Yes, black lives will matter with Death with Dignity Act

As a proponent of aid in dying and as one who has worked to achieve justice and fairness for people of color as a legal services for the poor and prisoners’ rights lawyer, I diligently try to be sensitive to issues involving race in the healthcare system.

So, I understand the important, serious, concerns raised by Dr. Dugdale with respect to problems of access to and equal treatment of racial minorities in healthcare and the past and current discrimination faced by people of color.

However, none of these concerns impact aid in dying for communities of color. Keep in mind that prescriptions of life ending medications are only made pursuant to the request of a dying, mentally competent patient, and usually after a process which includes numerous safeguards, as are in the DC Death with Dignity Act. I have been involved with aid in dying issues for almost 15 years and have studied the issue quite carefully.

{mosads}Dugdale contends that “Lawmakers should think hard before making it legal for white doctors like her to facilitate the deaths of patients in a district predominantly comprised of racial and ethnic minorities.”

This is not a valid concern. Consider that white and any doctors engage much more in the actual facilitating of the deaths of their patients when they remove life sustaining treatment, a feeding tube, ventilator, cardiac device, etc.

When doctors are involved in the process of aid in dying, they prescribe the medications for mentally competent patients who have asked for the prescription and patients must self administer the medicines if they choose to do so. Thus, there is much less involvement in the resulting death. It is the patient who is in control of the dying process.

Dugdale mentions that the states that have legalized what she terms “assisted suicide”, a term used by opponents, not supporters of medical aid in dying, have majority white populations.

But virtually all states have majority white populations, with several exceptions, including California, which now has an aid in dying law covering more people than the other states combined where aid in dying is permitted.

Each state of course has minority populations and very few people of color in those states where aid in dying is legal have died by this option. In fact, very few people overall access aid in dying, only about 1 in 300 who die in Oregon each year where aid in dying has been legal for 19 years. Dugdale does not express what her concern is here, but considering the facts about the racial makeup of states seems irrelevant.

She expresses concern about “abuses of vulnerable populations” in referencing certain facts in Oregon, which again are neither relevant nor a cause for alarm. These include the fact that most people are 65 or over who choose aid in dying. That is true, but of course most people who die are over 65 and those who choose aid in dying are not the eldest of the elderly.

She states that most people are single, even though the clear majority have family support and one study suggests that those who access aid in dying have as good if not better quality deaths. She states that most lack a college degree, even though a much higher percentage of Oregonians have some college education and a college degree than most of its citizens.

Most importantly, the evidence is clear, according to a study reported in the Journal of Medical Ethics in 2007, that there is no disproportionate impact on vulnerable populations respecting age, color, disability, poverty, etc.

Dugdale cites very disturbing disparities in health care regarding people of color, historical and current. They need to be addressed now. But none of them have any connection to aid in dying and the right of a mentally competent, adult patient who is terminally ill to access aid in dying.

And, there is no evidence that people who seek aid in dying are doing so because of a lack of access to quality health care generally or to palliative or hospice care. In fact, the evidence is to the contrary. In Oregon, about 90 percent of those who use aid in dying are enrolled in hospice. They are getting quality end of life care, but even hospice cannot relieve all suffering.

Reference is made to statistics in Belgium which are concerning, but Belgian law is so different than the laws in the U.S., where there is no slippery slope is in the making.

The aid in dying laws in the U.S. are very similar to each other, as are proposed laws. None of them allow euthanasia, as Belgian law does, where doctors may give lethal injections to their patients.

It is truly hard to understand why Dugdale even raises the Belgium experience rather than the evidence from Oregon or Washington which is so positive and truly relevant. It, unfortunately, appears to be nothing less than fear mongering and perhaps reflects the author’s bias against aid in dying for anyone.

Finally, Dugdale suggests that if bills that permit aid in dying are passed “particularly in places with predominantly minority and vulnerable populations, we may just be adding to the atrocities committed by society and the health care profession toward black and Hispanic patients.”

Unquestionably, we must always be very concerned and vigilant about the treatment of people of color in the healthcare system. Yet, despite her caution, there is no evidence to date it appears, none, and Dugdale does not suggest that there is any, that connects aid in dying and health care in minority communities in any negative way at all.

All terminally ill, mentally competent adult patients should have the option of aid in dying, to achieve a peaceful death.

David C. Leven is the executive director emeritus and senior consultant for End of Life Choices in New York.

The views of contributors are their own and are not the views of The Hill.