The Danger of 

Assisted Suicide Laws

Part of the Bioethics and 

Disability Series

National Council on Disability

October 9, 2019
National Council on Disability (NCD)

1331 F Street NW, Suite 850

Washington, DC 20004

The Danger of Assisted Suicide Laws: Part of the Bioethics and Disability Series

National Council on Disability, October 9, 2019

This report is also available in alternative formats. Please visit the National Council on Disability (NCD) 

website (www.ncd.gov) or contact NCD to request an alternative format using the following information:

ncd@ncd.gov Email

202-272-2004 Voice

202-272-2022 Fax

The views contained in this report do not necessarily represent those of the Administration, as this and 

all NCD documents are not subject to the A-19 Executive Branch review process.
National Council on Disability

An independent federal agency making recommendations to the President and Congress 

to enhance the quality of life for all Americans with disabilities and their families.

Letter of Transmittal

October 9, 2019

The President

The White House

Washington, DC 20500

Dear Mr. President:

On behalf of the National Council on Disability (NCD), I am pleased to submit Assisted Suicide Laws 

and Their Danger to People with Disabilities, part of a five-report series on the intersection of disability 

and bioethics. This report, and the others in the series, focuses on how the historical and continued 

devaluation of the lives of people with disabilities by the medical community, legislators, researchers, 

and even health economists, perpetuates unequal access to medical care, including life-saving care.

NCD has long opposed assisted suicide laws. In 1997, after a thorough review of the forms of 

discrimination people with disabilities experienced in American society, NCD issued Assisted Suicide: 

A Disability Perspective, opposing legalization of assisted suicide, concluding that the evidence 

indicated that the interests of the few people who would benefit from assisted suicide were “heavily 

outweighed by the probability that any law, procedures, and standards that can be imposed to regulate 

physician-assisted suicide will be misapplied to unnecessarily end the lives of people with disabilities.” 

Instead, NCD called for a comprehensive, fully-funded, system of assistive living services for people 

with disabilities.

Eight years later, in 2005, reaffirmed its position opposing the legalization of assisted suicide. The 

nation had observed the implementation of the Oregon assisted suicide law, and the evolution of 

cultural attitudes toward so-called “mercy killing,” of both the medical and non-medical variety. Jack 

Kevorkian was convicted of second-degree murder for committing active euthanasia of a man with 

ALS, utilitarian euthanasia advocate Professor Peter Singer was hired for a prestigious bioethics chair 

at Princeton University, two movies favorably depicting euthanasia of people with quadriplegia won 

Oscars, and numerous courts upheld the right of a guardian to starve and dehydrate a severely brain 

injured but healthy woman in Florida. The dangers to people with disabilities based on the devaluation 

of their lives was ever clearer.

Assisted Suicide Laws and their Danger to People with Disabilities reexamines the issue of assisted 

suicide in light of NCD’s prior reports, brings NCD’s earlier analysis up-to-date, and finds that the 

dangers and harms that NCD identified in 1997 and 2005 are at least as significant today. The report 

describes, among other things, a double standard in suicide prevention efforts where people with 

disabilities are not referred for mental health treatment when seeking assisted suicide, while people 

without disabilities receive such referrals. The report recommends steps that must be taken at the 

federal and state levels to ensure that people with disabilities have a system of assisted services and 

1331 F Street, NW ■ Suite 850 ■ Washington, DC 20004

202-272-2004 Voice ■ 202-272-2074 TTY ■ 202-272-2022 Fax ■ www.ncd.gov
supports; that medical providers inform patients seeking assisted suicide of these supports; and that 

medical providers receive training in disability competency and disability-risk factors for suicide.

NCD stands ready to assist the Administration, Congress and federal agencies to ensure that people 

with disabilities are not steered toward ending their lives due to a lack of supports and medical 

providers who are not required to help patients find alternatives.

Respectfully,

Neil Romano

Chairman

(The same letter of transmittal was sent to the President Pro Tempore of the U.S. Senate and the Speaker of the 

U.S. House of Representatives.)

2 National Council on Disability
National Council on Disability Members and Staff

Members

Neil Romano, Chairman

Benro Ogunyipe, Vice Chairperson

Billy Altom

Rabia Belt

James Brett

Daniel Gade

Andrés Gallegos

Wendy S. Harbour

Clyde Terry

Staff

Phoebe Ball, Legislative Affairs Specialist

Stacey S. Brown, Staff Assistant

Joan M. Durocher, General Counsel & Director of Policy

Lisa Grubb, Executive Director

Netterie Lewis, Administrative Support Specialist

Amy Nicholas, Attorney Advisor

Nicholas Sabula, Public Affairs Specialist

Amged Soliman, Attorney Advisor

Anne Sommers, Director of Legislative Affairs & Outreach

Ana Torres-Davis, Attorney Advisor

Keith Woods, Financial Management Analyst

The Danger of Assisted Suicide Laws 3
4 National Council on Disability
Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Safeguards and Their Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Lack of Data Collection, Oversight, and Investigation 

of Mistakes and Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

How Are Assisted Suicide Laws Viewed 

by Disability Organizations? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Recent Issues and Events: Bringing the NCD 

Position Up to Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Key Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

The US Department of Health and Human Services (HHS) . . . . . . . .  1

The Substance Abuse and Mental Health Services 

Administration (SAMHSA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

The National Institute on Disability, Independent Living, 

and Rehabilitation Research (NIDILRR) . . . . . . . . . . . . . . . . . . .  1

HHS Office for Civil Rights (OCR) . . . . . . . . . . . . . . . . . . . . . . . . . .  1

State Legislatures, and State Referenda and Initiatives . . . . . . . . . . . . 14

Primary Care Practitioners, Specialty Providers, Clinics, 

Hospitals, Laboratories, Diagnostic and Therapy Centers, 

and Other Healthcare Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Medical Schools and Other Healthcare Professional Education 

and Training Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

The Danger of Assisted Suicide Laws 5
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Introduction and Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Acronym Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Chapter 1: Safeguards and Their Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

What Are the Safeguards in Assisted Suicide Laws? . . . . . . . . . . . . . . . . . 19

Are There Problems with These Safeguards? . . . . . . . . . . . . . . . . . . . . . . . 19

Assisted Suicide Instead of Medical Treatment . . . . . . . . . . . . . . . . . .  2

Mistakes in Diagnosis and Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Depression and Demoralization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Demoralization and Internalized Oppression 

of People with Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Doctor Shopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Family and Economic Pressures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Good Faith . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Physicians Hold Disproportionate Power . . . . . . . . . . . . . . . . . . . . . . .  2

Safeguards Are Gradually Diminishing . . . . . . . . . . . . . . . . . . . . . . . .  3

Chapter 2: Lack of Data Collection, Oversight, and Investigation 

of Mistakes and Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Minimal Data and Scant Oversight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Conclusions Regarding the Data That Is Available . . . . . . . . . . . . . . . . . .  3

Trends in Data Collection Show Decrease over Time . . . . . . . . . . . . . . . .  3

Chapter 3: How Are Assisted Suicide Laws Viewed by Disability Organizations? . . . . .  3

Chapter 4: Recent Issues and Events: Bringing the NCD Position Up to Date . . . . . .  4

Sense of Congress Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

The Risks of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Loosening of the Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Double Standard in Suicide Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Evidence of Suicide Contagion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Suicide Prevention and Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

6 National Council on Disability
Consequences for People with Intellectual and Developmental 

Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

People of Color, Healthcare Disparity, and Assisted Suicide Laws . . . . . .  4

Improvements in Palliative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

The Criminalization of Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Chapter 5: Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

The Danger of Assisted Suicide Laws 7
8 National Council on Disability
Acknowledgments

This report is part of a series of reports on bioethics and people with disabilities which was developed 

through a cooperative agreement with the Disability Rights Education & Defense Fund (DREDF). The 

National Council on Disability (NCD) appreciates the work of Marilyn Golden, Senior Policy Analyst, 

DREDF, who contributed her expertise in the development of this report, and who shepherded the 

entire report series in cooperation with NCD. We also thank those who participated on the Advisory 

Panel, in interviews, and in the stakeholder convening, whose knowledge and willingness to share 

information helped make this series possible.

The Danger of Assisted Suicide Laws 9
10 National Council on Disability
Executive Summary

Purpose

As one part of a report series on bioethics, 

this report presents information on how 

assisted suicide laws may impact policies 

and practices related to the delivery of medical 

interventions and life-saving medical care for 

people with disabilities.

The purpose of this report is to provide an 

update to the previous NCD analysis of such 

laws, to examine whether the NCD predictions 

about the effect of these laws were correct, and 

to learn more about the relationship between 

assisted suicide laws and the provision of lifesustaining medical care and palliative care to 

people with disabilities. Do misunderstandings 

about the quality of life and the value of the lives 

of people with disabilities affect the development 

and operation of such laws? Are there ways 

to reduce or eliminate harms, and improve the 

understanding of policy makers, the medical 

community, and society in general?

Background

Promoted as a way to relieve suffering at the 

end of life, assisted suicide laws, as they have 

developed in the United States, generally allow 

physicians to prescribe lethal drugs to patients 

diagnosed with terminal illness and with a 

prognosis of 6 months or less to live, if certain 

procedural steps are followed. Many national 

disability organizations have taken positions 

opposing these laws, due to concerns regarding 

their impact on people with disabilities.

Key Findings

Safeguards and Their Limitations

Assisted suicide laws contain provisions 

intended to safeguard patients from problems or 

abuse. However, research for this report showed 

that these provisions are ineffective, and often 

fail to protect patients in a variety of ways, 

including:

■ Insurers have denied expensive, lifesustaining medical treatment but offered to 

subsidize lethal drugs, potentially leading 

patients toward hastening their own deaths.

■ Misdiagnoses of terminal disease can also 

cause frightened patients to hasten their 

deaths.

■ People with the disability of depression are 

subject to harm where assisted suicide is 

legal.

■ Demoralization in people with disabilities 

is often based on internalized oppression, 

such as being conditioned to regard help as 

undignified and burdensome, or to regard 

disability as an inherent impediment to 

The Danger of Assisted Suicide Laws 11
quality of life. Demoralization can also result 

from the lack of options that people depend 

on. These problems can lead patients 

toward hastening their deaths—and doctors 

who conflate disability with terminal illness 

or poor quality of life are ready to help them. 

Moreover, most health professionals lack 

training and experience in working with 

people with disabilities, so they don’t know 

how to recognize and intervene in this type 

of demoralization.

■ Financial and emotional pressures can 

distort patient choice.

■ Assisted suicide laws apply the lowest 

culpability standard possible to doctors, 

medical staff, and all other involved parties, 

that of a good-faith belief that the law is 

being followed, which creates the potential 

for abuse.

Lack of Data Collection, Oversight, 

and Investigation of Mistakes 

and Abuse

■ There is a substantial lack of data about 

assisted suicide, due not to lack of research, 

but to unnecessarily strict privacy and 

confidentiality provisions in assisted suicide 

laws.

■ Where assisted suicide is legal, states have 

no means of investigating mistakes and 

abuse, nor even a complaint mechanism 

or similar way for the public to report 

suspected problems.

■ Nevertheless, a few important conclusions 

can be gleaned from the minimal available 

data, including that assisted suicide laws 

require no evidence of consent when the 

lethal drugs are administered.

■ Trends show that the minimal amount of 

data collection that was mandated by earlier 

state laws is decreasing over time as some 

newer states adopt less restrictive assisted 

suicide laws.

How Are Assisted Suicide Laws Viewed 

by Disability Organizations?

As with many issues and social movements, 

individuals are not always in complete unison. 

Many national disability rights organizations 

oppose the legalization of assisted suicide. All 

national groups that have taken a position are 

opposed. NCD respects the rights of individuals 

to their opinions and acknowledges that some 

people with disabilities support, or are not 

opposed to, assisted suicide laws, but NCD, for 

the reasons described in this report, maintains its 

position opposing them.

Recent Issues and Events: Bringing 

the NCD Position Up to Date

■ A Sense of Congress resolution, 

H.Con.Res.80, was introduced in the 

115th Congress to express that assisted 

suicide puts those most vulnerable at risk 

of deadly harm. It garnered both Democrat 

and Republican cosponsors.

■ The risks of abuse are significant under 

assisted suicide laws and safeguards are not 

effective.

■ Loosening of the rules is increasing in 

various aspects of assisted suicide laws—in 

eligibility, in who can prescribe lethal drugs, 

in whether waiting periods are mandatory, 

and in how people with depression 

are treated—and in turn, each of these 

increases the risk of danger.

12 National Council on Disability
■ Evidence of suicide contagion in states 

where assisted suicide is legal has been 

found in several studies.

■ Improvement in palliative care in the last 

decade has the potential to reduce requests 

for assisted suicide, though palliative 

care should be more socially oriented and 

disability informed.

■ The criminalization of pain: Due to the opioid 

crisis, people who depend on opioids to 

manage pain often find themselves treated 

like criminals. It may become easier to 

obtain a prescription to die than one to 

relieve pain.

Key Recommendations

Congress

■ Congress should pass a resolution similar 

to H.Con.Res.80, introduced in the 

115th Congress, to express the Sense 

of the Congress that assisted suicide 

puts everyone, particularly people with 

disabilities, at risk of deadly harm.

■ Congress should amend the Social Security 

Act to remove Medicaid’s statutory bias for 

institutional long-term care rather than longterm services and supports (LTSS) provided 

for people living in the community.

■ Congress should explore legislative options 

to provide home and community-based 

LTSS through the Medicare program.

■ Congress should consider creating a new, 

public, long-term care insurance program

to pay for a broad range of long-term

supports and services, such as personal 

care aides, home modifications, or assisted 

living costs.

■ Congress should consider legislation for 

a comprehensive LTSS benefit that is not 

means tested.

The US Department of Health and 

Human Services (HHS)

The Substance Abuse and Mental 

Health Services Administration 

(SAMHSA)

SAMHSA should address the mental health 

challenges of living with a disability and chronic 

conditions, including challenges to people with a 

terminal prognosis, in suicide prevention efforts 

and education.

The National Institute on Disability, 

Independent Living, and Rehabilitation 

Research (NIDILRR)

NIDILRR should conduct research on disabilityrelated risk factors in suicide prevention, as 

well as research on people with disabilities who 

request assisted suicide and euthanasia.

HHS Office for Civil Rights (OCR)

OCR should issue a regulation specifically 

requiring nondiscrimination in suicide prevention 

services, which states that physicians must 

treat a request for assisted suicide or any other 

form of hastened death the same, regardless 

of whether or not the patient has a disability; an 

individual’s expression of wanting to die should 

not be explored any less rigorously or fully solely 

because the individual has a disability or a chronic 

or terminal condition.

As part of this nondiscrimination requirement, 

OCR should make clear that all HHS suicide 

prevention grants and services must comply 

with existing disability rights laws, including the 

ADA, Sections 504 and 508 of the Rehabilitation 

The Danger of Assisted Suicide Laws 13
Act, and Section 1557, including the provisions 

requiring accessible communications, so that all 

videos, documents, and other products ensure 

access to persons with disabilities.

OCR should issue a clarifying regulation 

pursuant to Section 504 and Section 1557 

and any other relevant federal laws to require 

physicians to provide people with disabilities with 

information on the full array of available clinical 

treatments and available LTSS and to require 

that referrals to such treatments and services be 

given if requested. The regulation should require 

hospitals to create a disability ombudsperson 

position who is authorized to facilitate 

communication between healthcare providers 

and patients with disabilities or their proxies and 

advocate on the patient’s behalf, when required, 

to ensure that all clinical and LTSS options and 

choices are made available.

State Legislatures, and State Referenda 

and Initiatives

■ States should not legalize any form of 

assisted suicide or active euthanasia.

Primary Care Practitioners, Specialty 

Providers, Clinics, Hospitals, 

Laboratories, Diagnostic and Therapy 

Centers, and Other Healthcare Services

■ Primary care practitioners, specialty 

providers, clinics, hospitals, laboratories, 

diagnostic and therapy centers, and other 

healthcare services must offer a full range of 

physical, communication, and programmatic 

access accommodations for patients with 

disabilities that are in compliance with 

the Americans with Disabilities Act (ADA) 

and Section 504 of the Rehabilitation Act, 

and that are consistent with culturally 

competent care.

Medical Schools and Other Healthcare 

Professional Education and Training 

Programs

■ Medical school and other healthcare 

professional education and training 

programs, including hospice, should require 

courses on skills and competencies needed 

to provide quality interprofessional health 

care to patients with disabilities.

Methodology

The methodology for this study included a 

stakeholder convening held at the beginning of 

the project, a literature review of disability studies, 

medical and social science articles, and media 

articles in popular newspapers and magazines. 

The literature review was supplemented by 

interviews with stakeholders. Further interviews 

and technical assistance were provided by 

scholars with expertise on this subject who 

served on the project’s Advisory Panel, and by 

two disability organizations that have focused on 

assisted suicide laws for at least two decades.

Introduction and Background

The National Council on Disability (NCD, also 

“the Council”) was an early opponent of the 

legalization of assisted suicide, having released 

a forceful, thorough statement in 19971 that the 

Council later reaffirmed in 2005.2 The dangers 

and harms to people with disabilities that NCD 

identified appear to be as significant today as 

they were in 1997 and 2005.

NCD’s concerns, then and now, stem from the 

understanding that if assisted suicide is legal, 

some people’s lives, particularly those of people 

with disabilities, will be ended without their fully 

informed and free consent, through mistakes, 

abuse, insufficient knowledge, and the unjust lack 

14 National Council on Disability
of better options. No safeguards have ever been 

enacted or proposed that can prevent this 

outcome.

