State laws legalizing assisted suicide violate the Americans with Disabilities Act

As bills to legalize assisted suicide fail across the board in liberal states like Connecticut, Maryland, and New York, some progressives may be left wondering why. Isn’t assisted suicide public policy about choice and autonomy, principles most Democrats hold dear? The answer for many of us is simple: disability discrimination.

I wrote a few years ago in these pages that Congress should be mindful of the Americans with Disabilities Act (ADA) when addressing assisted suicide public policy. Assisted suicide laws violate the landmark legislation that codifies disability as a protected class.

In the health care context, that means if you provide a certain standard of care to people — say, suicide prevention care — you cannot provide different or lesser standard of care to others based on disability.

Despite more than 30 years of the ADA being on the books, physician perceptions of the lives of people with disabilities remain abysmal. A recent Harvard study reports, “In [a] survey of 714 practicing U.S. physicians nationwide, 82.4% reported that people with significant disability have worse quality of life than nondisabled people. … [T]hese findings about physicians’ perceptions of this population raise questions about ensuring equitable care to people with disability. Potentially biased views among physicians could contribute to persistent health care disparities affecting people with disability.”

As we saw in the pandemic, states across the country promulgated Crisis Standards of Care, the triage rationing protocols put in place for medical professionals to know how best to mete out the limited resources. Multiple complaints were filed with the HHS Office for Civil Rights due to these policies systematically deprioritizing people with disabilities for life-saving medical resources, based on a misguided utilitarian view that non-disabled lives are worth more than the lives of people with disabilities.

Assisted suicide laws take the “less worthy” premise to the next level — “better off dead.” In their report, “The Dangers of Assisted Suicide Laws,” the National Council on Disability, a nonpartisan federal agency, reports, “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 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.”

In every medical appointment nowadays, doctors ask, “Do you feel safe at home?” and “Have you considered self-harm?” Whenever patients express a desire to harm or kill themselves in a medical setting, the standard of care is to initiate harm and suicide prevention care and services.

In most states, if medical professionals react to those same warning signs by saying instead, “Sure, I can help you with that,” and their patients kill themselves with their help, those caregivers would be prosecuted in criminal court, likely sued by patients’ families in civil court, and lose their licenses to practice medicine.

If, however, you happen to live in a jurisdiction where assisted suicide is legal, and you have a condition perceived by your doctor as limiting your life to six months or less, then both the standard of care and the usual criminal, civil, and professional protections afforded to everyone else are out the window for you. You, along with all other supposedly terminal patients, are shunted into the “better off dead” funnel, so long as doctor death is “acting in good faith.”

Every underlying condition qualifying a person for lethal drugs under assisted suicide laws also qualifies the same person for protection under the ADA. In many cases, these disabilities or conditions would not be at all life-threatening with proper medical care or long-term services and supports, yet they still can qualify for lethal drugs.

Some of the disturbing examples straight from the Oregon report include such treatable, non-life-threatening disabilities as diabetes, HIV, anorexia, arthritis, complications from a fall, hernia, and medical care complications.

Have we devalued some people so much that we are ready to waive protections in law and medical practice for vulnerable young people with eating disorders or mental health disabilities? Instead of helping them to live, society is all too ready to help them die by suicide, with state governments seemingly eager to pay for it.

The ADA was prescient and remains powerful. But it is only enforced through litigation. People with disabilities and the organizations that represent them can only hope for the fulfillment of its promise by fighting for it.

That’s why my organization has joined other organizations and individuals who filed a lawsuit in California Federal Court to overturn California’s assisted suicide law as an inherently discriminatory violation of the ADA, Section 504 of the Rehabilitation Act, and the Due Process and Equal Protection clauses of the 14th Amendment. To add assisted suicide as an “option,” but only for people with life-threatening disabilities, is just eugenics disguised to appeal to a deep cultural hunger for autonomy.

Neither the plaintiff group nor those endorsing this case are here to tell you what to do with your body. In fact, many in these groups are ardent advocates for reproductive rights. Most take no position on the moral or ethical implications of taking one’s own life.

This lawsuit doesn’t attempt to punish people for killing themselves — no state in the union criminalizes suicide, and we have no objection to that.

In our fight for health care equity, however, it has become abundantly clear that California’s assisted suicide law disproportionately affects people with disabilities, funneling medically expensive people away from real healthcare and providing just one “treatment” to which we all have equal access — death.

Matt Vallière is executive director of the Patients’ Rights Action Fund and Institute for Patients’ Rights, as well as a volunteer emergency medical services first responder.