ScienceBeta

Menu

No Evidence That ‘Death With Dignity’ Acts Disproportionately Impact Disadvantaged Patients

An analysis of two U.S. states[1] finds evidence that poor, uninsured patients are not being targeted disproportionately by medical aid in dying (MAID) legislation.

This retrospective observational cohort study reviewed a combined 28 years of data on MAID from 2 states (Oregon and Washington).

Policymakers and researchers have some concerns that MAID could be used as a rationalization to start terminating the lives of “undesirables” like poor and non-white people, raising the spectre of eugenics.

Just so we are all clear on what is being discussed, these laws are not about allowing people take their own lives or giving free rein to preventable suicides. Rather, they involve allowing physicians to provide planned, medical assistance with suicide.

The majority of suicides are linked to depression[2], suicidal thoughts and actions are typically temporary, and if we can prevent a suicide in the short term, we may stand a better chance to prevent it long term.

Entitled To Die?

The study’s findings raise more questions, however.

Part of the reason that disadvantaged patients are not inordinately impacted may be that they simply do not have access to healthcare services. Should we push for equal access to Death with Dignity services for those on lower incomes?

In the study, people receiving MAID –

    • Were equally distributed between male and female
    • 94.8% were non-Hispanic white individuals
    • 72.4% were older than 65 years
    • 71.5% had some college education
    • 88.5% were insured

Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life.

Trends in Medical Aid in Dying in Oregon and Washington
Credit: Luai Al Rabadi, et al CC-BY

MAID In The US

The Oregon Death With Dignity Act, passed in 1994, legally permits terminally ill adults (age ≥18 years) with legal Oregon (OR) residency to make the voluntary informed choice to obtain a physician’s prescription for oral drugs to end life.[3] In 2008, Washington state (WA) approved similar legislation, making it the second US state to legalize medical aid in dying (MAID).[4]

As of this writing, MAID has become more widely adopted and is officially permitted in 8 jurisdictions in the United States (OR [1994], WA [2008], Montana [2009], Vermont [2013], California [2015], Colorado [2016], District of Columbia [2017], and Hawaii [2019]) and will be adopted in New Jersey on August 1, 2019.

According to dignityindying.org.uk, 84% of the public supports the choice of assisted dying for terminally ill adults, and 44% of people would break the law and help a loved one to die, risking 14 years in prison.

“Concerns that MAID would unintentionally target socially disadvantaged patients have not materialized, as evidenced by the data presented in this article. States considering MAID legalization may see similar results if they model their rules on those put into place in the US Pacific Northwest,”

The authors concluded.

[1] Al Rabadi L, LeBlanc M, Bucy T, et al. Trends in Medical Aid in Dying in Oregon and Washington. JAMA Netw Open. Published online August 09, 20192(8):e198648. doi:10.1001/jamanetworkopen.2019.8648

[2] Silke Bachmann; Epidemiology of Suicide and the Psychiatric Perspective; Int J Environ Res Public Health. 2018 Jul; 15(7): 1425.

[3] Oregon Health Authority. Oregon revised statute: Oregon’s Death with Dignity Act

[4] Washington State Legislature. Death With Dignity Act