In December 2016, Colorado became the sixth state to legalize assisted suicide. This year, Compassion & Choices (the U.S.’s leading assisted suicide advocacy group) celebrated that “Colorado’s first year of implementation has been a success and is working as voters intended.”
Many will take them at their word—but that is precisely the problem. Assisted suicide legislation fails to protect against abuse, in no small part due to weak accountability and poor reporting practices.
Assisted suicide laws do not enforce good reporting practice, so abuse is easy to conceal. Victims must have the courage to step forward and report it. Oregon has had assisted suicide on the books for over twenty years, and only recently have abuse victims—Barbara Wagner and Dr. Brian Callister, for example—attracted public attention with their stories.
Compassion& Choices fights rigorous data collection protocols related to assisted suicide. This includes identifying assisted suicide drugs as the cause of death. The result is that, to the extent that it requires any reporting at all, it is only to give a feeling of transparency.
Like every other state with legal assisted suicide, Colorado must submit a yearly data summary to “ensure documentation requirements of [the End-of-Life Options Act] are met.” The state published its first report in February, and when read carefully, it illustrates a seriously flawed system of data collection.
The fact is, Compassion & Choices is celebrating too soon—it is impossible to tell how well Colorado’s laws are working. Rather than bringing clarity, their 2017 report raises some disturbing questions, unanswered by the data.
1. How exactly did these patients die?
Colorado’s law states that a patient’s death certificate should reflect the underlying illness as the cause of death, rather than assisted suicide drugs. This makes it impossible to know which patients, who went home with a prescription for lethal drugs, filled the prescription and later used the drugs to end their lives. The report states:
Statistics in this report for deaths are based on all deaths identified among individual prescribed aid-in-dying medication, whether or not they used this medication, and noting that death may have been caused by ingestion of medication, the underlying illness or condition, or some other cause.
How many patients, after acquiring the drugs, decided that they did not want to take them? We will never know.
More disturbing is that we do not know which patients ingested them of their own free will, and whether a third party caused them to ingest the drugs. Were some patients tricked or pressured into swallowing the drugs? Again, the data does not say. It cannot say, because the reporting system conceals the patient’s true cause of death.
Because the elderly are among some of our society’s most vulnerable, this lack of protections raises concerns of elder abuse. Unfortunately, here in Minnesota we’re all too familiar with tragic cases of elder abuse.bill.
Overall, this lack of reporting on how patients died obscures the data we have about use of assisted suicide. The fact is, the data do not reflect the reality of how many patients opt for assisted suicide, and how many die of other causes.
2. What “underlying conditions” justify assisted suicide?
The report includes data on the “underlying terminal illnesses/conditions” among patients who received prescriptions for the lethal drugs. No surprise, the majority had either cancer or ALS. But the table also includes the line item “Other illnesses/conditions”. This category includes 5 out of the 69 patients.
What does it mean? Again, there is no way to know. It could be autoimmune diseases or other terminal illnesses. It could also be that these patients were not in fact terminally ill.
One probing study of assisted suicide practice revealed that physicians define “terminal illness” as any illness that would result in death within six months if left untreated. It is not limited to illness that will kill a patient whether they are treated or not. The silence about the conditions of those five patients ought to make us wonder if they were in fact dying or if they could have survived with treatment.
Because Minnesota’s assisted suicide bill contains the same protocol for data collection, we would face the same uncertainties. Prescribing physicians would not be held accountable for making a terminal diagnosis and issuing lethal drugs to a patient whose illness is treatable.
3. Why is the data so incomplete?
Colorado’s assisted suicide reporting for 2017 is grossly incomplete. Of all forms and documents listed in the report, none had 100 percent reporting. Only 60 of the 69 patients’ files included an attending physician’s form. Just 47 of the patients’ records included their completed written request.
Most shockingly, though, is that of all 69 patients who got prescriptions for assisted suicide drugs, only one of their files included a mental health provider’s confirmation.
A series of disturbing questions arises from this chilling statistic:
Was it really the case that only one patient was referred for a mental health check before being prescribed suicide drugs?
What about the other 68—how much consideration was given to their mental health?
Is it possible that some of these patients got the drugs from their physicians even after their mental health providers refused to sign off?
These numbers show how vulnerable to serious abuse the assisted suicide practice is. Patients with depression, suicidal tendencies, or other mental illnesses can acquire lethal drugs when what they really need is psychological and emotional care.
This is the sort of abuse we could face in Minnesota under assisted suicide legislation. Patients requesting assisted suicide drugs would not have to undergo a mental health evaluation unless their physician judges them unable to give full consent. Minnesotans deserve to be evaluated and treated with respect to all their needs – psychological and emotional included.
Celebrating Too Soon
Compassion & Choices may be celebrating a successful first year of assisted suicide in Colorado, but the data does not support their excitement. There are simply too many gaps in reporting to know whether this law protects patients.
Minnesota’s assisted suicide legislation would leave many of these same questions unanswered. Colorado’s experience serves as a warning to Minnesotans to protect our loved ones from this dangerous legislation.