In 1997, the US Supreme Court left the 

question of whether to legalize assisted 

suicide, and “the . . . challenging task of 

crafting appropriate 

procedures . . .,” to the 

“‘laboratory’ of the 

States.”3 As of this 

writing, Oregon (1994), 

Washington State (2008), 

Vermont (2013), California 

(2015), Colorado (2016), Washington DC (2016), 

Hawaii (2018)4, New Jersey (2019), and Maine 

(2019) have legalized assisted suicide. A Montana 

Supreme Court decision (2009) may provide a 

States Where Assisted Suicide 

Is Legal

■ Oregon (1994)

■ Washington (2008)

■ Vermont (2013)

■ California (2015)

■ Colorado (2016)

■ District of Columbia (2016)

■ Hawaii (2018)

■ New Jersey (2019)

■ Maine (2019)

■ Montana (2009 MT Supreme Court 

decision may provide a defense against 

criminal charges for doctors who 

participate in an assisted suicide)

The Oregon “Death with Dignity 

Act” is the statutory model for all 

assisted suicide laws and proposed 

bills in the United States

defense against criminal charges for physicians 

who practice assisted suicide.5

Oregon was the first state to legalize assisted 

suicide. The Oregon “Death with Dignity Act” is 

the statutory model for all assisted suicide laws 

and proposed bills in the United States. For this 

reason, the Oregon 

model is a key focus 

throughout this report.

Most proponents and 

supporters of assisted 

suicide, like most of the 

medical establishment, 

still hold a deficit-oriented medical framework 

of disability instead of sociopolitical models of 

disability where disability can be neutral, an 

identity, the basis for a community, or everevolving depending on barriers and supports in 

the environment. Moreover, proponents have 

been slow to recognize how crucial LTSS can 

be, with home and community-based services 

(HCBS) providing many people with options that 

make longer lives far more appealing, even when 

they have been diagnosed (or misdiagnosed) 

as having a terminal illness. And most assisted 

suicide laws reference “dignity.” The idea that 

hastened death is a pathway to dignity for people 

facing physical decline reveals the public’s 

extreme disparagement of functional limitations 

and a perception that “dignity” is not possible 

for people who rely on supports, technology, or 

caregivers to be independent or alive.6 Many hold 

the attitude that a person with a disability may be 

better off dead than alive. For example, in 2012, an 

op-ed author in the Boston Phoenix reported that, 

on the night that her boyfriend with a significant 

disability suddenly became ill and later died in 

the emergency room, a nurse murmured to her, 

“Maybe it’s better this way.” She continued,

The Danger of Assisted Suicide Laws 15
I’ll never forget that moment. We’d been 

watching a movie together a few hours 

before. We had plans to go clubbing. Maybe 

it’s better this way?7

These types of misperceptions and 

misunderstandings are rooted in disability 

prejudice, and in the context of assisted suicide 

laws and policies, they create a deadly mix 

that poses multifaceted risks and dangers to 

people with disabilities as well as people in other 

vulnerable constituencies. These include people 

who are aging, are underinsured, have chronic 

or progressive conditions, and/or lack privilege in 

other ways.8

16 National Council on Disability
Acronym Glossary

ADA Americans with Disabilities Act

ALS amyotrophic lateral sclerosis

DREDF Disability Rights Education & Defense Fund

HCBS home and community-based services

HHS Health and Human Services

I/DD intellectual and developmental disabilities

LTSS long-term services and supports

NCD National Council on Disability

NIDILRR National Institute on Disability, Independent Living, and Rehabilitation Research

OCR Office for Civil Rights

OPHD Oregon Public Health Division

PCC Physicians for Compassionate Care

SAMHSA Substance Abuse and Mental Health Services Administration

The Danger of Assisted Suicide Laws 17
“Legalizing assisted suicide means that some 

people who say they want to die will receive 

suicide intervention, while others will receive 

suicide assistance. The difference between these

two groups of people will be their health or disability status, leading to a two-tiered system that 

results in death to the socially devalued group.

—Diane Coleman

18 National Council on Disability
Chapter 1: Safeguards and Their Limitations

T

his chapter addresses what safeguards 

assisted suicide laws provide. Are these 

safeguards effective, and if not, what are 

their limitations?

What Are the Safeguards 

in Assisted Suicide Laws?

US assisted suicide laws and bills contain 

a number of provisions pointed to by their 

supporters as tight safeguards. For example, 

Laurie Wilcox of New Jersey, a nurse “disabled 

by [a] life-shortening disease,” wrote in an oped reprinted on the website of Compassion 

& Choices, a leading organization promoting 

assisted suicide in the United States,

In fact, the New Jersey legislation has 

more than a dozen safeguards to prevent 

abuse and coercion. For example, two 

doctors must confirm the terminal 

prognosis, that the requesting person 

is mentally capable of making their own 

medical decisions and is physically able 

to self-ingest the medication, the person

must make two oral requests for the 

medication, as well as a written request 

witnessed by two people who can confirm 

the person is voluntarily making the 

request.9

With the New Jersey legislation passing in 

2019, these represent the most current best 

practices for safeguards for assisted suicide laws 

in the United States.

Are There Problems with 

These Safeguards?

There are many ways that provisions of safeguard 

provisions in US assisted suicide laws are 

inadequate, can be readily circumvented, or fail to 

protect patients from pressure to end their lives.

Many experts have contributed important 

analyses of this key issue. For example, as 

documented by Drs. Herbert Hendin and 

Kathleen Foley as early as 2008,

The Oregon law seems to require 

reasonable safeguards regarding the care of 

patients near the end of life, which include 

presenting patients with the option for 

palliative care; ensuring that patients are 

competent to make end-of-life decisions 

for themselves; limiting the procedure to 

patients who are terminally ill; ensuring 

the voluntariness of the request; obtaining 

a second opinion on the case; requiring 

the request to be persistent, i.e., made 

a second time after a two week interval; 

encouraging the involvement of the next 

The Danger of Assisted Suicide Laws 19
of kin; and requiring physicians to inform 

OPHD [the Oregon Public Health Division] 

of all cases in which they have written a 

prescription for the purpose of assisted 

suicide.

The evidence strongly suggests that these 

safeguards are circumvented in ways that 

are harmful to patients.10

Following are 

important ways that 

asserted safeguards 

under assisted suicide 

laws can and have been disregarded and even 

sidestepped entirely.11

Assisted Suicide Instead 

of Medical Treatment

The Oregon model assumes that if an eligible 

patient doesn’t want assisted suicide, they can 

receive medical treatment. But there is evidence 

that patients, including 

people with disabilities, 

are being denied 

treatment by insurers and 

offered assisted suicide 

instead, just as NCD 

predicted in 1997.12

When assisted suicide 

is legalized in the context 

of the US healthcare 

system, it immediately 

becomes the cheapest treatment. Direct coercion 

is not necessary. If insurers deny, or even simply 

delay, approval of expensive life-sustaining 

treatment, patients can be steered toward 

hastening their deaths—and sometimes insurers 

help them to do so. For example, in 2008, 

Barbara Wagner, a 64-year-old great-grandmother, 

The evidence strongly suggests that 

these safeguards are circumvented 

in ways that are harmful to patients

When assisted suicide is legalized ..

it immediately becomes the 

cheapest treatment. Direct coercion

is not necessary. If insurers deny,

or even simply delay, approval of 

expensive life-sustaining treatment, 

patients can be steered toward 

hastening their deaths 

was fighting recurring lung cancer. Her physician 

prescribed Tarceva to extend her life. Studies 

showed that the drug provided a 30 percent 

increased survival rate for patients with advanced 

lung cancer, and patients’ 1-year survival rate 

increased by more than 45 percent. But the 

Oregon Health Plan (Oregon’s Medicaid program) 

sent Wagner a letter saying the Plan would not 

cover the beneficial 

chemotherapy treatment 

“but . . . it would 

cover . . . physicianassisted suicide.”13

Around the same 

time, fellow Oregonian Randy Stroup was 

prescribed Mitoxantrone as chemotherapy for 

his prostate cancer. His oncologist said the 

medication’s benefit has been shown to be “not 

huge, but measurable”; while the drug may not 

extend a patient’s life by very long, it helped 

make the final months of life more bearable by 

decreasing pain.14 Yet 

Stroup also received a 

letter saying that the 

Oregon Health Plan 

would not cover his 

treatment, but would pay 

for the cost of, among 

other things, his assisted 

suicide.15

These treatment 

denials were based on 

an Oregon Medicaid rule that denies surgery, 

radiotherapy, and chemotherapy for patients 

with less than a 5 percent expectation of 5-year 

survival. H. Rex Greene, MD, former Medical 

Director of the Dorothy E. Schneider Cancer 

Center at Mills Health Center in San Mateo, 

California and a former member of the AMA 

20 National Council on Disability
Ethics Council, called this rule “an extreme 

measure that would exclude most treatments 

for cancers such as lung, stomach, esophagus, 

and pancreas. Many important noncurative 

treatments would fail the 5-percent/5-year 

[criterion].”16 These rules also presume that 

all physician estimates for life expectancy are 

always correct (see “Mistakes in Diagnosis and 

Prognosis” below), and that a shortened life span 

is not worth living.

Recent bills and laws to legalize assisted 

suicide have included a newer provision to 

prohibit an insurer from informing a patient in 

the same communication, such as a letter, about 

both a denial of treatment and the availability of 

lethal drugs. For example, the 2015 California law 

states: “Any [insurance carrier] communication 

shall not include both the denial of treatment and 

information as to the availability of aid-in-dying 

drug coverage.”17

Shortly after California’s assisted suicide 

law went into effect in 2016, Stephanie Packer, 

a mother of four and a cancer patient, was 

denied her previously approved chemotherapy 

treatment, but offered low-cost suicide pills by 

her insurer by phone instead.18 About a year 

later, Dr. Brian Callister, associate professor 

of internal medicine at the University of 

Nevada, said he tried to transfer two patients 

to California and Oregon for procedures not 

performed at his hospital. The patients were 

not terminal, but “would have become terminal 

without the procedures.” Representatives 

from the two patients’ insurance companies 

denied both transfer requests in separate 

phone calls. The insurance medical directors 

told Callister they would cover neither the 

procedures nor the transfers, but asked if he’d 

considered assisted suicide for his patients, 

though Callister did nothing to prompt such a 

suggestion.19

Mistakes in Diagnosis and Prognosis

Assisted suicide laws assume that doctors can 

estimate whether or not a patient diagnosed as 

terminally ill will die within 6 months. Actually, it 

is common for medical prognoses of a short life 

expectancy to be wrong. “Terminal Uncertainty,” 

a 2009 article in the Seattle Weekly, summarized 

a number of studies illustrating this problem and 

the reasons for it.20

The personal experiences of this problem are 

also noteworthy. For example, Jeanette Hall of 

Oregon was diagnosed with cancer in 2000 and 

told she had 6 months to a year to live. She knew 

about the assisted suicide law, and asked her 

doctor about it, because she didn’t want to suffer. 

Her doctor encouraged her not to give up, and 

she decided to fight the disease. She underwent 

chemotherapy and radiation. Eleven years later, 

she wrote, “I am so happy to be alive! If my 

doctor had believed in assisted suicide, I would 

be dead. . . . Assisted suicide should not be 

legal.”21 As of this writing in 2019, Jeanette Hall 

is alive and doing well, 19 years after her terminal 

diagnosis.22

In another example, disability rights advocate 

Anita Cameron, Director of Minority Outreach 

for Not Dead Yet, testified against an assisted 

suicide bill in New York, regarding her mother, 

Alice Bozeman. Cameron stated, “In June 2009, 

while living in Washington State, my mother 

was determined to be in the final stages of 

Chronic Obstructive Pulmonary Disease and 

placed in hospice. Two months later, I was told 

that her body had begun the process of dying. 

My mother wanted to go home to Colorado to 

die, so the arrangements were made. A funny 

The Danger of Assisted Suicide Laws 21
thing happened, though. Once she got there, her 

health began to improve! Almost 8 years later, 

she is still alive, lives in her own home in the 

community and is reasonably active.”23

In a final example, Laurie Hoirup, a California 

woman with a life-long significant disability of 

spinal muscular atrophy, survived by decades 

several terminal prognoses given to her by 

physicians over the course of her life, including 

one that she would never reach adulthood. She 

was a devoted wife, mother, and grandmother, 

served as director of a center for independent 

living and as chief deputy director of the State 

Council on Developmental Disabilities, and was 

a published author. She was an active disability 

advocate, including 

offering testimony on 

several occasions against 

California assisted suicide 

bills. She was the acting 

head of the Association 

of California State 

Employees with 

Disabilities. Hoirup finally 

died at the age of 60 from accidental causes.24

Her situation is illustrative and not unusual in the 

disability community.

Faulty prognoses pose considerable danger 

to people with new or progressive disabilities or 

diseases, who may often be misdiagnosed as 

terminally ill, but who, like Laurie Hoirup, could 

potentially outlive these prognoses by years or 

even decades. Research overwhelmingly shows 

that people with new disabilities frequently go 

through initial despondency and suicidal feelings, 

but later adapt well and find great satisfaction 

in their lives.25 However, adaptation takes 

considerably longer than the mere 15-day waiting 

period required by Oregon-model assisted 

Research overwhelmingly shows 

that people with new disabilities 

frequently go through initial 

despondency and suicidal feelings, 

but later adapt well and find great 

satisfaction in their lives

suicide laws. During an initial period after a new 

disability, and before one learns that a disability 

does not preclude a good quality of life, it can be 

too easy, where assisted suicide is legal, to make 

an irrevocable choice to die.

A counterexample was Dr. Richard Radtke, a 

well-known academic oceanographer in Hawaii 

for many years. Dr. Radtke had a very disabling 

form of muscular sclerosis for more than 

35 years. In the early period after his diagnosis, 

with an extremely limiting disability, doctors 

often misclassified him as terminally ill, and he 

experienced severe depression for 2 years. Had 

the option for assisted suicide been available 

at that time, he later acknowledged that he 

would have chosen it 

and died many years 

earlier. Instead, Radtke 

went on to a successful 

academic career, and 

was a happily married 

father. After his 

retirement, he served as 

president of a charitable 

foundation, and was grateful for the length and 

scope of his life, until he finally died of natural 

causes in 2012.26

Further, regarding mistakes in diagnosis and 

prognosis, the definition of “terminal” in Oregon 

model laws only require two doctors’ estimates 

that the patient will die within 6 months. There 

is no requirement that the doctors consider the 

likely impact of medical treatment, counseling, 

and other supports on survival. For example, a 

successful adaptation may necessitate referral to 

state and community resources, such as social 

workers, VA benefits, assistive technology, or 

grants to create an accessible home. Adaptation 

may also require counseling or antidepressant 

22 National Council on Disability
medication. Yet referrals to services, and to 

supportive counseling, are not included as 

safeguards in assisted suicide laws.

Also, while terminal predictions of some 

conditions, such as some cancers, are fairly well 

established 1 or 2 months before death, this is 

far less true 6 months out, as the law provides—

and is even less true for other diseases.27

Depression and Demoralization

People with the disability of depression are 

subject to harm where assisted suicide is legal. 

Yet the law’s supporters frequently suggest 

that, as a key safeguard, depressed people are 

ineligible for assisted suicide.28

Michael Freeland 

of Oregon was a case 

study of the potential 

for harm. With his 

permission, his case was 

extensively documented 

by Dr. Gregory Hamilton, 

a Distinguished Fellow of 

the American Psychiatric 

Association. This 

summary of Michael 

Freeland’s story is 

excerpted from Hamilton’s documentation:29

At age 62, Michael Freeland had a 43-year 

medical history of significant depression 

and suicide attempts. After receiving 

a diagnosis of terminal lung cancer, he 

requested assisted suicide. Dr. Peter 

Reagan, an assisted suicide advocate 

who was associated with the group 

Compassion in Dying (later renamed 

Compassion & Choices), a leading proassisted suicide organization, prescribed 

[T]he definition of “terminal” in 

Oregon model laws only require 

two doctors’ estimates that the 

patient will die within 6 months

There is no requirement that the 

doctors consider the likely impact of 

medical treatment, counseling, and 

other supports on survival

lethal drugs to Michael Freeland without 

even a cursory psychological evaluation. 

Reagan commented that he did not think 

such a consultation would be “necessary” 

for Mr. Freeland, according to Freeland’s 

daughter, who accompanied him to an 

appointment.

Freeland then made a telephone call to 

Physicians for Compassionate Care (PCC), 

a medical group dedicated to improving 

the care of seriously ill people without 

resorting to assisted suicide. The call was 

answered by a PCC volunteer who was 

trained in counseling people with serious 

illness. With encouragement from a doctor 

recommended 

by PCC, Freeland 

underwent 

chemotherapy and 

radiation treatment, 

which alleviated his 

cancer symptoms 

significantly. PCC 

volunteers arranged 

for him to receive 

adequate pain care, 

other appropriate medication, and 24-hour 

attendant services. A PCC volunteer stayed 

in touch with him to offer encouragement, 

as did some old friends, who began to visit 

him daily. He also received assistance to 

resolve other health and personal problems. 

With this multifaceted assistance, his 

suffering abated, as did his wish to take 

lethal drugs. He was able to fully reconcile 

with his daughter, who had been estranged 

from him during certain periods. In the 

end, he lived 2 years post-diagnosis; he 

eventually died of natural causes.

The Danger of Assisted Suicide Laws 23
What happened to Michael Freeland highlights 

parts of the complex web of problems for people 

with depression and demoralization under 

assisted suicide laws.

First, the work of PCC with Michael 

Freeland illustrates what Dr. Herbert Hendin, 

an international expert on suicide intervention, 

stated in Congressional testimony:

A request for assisted suicide is . . . usually 

made with as much ambivalence as are 

most suicide attempts. If the doctor does 

not recognize that ambivalence as well as 

the anxiety and depression that underlie the 

patient’s request for death, the patient may 

become trapped by that request and die in a 

state of unrecognized 

terror. . . .

Patients who request 

euthanasia are 

usually asking in the 

strongest way they 

know for mental and 

physical relief from suffering. When that 

request is made to a caring, sensitive, 

and knowledgeable physician who can 

address their fear, relieve their suffering, 

and assure them that he or she will remain 

with them to the end, most patients no 

longer want to die and are grateful for the 

time remaining to them. Advances in our 

knowledge of palliative care in the past 

twenty years make clear that humane care 

for the terminally ill does not require us to 

legalize assisted suicide and euthanasia. 

