or errors but examples of the actual policy of the State of Oregon Health Plan to deny not just "exotic" treatments but any surgery or chemotherapy "intended to prolong life or alter disease progression" to low income patients whom the state determines have less than a 5% chance of living 5 years. That's correct: not 6 months but 5 years (http://www.oregon.gov/OHPPR/HSC/docs/Apr08Plist.pdf, see p. 93 SI-1).
When the U.S. Supreme Court upheld Washington's ban on assisted suicide, it noted the State's interest in protecting the poor, the elderly and the disabled from "the real risk of subtle coercion and undue influence in end of life situations." Washington v. Glucksberg, 117 S. Ct. 2258, 2273, 138L.Ed.2d772, 521 U.S. 702 (1997). Then the Court went further:
The State's interest here goes beyond protecting the vulnerable from coercion; it extends to protecting disabled and terminally ill people from prejudice, negative and inaccurate stereotypes, and 'societal indifference.' [Washington] State's assisted suicide ban reflects and reinforces its policy that the lives of terminally ill, disabled, and elderly people must be no less valued than the lives of the young and healthy, and that a seriously disabled person's suicidal impulses should be interpreted and treated the same way as anyone else's.
Issue: Death by Lethal Drugs is Assisted Suicide.
Their claim: This is not assisted suicide.
Facts: The definition of assisted suicide is to kill oneself with the help of someone else. Even though killing oneself with the assistance of a physician is exactly what I-1000 legalizes and even though it's plainly clear to everyone, I-1000 backers insisted on renaming the practice as "obtaining and self-administering life-ending medication." Sec. 18. Verbal engineering and euphemisms don't change reality.
The United States Supreme Court has no difficulty using the term "assisted suicide." In 1997, the United States Supreme Court upheld the constitutionality of Washington state's ban on assisted suicide, using the term "assisted suicide" no less than 45 times in the court's opinion. Washington v. Glucksberg, 521 U.S. 702, 117 S. Ct. 2258 (1997)."Assisted suicide" is also the journalistic standard term used by the Associated Press.
Redefining assisted suicide as a medical procedure will harm the medical profession because it will put assisted suicide on a par with all other beneficial medical procedures. The Washington State Medical Association (WSMA) recognizes the dangers this initiative presents: "Our focus should remain on caring for terminally ill patients and should never shift toward helping them kill themselves." www.wsma.org/files/Downloads/NewsEvents/PressReleases/pr_I1000_%20release.pdf
Their claim: The mental state of people who are suicidal is very different from the mental state of an end-stage terminally ill patient. These patients want to live but cancer or another terminal illness is killing them.
Facts: Studies show that people lose their desire for assisted suicide when their depression and pain are properly treated. H. Hendin, Seduced by Death: Doctors, Patients and the Dutch Cure 24-25 (1997).
Suicide, whether assisted or not, is a cry for help. Offering terminally ill patients assisted suicide is a sure way to stifle their desire to live.
In a new study of patients seeking assisting suicide in Oregon, published October, 2008 in the British Medical Journal, researchers found that of 58 patients, 1 out of 4 was depressed. Of the 18 patients in the study who received a prescription for a lethal drug, 3 patients (1 out of 6) were clinically depressed at the time they received the prescription.
Official Oregon statistics show that not a single one of the 85 patients receiving lethal prescriptions in Oregon in 2007 was referred for psychiatric evaluation. The lack of protection for depressed patients isn't theoretical; it's real and there are hard data to show it. The touted protections are obviously not strict enough, and they don't work.
Source: British Medical Journal article: BMJ 2008;337;a1682
As reported by the Oregonian: http://www.oregonlive.com/news/index.ssf/2008/10/ohsu_study_finds_depression_in.html
Oregon DHS report: www.oregon.gov/DHS/ph/pas/docs/yr10-tbl-1.pdf
Their claim: Doctors already help hasten patients' deaths, but they do it behind closed doors. I-1000 would regulate this practice, take it out of the back-alley and bring it into the open - where patients, families and doctors can talk about it.
Facts: Doctors should not be killing people behind closed doors or otherwise. Patients already have the right to refuse treatment. The decision to end treatment is not made behind closed doors, and people can and should already be talking about it.
There is a difference between refusing life saving or life sustaining treatment and a lethal overdose given for the purpose of immediately ending the patient's life, even if both have the same end result. The U. S. Supreme Court recognized this difference in Vacco v. Quill and said that making a distinction between refusing unwanted medical treatment and assisting a suicide "follows a longstanding and rational distinction." The court found that the right to refuse treatment is based on "well established, traditional rights to bodily integrity and freedom from unwanted touching," and not on "a general and abstract 'right to hasten death.' Vacco v. Quill, 117 S. Ct. 2293, 2301, 138 L. Ed.2d (1997).
