The Federation and Physician-Assisted Suicide

by Chris Danielsen

This article addresses suicide. Suicidal thoughts or actions (even in very young children, older adults, and people with life-threatening illness/disability) are a manifestation of extreme distress and should not be ignored. If you or someone you know needs immediate help, call or text the national Suicide & Crisis Lifeline at 988.

From the Editor: I love the process of policymaking that takes place when we consider resolutions. In some cases the facts and circumstances articulated make it clear what our policy should be and our resolves speak to who we are going to tell and exactly what we will say to them. In other cases, the information we have for consideration has, in my opinion, been insufficiently clear for us to make a good decision between the time we first see a resolution and when we are asked to vote on it. I think the Braille Monitor should be a good place to discuss information and opinions that eventually lead to resolutions, and I thank Chris for his attempt to provide some framework for what we may again consider about physician-assisted suicide. As we have said so many times before, what we publish is often not our definitive opinion or policy but a view based on one person’s efforts to articulate their position and the facts they have uncovered. For what he has written, I offer Chris my thanks. Here it is:

It’s a running joke that there are never any controversial resolutions debated at national convention. In reality, there is usually at least one resolution that gets people talking, either off the convention floor or on it, and often both. At our 2023 convention in Houston, the controversial resolution was entitled “Regarding Opposing the Revival of Eugenics for the Blind.”

I was one of several people who spoke against the resolution. I happened to be the last person to do so. Some people have claimed that I killed the resolution. I do not claim such power. Indeed, I was somewhat reluctant to speak against the resolution because people I both love and respect in our movement supported it. Furthermore, I did not believe then, and do not believe now, that their concerns about the issue it sought to address are entirely unfounded. But I felt strongly that the resolution was not the right vehicle for addressing those concerns.

My late father used to debate issues with my sister and me. Whenever we had a lively dinner-table discussion, he would remind us that he was not as interested in hearing about what we were against as in hearing about what we were for. With that in mind, this article is not primarily intended to rehash the failed resolution or my objections to it. Instead, because I believe the issue will, and perhaps even should, come up again, I hope to propose an approach to the issue of physician-assisted suicide that I believe will be more constructive and consistent with our philosophy.

First, a couple of housekeeping details. I have chosen to use the term “physician-assisted suicide” because I think it is the most accurate term for the practice we are trying to address. People with different opinions about it may call it different things, but what we are discussing is the assistance of a physician in ending someone’s life.

In addition to the precise definition of what we are discussing, it’s important to stipulate that I will only discuss laws surrounding the practice in the United States. Those laws limit physician-assisted suicide to patients whose diseases or medical conditions are terminal, meaning that the inevitable result of the disease or condition’s progress will be death, with or without intervention.

A Wikipedia article entitled “Assisted Suicide in the United States” says that eleven jurisdictions, ten states, and the District of Columbia have laws permitting this practice. It further indicates that all of those laws limit its use to terminal conditions, often in cases where at least two physicians have independently diagnosed the condition and certify that the prognosis is that a patient only has a maximum of six months to live. In addition to the agreement of two doctors on the diagnosis and prognosis, the laws also typically require some combination of other safeguards: The patient must have the capacity to make decisions, must be examined in order to determine whether they have an underlying mental illness, and must receive counseling. If and when all of these conditions are met, a physician prescribes a lethal dose of drugs called barbiturates, which the patient must typically administer themselves. Thus, physicians in these states are not committing euthanasia, which is when one person kills another to end the other person’s suffering. They cannot and do not act on their own initiative to end someone’s life. They are instead providing the patients with the means to end their own lives. You can read the article at https://en.wikipedia.org/wiki/Assisted_suicide_in_the_United_States.

Not all of the laws are exactly the same. Furthermore, Wikipedia isn’t always an indisputably accurate source of information. However, the article doesn’t have any of Wikipedia’s flags indicating that it might not be accurate. Also, the editor of this magazine asked its readers for their understanding of the assisted suicide laws in the states where they lived, if their state had one. Those who responded indicated that they believed their state laws roughly conformed to the conditions and restrictions the article describes. A Federationist in Oregon told me in a conversation that the state’s safeguards appear to be rigorous. She said that she knew of a case where a patient with Alzheimer’s disease wanted to avail themselves of the state’s assisted-suicide law, which has been on the books for some thirty years. Although this patient met the requirement of having a terminal illness, their disease, which is characterized by dementia that worsens as it progresses, was also sufficiently advanced that the doctors who examined them did not believe they still had the mental capacity to make the decision. As a result, their request for physician-assisted suicide was denied.

All that said, this is not a research piece. I prepared it on my volunteer time, not as part of any official duties with the National Federation of the Blind, and that time is limited. I think it is probably worth someone doing a deep dive into the law and practice of assisted suicide, or perhaps someone can point readers to somewhere that has been done. I am basing my arguments only on what I know and have gathered based on a time-constrained look at the issue.