Study has shown that the more physicians 

know about palliative care, the less apt they 

are to favor legalizing assisted suicide and 

“Study has shown that the more 

physicians know about palliative 

care, the less apt they are to favor 

legalizing assisted suicide and 

euthanasia.

euthanasia. Our challenge is to bring that 

knowledge and that care to all patients who 

are terminally ill.30

Thus, the challenge for doctors is to find out 

what is behind the patient’s request to hasten 

death, and address it. Yet, where assisted 

suicide is legal, such a request begins a legally 

sanctioned process. The depression remains 

undiagnosed, and the only treatment consists of 

a lethal prescription.31

Another significant concern is assisted suicide 

laws’ very limited requirement that the attending 

physician must inform the patient of alternative 

options, including “comfort care, hospice care, 

palliative care, and 

pain control”;32 but no 

physician or other party 

is required to actually 

provide the alternative 

treatments, services, 

and programs. And 

nonmedical supports, 

such as long-term services and supports (LTSS), 

including home health care and assistance, 

as well as counseling, may be even more 

important—though many doctors do not have 

knowledge of such services and supports to a 

degree that allows them to fully inform people 

requesting lethal drugs.

The 1997 NCD statement addressed the 

major gap between informing the patient of 

alternative options and those alternatives actually 

being available and provided:

. . . In proposals to legalize assisted suicide, 

proponents are sometimes willing to agree 

that a decision to choose suicide must be 

24 National Council on Disability
preceded by a full explanation of the 

programs, resources, and options available 

to assist the patient if he or she does not 

decide to pursue suicide.33

Many people with disabilities find this to be 

a very shallow promise when they know 

that all too often the 

programs are too 

few, the resources 

are too limited, and 

the options . . . often 

nonexistent. Society 

should not be ready 

to give up on the 

lives of its citizens 

with disabilities until it has made real and 

persistent efforts to give these citizens a 

fair and equal chance to achieve a 

meaningful life.34

These unmet support 

needs impact people 

with terminal illness 

as well.

As mentioned 

above, additional factors 

complicate the situation 

of depression in the 

context of assisted 

suicide. Though assisted 

suicide requests 

from people with terminal illness, like most 

suicide requests, are usually based on fear and 

depression,35 Oregon’s statistics show that, 

for example, in 2017, only 3.5 percent of those 

who reportedly died under the Oregon law 

were referred by the prescribing doctor for a 

psychological evaluation before a prescription 

“Society should not be ready to give 

up on the lives of its citizens with 

disabilities until it has made real 

and persistent efforts to give these 

citizens a fair and equal chance to 

achieve a meaningful life.

Oregon’s statistics show that ... 

2017, only 3.5 percent of those who

reportedly died under the Oregon 

law were referred by the prescribing 

doctor for a psychological 

evaluation before a prescription for 

lethal drugs was written. In 2018, it

was 1.8 percen

for lethal drugs was written.36 In 2018, it was 

1.8 percent.37 Some other states refer even fewer 

people. In Colorado, only 1 out of the reported 

69 people (1.4 percent) was so referred.38

Moreover, only 6 percent of Oregon 

psychiatrists were confident they could diagnose 

depression after one 

visit, according to one 

study.39 Yet the definition 

in the Oregon assisted 

suicide law of psychiatric 

“counseling” permits 

only one visit. And 

another study showed 

that primary care 

physicians are generally not experts in diagnosing 

depression at all.40

Another key factor, poorly understood, is 

that people with depression can, in fact, receive 

lethal drugs under assisted suicide laws, because 

such patients are still 

technically eligible as 

long as they are deemed 

legally competent; 

that is, “competent 

and not suffering 

from a psychiatric or 

psychological disorder 

or depression causing 

impaired judgment.”41

[Emphasis added.] Thus, 

patients with depression may be considered 

legally competent to decide to end their 

lives merely because the depression doesn’t 

impair their legal competency. As Hendin and 

Foley pointed out, “Reducing the psychiatric 

consultation to the issue of competency ignores 

all the other psychological factors that go into the 

The Danger of Assisted Suicide Laws 25
request for assisted suicide.”42 And these factors 

can impair decision-making judgment, even if that 

impairment of judgment does not quite meet the 

threshold for legal incompetence.

A study in the British Medical Journal further 

documented that people with depression are 

receiving lethal drugs under assisted suicide 

laws. As Dr. William Toffler wrote in the Wall 

Street Journal Online in 2015,43

A . . . British Medical Journal [study] 

examined 58 Oregonians who sought 

information on assisted suicide. Of them, 

26% met the criteria for depressive 

disorder, and 22% for anxiety disorder. 

Three of the 

depressed individuals 

received and ingested 

the lethal drugs, dying 

within two months 

of being interviewed. 

The study’s authors 

concluded that 

Oregon’s law “may 

not adequately protect all patients [with a 

mental illness].”44

And further, is the depression clinically 

diagnosable, or subclinical? Recent research and 

clinical work suggest that affective states such 

as demoralization also pressure people toward 

wanting to die, yet these states are even less 

likely than clinical depression to be addressed. 

Demoralization may be an unrecognized and 

unaddressed precipitant of requests to die.45

Lastly, given the history of forced treatment 

and institutionalization that psychiatric survivors 

have experienced, it is important to be clear 

that, when discussing the serious matter of 

[I]nternalized oppression; in other 

words, being conditioned by 

dominant cultural values to believe 

that needing help is undignified, 

less than fully human, and again, 

burdensome to others

depression in the context of assisted suicide 

laws, the goal is not to force any treatment on 

people who may have depression and/or who 

may wish to hasten their deaths, including but 

not limited to medication, institutionalization, 

or hospitalization.46 Rather, what’s needed is a 

variety of available medical treatment options 

as well as home and community-based service 

options, ideally self-directed, from which the 

individual genuinely benefits—similar to the range 

of services that Dr. Greg Hamilton and his staff 

assisted Michael Freeland to find.

Demoralization and Internalized 

Oppression of People with Disabilities

Dr. Carol Gill, Ph.D., 

Professor Emerita in the 

Department of Disability 

and Human Development 

at the University of 

Illinois at Chicago, has 

discussed how, for some 

people with disabilities, 

demoralization, similar 

in some ways to depression, is one of the most 

powerful, yet difficult, risk factors regarding 

assisted suicide. Dr. Gill’s works discuss 

internalized oppression; in other words, being 

conditioned by dominant cultural values to believe 

that needing help is undignified, less than fully 

human, and again, burdensome to others. She 

has asked, “How can one provide safeguards 

for that?”47

For some people with disabilities, 

demoralization or depression may be caused by 

the long-term struggle against socially 

constructed obstacles to one’s life goals, social 

devaluation of disability, social isolation, financial 

concerns, and lack of support to make life 

26 National Council on Disability
meaningful. Further, feeling like a burden is a 

potent risk factor for demoralization. According 

to Dr. Gill, unfortunately, the tendency to equate 

disability with burdensomeness is pervasive 

in our society, placing people with disabilities 

and seriously ill people at substantial risk of 

demoralization.48

This appears to be borne out in studies. For 

example, an article on patient requests to hasten 

death from the Archive of 

Internal Medicine stated,

Symptoms and loss of 

function can give rise 

to dependency on 

others, a situation that 

was widely perceived 

as intolerable . . . : “I’m inconveniencing, 

I’m still inconveniencing other people who 

look after me and stuff like that. I don’t want 

to be like that. I wouldn’t enjoy it, I wouldn’t. 

I wouldn’t. No. I’d 

rather die.”49

A related factor is the 

absence of alternatives 

for control in the face 

of an advanced or 

terminal condition. 

If an individual’s only 

alternatives to assisted suicide are nursing home 

placement, burned-out family care, or suffering in 

isolation, assisted suicide may seem preferable. 

As the example of Michael Freeland illustrated, 

no current assisted suicide law requires that 

resources be made available for real alternatives, 

including advocacy to help individuals understand 

that they deserve, and can have, better options 

than death.

If an individual’s only alternatives to 

assisted suicide are nursing home 

placement, burned-out family care, 

or suffering in isolation, assisted 

suicide may seem preferable

“Shopping” for doctors is part of 

the US healthcare system, and 

an important right, though in the 

context of assisted suicide, it creates 

an opportunity for sidestepping 

safeguards in the law

Doctor Shopping

US assisted suicide laws allow physicians to 

prescribe lethal drugs to patients who meet 

certain legal criteria relating to terminal illness 

and with the agreement of a second doctor. 

If the first doctor believes legal criteria have not 

been met and denies a patient’s request for lethal 

drugs, patients may continue to seek additional 

physicians until they find 

one who will obtain a 

colleague’s concurrence 

and prescribe a lethal 

dose.

And if heirs, family 

members, or caregivers 

are pushing people with 

disabilities, terminal illness, or chronic illness 

toward assisted suicide, but the patients’ primary 

care physician refuses the request, they, too, can 

seek additional physicians until they find one who 

will grant it. “Shopping” for doctors is part of the 

US healthcare system, 

and an important right, 

though in the context 

of assisted suicide, it 

creates an opportunity for 

sidestepping safeguards 

in the law.

One example is Kate 

Cheney, who was age 85 

and experiencing early dementia when she died 

by assisted suicide under Oregon’s law. Her own 

physician had declined to provide a lethal 

prescription. But her managed care provider then 

found a second physician who ordered a 

psychiatric evaluation, which found that Cheney 

lacked “the very high level of capacity required to 

weigh options about assisted suicide.” Cheney’s 

request was again denied, and her daughter 

The Danger of Assisted Suicide Laws 27
“became angry.” Another evaluation took place, 

this time with a psychologist who insisted on 

meeting Cheney alone. The psychologist deemed 

Cheney competent while noting that her “choices 

may be influenced by her family’s wishes and 

her daughter . . . may be somewhat coercive.” 

Cheney soon took the lethal drugs and died.50

The documented concerns about Cheney’s 

dementia and a “somewhat coercive” adult 

daughter were not sufficient to stop the assisted 

suicide process, though either should have been 

disqualifying.

There is evidence suggesting that a key role 

is played by organizations that support assisted 

suicide, which have 

helped patients and 

their families through 

the assisted suicide 

process, and which can 

refer interested parties to 

doctors who will tend to 

approve such requests. 

Compassion & Choices 

(formerly known as the 

Hemlock Society51) was 

involved in 75 percent to 90 percent of Oregon’s 

reported assisted suicides, according to their 

own data, until they stopped releasing such 

information to the public after 2008.52

Family and Economic Pressures

Oregon and Washington State statistics, minimal 

though they are, show a high rate of patients’ 

concern about being a burden on others.53 Yet, 

assisted suicide laws have no protections for 

patients when financial or emotional pressures, 

sometimes from family, distort patient choice. 

Examples of economic pressures and abuse 

include Linda Fleming and Thomas Middleton.

Compassion & Choices (formerly 

known as the Hemlock Society) was 

involved in 75 percent to 90 percent 

of Oregon’s reported assisted 

suicides, according to their own data, 

until they stopped releasing such 

information to the public after 2008

Linda Fleming, diagnosed with stage four 

pancreatic cancer, was the first person to use 

the Washington State assisted suicide law. 

Despite the fact that she had financial problems, 

had been unable to work due to a disability, and 

was forced to declare bankruptcy, the Director 

of Compassion & Choices of Washington said 

that her situation presented “none of the red 

flags” that might have given his group pause in 

supporting her request for death.54

Thomas Middleton was diagnosed with 

amyotrophic lateral sclerosis (ALS),55 moved 

into the home of Tami Sawyer in July 2008, and 

died by assisted suicide later that same month. 

Middleton had named 

Sawyer his estate trustee 

and put his home in the 

trust. Two days after 

he died, Sawyer listed 

the property for sale, 

sold it, and deposited 

the $90,000 proceeds 

into her own personal 

account, not Thomas 

Middleton’s trust 

account.56 A federal investigation into real estate 

fraud exposed this abuse. Sawyer was indicted 

for first-degree criminal mistreatment and firstdegree aggravated theft, partly over criminal 

mistreatment of Thomas Middleton.

Of those in Oregon who reportedly died from 

ingesting a lethal dose of medication in 2018, 

more than 9 out of 168 (7.3 percent) mentioned 

“financial implications of treatment” as a 

consideration.57

As Dr. Carol Gill explains, not all of the 

family-related pressures are malicious or even 

explicit. As one example, supportive family 

members can find it difficult to accept functional 

28 National Council on Disability
impairment in a loved one. The desire to end the 

perceived suffering of a family member can seem 

altruistic, but nonetheless, can have the effect of 

pressuring the ill person to hasten their death. 

Also, a worried family may be supportive, but 

can still lead an ill family 

member to feel pressure 

toward an early exit 

from life simply to avoid 

high medical bills from 

depleting scarce financial 

resources. And further, 

disability is associated 

with suffering, even by 

many loving family members. Consequently, 

while family members may not express the idea 

in such explicit terms, the notion that people with 

disabilities are “better off dead” is a common 

view that may further erode safeguards.58

Good Faith

The Oregon law lists procedural steps for the 

patient, doctors, and other participants, and then 

provides broad immunity for everyone involved:

No person shall 

be subject to civil 

or criminal liability 

or professional 

disciplinary action 

for participating in 

good faith compliance with ORS 127.800 to 

127.897. This includes being present when 

a qualified patient takes the prescribed 

medication to end his or her life in a 

humane and dignified manner.59

Thus, the Oregon model protects anyone, 

including physicians, from all criminal and civil 

Of those in Oregon who reportedly 

died from ingesting a lethal dose 

of medication in 2018, more than 9 

out of 168 (7.3 percent) mentioned

“financial implications of treatment” 

as a consideration

It is virtually impossible to disprove 

a claim of good faith, making 

all other safeguards effectively 

unenforceable

liability if they provide lethal drugs based on a 

“good faith” belief that statutory criteria are 

met. Every other US assisted suicide law and 

proposal includes a similar provision. As the NCD 

2005 statement pointed out, this is the lowest 

culpability standard 

possible, even below that 

of negligence, which is 

the minimum standard 

governing all other 

physician duties.60 This 

same protection from 

liability is also provided 

to family members, 

caregivers, and other associates of the patient, 

regardless of their actions.

It is virtually impossible to disprove a claim of 

good faith, making all other safeguards effectively 

unenforceable. For example, the individual may 

be depressed, or may be responding to coercion 

from other people. But if everyone involved 

claims they acted in a good faith belief that 

all circumstances complied with the law, they 

have no liability, since it is virtually impossible to 

disprove a stated claim 

of good faith, which is 

merely a personal belief. 

If the liability standard for 

physicians under assisted 

suicide laws were 

negligence, as it is for all 

other medical practices, then physicians might be 

found negligent in these situations.

Physicians Hold 

Disproportionate Power

Doctors are respected authority figures for 

most people and can influence a patient just 

by bringing up assisted suicide as a potential 

The Danger of Assisted Suicide Laws 29
treatment, implicitly suggesting that it could be 

appropriate for them.

As stated in the Journal of the American 

Medical Association,

Physicians can influence patients, even in 

ways they may not consciously appreciate. 

Patients seeking physician-assisted suicide 

may seek validation to end their lives. 

Indeed, studies have shown that socially 

isolated vulnerable individuals seek social 

support and contact through visits with 

their physicians. [And] physicians can 

influence patients based on the physician’s 

own potential fears of 

death and disability.61

The NCD 1997 

position statement 

addressed prejudice by 

healthcare professionals 

in detail:

People with 

disabilities’ lives 

are frequently 

viewed as valueless by others, including 

members of the medical profession. People 

with disabilities are often harassed and 

coerced to end their lives when faced 

with life-threatening conditions, even if 

the conditions are imminently treatable; 

others have had their lives involuntarily 

terminated by medical personnel. These 

practices manifest blatant prejudice and 

are a virulent form of the discrimination 

that the Americans with Disabilities Act 

and other laws condemn. Legal and 

medical authorities should denounce and 

[R]esearch showed that health 

professionals who had negative 

assessments of quality of life for 

people with disabilities were less 

likely to offer, or even know much 

about, options to extend and 

enhance life with a disability, such 

as noninvasive ventilation

prohibit any attempt to pressure, harass, 

or coerce any individual to shorten her or 

his life; they should certainly proscribe 

any action to terminate an individual’s life 

taken without that person’s full, voluntary, 

and informed consent, whether it be called 

“suicide,” “mercy killing,” “letting nature 

take its course,” or some other euphemistic 

term. And certainly there should be official 

condemnation and cessation of practices 

by which people with disabilities are 

pressured to sign “Do Not Resuscitate” 

consent forms, or such forms are hidden 

within a stack of admission and consent 

papers in the hope 

that [patients] will sign 

them without paying 

attention to what is 

being signed.62

As mentioned above, 

health professionals, in 

general, receive little 

training about life with 

a disability, or disability 

resources. Most know 

little more than the general public about daily life 

with a disability and options for supports. Thus, 

they don’t know how to recognize and intervene 

when patients experience disability-related 

demoralization as described above.63

Even with benign intentions, physicians 

generally dispense only medical facts: diagnosis, 

prognosis, and medical treatment options. Very 

rarely can they address nonmedical, quality-of-life 

interventions that are often much more important 

for managing an advanced chronic or terminal 

condition and making continued life desirable. 

For example, John Bach’s research showed 

30 National Council on Disability
that health professionals who had negative 

assessments of quality of life for people with 

disabilities were less likely to offer, or even know 

much about, options to extend and enhance life 

with a disability, such as noninvasive ventilation.64

Further, “incurable” is often assumed to 

mean unbearable or hopeless. Because most 

disabilities are not curable, and disability is 

equated with suffering, the public and many 

health professionals conclude that life with 

disability is hopeless.65 Thus, a patient with a 

pre-existing physical or sensory disability might 

be perceived differently than someone who is not 

already disabled, but is diagnosed with a terminal 

disease such as cancer, in that physicians might 

allow the disability to be a reason to more easily 

accept that the patient’s request for death is 

valid, due to their a perception that living with a 

disability is not worthwhile.

All of this can contribute to further erosion 

of the supposed safeguards in the operation of 

assisted suicide, once it is legalized.

Safeguards Are Gradually Diminishing

Assisted suicide proposals tend to promise 

strict safeguards that will, in theory, avoid any 

dangers or problems. But once passed, the 

restrictions tend to be ineffective or inadequate, 

as shown in this chapter. Chapter 2 will discuss 

how requirements for data collection have been 

decreased in recent statutes. And Chapter 4 will 

show how rules governing assisted suicide are 

being loosened, and how new proposals may 

reduce them further.

