An Illinois bill that would legalize medical aid in dying, also called physician-assisted suicide, is modeled on legislation in 10 other states and Washington, D.C.
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In November, a poll on physician-assisted suicide appeared on Capitol Fax, a website focused on Illinois government and politics. The poll presented a policy concept for physician-assisted suicide in Illinois based on the recommendations of the Illinois End of Life Options Coalition, which is advocating for legislation to legalize it (they prefer to call it medical aid in dying). Now the proposed law, Illinois Senate Bill 3499, is gaining momentum in the Illinois legislature to do just that.
Polls like this have influenced legislators. It found that 71% of the 506 people surveyed said they were in favor of legislation promoting physician-assisted suicide in the framework presented. However, the information given to respondents was extremely one-sided, making one wonder how the results might have differed if the question had been framed more objectively.
The coalition says it advocates for “medical aid in dying and not assisted suicide, as it is commonly known.” This is simply a language game. “Medical aid” sounds a lot more attractive than “suicide,” but the two phrases refer to the same thing — a doctor prescribing drugs that a person can take to end his or her life.
The proposed concept for medical aid in dying was also presented in a way that downplayed the many legitimate concerns raised by those who oppose the practice. It begins by claiming medical aid in dying would remain completely optional for doctors and patients. This sounds ideal, but it completely ignores practical realities. Despite supposed protections, doctors could quickly be coerced into participating over their own objections. In fact, there are already those who argue that doctors should be forced to provide any legal service a patient desires or choose another profession.
Subtle pressures to choose physician-assisted suicide
While it will be technically true that physician-assisted suicide is optional for patients, there is a lot more to be said. Canada offers a good example: Recent reports highlighted cases in which people sought medical treatment and instead were offered assisted suicide. There are a host of things influencing people’s decisions so that even if it is “optional” they feel that physician-assisted suicide is the only viable option. Those nearing the end of life due to terminal illness often suffer from depression as well. These pressures are more subtle than overt coercion, but can easily drive people toward a choice they would not otherwise make.
Claiming physician-assisted suicide is optional also neglects its many financial aspects. For those without insurance, physician-assisted suicide will be much cheaper than treatment or appropriate end-of-life care. Insurance companies would have an incentive to direct people toward it because it is cheaper than treatment. It’s possible people would find themselves in situations where coverage for their treatment is delayed or denied, but they are approved for immediate physician-assisted suicide. Pressures like this disproportionately affect those with disabilities, so much so that a disability rights group is suing California over its laws, calling them “discriminatory.” All of this makes claims of physician-assisted suicide being “optional” dubious at best.
Advocates for the proposed law in Illinois emphasize certain requirements and safeguards. In states that have approved physician-assisted suicide, these kinds of requirements and safeguards are almost always in place initially. However, as soon as it gets passed, efforts will be made to loosen requirements and remove safeguards. This has happened in Canada and many European countries that have approved physician-assisted suicide and is currently taking place in several U.S. states. For example, proposed bill A1880 in New Jersey provides a mechanism for waiving the current 15-day waiting period for certain patients.
What starts as something only for terminally ill adults becomes pushed for chronically ill adults, then healthy adults who nevertheless want to die, then for older teens, then for children who may be suffering. Once a state determines that someone has the right for doctors to help them kill themselves, most of the safeguards stop making sense — why should you have to be sick, or a certain age, or in a certain situation, to exercise your rights?
There are a host of reasons why one might be skeptical of proposed physician-assisted suicide legislation, and polls such as the one advocates point to do a disservice to the public. As the Illinois legislature debates the merits of legalizing physician-assisted suicide, more reliable information is needed to ensure that both sides receive a fair hearing.
Bryan Just is event and executive services manager at The Center for Bioethics & Human Dignity and is managing editor of the journal Ethics & Medicine. He is pursuing a Ph.D. in church history at Trinity Evangelical Divinity School.
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