I lay this groundwork because it is important for readers to understand the assumptions and evidence that I am using to make my arguments. Readers may have information that I don’t have, and I am sure the Monitor editor joins me in inviting them to share such information so that the discussion can continue.

I understand the concern that physician-assisted suicide is a potential danger to the blind, the deafblind, and others with disabilities, at least in theory. We all know that public attitudes about blindness are generally awful. That fact is one of the reasons our movement exists. We are constantly refuting the belief that our lives cannot be meaningful, productive, fulfilling, and joyful. We are, in the view of far too many, broken people whose lives are severely limited, with our suffering only relieved by the aid of others, which makes us a burden to them and to society as a whole.

Worse yet, popular culture has too often endorsed the idea that dying is preferable to living with a disability. The Oscar-winning film “Million Dollar Baby,” in which a female boxer convinces her coach to help her commit suicide when a severe injury ends her career and leaves her with permanent disabilities, is just one disturbing example of this trope.

Finally, we know that people experiencing vision loss often do feel depressed and even suicidal. Some of us have spoken with individuals who are going through these emotions, and a friend recently told me that she knew people who went through with suicide, although not of the physician-assisted variety. It’s easy to imagine that someone who has not yet been exposed to positive messages and role models might seek to take the physician-assisted-suicide route, if available, as a way out of their sense of grief, isolation, and helplessness.

All of these are important concerns, and they have implications for the provision of healthcare generally, and possibly for physician-assisted suicide in particular. The late and dearly missed Dr. Adrienne Asch, in a convention speech recently reprinted in this magazine, laid out some of those implications better than I can. Among them is the question of allocation of healthcare resources: Will blind people, and other people with disabilities, be pushed toward the end of the line for lifesaving care?

For me, these genuine concerns suggest that the National Federation of the Blind ought to be engaged in our nation’s continuing conversation about various healthcare issues, including physician-assisted suicide. Because we believe, as a movement, that blind people’s lives are as worthwhile as anyone else’s, we do not want others making adverse decisions about them. We do not wish to be first in line to die or last in line for lifesaving treatment. We can and should fight to ensure that neither of those things happen.

While most of us can nod in agreement when reading the previous paragraph, our philosophy also raises a counterargument. We believe that blind people have capacity for self-care and self-determination. We also hold true that we are a cross-section of society and reflect its diversity. That means that to some of us, the idea of killing ourselves, under any circumstances, is abhorrent. But others of us, while we would never seek our own death because of blindness or deafblindness, might wish to avail ourselves of physician-assisted suicide under other circumstances.

We probably all agree that blindness should never be the single or even primary condition that makes someone a candidate for assistance in dying. But blind people should not be precluded from such assistance if we want it for the reasons it is traditionally granted in the states where it is allowed. Most of us would be rightly indignant if, on the basis of blindness, our doctors suggested that we did not have the capacity to consent to an appendectomy, or plastic surgery, or any other given medical treatment, critical or elective. If we live in a jurisdiction where physician-assisted suicide is lawful, is it consistent with our philosophy to argue that it cannot and must not be among our options? Is it not the very essence of custodial thinking to argue that because we are blind, we must be protected from ourselves and denied the ability to end our lives in the manner of our choosing, rather than waiting for a prolonged and painful condition to finish us off?

As a movement, we also want blind people, subject to the jurisdictions where they reside to have the same legal rights as everyone else, even if as individuals many of us would never exercise some of them. I may not wish to grow or smoke marijuana, but I want other blind people to be able to do it if it is lawful where they live. I feel the same way about physician-assisted suicide.

This was my problem with last summer’s resolution. Although it contained some passages affirming our right to self-determination, its tenor, and some of its specific clauses, suggested that our organization ought to oppose physician-assisted suicide categorically because the practice, by its very nature, violates our Constitutional rights and threatens our existence. At least in this country, I do not think there is evidence for this proposition, based on my admittedly limited research. (I do think there is potential evidence of the practice occurring beyond this limited scope in other countries.) Our existing laws seem clear that patients must have a terminal condition, one that will naturally end in death within six months. Blindness and deafblindness are not terminal conditions, regardless of one’s attitudes about them or their impact on quality of life. A physician who claimed otherwise would be making a subjective judgment rather than one based on solid medical evidence, and therefore opening themselves, in my view, to discipline that might include the removal of their medical license, and possibly even to criminal punishment. I doubt that existing laws give physicians the kind of leeway we fear. But if we believe they do, then a tailored approach would involve amending them to specify that blindness and deafblindness are not grounds for physician-assisted suicide.

I want to close by reiterating that I am applying this argument exclusively to the matter of physician-assisted suicide. As Dr. Asch pointed out, there are other ethical issues that we need to be aware of as medical science continues to advance. We need to stand firm that our lives are worth living and make sure that the legal and medical establishments recognize that truth. But I believe that we should be careful of trampling on the rights of others, or even inadvertently on our own, as we do so.