The Danger of Assisted Suicide Laws 31
32 National Council on Disability
Chapter 2: Lack of Data Collection, Oversight, 

and Investigation of Mistakes and Abuse

T

his chapter addresses how assisted 

suicide laws and proposals in the United 

States address data collection and 

analysis. Do they provide adequate oversight? Do 

they establish a way to investigate mistakes and 

abuse? Do their data reveal anything useful? And 

what else is needed?

Minimal Data and Scant Oversight

Many key questions 

about assisted suicide 

laws cannot be answered 

because of the substantial 

lack of data, including 

both quantitative and 

qualitative data, on the 

medical and demographic 

profiles of people who 

have sought and used 

assisted suicide. This is 

not due merely to the 

lack of research, but because of the very strict 

privacy and confidentiality requirements that are 

structured into every assisted suicide law to date.

As a Michigan Law Review article stated 

under the heading “Excessive Secrecy,”

OPHD has focused more on patientdoctor confidentiality than on monitoring 

compliance or abuse. The agency has 

developed confidentiality measures unique 

to physician-assisted suicide which appear 

to be unnecessarily secretive and limit the 

potential for thorough research into the 

dimensions and context of this practice as 

it unfolds. . . . Medical standards require 

openness about facts, research data, and 

records to assess the appropriateness of 

treatment. The anonymity and secrecy 

about physician 

practice of assisted 

suicide makes such 

an assessment 

impossible. If 

physician-assisted 

suicide is to be 

part of the medical 

treatment for terminal 

illness, why are 

existing patient-doctor 

confidentiality rules 

not sufficient . . . ? Restricting access 

to information about the indications for 

assisted suicide, patient data, radiologic 

documentation, and specific drug therapy 

limits the opportunity to establish an 

objective standard of care, provides 

excessive protection to the physician and, 

in the name of confidentiality, leaves the 

patient vulnerable.66

Medical standards require 

openness about facts, research 

data, and records to assess the 

appropriateness of treatment

The anonymity and secrecy about 

physician practice of assisted 

suicide makes such an assessment 

impossible

The Danger of Assisted Suicide Laws 33
Consequently, it is difficult to understand the 

personal, financial, medical, and psychological 

circumstances of people who request and 

use assisted suicide. If it were available, this 

information would enable all parties to better 

interpret why and how assisted suicide is carried 

out and what interventions or information might 

improve the options of doctors, patients, and 

their families. It would 

enable the public to 

better understand if there 

have been any medical 

complications during 

administration of assisted 

suicide drugs, as well as 

other problems associated 

with this practice.

As the NCD 2005 statement pointed out, 

and as the annual brief statistical reports from 

Oregon make clear, the state has not, and 

in fact, cannot assess the extent of nonreporting 

or noncompliance with the law’s purported 

safeguards. The Oregon 

Health Authority reports 

are based on forms filed 

with the state by the 

physicians who prescribe 

lethal doses and the 

pharmacies that dispense 

the drugs. As the early 

reports admitted:

Underreporting and noncompliance is . . . 

difficult to assess because of possible 

repercussions for noncompliant physicians 

reporting to the division.67

This odd justification seems to be stating 

that doctors are unlikely to report their own lack 

[A]s the annual brief statistical 

reports from Oregon make clear, 

the state has not, and in fact, cannot 

assess the extent of nonreporting 

or noncompliance with the law's 

purported safeguards 

Similarly, the state has no way for 

the public, family members, or 

other healthcare professionals to 

report suspected problems, nor 

even a means of investigating 

mistakes and abuse

of compliance with the law. It also implies that 

physicians may circumvent safeguards or not 

follow procedures, including mandated reports, 

because authorities refrain from providing any 

oversight or follow-up. Given that physicians are 

already protected by the law and cannot be held 

negligent, this is especially remarkable.

Similarly, the state has no way for the public, 

family members, or other 

healthcare professionals 

to report suspected 

problems, nor even a 

means of investigating 

mistakes and abuse. As 

the Oregon Department 

of Health and Human 

Services stated:

We are not given the resources to 

investigate [assisted suicide cases] and not 

only do we not have the resources to do it, 

but we do not have any legal authority to 

insert ourselves.68

One consequence, 

which applies to all 

assisted suicide laws to 

date, is that important 

questions go unasked, 

such as why some 

doctors refuse to assist 

patients in suicide. Doctors who said “no” may 

have concluded that a patient did not meet legal 

requirements—essential information to evaluate 

a law’s outcomes. Further, none of these states 

interview family members or friends to learn 

about the physical and emotional status of those 

who died, nor do they interview or collect any 

information from patients prior to their deaths.69

34 National Council on Disability
Another significant problem with data 

collection is the secrecy created by a common 

provision in assisted suicide laws for the last 

decade concerning death certificates, and the 

ability of physicians to falsify them so they do 

not show assisted suicide as the actual cause 

of death. This provision in Connecticut bills in 

2015 and 2019 prompted that State’s Division of 

Criminal Justice to enter the debate. While not 

taking a position on the overall bill both times, the 

Division asked the legislature for deletion of this 

provision:

Section 9(b) effectively mandates the 

falsification of death 

certificates under 

certain circumstances. 

It states: “The person 

signing the qualified 

patient’s death 

certificate shall list the 

underlying terminal 

illness as the cause of 

death.” This is simply 

not the case; the 

actual cause of death 

would be the medication taken by or given 

to the patient. This language contradicts the 

death certificate form itself, which states for 

the person making the certification: “On the 

basis of examination, and/or investigation, 

in my opinion, death occurred at the time, 

date, and place, and due to the cause(s) 

and manner stated.” . . . The practical 

problem for the criminal justice system and 

the courts will be confronting a potential 

Murder prosecution where the cause of 

death is not accurately reported on the 

death certificate.70

As the Oregon Department of 

Health and Human Services stated: 

“We are not given the resources to 

investigate [assisted suicide cases] 

and not only do we not have the 

resources to do it, but we do not 

have any legal authority to insert 

ourselves.

Daniel Callahan, Senior Research Scholar and 

President Emeritus of the Hastings Center, has 

written:

In the case of Oregon, we have been 

assured that all is well, that no abuses are 

occurring. . . . If you know, just know, there 

are no abuses, why bother? Regulations of 

that kind, protected from public scrutiny, 

but with the ring of authority and oversight, 

are a Potemkin village form of regulatory 

obfuscation. They look good, sound good, 

feel good, but have nothing behind them.71

As Maryland state 

Senator Bob Cassilly 

wrote in the Baltimore 

Sun in 2019:

The [Maryland] 

doctor assisted 

suicide bill . . . gives 

undue influence 

to the health 

care industry and 

prevents even close 

family members from uncovering the facts 

or taking any action to protect a loved one’s 

interests.

Consider a possible scenario of a brother, 

George, who wants to find out why his 

sister, June, recently diagnosed with 

cancer, was unexpectedly found dead 

on her kitchen floor only days after her 

diagnosis. June’s death certificate would 

simply indicate that she died of her illness 

many months earlier than doctors had first 

advised, making no mention of the poison 

she ingested. George would have no access 

The Danger of Assisted Suicide Laws 35
to any records of the conversations June 

had with the doctor provided by June’s 

insurance company.72 George would never 

know that June’s doctor told her that she 

could elect expensive treatment, paid in 

part by her insurer, to extend June’s life but 

that in doing so June would likely become 

a considerable burden on her family and 

friends. George would never know that in 

June’s distraught mental state her doctor 

advised that she could avoid becoming a 

burden by taking . . . very inexpensive pill[s], 

paid for by her insurance company, to end 

her life. George would never know that, 

despite June’s considerable mental anguish 

over the decision to take her own life, she 

was never provided access to a mental 

health counselor nor did any outside doctor 

review the terminal diagnosis. George 

would also never know that all of those who 

influenced June’s decision to end her life 

were employed by the same health care 

provider who stood to gain financially from 

June’s quick death: the advising doctor, 

the doctor tasked to prescribe the poison, 

and two hospital staff who witnessed 

June sign the written consent. If George 

was sufficiently alarmed and tried to file 

a lawsuit, he would find that he could not 

obtain any of the relevant medical records 

and that the hospital and doctors are 

immune from suit so long as George cannot 

prove they acted in bad faith, an impossible 

burden given that all of the facts rest with 

June and the records George cannot obtain.73

Proponents of assisted suicide frequently 

state that no abuses, problems, or even medical 

complications have ever occurred under these 

laws. For example, current and former governors 

of Hawai’i stated:

With more than 30 years combined of 

practice in the authorized states, there has 

not been a single instance of documented 

abuse of medical aid in dying. Two decades 

of rigorously observed and documented 

experience in Oregon shows us the law 

has worked as intended, with none of the 

problems opponents had predicted.74

Given the lack of data collection and the 

absence of transparency, one cannot turn to 

official records to document such problems. 

In fact, quite a few problems, complications, 

and even abuses have been documented, by 

either the media, patients and their families, 

or other concerned watchdogs; some of these 

are described throughout this report. The 

Disability Rights Education & Defense Fund 

(DREDF) compiled approximately 16 examples in 

various categories, including “Doctor Shopping 

Gets Around Any ‘Safeguards,’” “Depression,” 

“Economic Pressures and Coercion,” “SelfAdministration,” “Deadly Mix Between Our 

Broken Healthcare System and Assisted Suicide,” 

“Breakdown in Rules Attendant to Changing the 

Law,” “Medical Complications,” and “Impacts by 

Doctors and Their Quality of Care.”75

Rather than correcting any of these 

fundamental problems, OPHD responded to 

pressure from pro-assisted suicide advocates to 

stop using the term “assisted suicide.” OPHD 

had originally employed this term, commonly 

used in the legal and medical literature, for 

7 years on its website and in its annual reports. 

But Compassion & Choices, in the wake of 

polling data that public support for assisted 

36 National Council on Disability
suicide decreases if the word “suicide” appears, 

successfully pressured OPHD in 2006 to switch 

to more nebulous terms such as “persons who 

use the Oregon Death with Dignity Act.” The 

war over terminology for assisted suicide, which 

persists to this day, traces back to these events.76

Conclusions Regarding the Data 

That Is Available

Even the minimal data provided by Oregon 

demonstrates several important points. For one, 

it shows that, except for the first year, people 

whose illnesses did not result in death within 

6 months have received lethal prescriptions in 

all 20 years the assisted suicide law has been in 

effect.77 Washington State reports comparable 

results,78 and no other states to date have made 

this data public.

Further, reasons for 

requesting assisted 

suicide that sound 

like a cry for help 

with disability-related 

concerns appear to be ignored. The top five 

reasons doctors give for their patients’ assisted 

suicide requests are not pain or fear of future 

pain—that alone is noteworthy—but psychological 

issues that are all-too-familiar to the disability 

community: “loss of autonomy” (95.5 percent), 

“less able to engage in activities” (94.6 percent), 

“loss of dignity” (87.4 percent), “losing control of 

bodily functions” (56.5 percent), and “burden on 

others” (51.9 percent).79

It should be noted that the “reasons” are not 

directly gathered from the individuals themselves 

but are gathered from proxies (their physicians) 

after assisted suicides have already occurred. This 

is a concerning source of potential error, without 

any way to validate the reports. Moreover, the fact 

[T]here is no way for authorities to 

know whether the lethal dose was 

self-administered and consensual

that the reporting forms include these particular 

check boxes to indicate patients’ reasons means 

that these reasons were viewed as acceptable 

from the beginning of the laws’ implementation. 

Yet they are based on an uninformed analysis of 

how to address disability-related issues.80

And perhaps most importantly, the Oregon 

data reveal that there is no required evidence 

of consent or self-administration of lethal 

drugs. In about half the reported cases, the 

Oregon Health Authority reports state that no 

healthcare provider was present at the time 

of ingestion of the lethal drugs or at the time 

of death.81 This means there is no way for 

authorities to know whether the lethal dose was 

self-administered and consensual. Therefore, 

although self-administration is touted as one of 

the key “safeguards,”82

in about half the cases, 

there is no evidence of 

consent. If the drugs 

were, in some cases, 

administered by others 

without consent, no one would know. See more 

about this key issue in Chapter 4.

Trends in Data Collection Show 

Decrease over Time

Possibly due to public discussion and debate over 

what has been gleaned from the minimal data 

under the Oregon law, the trend over time is to 

collect and/or report even less data.

For example, certain data in states that 

legalized assisted suicide more recently is 

collected but not reported to the public. In 

Oregon and Washington State, the first states 

to legalize assisted suicide (Oregon in 1994 

and Washington State in 2008), some general, 

minimal data about a patient’s reason(s) for 

The Danger of Assisted Suicide Laws 37
requesting lethal drugs is collected and reported 

annually. Washington State’s 2017 Annual 

Report, for example, stated that leading reasons 

for requesting assisted suicide were losing 

autonomy, being less able to engage in activities 

that make life enjoyable, loss of dignity, and 

being a burden on family, friends, and caregivers. 

More than 50 percent of patients cited were 

concerned about being a burden on others.83

But in California, which legalized assisted suicide 

in 2015, while this data is collected, it is not 

required to be publicly reported—and the state 

has not reported this information voluntarily, so it 

remains unknown.

Another California example concerns a 

provision in the law characterized by Rita Marker, 

Executive Director of the Patients Rights Council, 

as “extremely dangerous.”

“443.19. (a) The State Department of 

Public Health shall collect and review the 

information submitted . . . The information 

collected shall be confidential and shall 

be collected in a manner that protects the 

privacy of the patient, the patient’s family, 

and any medical provider or pharmacist 

involved with the patient under the 

provisions of this part. The information 

shall not be disclosed, discoverable, 

or compelled to be produced in any 

civil, criminal, administrative, or other 

proceeding.” [Emphasis added.]

The first sentence . . . would protect 

the privacy of patients and individuals 

participating in doctor-prescribed

suicide. However, the second sentence 

(highlighted in bold) is new. [It] could 

protect any person who causes a 

vulnerable patient’s death, even if the 

person’s actions were in violation of 

[California’s] End of Life Option Act.

For example, if a family member finds out 

that someone coerced a loved one into 

signing the written assisted-suicide request 

and then forced the loved one to take the 

lethal drugs after [they] were mailed to 

the patient’s home, [this] provision would 

actually prohibit any investigation into the 

loved one’s death.

This new wording sets the stage for 

massive patient abuse and complete 

protection for those engaged in criminal 

activity that culminates in a patient’s 

death. Absolutely no information related 

to the patient’s death could be disclosed 

to law enforcement or any other 

investigating body.

Nothing in any other state proposal [until 

this point in time] has ever contained this 

type of language.84

The later Hawaii law (2018) contains a similar 

provision.85

38 National Council on Disability
Chapter 3: How Are Assisted Suicide Laws Viewed 

by Disability Organizations?

T

he disability community is highly diverse, 

and not every disability group is actively 

speaking out about assisted suicide laws, 

or even working on the issue. However, every 

prominent national disability organization that 

takes any position on assisted suicide laws is 

in opposition. Many of these well-established 

organizations are predominantly managed and 

directed by people with disabilities, widely 

respected for their advocacy, and reflect 

diverse disability leadership. Included are 

the National Council on Independent Living, 

The Arc of the United States, the American 

Association of People with Disabilities, United 

Spinal Association, Not Dead Yet, ADAPT, the 

Association of Programs for Rural Independent 

Living, and the DREDF. (See a complete list 

of national organizations that oppose assisted 

suicide laws.86) Research has not revealed any 

examples of national disability organizations—

whether or not they are led by people with 

disabilities—that are in favor of such laws. 

However, there is also a wide range of disability 

organizations that do not take any position on 

assisted suicide laws, particularly if it is not a 

priority for their work.

As with many issues and social movements, 

various individuals are not always in complete 

unison. Some people with disabilities do support 

these laws in whole or in part, but their views 

have not been echoed by established national 

disability rights organizations.

The Danger of Assisted Suicide Laws 39
40 National Council on Disability
Chapter 4: Recent Issues and Events: Bringing 

the NCD Position Up to Date

Over the last 25 years, there has been 

a vigorous policy debate in state after 

state over proposed assisted suicide 

laws. In many states, multiconstituency coalitions 

have come together to oppose assisted suicide 

laws that include disability advocates, physicians, 

faith-based organizations, and other groups.

Far more state proposals are rejected than 

passed, often due to education and advocacy 

efforts about the dangers and harms of assisted 

suicide laws by the coalitions described above. 

According to the Patients 

Rights Council,

[S]ince Oregon 

legalized assisted 

suicide in 1994, 

many states have 

rejected assistedsuicide measures, 

some multiple times. Since January 1994 

[until] the end of January 2019, there have 

been 269 legislative proposals in more than 

39 states . . . Yet, over and over again, bills 

were either defeated, tabled for the session, 

withdrawn by sponsors, or languished with 

no action taken.87

For example, in 2018, assisted suicide 

proposals in 19 states were defeated, while only 

Hawaii’s passed. In 2017, proposals in 27 states 

were defeated; none passed. A complete listing 

of US assisted suicide proposals is maintained by 

the Patients Rights Council.88

Several key evolving issues in the assisted 

suicide debate were raised in a 2015 California 

court decision (brought before assisted suicide 

was legalized there). The judge held that “Most 

states make it a crime to assist suicide. . . . They 

are long standing expressions of the States’ 

commitment to the protection and preservation 

of all human life.” (Glucksberg, at p. 710.) The 

decision continued,

Far more state proposals are 

rejected than passed, often due 

to education and advocacy efforts 

about the dangers and harms 

of assisted suicide laws by the 

coalitions described above

The Danger of Assisted Suicide Laws 41

It is one thing to 

take one’s own life, 

but quite another 

to allow a third 

person assisting 

in that suicide to 

be immune from 

investigation by the coroner or law 

enforcement agencies.

In such a case, the state has a legitimate 

competing interest in protecting society 

against abuses. . . . It is the interest of the 

state to . . . protect the lives of those who 

wish to live . . . (Donaldson, at p. 1622)

Since “Aid in Dying” is quicker and less 

expensive [than other treatment options], 

there is a much greater potential for its abuse, 
e.g., greedy heirs-in-waiting, cost containment 

strategies, impulse decision-making, etc. . . . 

Further, “Aid in Dying” creates the possible 

scenario of someone taking his life based 

upon an erroneous diagnosis of a terminal 

illness, which was, in fact, a misdiagnosis . . . 