If doctors are administering lethal overdoses behind closed doors, as the proponents argue, that's illegal and it would still be illegal even if I-1000 passed.
Issue: I-1000 Doesn't Protect Depressed People.
Their claim: If there is any question about depression or mental competence, then the patient must be referred for a mental health evaluation. Independent studies have shown that most patients who request death with dignity are not depressed.
Facts: The language of the initiative would allow doctors to prescribe lethal overdoses even if a patient is depressed unless the doctor further believes that depression or other mental illness is impairing the patient's judgment. Section 6 of the initiative provides:
If, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling. [Emphasis added.]
If the patient is depressed, even profoundly depressed, but the doctor (in his personal opinion) believes the depression has not impaired the patient's judgment, there is no requirement to refer the patient for counseling.
Studies have shown that "physicians are not reliably able to diagnose depression, let alone to determine whether depression is impairing judgment." Herbert Hendin and Kathleen Foley, Physician Assisted Suicide in Oregon: A Medical Perspective, 106 Mich. Law Review 1613, 1621 (2008) (citations omitted). Only 5% of Oregon psychiatrists believe they can confidently diagnose depression in a single visit. The initiative does not require that the doctors involved in the assisted suicide have any training or expertise in diagnosing depression or determining competency.
Issue: I-1000 is the first step to an expansion of assisted suicide for the chronically ill and for those with mental suffering, and subsequently for voluntary and non-voluntary euthanasia.
Their claim: [Opponents to assisted suicide] have propagated many conspiracy theories about I-1000.
Facts: We don't need to propagate conspiracy theories; assisted suicide advocates provide them freely. Advocates of assisted suicide openly admit that they ultimately want assisted suicide to be even more available.
From the New York Times: "[Booth] Gardner wants a law that would permit lethal prescriptions for people whose suffering is unbearable, a standard that can seem no standard at all . . ." Daniel Bergner, "Death in the Family," New York Times, 12/2/2007, www.nytimes.com/2007/12/02/magazine/02suicide-t.html (Last accessed 10/14/2008).
In Washington v. Glucksberg, the Supreme Court case upholding Washington State's ban on assisted suicide, the Supreme Court said: "Thus, it turns out that what is couched as a limited right to 'physician assisted suicide' is likely, in effect, a much broader license, which could prove extremely difficult to police and contain." Washington v. Glucksberg, 117 S. Ct. 2258, 2274.
Issue: Washington Doesn't Need I-1000.
Their claim: Even with advances in pain and palliative care, pain cannot be adequately controlled for between 5 and 30 percent of the terminally ill (Robb Miller, Executive Director of Compassion & Choices Washington, radio interview on the David Boze Show, KTTH, October 14, 2008.)
Facts: In the vast majority of cases, perhaps 98-99%, pain can be controlled.
Advances in palliative care (care that alleviates symptoms without curing) have made it possible for doctors to provide effective pain relief that makes assisted suicide unnecessary. We should focus on improving hospice care rather than killing patients unnecessarily.
Issue: I-1000 will result in coercion of vulnerable people.
Their claim: Coercion is a felony under the law, punishable by life in prison and a $50,000 fine. That's a big risk to take to "coerce" a terminally ill patient who will be dead soon anyway.
Facts: The initiative does not require that the death be witnessed. In the case of coercion by a family member, the victim, who may be the only person who could testify about the coercion, would be dead.
Terminally ill people, like all very ill persons, are vulnerable. Having a doctor or family members suggest assisted suicide will make them think suicide is what's expected of them. A suggestion will become an expectation which will become a duty.
A leading British ethicist, Baroness Warnock, recently declared that there should be a duty to die. "[She] said pensioners in mental decline are 'wasting people's lives' because of the care they require and should be allowed to opt for euthanasia even if they are not in pain." She further stated, "I've just written an article called 'A Duty to Die?' for a Norwegian periodical. I wrote it really suggesting that there's nothing wrong with feeling you ought to do so for the sake of others as well as yourself." (http://www.telegraph.co.uk/news/uknews/2983652/Baroness-Warnock-Dementia-sufferers-may-have-a-duty-to-die.html) This kind of subtle coercion would not be legally prosecuted but would nevertheless be very real.
The U.S. Supreme Court has said: "We have recognized, however, the real risk of subtle coercion and undue influence in end of life situations." Washington v. Glucksberg, 117 S. Ct. 2258, 2273 (1997).
