Will black lives matter to Death with Dignity Act?

Last November, Washington D.C. Mayor Muriel Bowser approved the Death with Dignity Act. If Congress does nothing during its 30-day review period, D.C. will join six states that have already legalized or decriminalized doctor-assisted suicide.

On the surface, this may just seem like a growing trend toward giving patients the right to end their lives. But viewing this development as part of the beginning of a national shift on the subject leaves out one glaring factor — race.

Last year, fewer than 10 percent of medical school graduates were black or Hispanic. This put the medical profession well behind the police department – the proportion of black doctors (5.7 percent) is less than half that of black officers (12.2 percent) and the proportion of Hispanic doctors (4.6 percent) less than half that of Hispanic officers (11.6 percent).

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

Why should race make a difference? All six states that have legalized or decriminalized assisted suicide have majority white populations. Oregon was the first US state to legalize assisted suicide in 1997. What we do know of the mostly white Oregonians who have ingested lethal drugs is that the majority are over the age of 65, single, and lack a college degree. Oregon does not record other indicators that could point to abuses of vulnerable populations. Of course, not all racial and ethnic minorities can be considered “vulnerable.” But many are.

Not many doctors would intentionally discriminate. But data show that African American patients receive inferior healthcare when compared with other groups.

A study published this week found that black women are more than twice as likely as white women to die from cervical cancer — a disease which is largely preventable.

A large study published in the New England Journal of Medicine in 2014, found that black Medicare Advantage plan enrollees between 2006 and 2011 were substantially less likely than white enrollees to have adequate control of blood pressure, cholesterol, and diabetes.

Still other studies have found that blacks are less likely than non-Hispanic whites to be referred for cardiac procedures, to receive opiate pain medication in the emergency room, or to be referred for evaluation for kidney transplantation once on dialysis. Many of these same disparities also hold for Hispanics. 

These disparities did not just happen. Just as the systematic abuse of black Americans in the justice system today can be tied to Jim Crow laws of the past, the same comparison can be made in medicine.

The Tuskegee syphilis study is perhaps the most infamous. Between 1932 and 1972, the US Public Health Service conducted the “Tuskegee Study of Untreated Syphilis in the Negro Male” in rural Alabama.

The aim of the study was to observe the natural progression of syphilis. Six hundred poor, black sharecroppers agreed to participate in exchange for free health care and burial insurance. The men were not informed that they had syphilis. They were simply told that they were being treated for their “bad blood.” And even after penicillin became the standard cure for the disease in 1947, the study continued for 25 years, infecting many other men, women, and children. Sadly, Tuskegee is not an isolated example.

Certainly, some will object to the suggestion that we should be cautious about legalizing physician-assisted suicide because of race. It might seem like discrimination. But if data from Belgium are anything to go by, vulnerable populations are at high risk for having death imposed. By 2013, lethal injections of patients accounted for one in 22 deaths in the region of Flanders. And between 2007 and 2013, the number of uneducated, elderly women living in nursing homes who received lethal injections nearly doubled.

As the New York Department of Health put it, this risk to vulnerable populations “does not reflect a judgment that physicians are more prejudiced or influenced by race and class than the rest of society – only that they are not exempt from the prejudices manifest in other areas of our collective life.” 

Each day doctors strive to care for their patients, regardless of race, ethnicity, or socioeconomic status. Many are cognizant of past abuses. Many are keen to demonstrate that things have changed. But if physician-assisted suicide bills 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 profession toward black and Hispanic patients.

Lydia S. Dugdale is a physician and Associate Director of the Program for Biomedical Ethics at Yale School of Medicine. She is also a Public Voices Fellow.

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