After all, doctors are not infallible.

Furthermore, “Aid in Dying” . . . could have 

the unintended consequence of causing 

people who are not terminally ill . . . to 

view suicide as an option in their unhappy 

life. For example, . . . a bullied transgender 

child, or a heartsick teenaged girl whose 

first boyfriend just broke up with her, 

questioning whether 

life is really worth 

living. These children 

may be more apt 

to commit suicide 

in a society where 

the terminally ill are 

routinely opting for 

it. . . .” (Donaldson, 

at p. 1623.)89

Sense of Congress Resolution

In the US House of Representatives in 2017, 

Congressman Brad Wenstrup introduced 

H.R. Con. Res. 80, “Expressing the sense of 

the Congress that assisted suicide . . . puts 

everyone, including those most vulnerable, 

at risk of deadly harm. . . .” It garnered both 

Democrat and Republican cosponsors in equal 

numbers.90 NCD wrote a letter in support of 

this resolution.

Other key evolving issues and noteworthy 

events in the assisted suicide debate include the 

following examples.

[W]here assisted suicide is legal, an 

heir or abusive caregiver can steer 

someone toward it, witness the 

request, pick up the lethal dose, and 

even, in the end, give the drug—

because when the lethal agents 

are administered, no witnesses are 

required

The Risks of Abuse

Disability abuse91 and elder abuse92 are rising 

problems. NCD has recently released several 

reports documenting such abuse. Elder law 

attorney Margaret Dore has written that the 

Washington State assisted suicide law “invites 

coercion.” According to her analysis, where 

assisted suicide is legal, an heir or abusive 

caregiver can steer someone toward it, witness 

the request, pick up the lethal dose, and even, 

in the end, give the drug—because when the 

lethal agents are administered, no witnesses are 

required.93

This surprising fact, 

a part of every assisted 

suicide proposal and law, 

was underscored by the 

Patients Rights Council in 

discussing a recent bill:

Patients would have 

no protection once 

the prescription is 

filled. The patient’s 

health care provider 

is not required to be present when the 

patient takes the lethal drugs. There is no 

way to know who, if anyone, is present or 

what actually takes place leading up to the 

patient’s death. The patient could be tricked 

or forced into taking the overdose. And no 

one would ever know. Why aren’t there any 

protections at the most important part of 

the process?94

As John Kelly, a leading disability rights 

advocate and writer working against assisted 

suicide laws, and the Director of Second 

42 National Council on Disability
Thoughts Massachusetts, pointed out, “For there 

to be any real safeguard against abuse, officials 

would need to investigate the home situation.”95

However, as discussed in Chapter 2, no 

assisted suicide laws to date authorize any type 

of investigation of alleged abuse, nor do they 

even include a means for the public to report 

suspected mistreatment.

Loosening 

of the Rules

Proposals to legalize 

assisted suicide are 

gradually growing less 

and less protective of 

public safety, and thus, their legalization would 

pose increased dangers. Loosening of the rules 

is occurring in a number of different ways. 

Examples include:

Eligibility Determinations. The definition 

of “terminal” in most assisted suicide 

statutes requires that two doctors 

predict that the person will die within 

6 months. Many conditions will or may 

become terminal if certain medications 

or routine treatments are discontinued. 

The list of conditions found eligible for 

assisted suicide in Oregon, according 

to annual reports, has grown over the 

years to include: neurological disease, 

respiratory disease, heart/circulatory 

disease, infectious disease, gastrointestinal 

disease, endocrine/metabolic disease 

(e.g., diabetes), arthritis, arteritis, 

sclerosis, stenosis, kidney failure, and 

musculoskeletal system disorders.96 But 

people with many such conditions would 

not die if properly treated.

[N]o assisted suicide laws to date 

authorize any type of investigation 

of alleged abuse, nor do they even 

include a means for the public to 

report suspected mistreatment

As one advocate explained,

In legislation that we have seen to date, 

it is far too easy to qualify for assisted 

suicide. Most set the bar at anyone who, 

with or without treatment, would have 

six months to live. Using myself as an 

example, if I were to stop managing my 

diabetes, I would 

easily meet this 

standard. I am not 

alone; this expansive 

definition includes a 

great many people 

with disabilities who 

will happily live for 

Conditions Eligible for Assisted 

Suicide in Oregon

■ Neurological disease

■ Respiratory disease

■ Heart/circulatory disease

■ Infectious disease

■ Gastrointestinal disease

■ Endocrine/metabolic disease (e.g., diabetes)

■ Arthritis

■ Arteritis

■ Sclerosis

■ Stenosis

■ Kidney failure

■ Musculoskeletal system disorders. 

Note: People with many such conditions 

would not die if properly treated. 

The Danger of Assisted Suicide Laws 43
decades with proper treatment. This is 

a definition which leaves people [with 

disabilities] wide open to potential 

abuse.97

A recent Hawaii bill had no requirement 

for a second doctor, often termed the 

consulting physician, to confirm the 

patient’s diagnosis or eligibility for assisted 

suicide. All actions 

could be carried out 

by a single attending 

physician. In the end, 

this bill failed to pass, 

though a bill passed 

the following year 

that did require a 

consulting physician’s 

concurrence.98 Further, 

as of this writing in 2019, an Oregon bill 

to broaden its law, HB 2232, would define 

terminal disease as “a disease that will, 

within reasonable medical judgment, 

produce or substantially contribute to a 

patient’s death.”99

Almost anyone with 

a chronic condition 

or disability would 

be eligible under that 

definition.

Authority to 

Prescribe Lethal 

Drugs. Some recent assisted suicide 

proposals would allow nonphysicians to 

prescribe lethal drugs. For example, a 2019 

bill in New Mexico would have allowed 

a “health care provider,”100 defined as a 

physician, an osteopathic physician, a nurse 

licensed in advanced practice, or a physician 

[A]n Oregon bill to broaden 

its law, HB 2232, would define 

terminal disease as “a disease that 

will, within reasonable medical 

judgment, produce or substantially 

contribute to a patient’s death.

[A] recent bill in New York State 

would make it possible for the 

patient to receive the lethal drugs 

within a day after the diagnosis of a 

terminal illness is confirmed

assistant to diagnose a patient’s terminal 

disease and to prescribe the lethal drugs for 

assisted suicide.101 And the Hawaii law, as 

originally proposed, would have permitted 

advanced practice registered nurses, as well 

as doctors, to be “attending provider[s]” 

who could diagnose a patient’s terminal 

disease and prescribe lethal drugs.102

Waiting Periods.

The Oregon model 

requires a waiting 

period of 15 days after 

lethal drugs are initially 

requested. This has 

been touted as a way 

to allow considerations 

of alternatives and 

protect vulnerable 

individuals. Yet some recent bills are moving 

away from this protection. For example, a 

recent bill in New York State would make it 

possible for the patient to receive the lethal 

drugs within a day after the diagnosis of 

a terminal illness is 

confirmed.103 As of this 

writing in 2019, a bill 

in Oregon would also 

create exceptions to 

the waiting period.104

People with 

Depression. As of 

this writing, an amendment to a Maryland 

bill105 would require psychiatric evaluations, 

geared toward determining if a mental state 

such as depression is causing impaired 

judgment. Compassion & Choices issued 

a press release calling this and other 

amendments “excessive.”106 In response, 

44 National Council on Disability
five Maryland state senators from the 

Democratic Party released a statement 

saying, “By deeming mental health 

evaluations as ‘excessive,’ Compassion 

and Choices is saying that the success 

of this flawed proposal is more important 

than attempts to protect those [people] 

who have a mental illness. We are asking 

that if you share OUR commitment to 

mental health, please [contact] Committee 

members . . . [to vote] NO on . . . Senate 

Bill 311.”107 [Emphasis in original.]

Expansion is most overt in the few countries 

outside the United States 

that permit assisted 

suicide and other forms 

of hastened death, such 

as active euthanasia 

(lethal injections 

by doctors). These 

countries include the 

Netherlands, Belgium, 

and Canada.108 As Rita 

Marker pointed out, “The 

true relevance for the US 

of developments in other countries is seeing how 

fast this moves and how it’s promoted for those 

who can’t even request it themselves.”109 The 

countries permitting this include the Netherlands, 

Belgium, and Canada.110

To illustrate these two consequences of 

expansion, the Dutch example provides the 

longest experience with assisted suicide in any 

country. Although it remained technically illegal 

until 2002, the Netherlands first began to legally 

tolerate assisted suicide in the early 70s.111

Today, active euthanasia has almost completely 

replaced assisted suicide.112 Dr. Herbert Hendin 

[A]n amendment to a Maryland 

bill would require psychiatric 

evaluations, geared toward 

determining if a mental state such 

as depression is causing impaired 

judgment. Compassion & Choices

issued a press release calling this 

and other amendments “excessive.

documented how assisted suicide and lethal 

injections have become not the rare exception 

but the rule for people with terminal illness in 

the Netherlands. Hendin was one of only three 

foreign observers given the opportunity to study 

these medical practices in the Netherlands in 

depth. He stated in Congressional testimony:

Over the past . . . decades, the 

Netherlands has moved from assisted 

suicide to euthanasia, from euthanasia 

for the terminally ill to euthanasia for the 

chronically ill, from euthanasia for physical 

illness to euthanasia for psychological 

distress, and from 

voluntary euthanasia 

to nonvoluntary and 

involuntary euthanasia. 

Once the Dutch 

accepted assisted 

suicide, it was not 

possible legally or 

morally to deny . . . 

active . . . euthanasia 

[lethal injections] to 

those who could not 

effect their own deaths. Nor could they 

deny assisted suicide or euthanasia to the 

chronically ill who have longer to suffer 

than the terminally ill or to those who have 

psychological pain not associated with 

physical disease. To do so would [have been 

seen as] a form of discrimination.

Involuntary euthanasia has been justified as 

necessitated by the need to make decisions 

for patients not competent to choose for 

themselves. . . . The Remmelink report [the 

Dutch government’s commissioned study of 

the problem] revealed that in over 

The Danger of Assisted Suicide Laws 45
1,000 cases, of the 130,000 deaths in the 

Netherlands each year, physicians admitted 

they actively caused or hastened death 

without any request from the patient. . . . 

In [many] of these cases . . ., physicians 

gave the patient’s impaired ability to 

communicate as their justification for not 

seeking consent.113

Further on the subject of loosening the rules, 

Hendin also testified,

Legal sanction creates a permissive 

atmosphere that seems to foster not 

taking the guidelines 

too seriously. The 

notion that . . . 

American doctors . . . 

would follow 

guidelines if assisted 

suicide were legalized 

is not borne out by 

the Dutch experience; 

nor is it likely 

given the failure of 

American practitioners 

of assisted suicide to follow elementary 

safeguards in cases they have published.114

Double Standard in Suicide 

Prevention

Diane Coleman, president and founder of Not 

Dead Yet, a grassroots disability organization 

opposed to legalizing assisted suicide, developed 

the important critique that the

public image of severe disability as a fate 

worse than death . . . become[s] grounds 

Before Oregon legalized assisted 

suicide, its suicide rate was similar 

to the national average. Yet by

2010, Oregon's suicide rate was 

41 percent above the national 

average. In states overall, assisted

suicide laws are associated, on 

average, with a 6 percent increase 

in a state’s total suicide rate

for carving out a deadly exception to 

longstanding laws and public policies about 

suicide [prevention] services. . . . Legalizing 

assisted suicide means that some people 

who say they want to die will receive 

suicide intervention, while others will 

receive suicide assistance. The difference 

between these two groups of people will 

be their health or disability status, leading to 

a two-tiered system that results in death to 

the socially devalued group.115

Evidence of Suicide Contagion

Studies show an 

increased rate of general 

suicide in states where 

assisted suicide is legal. 

In Oregon, government 

reports show a statistical 

correlation between 

assisted suicide under 

the Oregon law and 

an increase in other 

suicides. Before Oregon 

legalized assisted 

suicide, its suicide rate 

was similar to the national average. Yet by 2010, 

Oregon’s suicide rate was 41 percent above the 

national average.116

In states overall, assisted suicide laws are 

associated, on average, with a 6 percent increase 

in a state’s total suicide rate.117

Dr. Aaron Kheriaty, associate professor of 

psychiatry and director of the medical ethics 

program at the University of California at Irvine 

School of Medicine, pointed out, “[Such] results 

should not surprise anyone familiar with the 

literature on the social contagion effects of 

46 National Council on Disability
suicidal behavior. You don’t discourage suicide by 

assisting suicide . . . [P]ublicized cases of suicide 

can produce clusters of copycat cases, often 

disproportionately affecting young people, who 

frequently use the same method as the original 

case.”118 This dynamic, known as the Werther 

Effect, was cited as a danger of assisted suicide 

by Judge Gregory W. Pollack in his decision in the 

2015 California lawsuit quoted at the beginning of 

this chapter.

Suicide Prevention and Disability

In 2014, the State of Connecticut issued 

the “Connecticut Strategic Plan for Suicide 

Prevention (PLAN 2020)” to increase the 

effectiveness of suicide prevention.119 This was 

the first known suicide prevention effort to 

specifically address disability issues. Notably, it 

singled out disability-specific suicide risk factors 

including:

■ Difficulties navigating social and financial 

services;

■ Stress of chronic stigma and discrimination;

■ The loss or threat of loss of independent 

living, and

■ Institutionalization or hospitalization.

Further, Plan 2020 included acknowledgement 

that:

■ The active disability community in 

Connecticut has been vocal about the need 

for suicide prevention services, including 

disability cultural competency;

■ There may be unintended consequences of 

assisted suicide legislation on people with 

disabilities;

■ Many assume disability is a fate worse than 

death; and

■ People with disabilities have a right to 

responsive suicide prevention services.

Plan 2020 recommendations included:

■ Training practitioners to develop expertise 

in working with people with disabilities who 

are suicidal; and

■ Not assuming that suicide is a rational 

response to disability.

Consequences for People with 

Intellectual and Developmental 

Disabilities

Assisted suicide laws also have consequences 

for people with intellectual and developmental 

disabilities (I/DD). There is a major emphasis 

currently in I/DD services on future planning and 

end-of-life care.120 Families and professionals 

who endorse assisted suicide may advocate 

for people with I/DD to have this option with 

guardian consent. This raises complex issues 

beyond the scope of this study, such as surrogate 

versus supportive decision making. There is also 

a history of institutionalization, as was addressed 

above for psychiatric survivors, which has been 

shown, in many cases, to violate the Americans 

with Disabilities Act (ADA) and the Supreme 

Court Olmstead decision.121

People of Color, Healthcare Disparity, 

and Assisted Suicide Laws

There is concern about the impact of assisted 

suicide laws on people of color, as has been 

shown both through research122 and statements 

from legislators and other opinion leaders 

The Danger of Assisted Suicide Laws 47
(see later in this section). This is true despite data 

from the Oregon Health Authority consistently 

showing that mostly white, educated, insured 

people request assisted suicide.123

The Pew Research Center in 2013 found that 

65 percent of people in the African American 

and Hispanic communities oppose these laws.124

Anita Cameron explained that “black, indigenous, 

and [other] people of color” are at particular risk 

of being harmed by assisted suicide laws.125

In the run-up to passage of the California law, 

opposition from Latino legislators nearly stopped 

it. For example, Assemblyman Jimmy Gomez 

said the bill had insufficient protections for 

vulnerable patients. He said he grew up without 

health insurance and 

watched his father delay 

getting treatment for 

cancer until it was too 

late. He worried that 

uninsured patients would 

be more likely to choose 

assisted death because 

they felt it was their only 

treatment option, while those who do not speak 

English might not fully understand the choice. 

“How do we deal with the fact that the system 

is fundamentally unfair to people in underserved 

communities?” he said.126

In Washington, DC, with half its population 

being African American, there was significant 

resistance to an assisted suicide bill. The 

Washington Post quoted Patricia King, a 

Georgetown Law School professor who has 

written about the racial dynamics of assisted 

death, when she said that “Many in the black 

community distrust the health-care system 

and fear that racism in life will translate into 

discrimination in death. . . . Historically, African 

“Historically, African Americans 

have not had a lot of control over 

their bodies, and I don’t think 

offering them assisted suicide is 

going to make them feel more 

autonomous.

Americans have not had a lot of control over 

their bodies, and I don’t think offering them 

assisted suicide is going to make them feel 

more autonomous.” The Post continued, “Some 

worry that blacks, who tend to have less access 

to treatment and preventive care, may think 

that ending their lives early is their best option 

when given a terminal diagnosis.”127 An opinion 

piece in The Hill by Dr. Lydia S. Dugdale also 

linked assisted suicide to the facts of healthcare 

disparities affecting African American patients. 

She wrote,

A study . . . found that black women are 

more than twice as likely as white women 

to die from cervical 

cancer—a disease 

which is largely 

preventable. . . . 

Still other studies 

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. . . . 

Each day doctors strive to care for their 

patients, regardless of race, ethnicity, or 

socioeconomic status. Many are cognizant 

of past abuses . . . and 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.128

48 National Council on Disability
Improvements in Palliative Care

Palliative care is comfort care that affords 

relief, as opposed to curative care. In the last 

decade, the field of palliative care has developed 

significantly.

One aspect of palliative care is palliative 

sedation. In rare cases, when other forms of 

palliative care cannot relieve significant pain or 

discomfort, the patient can be sedated to the 

point where the discomfort is relieved while the 

dying process takes place, in a way that does not 

cause or hasten death.129 This and other aspects 

of palliative care today can provide a legal solution 

to significantly painful or uncomfortable deaths 

that do not endanger 

others in the way that 

assisted suicide laws do.

Ideal approaches to 

palliative care should 

encompass social and 

lifestyle interventions 

as well as medical 

supports. There has 

been an increased 

emphasis on cultural 

competence as the context in which palliative 

care should be understood and practiced. 

Arguably, living with disability entails many 

cultural and social factors that should be 

addressed by professionals working with people 

with functional limitations (and their families) 

at the end of life. Improvements in palliative 

care have the potential to reduce requests for 

hastening one’s death.

