This special edition of the Disability and Health Journal examines the issues related to assisted suicide and disability, the legal considerations, and the Oregon and Washington experiences. We solicited manuscripts from disability advocates and disability scholars, most of whom we knew opposed assisted suicide; however, we believe the varied approaches of the authors broadened the discussion and every article contains a literature review. In total, this issue contains important and thoughtful articles about assisted suicide written by scientists, lawyers, scholars, and disability rights advocates.
When a policy on assisted suicide (otherwise known as “aid in dying”) was being considered by the American Public Health Association (APHA) in 2007 and 2008, I was the chairperson of the APHA Disability Section Policy Committee. I was responsible for disseminating information to the 250 members of the Disability Section and conveying an endorsed policy view from the Disability Section to the Governing Council of APHA. I was there when the debates occurred and when the Governing Council voted on the Aid in Dying policy. During the 16-month period during which the Disability Section Policy Committee deliberated, I read the literature, talked to experts, and communicated with the APHA Disability Section membership on the issue. One of the lessons learned by the APHA members, who were seeking evidence on the subject, was the fact that the literature on the U.S. experience with assisted suicide is sparse. This special issue of Disability and Health Journal should help fill that void.
The lead article is written by a cadre of academics: Charles Drum, JD, PhD, Glen White, PhD, Genia Taitano, PhD, and Willi Horner-Johnson, PhD. They review the literature and present data from a focus group. Their manuscript, “The Oregon Death with Dignity Act: Results of a Literature Review and Naturalistic Inquiry,” describes the search process used to identify 13 peer-reviewed journal articles that report empirical data on the Oregon experience and the evidence contained in these manuscripts. In addition, Drs. Drum, White, Taitano, and Horner-Johnson report the findings of a focus group to begin to answer the question, “What opinions do Oregonians with disabilities hold about the DWD Act and its effects?”
The second article in this volume is written by Marilyn Golden, a disability rights advocate. Ms. Golden presents an overview of policy arguments against legalization of assisted suicide. Her arguments include some from the disability perspective and some from a societal view. Many of the opinions presented in this manuscript have been the themes heard in states where legislation is being considered. It is important to know what has been said, the source of the data, and the examples that are often used. This manuscript should provide the reader with a thorough overview of the opposition view of assisted suicide.
The third article focuses on the ways disability rights opposition to assisted suicide has been misrepresented. This scholar, Carol Gill, PhD, provides an analysis of the media portrayal of the disability rights activists and their position on assisted suicide. Her explanation of the way the “straw man” is constructed and disputed is extremely enlightening and should be considered by all advocates who engage in this or other policy debates.
We also present a manuscript from Diane Coleman, JD, the attorney representing Not Dead Yet, one of the oldest and most consistent opponents of assisted suicide. In the fourth article, Ms. Coleman provides an overview of the fight against legalization of assisted suicide at the Supreme Court and the arguments and information used to oppose passage of laws legalizing assisted suicide.
The fifth manuscript is written by Gloria Krahn, PhD, a scholar who was teaching and conducting disability-related research in Oregon until earlier this year. Dr. Krahn is now the Director of the Disability and Health Team at the Centers for Disease Control and Prevention. Dr. Krahn provides an essay about her personal journey as she considered the issues related to assisted suicide.
The final article is written by Kirk Allison, PhD, from the University of Minnesota. Dr. Allison considers the implications of assisted suicide from a population perspective, a concept that is central to the public health debate. He also considers some semantic issues that have presented themselves during this debate.
All of the articles published in this special issue emerged during the 2 years the APHA struggled to adopt a policy on assisted suicide. During that time, I personally went from seeing this issue as a personal right to understanding that assisted suicide is at the heart of the disability movement. The broadly used definition of “disability” includes individuals who have limitations in their functional status and/or use assistive devices to maintain function. Almost all people at the end of life can be included in the definition of “disability.” Thus, the practice of assisted suicide results in death for people with disabilities. People with disabilities have been recognized as a health disparity group (included in Healthy People 2010); they experience substantial discrimination in society, and yet they can live extremely high-quality lives. The ADA is civil rights legislation that guarantees equal treatment under the law. From the perspective of the ADA, the assisted suicide debates raise the question: Should we have laws that give physicians the ability to prescribe lethal doses of medicine to people, who are told they have less than 6 months to live, OR should we provide the supports, services, and pain management they need to continue living?
I encourage you to read this important issue of Disability and Health Journal with an open mind. The APHA did not support the Disability Section's opposition to an assisted suicide policy. The aid in dying policy was approved by APHA in November 2008, and in 2009 Washington became the second state to have a law legalizing aid in dying. There will be many states in the next decade that introduce or consider the introduction of laws to legalize assisted suicide. The issues are complex and the evidence is not robust. Some of the readers of Disability and Health Journal can use the manuscripts in this edition of the journal to help them understand the issues that will be debated in their state legislatures. We know there is another side to the debate, and this volume does not present the proponents' arguments, which have been presented in other journals. We thought it necessary to focus on the unique perspective to the disability community. Now we invite you to submit your own manuscripts about this or other ethical issues or to conduct thorough literature reviews on the challenges related to disability. This will make our journal vibrant.
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