Assisted suicide legislation has fatal flaws

(Editor’s note: Edward Mechmann, director of public policy for the New York Archdiocese, delivered this testimony at a New York State Assembly hearing May 3 in New York City. He spoke on behalf of the New York State Catholic Conference, which represents the state’s bishops on public policy issues. Learn more at www.nyscatholic.org.)

The legal flaws in the so-called “Medical Aid in Dying Act” assisted suicide legislation pose real dangers to the public and to vulnerable patients. In our view, there is no way to fix this legislation, and we will oppose any bill that would legalize physician-assisted suicide.

1. Assisted suicide is fundamentally different from accepted medical practices.

One of the central arguments offered by supporters of assisted suicide is that it is essentially indistinguishable from accepted medical practices such as palliative sedation and the withdrawal of excessively burdensome treat­ments. But this fails to recognize crucial ethical, medical and legal distinctions in the intention of the physician and the causality of death.

In the case of palliative sedation, the intention of the doctor is to treat symptoms, not to cause death. In case of assisted suicide, the intention of the doctor is precisely to intentionally cause the patient’s death. In the case of palliative sedation, death will happen due to the underlying illness, while with assisted suicide, the patient’s death is directly and unequivocally caused by the lethal drugs the doctor prescribes.

The same key distinctions apply between declining life-sustaining treatment and assisted suicide. When a patient declines treatment, the doctor does not intend to cause the patient’s death. Instead, he is respecting the patient’s wishes, which he is required under the law to do. When the patient declines treatment, the doctor stands aside and allows nature to take its course. In assisted suicide, the doctor preempts nature and is complicit in the patient’s suicide.  

2. Legalization will hurt efforts to prevent suicides.

This legislation is being proposed as if it will only affect individual patients and it has nothing to do with suicide in general. Nothing could be further from the truth. This bill contradicts and undermines current legal and policy efforts to safeguard vulnerable people from suicide.

Suicide is the 10th leading cause of death in the United States. The number of deaths from suicide has increased more than 26 percent in the last decade. Great efforts are made in our schools and correctional system to prevent suicides. Legalization of assisted suicide would contradict and undermine those efforts by sending a dangerous message: namely, suicide is okay for some people.

This bill would also strip suicidal patients of existing legal protections. Under current law, persons at risk of harming themselves can be involuntarily committed for evaluation and treatment. This bill states that “a patient who requests medication under this article shall not, because of that request, be considered to be a person who is suicidal….” It creates an invidious double standard: Terminally ill and disabled patients are denied safeguards that are guaranteed to all others.

States that have legalized assisted suicide have seen an increase in suicides in general. In Oregon, for example, the overall suicide rate is 42 percent higher than the national average. Legalization of assisted suicide would send a message to people with depression, a decrease in daily functioning or a disability that suicide is an acceptable option.

3. Physician-assisted suicide cannot be limited.

Passage of this bill will inevitably lead to an expansion of assisted suicide to euthanasia. This bill is supposed to be limited to those who are terminally ill at the very end of life. But the bill defines a “terminal illness or condition” as “an incurable and irreversible illness or condition that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.” This definition would include many persons with disabilities or chronic debilitating illnesses, who would soon die if they simply declined to continue their regular treatments.

Prominent advocates for assisted suicide have expressed support for removing any legal restrictions such as age restrictions, and have argued that doctors should be allowed to administer the fatal medicine: In other words, they want to legalize euthanasia.

4. There are inadequate safeguards to protect vulnerable patients.

Advocates for legalization frequently point to alleged safeguards that are in the bill. But these are grossly inadequate and endanger vulnerable persons.

The only safeguards in the bill deal with the time before the patient receives the prescription for deadly drugs. There is no mandatory referral to determine if the patient is suffering from a treatable mental illness that led to the suicide request.

The danger is much worse after the patient receives the pills. There is no follow-up evaluation to determine if the patient’s condition has changed or if other treatments have become available. There is no further evaluation to determine if the patient is suffering from a mental illness. No physician or other health professional is required to be present when the patient takes the lethal pills. There is no evaluation of the patient’s decision-making capacity at the time they take the lethal drugs. There is no way to know if the patient is being coerced into taking the lethal medication. There is no way to know if the patient is even self-administering the pills. There is no way to ensure that only the patient is taking the drugs.

5. There will be no accountability and oversight to prevent abuses.

The bill actually requires that the physician state untruthfully on the death certificate that “the cause of death was the underlying terminal illness or condition of the patient.” That is simply not true: It was a suicide caused by lethal drugs. Lying on the death certificate will cripple efforts to oversee the implementation of the law, since there will be no way to do an independent evaluation of cases.

There is also no mechanism for a systematic evaluation and oversight by the Health Department. The Department is also given no authority to investigate suspicious cases or to enforce the bill.

This legislation poses real dangers to the public and to vulnerable patients. We strongly urge the Assembly Health Committee and the Legislature as a whole to reject it.