The Criminalization of Pain

Disability activist Anita Cameron has written 

about how “Our country is in the midst of an 

[Palliative sedation] and other 

aspects of palliative care today 

can provide a legal solution 

to significantly painful or 

uncomfortable deaths that do not 

endanger others in the way that 

assisted suicide laws do

opioid crisis which has resulted in what I call 

the criminalization of pain. . . . Many people 

who depend on opioids . . . to manage pain . . . 

[find themselves] subjected by doctors to drug 

testing and pill counting . . . and feel as if they 

are being treated like criminals.” Cameron points 

out that emergency rooms treat such patients 

like addicts and drug seekers. As more people 

experience poor pain management, she argues, 

it’s easy to see that if assisted suicide is legal, this 

could drive increased requests for lethal drugs. 

Cameron commented, “How ironic that it may 

become easier . . . to get a prescription to die 

than one to relieve pain. . . . Policymakers should 

be working to increase 

access to . . . palliative 

care, not enacting laws 

that allow doctors [to 

hasten . . . deaths].”130

Cameron’s concerns 

are echoed by others’ 

findings. In fact, the 

news media and the 

Centers for Disease 

Control have reported 

a rise in suicidal thinking and actual suicides 

among people with chronic pain who are denied 

the drugs they need, especially among veterans, 

people in rural areas with limited healthcare 

choices, and people of color.131 Also, writers in 

the Journal of Palliative Medicine and the Journal 

of the American Medical Association have written 

about how patients often fear the prospect of 

unrelieved pain. Unfortunately, more physicians 

withhold pain medication because of ungrounded 

concerns about patient addiction or that higher 

doses may accelerate death through respiratory 

suppression. Appropriate pain relief, however, 

rarely does either.132

The Danger of Assisted Suicide Laws 49
50 National Council on Disability
Chapter 5: Recommendations

NCD has considered recommending ways 

to “improve” assisted suicide proposals 

and laws by making their provisions 

more stringent, but has decided against doing 

so, because the Council does not believe that 

added safeguards, modified safeguards, or indeed 

safeguards of any kind, will remove the inherent 

dangers in assisted suicide laws. Also, such a 

message can be readily confused with the idea 

that legalized assisted suicide is acceptable as 

long as its rules are stronger, which is not true. 

On the contrary, the basic dangers of legalizing 

assisted suicide are inherent and cannot be 

eradicated.

Implementation of assisted suicide laws has 

demonstrated that even the current “safeguards,” 

which are modest at best, are easily circumvented. 

Rather than strengthening safeguards, the 

tendency has been either to propose looser rules 

or to simply disregard them, notwithstanding the 

letter of the law. Examples from other countries 

have also demonstrated that once assisted suicide 

seems “safe,” then euthanasia and assisted suicide 

for nonterminal diseases becomes a reasonable 

next step. Thus, there is no reason to believe that 

better laws, training of physicians, data collection or 

safeguards will provide real protection from harms 

and abuse in any meaningful way.

Congress

Congress should pass a resolution similar to H.Con.Res.80 from the 115th Congress to 

express the Sense of the Congress that assisted suicide puts everyone, particularly people 

with disabilities, at risk of deadly harm.

Congress should amend the Social Security Act to remove Medicaid’s statutory bias for 

institutional long-term care rather than long-term services and supports (LTSS) provided for 

people living in the community. Although the Olmstead decision calling for Medicaid home 

and community-based services rather than institutionalization for people with disabilities has 

reduced states’ emphasis on institutionalization, the funding bias remains.

Congress should explore legislative options to provide home and community-based LTSS 

through the Medicare program. Options could include expanding the limited in-home benefit; 

building on supplemental services recently made available through Medicare Advantage; and 

(continued)

The Danger of Assisted Suicide Laws 51
Congress, continued

creating a new complex care benefit that would deliver a comprehensive range of healthcare 

services, including LTSS.

Congress should consider creating a new, public, long-term care insurance program to 

pay for a broad range of long-term supports and services, such as personal care aides, home 

modifications, or assisted living costs. Consideration should be given to supporting the program 

through a modest tax, comparable to recently enacted legislation in Washington State.

Congress should consider legislation for a comprehensive LTSS benefit that is not means tested.

Executive Branch

The US Department of Health and Human Services (HHS)

The Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA should address the mental health challenges of living with a disability and chronic 

conditions, including challenges to people with a terminal prognosis, in suicide prevention 

efforts and education.

The National Institute on Disability, Independent Living, and Rehabilitation 

Research (NIDILRR)

NIDILRR should conduct research on disability-related risk factors in suicide prevention, as 

well as research on people with disabilities who request assisted suicide and euthanasia.

HHS Office for Civil Rights (OCR)

OCR should issue a regulation specifically requiring nondiscrimination in suicide prevention 

services which states that physicians must treat a request for assisted suicide or any other 

form of hastened death the same, regardless of whether or not the patient has a disability; 

an individual’s expression of wanting to die should not be explored any less rigorously or fully 

solely because the individual has a disability, or a chronic or terminal condition.

As part of this nondiscrimination requirement, OCR should make clear that all HHS suicide 

prevention grants and services must comply with existing disability rights laws, including 

the ADA, Sections 504 and 508 of the Rehabilitation Act, and Section 1557, including the 

provisions requiring accessible communications, so that all videos, documents, and other 

products ensure access to persons with disabilities.

(continued)

52 National Council on Disability
Executive Branch, continued

OCR should issue a clarifying regulation pursuant to Section 504 and Section 1557 and 

any other relevant federal laws to require physicians to provide people with disabilities with 

information on the full array of available clinical treatments and available LTSS and requiring 

that referrals to such treatments and services be given if requested. The regulation should 

require hospitals to create a disability ombudsperson position who is authorized to facilitate 

communication between healthcare providers and patients with disabilities or their proxies 

and advocate on the patient’s behalf, when required, to ensure that all clinical and LTSS 

options and choices are made available.

State Legislatures, and State Referenda and Initiatives

States should not legalize any form of assisted suicide or active euthanasia, whether called 

by these terms or any other terms. States must, rather, ensure a strong healthcare system 

that includes LTSS for all, including people with disabilities with or without a terminal 

prognosis; ensure that people with disabilities are protected from discrimination; and provide 

services that enable independent living and supported self-determination for people with 

disabilities.

The Danger of Assisted Suicide Laws 53

State Agencies That Deal with Suicide Prevention

All state agencies that deal with suicide prevention should address the specific challenges of 

people with disabilities and people with chronic conditions, including people with a terminal 

prognosis.

State agencies that deal with suicide prevention should appropriate funding for research 

to address the challenges of people with disabilities and people with chronic conditions, 

including people with a terminal prognosis, on disability-related risk factors in suicide 

prevention, as well as research on gathering data directly from people who request assisted 

suicide and euthanasia.
Professional Healthcare Practitioners

Professional healthcare practitioners should always inform patients with disabilities, 

including those with a terminal prognosis and regardless of the cause of their disability, 

about the full array of clinical treatment options available to them. Patients should also 

always be informed about and referred to available LTSS, including palliative care, personal 

care and assistance, counseling, skilled nursing, and other supports available through 

government programs, health insurance, and community-based sources.

Primary Care Practitioners, Specialty Providers, Clinics, Hospitals, 

Laboratories, Diagnostic and Therapy Centers, and 

Other Healthcare Services

Primary care practitioners, specialty providers, clinics, hospitals, laboratories, diagnostic 

and therapy centers, and other healthcare services must offer a full range of physical, 

communication, and programmatic access accommodations for patients with disabilities 

that are in compliance with the ADA and Section 504 of the Rehabilitation Act, and that 

are consistent with culturally competent care. Similarly, LTSS programs, particularly those 

provided in a community location, must also ensure physical accessibility and provide any 

accommodations clients require to participate fully as required by the ADA and Section 504.

Medical Schools and Other Healthcare Professional Education 

and Training Programs

Medical school and other healthcare professional education and training programs, 

including hospice, should require courses on skills and competencies needed to provide 

quality interprofessional health care to patients with disabilities and should develop a core 

set of disability competencies based on the Ohio State cultural competency standards133

54 National Council on Disability

(continued)
Medical Schools and Other Healthcare Professional Education 

and Training Programs, continued

The Danger of Assisted Suicide Laws 55

to facilitate the integration of disability content into healthcare education and training 

programs, specifically:

■ Training on palliative and other end-of-life care, including palliative sedation in the rare 

cases when patients are dying in unrelievable pain or other significant discomfort.

Core competencies should also include:

■ Contextual and conceptual frameworks on disability,

■ Professionalism and patient-centered care,

■ Legal obligations and responsibilities for caring for patients with disabilities,

■ Teams and systems-based practice,

■ Clinical assessment, and

■ Clinical care over the life span and during transitions.
56 National Council on Disability
Endnotes

1 National Council on Disability (NCD), “Assisted Suicide: A Disability Perspective Position Paper,” March 24, 

1997, https://www.ncd.gov/publications/1997/03241997.

2 NCD, “Cover Memorandum upon the Reissuance of the NCD Statement Opposing Legalization of Assisted 

Suicide,” June 9, 2005, https://www.ncd.gov/publications/2005/cover-memorandum-upon-reissuance-ncdstatement-opposing-legalization-assisted-suicide.

3 Washington v. Glucksberg, 521 US 702 (1997) and Vacco v. Quill, 521 US 793 (1997).

4 Some of these laws became effective in a later year. For example, the Hawaii statute did not become effective 

until 2019. Our Care, Our Choice Act, 2018 Haw. Sess. Laws Act 2739, § 12 at 39. https://www.capitol.hawaii

.gov/session2018/bills/GM1102_.PDF.

5 At the federal level, Section 1553 of the Affordable Care Act prohibits discrimination against individuals or 

institutional healthcare entities that do not provide assisted suicide services.

6 Carol Gill, Ph.D., and member, Advisory Panel, NCD Bioethics series, personal communication to the author, 

April 6, 2019, and Carol J. Gill, Ph.D., “Disability, Constructed Vulnerability, and Socially Conscious Palliative 

Care,” Journal of Palliative Care 22, no. 3 (2006): 186–89.

7 S. I. Rosenbaum, “Killing with Kindness: Why the Death with Dignity Act Endangers People with Disabilities,” 

The Boston Phoenix, October 31, 2012, https://dredf.org/wp-content/uploads/2012/08/Boston-Phoenix-onQuestion.pdf.

8 Paul Longmore, “The Resistance: The Disability Rights Movement and Assisted Suicide,” in Why I Burned My 

Book and Other Essays on Disability (Philadelphia: Temple University Press, 2003): 178–95.

9 Laurie Wilcox, “My Sister and I Are Nurses Who Are Disabled by Life-Shortening Diseases. Let Us Die Our 

Own Way,” New Jersey Star Ledger Opinion, November 13, 2018, https://www.nj.com/opinion/2018/11/

my_sister_and_i_are_nurses_who_are_disabled_by_lif.html. This is a summary. For example, regarding the 

California law, the California Medical Association listed its rules in detail. See https://www.cmadocs.org/store/

info/productcd/3459/t/the-california-end-of-life-option-act.

10 Dr. Herbert Hendin and Dr. Kathleen Foley, “Physician-Assisted Suicide in Oregon: A Medical Perspective,” 

Michigan Law Review, 106 (June 2008): 1613, accessed May 23, 2018, https://dredf.org/wp-content/

uploads/2012/08/Hendin-Foley-Michigan-Law-Review.pdf. Herbert Hendin was the Chief Executive Officer 

and Medical Director, Suicide Prevention International, and Professor of Psychiatry, New York Medical 

College. Kathleen Foley was an attending neurologist, Memorial Sloan-Kettering Cancer Center; Professor of 

Neurology, Neuroscience, and Clinical Pharmacology, Weill Medical College of Cornell University; and Medical 

Director, International Palliative Care Initiative of the Open Society Institute.

11 Some of the ways supposed protections are sidestepped apply specifically to people with disabilities. Others 

might apply to some people without disabilities as well, particularly elders and people who are underinsured. 

But even these tend to have a disproportionate impact on people with disabilities, due to many factors: 

historic discrimination in the medical field toward people with disabilities; the lack of treatments and other 

options; and the vulnerability of some disabled people to coercion, or to feeling burdensome or unwanted by 

trusted individuals including professionals, family members, and caregivers.

12 NCD, “Assisted Suicide.” In this 1997 position paper, NCD stated: “The pressures upon people with 

disabilities to choose to end their lives, and the insidious appropriation by others of the right to make that 

choice for them are already way too common in our society. These pressures are increasing and will continue 

to grow as managed health care and limitations upon health care resources precipitate increased ‘rationing’ of 

health care services and health care financing.” This was attributed in part to: “One author has observed that, 

The Danger of Assisted Suicide Laws 57
as health care costs increase, while funding for health care and supportive programs is restricted, ‘assisted 

suicide becomes a more cost-effective, expedient, and ultimately socially acceptable option.’” Paul Steven 

Miller, “The Impact of Assisted Suicide on Persons with Disabilities—Is It A Right Without Freedom?” Issues 

in Law & Medicine 9 (1993): 54, 56 n. 33.

13 Kenneth R. Stevens Jr., MD, “Oregon Rationing Cancer Treatment But Offering Assisted Suicide to Cancer 

Patients—Paying to Die But Not to Live,” Physicians for Compassionate Care Educational Foundation, June 

6, 2008, http://www.pccef.org/articles/art67.htm. Stevens is Professor Emeritus and former Chairman of 

Radiation Oncology at Oregon Health & Science University.

14 Stevens, “Oregon Rationing Cancer Treatment.”

15 Dan Springer, “Oregon Offers Terminal Patients Doctor-Assisted Suicide Instead of Medical Care,” Fox News, 

July 28, 2009, https://www.foxnews.com/story/oregon-offers-terminal-patients-doctor-assisted-suicideinstead-of-medical-care.

16 H. Rex Greene, MD, personal communication to the author, July 5, 2009.

17 Cal. Health & Safety Code § 443.13(c).

18 The Center for Bioethics and Culture Network, Compassion and Choice Denied, October 3, 2016, https://

youtu.be/hwLs3D062Vk. Video about Stephanie Packer. See also, Bradford Richardson, “Assisted-Suicide 

Law Prompts Insurance Company to Deny Coverage to Terminally Ill California Woman,” Washington Times, 

October 20, 2016, https://www.washingtontimes.com/news/2016/oct/20/assisted-suicide-law-promptsinsurance-company-den/.

19 Patients Rights Action Fund, Physician Assisted Suicide—The Real Effects, May 31, 2017, https://www

.youtube.com/watch?v=CWrpr_5e4RY. Video about Dr. Brian Callister’s patients. See also Australian Care 

Alliance, An international analysis of “Fifteen Fatally Flawed Experiments: California,” accessed January 27, 

2019, https://www.australiancarealliance.org.au/california.

20 Nina Shapiro, “Terminal Uncertainty,” Seattle Weekly, January 14, 2009, https://dredf.org/wp-content/

uploads/2012/08/Terminal-Uncertainty.pdf. This article’s subtitle is, “Washington’s new Death with Dignity law 

allows doctors to help people commit suicide once they’ve determined that the patient has only six months 

to live. But what if they’re wrong?” The author explores both the clinical and statistical uncertainty in terminal 

prognoses.

21 Jeanette Hall, letter to the editor, Boston Globe, October 4, 2011, http://archive.boston.com/bostonglobe/

editorial_opinion/letters/articles/2011/10/04/she_pushed_for_legal_right_to_die_and___thankfully___was_

rebuffed/.

22 Dr. Ken Stevens, Jeanette Hall’s oncologist, interview with the author, January 18, 2019.

23 Anita Cameron, “Testimony Opposing New York Assisted Suicide Bill A2383A,” Not Dead Yet, May 3, 2018, 

http://notdeadyet.org/testimony-of-anita-cameron-opposing-new-york-assisted-suicide-bill-a2383a.

24 Nashelly Chavez, “Woman in Wheelchair Drowns in Bizarre Accident on Sacramento River,” Sacramento Bee, 

July 5, 2016, https://www.sacbee.com/news/local/crime/article87867037.html, and Catherine Campisi, Retired 

Director, California Department of Rehabilitation, personal communication to the author, April 21, 2019.

25 Harris, Louis & Associates, The ICD Survey of Disabled Americans: Bringing Disabled Americans into the 

Mainstream (1986): 55; K. A. Gerhart, et al., “Quality of Life Following Spinal Cord Injury: Knowledge and 

Attitudes of Emergency Care Providers,” Annals of Emergency Medicine 23 (1994): 807–12; P. Cameron 

et al., “The Life Satisfaction of Nonnormal Persons,” Journal of Consulting and Clinical Psychology 41 (1973): 

207–14; C. Ray and J. West, “Social, Sexual and Personal Implications of Paraplegia,” Paraplegia 22 (1984): 

75–86; R. Stensman, “Severely Mobility-Disabled People Assess the Quality of Their Lives,” Scandinavian 

Journal of Rehabilitation Medicine 17 (1985): 87–99; G. G. Whiteneck et al., “Rocky Mountain Spinal Cord 

Injury System Report,” National Institute of Handicapped Research (1985): 29–33; and M. G. Eisenberg and 

C. C. Saltz, “Quality of Life Among Aging Spinal Cord Injured Persons: Long Term Rehabilitation Outcomes,” 

Paraplegia 29 (1991).

58 National Council on Disability
26 Richard Radtke, “A Case Against Physician-Assisted Suicide,” Journal of Disability Policy Studies 16, no. 1 

(Summer 2005): 58–61. This description was updated to include Radtke’s death in 2012.

27 E. B. Lamont et al., “Some Elements of Prognosis in Terminal Cancer,” Oncology (Huntington) 9 (1999): 

1165–70; M. Maltoni et al., “Clinical Prediction of Survival Is More Accurate Than the Karnofsky Performance 

Status in Estimating Lifespan of Terminally-Ill Cancer Patients,” European Journal of Cancer 30A, no. 6 (1994): 

764–66; N. A. Christakis and T. J. Iwashyna, “Attitude and Self-Reported Practice Regarding Prognostication 

in a National Sample of Internists,” Archives of Internal Medicine 158, no. 21 (1998): 2389–95; J. Lynn et al., 

“Prognoses of Seriously Ill Hospitalized Patients on the Days Before Death: Implications for Patient Care and 

Public Policy,” New Horizons 5, no. 1 (1997): 56–61. Note that “Seventeen percent of patients [outlived their 

prognosis] in the Christakis study. This roughly coincides with data collected by the National Hospice and 

Palliative Care Organization, which in 2007 showed that 13 percent of hospice patients around the country 

outlived their 6-month prognoses. . . . When a group of researchers looked specifically at patients with three 

chronic conditions—pulmonary disease, heart failure, and severe liver disease—they found that many more 

people outlived their prognosis than in the Christakis study. Fully 70 percent of the 900 patients eligible for 

hospice care lived longer than 6 months, according to a 1999 paper published in the Journal of the American 

Medical Association.” See Nina Shapiro, “Terminal Uncertainty.”