Issue: I-1000 is Shrouded in Secrecy.
Their claim: Reporting is required, and physicians who do not file the required reports are liable under the law.
Facts: The Oregon statute, like I-1000, grants very little authority to monitor and investigate individual cases. Oregon's largest newspaper, the Oregonian, has recommended that Washingtonians vote against I-1000 because "Oregon's physician-assisted suicide program has not been sufficiently transparent. Essentially, a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know . . ." Aid in Dying, Oregon-style, The Oregonian, September, 21, 2008. http://oregonlive.com/editorials/oregonian/index.ssf?/base/editorial/1221863106315720.xml&coll=7 (last accessed 10/23/2008)
According to the State of Washington Voters' Pamphlet, the estimated costs for ongoing data collection and reporting for I-1000 are estimated to be $19,000 for the biennium, that is, less than $10,000 per year. With so little funding, the State will not have the resources to adequately document how the program is working.
The only consequence for failing to report or incomplete reporting is that the doctor will be contacted to request a complete report. Sec. 15 (1)(b). There are no other penalties in the initiative. As is the case in Oregon, without money or authority, it is unlikely the State will do any effective investigation into abuses.
Their claim: Any physician who wants the protection of the law must report accurately, and is subject to investigation if necessary. Most doctors do report accurately, and would not risk malpractice lawsuits or a rise in their malpractice insurance rates.
Facts: I-1000 gives broad and unprecedented protection to doctors. Section 19(a) states:
A person shall not be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with this chapter.
This section sets up a good faith standard for doctors. This is far lower than the normal negligence standard:
Good faith is a troublesome, subjective standard. . . . In professional practices a negligence standard based on objective, established medical guidelines is customary. If the intent of the assisted suicide law is to protect physicians from accountability for violating the statute's provision, the good faith standard is ideal. But if the intent of the law is to provide protection for patients, a negligence standard would be more appropriate.
Herbert Hendin and Kathleen Foley, Physician Assisted Suicide in Oregon: A Medical Perspective, 106 Mich. Law Review 1613, 1627 (2008)
Issue: I-1000 Will Encourage Health Insurance Companies to Deny Care to Save Money.
Their claim: This hasn't happened in 10 years in Oregon. Independent studies show that insurance companies or HMOs would not gain financially by encouraging people to use I-1000, and they would be financially ruined by public outcry if they tried to do so.
Facts: For the disabled and the poor, in fact for most people, their health insurance determines which medical services are available. There is an obvious incentive for insurers to offer assisted suicide because the cost of the drugs for assisted suicide is generally less than $100 while continued treatment and even palliative care for the terminally ill are much more costly.
The Oregon Health Plan has denied coverage for chemotherapy, but offered assisted suicide. Barbara Wagner received a letter from the Oregon Health Plan denying coverage for her chemotherapy and offering comfort care and assisted suicide. A Gift of Treatment, The Register-Guard, http://www.kval.com/news/26140519.html (last accessed 10/23/2008).
There is enormous potential for "savings" if assisted suicide were to be covered and used by Medicare, which millions of seniors depend on for their health care. Last year Medicare spent $432 billion dollars. Of that, $60 billion was spent on patients in their last 2 months of life. There would be substantially more "savings" if people in their last 6 months of life were steered into assisted suicide.
Issue: I-1000 Creates a Slippery Slope.
Their claim: In 10 years of experience in Oregon, the slippery slope has not happened. Slippery slope arguments are not valid; they are used to instill fear.
Facts: In 30+ years of experience in the Netherlands, the slippery slope has most certainly happened. The Netherlands has extended the practice to the chronically ill, to 16-year-olds, to infants, to people with mental suffering, all the way to tolerating non-voluntary euthanasia (people who have not asked for it).
Citing a Dutch government study, the U. S. Supreme Court in Washington v. Glucksberg, 117 S. Ct. 2258, 2274, stated:
This study suggests that, despite the existence of various reporting procedures, euthanasia in the Netherlands has not been limited to competent, terminally ill adults who are enduring physical suffering, and that regulation of the practice may not have prevented abuses in cases involving vulnerable persons, including severely disabled [newborns] and elderly persons suffering from dementia.
Once allowing people to kill themselves is legalized and becomes thought of as a good thing, there is little justification for not extending this new-found "right" to other groups of people.
The "6 months to live" barometer is completely arbitrary. Once it has been legalized, there would be no logical or defensible reason not to make it 12 months, or even to open it up to people with chronic non-terminal illness such as chronic pain syndrome, multiple sclerosis, quadriplegia, and so on.