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By Carolyn McDonnell
Litigation Counsel, Americans United for Life
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For nearly 30 years, the United States has been grappling with states' decriminalization of physician-assisted suicide. Oregon was the first state to allow the practice through referendum in 1994 (codified into law in 1997). Since then, nine additional jurisdictions—California, Colorado, the District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Vermont, and Washington—have passed legislation that permits assisted suicide. One state, Montana, was forced to adopt it by judicial activism, when the state's supreme court devised a "consent" defense to homicide charges for physician-assisted suicide.
Yet decriminalization is not enough for the assisted suicide lobby. It is now pushing to remove even the few "safeguards" currently in place to protect patients from coercion and abuse. California dropped its reflection period from 15 days to a mere 48 hours, severely limiting a safeguard that ensures a patient takes the time to understand the severity of assisted suicide. Vermont allows telemedical assisted suicides without requiring the prescribing doctor to medically evaluate the patient in person. Oregon and Vermont have settled lawsuits that permitted suicide tourism. Since the decriminalization of assisted suicide increases the rates of non-assisted suicide, suicide tourism will undercut national suicide prevention policies.
Some states, such as Washington and Hawaii, have considered allowing non-physicians to prescribe lethal drugs. This raises the issue of whether those non-physicians have the necessary training to ensure patient competency. Oregon data show approximately 0.7 percent of patients requesting assisted suicide received counseling referrals in 2022, even though as many as 50 percent of such patients have or show signs of depression. Even more concerning, permitting non-physicians to prescribe lethal drugs will exacerbate the phenomenon of doctor shopping. According to the Oregon data, the median patient-physician relationship is only five weeks old, with some relationships lasting less than one week.
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Around 2016, assisted suicide doctors turned away from using short-acting barbiturates due to price gouging and supply issues. Instead, they began mixing experimental drug compounds at lethal dosages to assist suicides. The U.S. Food and Drug Administration has not approved these compounds and dosages. States cannot provide pharmaceutical guidelines for these experimental drug cocktails. And as The Atlantic reported in 2019, assisted suicide doctors are prescribing these drugs with "no government-approved clinical drug trial, and no Institutional Review Board oversight." Assisted suicide doctors are experimenting directly upon patients with virtually no oversight.
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In this death-on-demand model, medical professionals have limited ability to conscientiously object to participating in assisted suicide. In fact, medical professionals already have had to challenge state laws that force them to assist in suicides. In Christian Medical & Dental Associations v. Bonta, a district court issued a preliminary injunction against a California law requiring conscientiously objecting doctors to medically document a patient's lethal drug request. This documentation counts as the first of the two required lethal drug requests, which means an objecting medical professional would still assist in a patient's suicide. There also was recent litigation, in Lacy v. Torrez, against New Mexico's law, which had required conscientiously objecting doctors to tell patients of the availability of suicide assistance and provide a medical referral for it. In response to the litigation, New Mexico amended its assisted suicide statute, expanding conscience protections for medical professionals.
The assisted suicide lobby is heading towards promoting death on demand for vulnerable patients. But even that will not be enough. In Shavelson v. Bonta, an assisted suicide doctor has argued that under federal disability rights laws, California must allow active euthanasia—the intentional killing of a patient—of persons with disabilities who cannot self-administer lethal drug compounds. Although a district court has rejected this argument, and the case is on appeal before the Ninth Circuit Court of Appeals, the case shows that assisted suicide doctors are exploring the best legal avenue to introduce euthanasia in the United States.
Assisted suicide is ageist, ableist, and an attack on human dignity. Society must push back against the assisted suicide lobby's goal of death on demand, which is rife with abuse and discrimination. We owe everyone suicide prevention, not abandonment.
Carolyn McDonnell serves as Litigation Counsel at Americans United for Life.
The views expressed in this article are the writer's own.
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