28 Lisa Esposito, “What’s Really Involved in Physician-Assisted Death?” US News Health, November 3, 2017, 

https://health.usnews.com/health-care/patient-advice/articles/2017-11-03/whats-really-involved-in-physicianassisted-death. For example, “The patient cannot be suffering from impaired judgment due to depression or 

another psychiatric or psychological condition.”

29 N. Gregory Hamilton, MD, and Catherine Hamilton, MA, “Competing Paradigms of Responding to Assisted 

Suicide Requests in Oregon: Case Report,” presented at the American Psychiatric Association Annual 

Meeting, New York, New York, May 6, 2004, http://www.pccef.org/articles/art28.htm and N. Gregory 

Hamilton, MD, “Testimony to the Select Committee on the Assisted Dying for the Terminally Ill Bill,” House of 

Lords, Portland, Oregon, December 10, 2004, http://www.pccef.org/articles/art32HouseOfLords.htm.

30 Herbert Hendin, “Suicide, Assisted Suicide and Euthanasia: Lessons from the Dutch Experience,” testimony 

presented to the Subcommittee on the Constitution, US House of Representatives Oversight Hearing, 

Washington, DC, April 29, 1996.

31 For example, the Oregon Death with Dignity Act (DWDA), Or. Rev. Stat. 127.825 s.3.03., https://www.oregon

.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/

ors.aspx. This section states “If, in the opinion of the attending physician or the consulting physician a patient 

may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, 

either physician shall refer the patient for counseling. No medication to end a patient’s life in a humane and 

dignified manner shall be prescribed until the person performing the counseling determines that the patient is 

not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.” Thus, a 

reference to “counseling” to determine the presence of a psychiatric or psychological disorder or depression 

is only required if, in the opinion of the attending [or consulting] physician, a patient may be experiencing such 

a condition. As is explained a few paragraphs later, very few such referrals are actually ever made, despite 

evidence that people with depression are, in fact, receiving lethal drugs under the Oregon assisted suicide law.

32 For example, under the California law, see The California End of Life Option Act, Document # 3459, California 

Medical Association (CMA) Legal Counsel, January 2016, accessed February 12, 2019, https://www.cmadocs

.org/store/info/productcd/3459/t/the-california-end-of-life-option-act.

33 NCD, “Assisted Suicide,” citing “e.g., Brief for Amici Curiae, Gay Men’s Health Crisis et al. in Vacco v. Quill, 

No. 95-1858, and State of Washington v. Glucksberg, No. 96-110, October Term, 1996, at p. 15.”

34 NCD, “Assisted Suicide,” citing “the Council’s proposals as to how America might better afford people with 

disabilities opportunities for independence, dignity, self-sufficiency, and full participation, [are available at] 

National Council on Disability, Achieving Independence: The Challenge for the 21st Century (1996).”

The Danger of Assisted Suicide Laws 59
35 H. Rex Greene, “Opposition to Neutrality on AB 651H,” letter to the California Medical Association (CMA) 

Council on Ethical Affairs, February 22, 2006, https://dredf.org/public-policy/assisted-suicide/opposition-toneutrality-on-ab-651/.

36 Oregon Death with Dignity Act, 2017 Data Summary, accessed February 18, 2019, https://www.oregon.gov/

oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/

year20.pdf.

37 Oregon Death with Dignity Act, 2018 Data Summary, accessed March 16, 2019, https://www.oregon.gov/

oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/

year21.pdf.

38 Regarding Colorado, “Although the law requires a referral to a psychiatrist or psychologist ‘if the attending 

physician believes that the individual may not be mentally capable of making an informed decision,’ only 1 out 

of 69 people (1.4%) is reported as having been so referred.” Australian Care Alliance, accessed February 17, 

2019, https://www.australiancarealliance.org.au/colorado.

39 L. Ganzini et al., “Attitudes of Oregon Psychiatrists Towards Assisted Suicide,” American Journal of Psychiatry

153 (1996): 1469–75.

40 John Cloud, “Study: Doctors Don’t Always Spot Depression,” Time Magazine, July 30, 2009, http://content

.time.com/time/health/article/0,8599,1913312,00.htm.

41 For example, for Washington State and Oregon: Revised Code of Washington 70.245.010; Oregon Legislative 

Statue 127.800 §1.01.

42 Hendin and Foley, “Physician Assisted Suicide.”

43 William Toffler, “A Doctor-Assisted Disaster for Medicine,” Wall Street Journal Online, August 17, 2015, https://

www.wsj.com/articles/a-doctor-assisted-disaster-for-medicine-1439853118.

44 Linda Ganzini, Elizabeth R. Goy, and Steven K. Dobscha, “Prevalence of Depression and Anxiety in Patients 

Requesting Physicians’ Aid in Dying: Cross Sectional Survey,” British Medical Journal 337 (2008): 1–5, 

accessed February 18, 2019, https://www.bmj.com/content/337/bmj.a1682.

45 David W. Kissane, “The Contribution of Demoralization to End of Life Decisionmaking,” Hastings Center 

Report 34, no. 4 (2004): 21–31; and Sophie Robinson et al., “A Systematic Review of the Demoralization 

Syndrome in Individuals with Progressive Disease and Cancer: A Decade of Research,” Journal of Pain and 

Symptom Management (March 3, 2015): 605–8.

46 Even if someone is depressed and/or suicidal, there are alternatives to hospitalization. There is an increasing 

recognition that simply hospitalizing an individual is not an effective way to address suicide. See Susan 

Stefan, JD, “Transforming Suicide Assessment, Prevention and Treatment Approaches: The New Consensus,” 

National Association of Rights Protection and Advocacy, accessed February 18, 2019, http://narpa.org/

conferences/2017/transforming-suicide-assessment-prevention-and-tx-approaches. Also see American 

Psychiatric Association, “Hospitalization, by itself, is not a treatment” (2003), and American Association of 

Suicidology/Suicide Prevention Resource Center, “Sadly, there is no evidence whatsoever that psychiatric 

hospitalization prevents suicide” (2010) and Joint Commission, “Hospitalization is often necessary for a 

patient’s immediate safety, but hospitalization used solely as a containment strategy may be ineffective 

or counterproductive and considered by the patient as a disincentive or penalty for expressing suicidal 

thoughts” (2016).

47 Carol Gill, Ph.D. (Professor Emerita in the Department of Disability and Human Development at the University 

of Illinois at Chicago [UIC]), “Depression in the Context of Disability and the ‘Right to Die,’” Theoretical 

Medicine 25 (2004): 171–98. Also, “Health Professionals, Disability, and Assisted Suicide: An Examination of 

Relevant Empirical Evidence and Reply to Batavia (2000),” Psychology, Public Policy, and Law 6, no. 2 (2000): 

526–45. Also, Carol J. Gill, Ph.D., “No, We Don’t Think Our Doctors Are Out to Get Us: Responding to the 

Straw Man Distortions of Disability Rights Arguments Against Assisted Suicide,” Disability and Health Journal

3 (2010): 31–38. Also, “Disability, Constructed Vulnerability, and Socially Conscious Palliative Care,” Journal of 

Palliative Care 22, no. 3 (2006): 183–89.

60 National Council on Disability
48 Carol Gill, Ph.D., personal communication to the author, April 6, 2019, and Carol J. Gill, Ph.D., “Disability, 

Constructed Vulnerability, and Socially Conscious Palliative Care.”

49 Susan D. Block and J. Andrew Billings, “Patient Requests to Hasten Death: Evaluation and Management in 

Terminal Care,” Archive of Internal Medicine 154, no.18 (1994): 2039–47.

50 Erin Barnett, “A Family Struggle: Is Mom Capable of Choosing to Die?,” The Oregonian, Oct. 17, 1999.

51 Patients Rights Council, “Facts about Hemlock* and Caring Friends,” http://www.patientsrightscouncil

.org/site/hemlock-and-caring-friends/. “In mid 2003, the Hemlock Society changed its name to ‘End-of-Life 

Choices.’ At the end of 2004, End-of-Life Choices merged with Compassion in Dying. The organization is now 

known as ‘Compassion and Choices.’”

52 Peter Goodwin, “Charting a New Course, Building on a Solid Foundation, Imagining a Brighter Future for 

America’s Terminally Ill,” transcript of presentation at 13th National Hemlock Society Biennial Conference, 

January 11, 2003, San Diego, California. Also, Compassion in Dying of Oregon, Summary of Hastened 

Deaths, data attached to Compassion in Dying of Oregon’s IRS Form 990 for 2003. Also, Dr. Elizabeth Goy 

of Oregon Health and Science University was an Assistant Professor in the Department of Psychiatry, 

School of Medicine. In 2004, members of the British House of Lords traveled to Oregon seeking information 

regarding Oregon’s assisted suicide law for use in their deliberations about a similar proposal that was under 

consideration in Parliament. They held closed-door hearings in which Goy spoke on December 9 and 10, 2004 

and published the proceedings on April 4, 2005. House of Lords Select Committee on the Assisted Dying for 

the Terminally Ill Bill, Assisted Dying for the Terminally Ill Bill [HL] Vol. II: Evidence (London: The Stationery 

Office Limited, 2005), 291, Question 768, available at: http://www.publications.parliament.uk/pa/ld200405/

ldselect/ldasdy/86/86ii.pdf (accessed January 29, 2019). And Kenneth R. Stevens, Jr., MD, The Proportion 

of Oregon Assisted Suicides by Compassion & Choices Organization, Physicians for Compassionate Care 

Educational Foundation, March 4, 2009, http://www.pccef.org/DOWNLOADS/AssistedSuicidesbyCC2009

report.pdf.

53 This is documented extensively in Chapter 3.

54 William Yardley, “First Death for Washington Assisted-Suicide Law”, New York Times, May 23, 2009, 

http://www.nytimes.com/2009/05/23/us/23suicide.html?_r=0.

55 Amyotrophic Lateral Sclerosis, also known as Lou Gehrig’s disease.

56 “Sawyer Arraigned on State Fraud Charges,” KTVZ.com, Sept. 7, 2011, https://www.ktvz.com/news/crime/

sawyers-go-to-prison-victims-see-justice-but-money/68441556.

57 Oregon Death with Dignity Act, 2018 Data Summary.

58 Carol Gill, Ph.D., personal communication to the author, April 6, 2019, and Carol J. Gill, Ph.D., “Disability, 

Constructed Vulnerability, and Socially Conscious Palliative Care.”

59 Oregon Death with Dignity Act (DWDA), Or. Rev. Stat. 127.800 et seq., https://www.oregon.gov/oha/PH/

PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx.

60 NCD, “Cover Memorandum.”

61 S. H. Miles, “Physicians and Their Patients’ Suicides,” JAMA 271 (1994): 1786–88.

62 NCD, “Assisted Suicide: A Disability Perspective.”

63 Carol Gill, Ph.D., personal communication to the author, April 6, 2019, and Carol J. Gill, Ph.D., “Disability, 

Constructed Vulnerability, and Socially Conscious Palliative Care.”

64 John R. Bach, “Ventilator Use by Muscular Dystrophy Association Patients,” Archives of Physical Medicine 

Rehabilitation 73, no. 2 (February 1992), https://www.archives-pmr.org/article/0003-9993(92)90098-H/fulltext.

65 Carol Gill, Ph.D., personal communication to the author, April 6, 2019, and Carol J. Gill, Ph.D., “Disability, 

Constructed Vulnerability, and Socially Conscious Palliative Care.”

66 Hendin and Foley, “Physician-Assisted Suicide in Oregon,” 1627–28.

67 “Oregon State Assisted Suicide Reports Substantiate Critics’ Concerns,” Not Dead Yet, October 4, 2016, 

http://notdeadyet.org/2016/10/oregon-state-assisted-suicide-reports-substantiate-critics-concerns.html, 

accessed February 1, 2019.

The Danger of Assisted Suicide Laws 61
68 Oregon Department of Human Services, “No Authority to Investigate Death with Dignity Case,” News 

Release, March 4, 2005, https://dredf.org/wp-content/uploads/2012/08/Oregon-DHS.pdf.

69 For example, see Oregon Health Authority, “Methods,” Death with Dignity Annual Reports, available 

at https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/

DEATHWITHDIGNITYACT/Documents/methods.pdf (accessed July 24, 2019).

70 State of Connecticut, Division of Criminal Justice, “Testimony of the Division of Criminal Justice,” Hearing on 

H.B. No. 7015, Joint Committee on Judiciary, March 18, 2015. Also State of Connecticut, Division of Criminal 

Justice, “Testimony of the Division of Criminal Justice,” Hearing on H.B. No. 5898, Joint Committee on Public 

Health, March 18, 2019, https://www.cga.ct.gov/2019/PHdata/Tmy/2019HB-05898-R000318-CT Division of 

Criminal Justice-TMY.PDF. The Division of Criminal Justice used the same language regarding the same 

section number in both instances.

71 Daniel Callahan, “Organized Obfuscation: Advocacy for Physician-Assisted Suicide,” Hastings Center Reports

(September–October 2008): 32.

72 Assisted suicide bills and laws generally state explicitly that payments of any life, health, or accident 

insurance, or annuity policy, are unaffected if death is by assisted suicide.

73 Maryland state Senator Bob Cassilly, “Sen. Cassilly: Medically Assisted Suicide Sends Message to Elderly 

That They Are a Burden,” Baltimore Sun, February 26, 2019, https://www.baltimoresun.com/news/opinion/

readersrespond/bs-ed-rr-physician-assisted-suicide-elderly-burden-letter-20190226-story.html.

74 Former Hawaii Governors George Ariyoshi, John Waihee, Benjamin Cayetano, and Neil Abercrobie, “Allowing 

Life-ending Medication Is a Compassionate Choice”, Honolulu Star Advertiser, December 15, 2016, https://

www.staradvertiser.com/2016/12/15/editorial/island-voices/allowing-life-ending-medication-is-a-compassionatechoice/, reprinted by Compassion & Choices, accessed March 2, 2019, https://compassionandchoices.org/

news/allowing-life-ending-medication-compassionate-choice/.

75 “Some Oregon and Washington State Assisted Suicide Abuses and Complications,” compiled by the 

Disability Rights Education & Defense Fund (DREDF), accessed March 2, 2019. https://dredf.org/publicpolicy/assisted-suicide/some-oregon-assisted-suicide-abuses-and-complications/. Also see Stephanie Packer, 

Youtube video at https://youtu.be/hwLs3D062Vk, October 3, 2016, and Dr. Brian Callister, Youtube video at 

https://www.youtube.com/watch?v=CWrpr_5e4RY, May 31, 2017.

76 American Medical News, “Oregon Nixes Use of Term “Physician-assisted Suicide—Right-to-die Advocates 

Hope that Changing the Language May Help Pass Laws in Other States,” November 6, 2006, https://

amednews.com/article/20061106/profession/311069952/7/.

77 Not Dead Yet, “Oregon State Assisted Suicide Reports Substantiate Critics’ Concerns”, May 16, 2018, http://

notdeadyet.org/oregon-state-assisted-suicide-reports-substantiate-critics-concerns. “The Oregon Health 

Division assisted suicide reports show that non-terminal people receive lethal prescriptions every year 

except the first. . . . The prescribing physicians’ reports to the state include the time between the request for 

assisted suicide and death for each person. However, the online state reports do not reveal how many people 

outlived the 180-day prediction. Instead, the reports give that year’s median and range of the number of days 

between the request for a lethal prescription and death. . . . In 2017, at least one person lived 603 days; across 

all years, the longest reported duration between the request for assisted suicide and death was 1009 days. 

In every year except the first year, the reported upper range is significantly longer than 180 days (six months). 

[Yet] the definition of ‘terminal’ in the statute . . . requires that the doctor predict that the person will die 

within six months.” It cannot be known whether those who took the lethal drugs within the 180 days would 

have lived longer had they waited longer.

78 Death with Dignity Data, Washington State Department of Health, https://www.doh.wa.gov/YouandYourFamily/

IllnessandDisease/DeathwithDignityAct/DeathwithDignityData. For example, Washington reports whether the 

time from request to death was greater or less than 25 weeks. In the last 3 years, the percent who lived longer 

than 25 weeks was 16, 12 and 10 percent of those who died. As in Oregon, it cannot be known whether those 

who took the lethal drugs within the 180 days would have lived longer had they waited longer.

62 National Council on Disability
79 Oregon Death with Dignity Act, 2018 Data Summary.

80 Carol Gill, Ph.D., personal communication to the author, November 2, 2018.

81 Oregon Death with Dignity Act, 2018 Data Summary.

82 Although self-administration is touted as one of the key “safeguards” in US assisted suicide laws, whether 

patient self-administration is legally required is a complicated question. For example, the terms “selfadministration,” “ingesting,” and/or “take” [the drugs] are sometimes absent, undefined, or are defined 

differently than assisted suicide proponents’ descriptions suggest. By some analyses, the Oregon law is 

ambiguous as to whether lethal drugs may only be administered by the patient him- or herself. The California 

law clearly states that “’Self-administer’ means a qualified individual’s affirmative, conscious, and physical 

act of administering and ingesting the aid-in-dying drug to bring about his or her own death,” although it also 

states that “a person who is present may, without civil or criminal liability, assist the qualified individual by 

preparing the aid-in-dying drug so long as the person does not assist the qualified person in ingesting the 

aid-in-dying drug.” How much assistance is legal? If the qualified individual uses a feeding tube, may others 

place the lethal agents in it? There are additional issues beyond the scope of this paper to fully explore. 

Cal. Health & Safety Code § 443.13(p) & 443.14(a).

