The impact of assisted suicide on persons with disabilities - is it a right without freedom?

• Author: Miller, Paul Steven

A twenty-two year old woman, a student at a large state university, discovers she is pregnant. When she tells her boyfriend, he breaks off the relationship, saying that the pregnancy is her problem and responsibility. A solitary and private woman without many friends, she keeps the pregnancy a secret. Several weeks later, early in the first term, she has a miscarriage. She does not share her grief with anyone.

At about the same time, the woman's mother informs her that her father has abandoned the family and is seeking a divorce. As a result, her parents cannot pay for the remainder of her college education. Without the financial support of her family, she will not be able to complete her schooling. The young woman's grades slip, creating more anxiety for her.

Concerned about her future, about her financial situation, about her personal, family, and social life, the woman goes to the university health center and asks the physician on duty for a prescription of barbiturates. She tells the physician that she intends to kill herself. The physician speaks with the woman for a short while and concludes that she truly is despondent and voluntarily wants to take her own life. He prescribes the medication she requests; she leaves and kills herself.

Although the above scenario is only hypothetical, there is general agreement among case law and medical ethical standards that the physician would have acted irresponsibly and even criminally.(1) Moreover, the general public's reaction would be one of sadness at the loss of a young person's life.(2) However, if the woman in the above hypothetical situation had a permanent disability, society's attitudes about the same suicide and the physician's assistance in the suicide would change dramatically.(3) There is a double standard between the value of the life of a person who is able-bodied and that of a person with a disability.(4) This double standard exists based upon society's prejudice against persons with disabilities. The current debate over a disabled person's "right to assisted suicide" reflects this prejudice.(5)

The different attitudes society has about the death of a disabled person, as opposed to that of an able-bodied person, are rooted in the stigma associated with being disabled.(6) Many able-bodied persons are tremendously fearful about becoming disabled. This fear is based upon the notion that a disabled person's life is inferior to, and less precious than, an able-bodied person's life. Such stereotypes about persons with disabilities become reflected in very dangerous ways within the debate over an individual's right to assisted suicide. These biased perceptions about persons with disabilities have the impact of robbing them of their dignity, reinforcing their self-hatred, and making integration into American social and economic life more difficult. When society pities and fears persons with disabilities to the extent that suicide is considered a rational choice, it is difficult to expect that same society will have enough respect to treat such persons as truly equal.

At the same historical moment in which a disabled person's civil rights are finally becoming recognized under federal law,(7) the right to die movement is reinforcing stereotypical notions about the "tragedy" of a disabled person's existence. The irony about assisted suicide is that concepts of personal autonomy, freedom, and dignity are used to empower persons with disabilities to kill themselves, rather than enabling them to live independent lives with dignity. Such basic civil rights concepts are turned on their heads to reinforce stereotypical roles leading to an acceptable and rational death for persons with disabilities, rather than to creating equal opportunity and independence. The debate over assisted suicide emphasizes "death with dignity" but ignores the possibility of granting dignity to the life of a person with a disability.

In addition to encouraging society at large to regard suicide for a person with a disability as rational, such prejudices reinforce the alienation persons with disabilities themselves feel about the world around them. The resulting self-hatred can then culminate in the "rational" act of suicide. In such an environment, suicide becomes not a "choice" but a rational preference. The debate over the right to suicide implies that the issue at hand is a question of freedom. In order for an assisted suicide to be truly the result of an unconstrained and free choice, society must rid itself of the constructs that make life with a disability stigmatized and undignified. If society refuses to assist a young, despondent able-bodied woman to commit suicide, the same values and ethics must prohibit assistance to a disabled woman desiring to commit the same act.

Assisted Suicide for Persons with Disabilities

There is nothing novel about suicide--people have been taking their own lives since the beginning of history.(8) However, for many people with disabilities, the "right to commit suicide" can be realized only with assistance due to the individual's own physical and/or environmental limitations. Unlike able-bodied persons who can quietly end their lives alone, persons with disabilities often require, due to the physical limitations of their bodies, the assistance and intervention of assisters. Moreover, many persons with disabilities do not live by themselves, utilize personal attendants and care providers for assistance, or live in group settings. Thus, environmental restrictions limit their access to suicide alternatives. It is important to acknowledge the necessity of assistance in the suicides of persons with disabilities.

In an assisted suicide, the assister does not merely allow one to die but actively provides the means that cause the death. Assisted suicide is not the refusal of medical treatment. It is the provision of an active means to stop life. Many misperceive assisted suicide as a form of euthanasia. The word euthanasia is derived from the Greek term referring to the practice of painlessly putting to death a person suffering from an incurable condition or disease.(9) However, disability alone is distinct from an incurable disease or terminal illness. Rather, it is a physical or mental characteristic requiring adaptation to the surrounding environment. And yet the possession of a disability alone was enough for the court in Bouvia v. Superior Court to justify and sanction suicide.(10)

People with Disabilities Live in an Oppressive Environment

That prejudice exists in society against persons with disabilities is clear. Such prejudice has repeatedly been recognized by courts. For example, in City of Cleburne v. Cleburne Living Center, Inc., the court stated that "through ignorance and prejudice, the mentally retarded have been subjected to a history of unfair and often grotesque mistreatment."(11)

Recently, Congress passed, and the President signed, the Americans with Disabilities Act (ADA), the first federal civil rights legislation prohibiting discrimination by private entities against persons with disabilities.(12) The ADA acknowledges the right of disabled persons to live with dignity, free from discrimination in private employment, public accommodations, transportation, local and state government services, and telecommunications. The ADA states.

(2) [H]istorically, society has tended to isolate and segregate individuals

with disabilities, and despite some improvements, such forms of

discrimination against individuals with disabilities continue to be a

serious and pervasive social problem;

(3) discrimination against individuals with disabilities persists in such

critical areas as employment, housing, public accommodations,

education, transportation, communication, recreation, institutionaliz-

tion, health services, voting, and access to public services;

....

(5) individuals with disabilities continually encounter various form of

discrimination, including outright intentional exclusion, the

discriminatory effects of architectural, transportation, and

communication barriers, overprotective rules and policies, failure to

make modifications to existing facilities and practices, exclusionary

qualification standards and criteria, segregation, and relegation to lesser

services, programs, activities, benefits, jobs, or other opportunities;

(6) ... [S]tudies have documented that people with disabilities, as a

group, occupy an inferior status in our society, and are severely

disadvantaged socially, vocationally, economically, and educationally;

(7) individuals with disabilities are a discrete and insular minority who

have been faced with restrictions and limitations, subjected to a history of

purposeful unequal treatment, and relegated to a position of political

powerlessness in our society, based on characteristics that are beyond the

control of such individuals and resulting from stereotypic assumptions

not truly indicative of the individual ability of such individuals to

participate in, and contribute to, society;

....

(9) the continuing existence of unfair and unnecessary discrimination

and prejudice denies people with disabilities the opportunity to compete

on an equal basis and to pursue those opportunities for which our free

society is justifiably famous....(13) Judicially sanctioned assisted suicide recognizes none of the above realities facing persons with disabilities; rather it approves of the stereotypical "worthlessness" of their lives.(14)

Society often identifies the cause of suffering of persons who have disabilities as the disability itself. Disability is viewed as a permanent sickness, creating only the semblance of life within...