83 Patients Rights Council, “Washington State Issues 8th Official Report on Doctor-Prescribed Suicide,” accessed 

May 23, 2018, http://www.patientsrightscouncil.org/site/washington/.

84 Rita Marker, Executive Director, Patients Rights Council, Commentary on California End of Life Option Act, 

ABX2-15, 2015. Marker has been the Executive Director of the Patients Rights Council since it began in l987. 

Marker, a practicing attorney, is also the author of the critically acclaimed book, Deadly Compassion (Morrow, 

1993; Harper/Collins, 1994; Avon Books, 1995).

85 Our Care, Our Choice Act, H.B. 2739, H.D. 1, 29th Leg. Sess., Reg Sess. (2018), Section 3, §14 (c), pp. 18–19, 

available at https://www.capitol.hawaii.gov/session2018/bills/GM1102_.PDF.

86 A complete listing of national disability organizations opposed to the legalization of assisted suicide can 

be found at http://notdeadyet.org/disability-groups-opposed-to-assisted-suicide-laws or https://dredf.org/

public-policy/assisted-suicide/national-disability-organizations-that-oppose-the-legalization-of-assisted-suicide/

(both accessed March 1, 2019). Many leading national medical associations, including the American Medical 

Association (AMA) and the American College of Physicians (ACP), are also opposed to the legalization of 

assisted suicide. See American Medical Association, Chapter 5, “Opinions on Caring for Patients at the 

End of Life, 5.8 Euthanasia,” accessed March 5, 2019, https://www.ama-assn.org/sites/default/files/mediabrowser/code-of-medical-ethics-chapter-5.pdf, and Annals of Internal Medicine, “Ethics and the Legalization 

of Physician-Assisted Suicide: An American College of Physicians Position Paper,” accessed March 5, 2019, 

http://annals.org/aim/article/2654458/ethics-legalization-physician-assisted-suicide-american-college-physiciansposition-paper.

87 Patients Rights Council, “Attempts to Legalize Euthanasia/Assisted-Suicide in the United States,” accessed 

March 5, 2019, http://www.patientsrightscouncil.org/site/failed-attempts-usa/.

88 Patients Rights Council, “Attempts to Legalize.”

89 ODonnell v. Harris, No. 37-2015-00016404 (Sup. Ct. S.D. County, July 24, 2015).

90 H.R. Con. Res. 80, 115th Cong., 1st Sess. (2017), https://www.congress.gov/bill/115th-congress/houseconcurrent-resolution/80/text.

91 The National Domestic Violence Hotline, “Domestic Violence & People with Disabilities,” https://www

.thehotline.org/is-this-abuse/domestic-violence-disabilities/, accessed February 13, 2019. Also Disability 

Justice, “Abuse and Exploitation of People with Developmental Disabilities,” https://disabilityjustice.org/justicedenied/abuse-and-exploitation/, accessed February 13, 2019. Also Nora Baladerian, Ph.D., Thomas F. Coleman, 

and Jim Stream, “Abuse of People with Disabilities,” A Report on the 2012 National Survey on Abuse of 

People with Disabilities, Spectrum Institute, Disability and Abuse Project, 2013.

92 American Association of Retired Persons (AARP), “Fighting Against Elder Abuse and Exploitation,” March 4, 

2015, https://www.aarp.org/politics-society/advocacy/caregiving-advocacy/info-2015/fight-against-elder-abuse.

The Danger of Assisted Suicide Laws 63
html. Also Peck Law Group, “Elder Abuse Data and Statistics,” January 26, 2013, http://www.premierlegal

.org/elder-abuse-data-and-statistics/. Also National Center on Elder Abuse, https://ncea.acl.gov/whatwedo/

research/index.html, accessed February 9, 2019. Also National Adult Protective Services Association, http://

www.napsa-now.org/get-informed/what-is-abuse/, accessed February 9, 2019. Also New England Journal of 

Medicine, “Elder Abuse,” November 12, 2015, https://www.nejm.org/doi/full/10.1056/NEJMra1404688.

93 Margaret Dore, “‘Death with Dignity’: What Do We Advise Our Clients?” King County Bar Association 

(Bulletin), May, 2009, https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=

article5.htm. 

94 Patients Rights Council, “New Mexico ‘Elizabeth Whitefield End of Life Options Act’ (HB 90) 2019,” 

http://www.patientsrightscouncil.org/site/new-mexico-elizabeth-whitefield-end-of-life-options-act-hb-90-2019-

analysis/.

95 John Kelly, interview with the author, January 30, 2019.

96 Oregon Health Authority, Public Health Division, Oregon Death with Dignity Act, 2017 Data Summary, 9 

including n. 2, https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/

DEATHWITHDIGNITYACT/Documents/year20.pdf.

97 Bruce Darling, “Opposing Policy Option 2.”

98 Hawaii 2017 HB 201.

99 See, H.B. 2232, 80th Leg., Reg. Sess. §3 (as introduced) (Or. 2019).

100 H.B. 90, 54th Leg., 1st Sess. § 2(D) (N.M. 2019)(definition of “health care provider”), available at https://www

.nmlegis.gov/Sessions/19%20Regular/bills/house/HB0090.pdf.

101 H.B. 90, 54th Leg., 1st Sess. § 2(G) (N.M. 2019), definition of “prescribing health care provider”, available at 

https://www.nmlegis.gov/Sessions/19%20Regular/bills/house/HB0090.pdf.

102 “Our Care, Our Choice Act,” 2018 Haw. Sess. Laws Act 2739, § 1, definition of “attending provider.”

103 NY A02383 “Medical Aid in Dying Act,” § 2899-e.1.

104 Oregon Senate Bill 579.

105 State of Maryland, Senate, End-of-Life Option Act, Maryland Senate Bill 311, http://mgaleg.maryland.gov/

2019RS/bills/sb/sb0311f.pdf.

106 Compassion & Choices, “Seriously Ill Advocates for MD End-of-Life Option Act Express Concerns 

That Reported Bill Amendments May Endanger Passing Law This Year,” March 14, 2019, https://

compassionandchoices.org/news/seriously-ill-advocates-for-md-end-of-life-option-act-express-concernsthat-reported-bill-amendments-may-endanger-passing-law-this-year/.

107 Maryland State Senators Bobby Zirkin et. al, “‘Compassion’ Lobby Says Evaluating Mental Illness Is 

‘Excessive,’” March 14, 2019, a statement cited by Maryland Against Physician Assisted Suicide, https://

stopassistedsuicidemd.org/compassion-lobby/.

108 Patients Rights Council, see generally, The Netherlands, http://www.patientsrightscouncil.org/site/holland/, 

Belgium, http://www.patientsrightscouncil.org/site/?s=belgium&cat=0&submit=Search, Canada, http://www

.patientsrightscouncil.org/site/?s=Canada&cat=0&submit=Search. Also, Australian Care Alliance, “Fifteen 

Fatally Flawed Experiments,” https://www.australiancarealliance.org.au/flawed_experiments.

109 Rita Marker, interview.

110 Patients Rights Council, see generally, The Netherlands, http://www.patientsrightscouncil.org/site/holland/, 

Belgium, http://www.patientsrightscouncil.org/site/?s=belgium&cat=0&submit=Search, Canada, http://www

.patientsrightscouncil.org/site/?s=Canada&cat=0&submit=Search. Also, Australian Care Alliance, “Fifteen 

Fatally Flawed Experiments,” https://www.australiancarealliance.org.au/flawed_experiments.

111 Both euthanasia and assisted suicide have been widely practiced in the Netherlands since 1973, although 

they were against the law until 2002. The Dutch situation between 1973 and 2002 was an outgrowth of a 

series of court decisions and medical association guidelines, beginning with a 1973 District Court case in 

which Geertruida Postma, a Dutch physician, was convicted of the crime of euthanasia after she ended the 

64 National Council on Disability
life of her seriously ill mother. See Nederlandse Jurisprudentie 1973, no. 183, District Court of Leeuwarden, 

21, February 21, 1973; translation in Walter Lagerway, Issues in Law and Medicine, 3 (1988): 429, 439–42. 

Her admission that she had given her mother a lethal injection seemed calculated to force public and legal 

reconsideration of the laws against assisted suicide (Penal Code of the Netherlands, §294) and euthanasia 

(Penal Code of the Netherlands, §293). While finding Dr. Postma guilty of the crime of mercy killing that was 

punishable by imprisonment for a maximum of 12 years, the court imposed a 1-week suspended sentence 

and a week’s probation. The Dutch court relied heavily on expert testimony by the District’s medical inspector 

who set forth certain conditions “under which the average physician thought euthanasia should be considered 

acceptable.” Inclusion of those conditions formed the basis for subsequent acceptance of euthanasia and 

assisted suicide in the Netherlands. The guidelines required that the patient must be considered incurable 

and experiencing subjectively unbearable suffering; the request for termination of life should be in writing; 

and there should be adequate consultation with other physicians before death could be induced. See Carlos 

Gomez, Regulating Death: Euthanasia and the Case of the Netherlands (Old Tappan, NJ: Free Press, 1991), 30. 

Other cases followed, each widening the boundaries and further liberalizing the conditions under which 

euthanasia and assisted suicide, although remaining illegal, would not be punished. Among the cases was 

the Alkmaar case (Nederlandse Jurisprudentie 1985, no. 106) in which a woman died after requesting death 

because “her advancing age and physical condition caused her to be dependent on others, thus leading 

to psychological suffering.” The case gave rise to the 1986 decision by the Hague Court of Appeals that 

recognized “psychic suffering” and “potential disfigurement of personality” as grounds for induced death. 

The courts have also exonerated physicians who assisted in the suicides of a young woman with anorexia 

nervosa (Amelo, Tijdschrift voor Gezondheidsrecht, 1992, No. 19) and a woman who was depressed over the 

death of her two children and the failure of her marriage (Assen, Nederlandse Jurisprudentie, 1994, No. 656). 

This discussion is drawn from the International Task Force on Euthanasia and Assisted Suicide, Assisted 

Suicide & Death with Dignity: Past, Present & Future—Part III, International Perspective, available at http://

www.internationaltaskforce.org/rpt2005_3.htm (accessed July 13, 2009). For additional discussion of these 

and other cases, see Gomez, Regulating Death; I. J. Keown, “The Law and Practice of Euthanasia in the 

Netherlands,” Law Quarterly Review 108 (1992): 51–52; Herbert Hendin, Seduced by Death: Doctors, Patients, 

and Assisted Suicide (New York: Norton, 1997); and Jonathan T. Smies, “The Legalization of Euthanasia in the 

Netherlands,” Across Borders International Law Journal, 7 (2004).

112 “Doctors had reported that a total of 2,146 people were euthanized and 152 died in assisted suicides in 

2008, while in 33 cases there was a combination of the two practices.” See Expatica.com, “Dutch Court Jails 

Euthanasia Group Chairman for Aiding Suicide,” May 30, 2009.

113 Hendin further testified, “In 13 percent of these cases, physicians who did not communicate with competent 

patients concerning decisions that might or were intended to end their lives gave as a reason for not doing so 

that they had previously had some discussion of the subject with the patient. Yet it seems incomprehensible 

that a physician would terminate the life of a competent patient on the basis of some prior discussion without 

checking if the patient still felt the same way.” Herbert Hendin, MD, Suicide, Assisted Suicide and Euthanasia: 

Lessons from the Dutch Experience, Testimony Summary, US House of Representatives, Subcommittee on 

the Constitution, April 29, 1996. Also, Hendin has written that, for over a thousand people each year in the 

Netherlands, physicians have ended their patients’ lives without consulting the patients. “The most alarming 

concern has been the documentation of [a] thousand cases a year in which patients who have not given their 

consent have their lives ended by physicians. A quarter of [the] physicians stated that they ‘terminated the 

lives of patients without an explicit request’ from the patient. Another third of the physicians could conceive 

of doing so.” Herbert Hendin, MD, “Commentary: The Case Against Physician-Assisted Suicide: For the Right 

to End-of-Life Care,” Psychiatric Times 21, no. 2, February 1, 2004, available at http://www.psychiatrictimes

.com/display/article/10168/54071.

114 Herbert Hendin, MD, Lessons from the Dutch Experience, Testimony to Subcommittee on the Constitution. 

The Danger of Assisted Suicide Laws 65
115 Diane Coleman, JD, “Not Dead Yet,” in The Case Against Assisted Suicide—For the Right to End-of-Life Care, 

ed. Kathleen Foley and Herbert Hendin (Baltimore: The Johns Hopkins University Press, 2002), 221.

116 “In 2010, the age-adjusted suicide rate among Oregonians of 17.1 per 100,000 was 41 percent higher than 

the national average.” Oregon Health Authority, Public Health Division, Suicides in Oregon: Trends and Risk 

Factors—2012 Report, November 2012, 1.

117 David Albert Jones and David Paton, “How Does Legalization of Physician-Assisted Suicide Affect Rates 

of Suicide?” Southern Medical Journal, October 10, 2015, http://sma.org/southern-medical-journal/article/

how-does-legalization-of-physician-assisted-suicide-affect-rates-of-suicide/.

118 Aaron Kheriaty, “The Dangerously Contagious Effect of Assisted-Suicide Laws,” Washington Post, November 

20, 2015, https://www.washingtonpost.com/opinions/the-dangerously-contagious-effect-of-assisted-suicidelaws/2015/11/20/6e53b7c0-83fb-11e5-a7ca-6ab6ec20f839_story.html?utm_term=.50c61d657eef. Aaron 

Kheriaty is an associate professor of psychiatry and director of the medical ethics program at the University of 

California at Irvine School of Medicine.

119 State of Connecticut, “State of Connecticut Suicide Prevention Plan 2020,” accessed March 12, 2019, 

https://www.sprc.org/sites/default/files/Conn_Suicide-Prevention-Plan-2020.pdf.

120 Roger J. Stancliffe, Michele Y. Wiese, and Sue Read, “End of Life and People with Intellectual Disability,” 

JARID Editorial, June 13, 2017, https://onlinelibrary.wiley.com/doi/abs/10.1111/jar.12383. Also see American 

Association on Intellectual and Developmental Disabilities (AAIDD), “Caring at the End of Life—Position 

Statement,” https://aaidd.org/news-policy/policy/position-statements/caring-at-the-end-of-life.

121 Olmstead v. L.C., 527 US 581 (1999).

122 Pew Research Center, “Views on End-of-Life Medical Treatments,” November 21, 2013, https://www

.pewforum.org/2013/11/21/views-on-end-of-life-medical-treatments/. A related source is Patricia K. Jennings 

and Clarence R. Talley, “A Good Death?: White Privilege and Public Opinion: Research on Euthanasia,” Race, 

Gender & Class 10, no. 3 (2003): 42–63, http://www.jstor.org/stable/41675087.

123 Oregon Death with Dignity Act, 2018 Data Summary.

124 Pew Research Center, “Views on End-of-Life Medical Treatments.”

125 Anita Cameron, “Testimony Opposing New York Assisted Suicide Bill A2383A.”

126 Alexei Koseff and Jeremy B. White, “California Assisted Death Bill Appears Finished for the Year,” Sacramento 

Bee, July 7, 2015, https://www.sacbee.com/news/politics-government/capitol-alert/article26660032.html.

127 Fenit Nirappil, “Right-to-Die Law Faces Skepticism in Nation’s Capital: ‘It’s Really Aimed at Old Black People,’” 

Washington Post, October 17, 2015, https://www.washingtonpost.com/local/dc-politics/right-to-die-lawfaces-skepticism-in-us-capital-its-really-aimed-at-old-black-people/2016/10/17/8abf6334-8ff6-11e6-a6a3-

d50061aa9fae_story.html?utm_term=.9b1a7dc625d1.

128 Lydia S. Dugdale, “Will Black Lives Still Matter to Death with Dignity Act?” The Hill, January 23, 2017, 

https://thehill.com/blogs/pundits-blog/healthcare/315731-will-black-lives-matter-to-death-with-dignity-act.

129 AMA meeting, “AMA OKs Palliative Sedation for Terminally Ill,” American Medical News, July 7, 2008. Also 

Timothy W. Kirk, Ph.D., and Margaret M. Mahon, Ph.D., RN, FAAN, “National Hospice and Palliative Care 

Organization (NHPCO) Position Statement and Commentary on the Use of Palliative Sedation in Imminently 

Dying Terminally Ill Patients,” Journal of Pain and Symptom Management 39, no. 5 (May 2010), DOI: 10.1016/

j.jpainsymman.2010.01.009.

130 Anita Cameron, “The Criminalization of Pain,” October 4, 2018, http://notdeadyet.org/2018/10/anita-cameronthe-criminalization-of-pain.html. Anita Cameron is the Director of Minority Outreach for Not Dead Yet.

131 John Heubusch, “The War on Opioids Is Saving Lives. But It’s Also Killing People Like Me,” Washington Post, 

March 27, 2019, https://www.washingtonpost.com/opinions/the-war-on-opioids-is-saving-lives-but-its-also-killingpeople-like-me/2019/03/27/cea00af6-50c2-11e9-a3f7-78b7525a8d5f_story.html?utm_term=.b0278d4daad0. 

Also Kate Nicholson, “The Other Side of the Opioid Epidemic—We’re People in Severe Pain,” The Hill, 

February 16, 2018, https://thehill.com/opinion/healthcare/374246-the-other-side-of-the-opioid-epidemic-werepeople-in-severe-pain. Also Will Stone, “Patients with Chronic Pain Feel Caught in an Opioid-Prescribing 

66 National Council on Disability
Debate,” Kaiser Health News, August 1, 2018, https://www.healthleadersmedia.com/clinical-care/

patients-chronic-pain-feel-caught-opioid-prescribing-debate.

132 S. A. Fohr, “The Double Effect of Pain Medication: Separating Myth from Reality,” Journal of Palliative 

Medicine 1 (1998): 315–26; T. A. Curry,” What Would Mom Want?” JAMA 315 (2016): 261–62.

133 Ohio State, “Core Competence on Disability for Healthcare Education,” April 2018, accessed March 5, 2019, 

http://nisonger.osu.edu/wp-content/uploads/2018/09/Core-Competencies-on-Disability_8.31.18.pdf.

The Danger of Assisted Suicide Laws 67
National Council on Disability 

1331 F Street, NW, Suite 850 

Washington, DC 20004