Correlation in not causation. Just because A precedes B doesn’t necessarily mean A caused B, even if lots of people predicted it would. But sometimes it can’t be ruled out. And that may be the case with Oregon’s decades-old physician-assisted suicide (PAS) law and recent efforts to deny life-saving care to COVID-19 patients with disabilities.
National Public Radio recently ran a story suggesting that some Oregon hospitals and doctors may be withholding health care to COVID-19 patients with significant disabilities.
According NPR investigative reporter Joseph Shapiro, Sarah McSweeney, a lady with multiple disabilities, entered a hospital in a Portland suburb with COVID-19. The doctor wanted to put her on a ventilator. She didn’t get one, even though Oregon had a surplus at that time and was lending its ventilators to other states. She died.
In the story, Jake Cornett of Disability Rights Oregon cites similar cases in which COVID-19 patients with disabilities have been denied care. “For a single state to have multiple cases like this coming up over and over, it should raise the alarm bell. It should convince people that this is a real problem that we need to quickly address at the state and federal level,” Cornett says in the story.
NPR investigated a dozen cases in Oregon. State Sen. Sara Gelser, who has been looking into denial-of-care claims for people with disabilities, told NPR that people think these are “dystopian stories that would never happen, but they do, and they have, and they will.”
The story’s take-away is that some Oregon health care providers have determined that certain people with severe disabilities lack a quality-of-life threshold such that treating them isn’t worth the effort or cost.
When Oregon voters approved a physician-assisted suicide measure in 1994, it became the first state to do so. Many people raised concerns that it might lead to a pattern of devaluing life, especially for certain populations — the very young, very old and for those with severe disabilities.
Multiple attempts were made over several years by the Clinton and George W. Bush administrations, as well as congressmen and senators, religious and patients’ rights groups, to challenge the law precisely because of the deadly threat it might pose to certain populations.
But the state was tenacious in asserting its right to help certain terminal patients end their lives with dignity. The U.S. Supreme Court agreed, twice (in 1997 and again in 2006), essentially concluding that under a federalist system the federal government is limited in what it can do and states, for better or worse, have the right to adopt such laws.
(Note: I was invited by medical ethicists at the time of the Oregon debate to contribute a chapter to a book — “Physician-Assisted Suicide: Expanding the Debate” — addressing the question of whether physician-assisted suicide would save the health care system money, which was one of the arguments for allowing it. I did and it didn’t.)
Physician-assisted suicides in Oregon have grown almost every year since, with a notable spike beginning in 2013 that continues to this day.
Death with Dignity, an advocacy group, writes, “In 2019, 112 Oregon physicians wrote 290 prescriptions to dying Oregonians who qualified for the Act; 188 people died using the medications obtained under the law.” Some people ask for the prescription but decide not to take it.
Since Oregon passed its law, eight other states have adopted similar laws, with most of them coming in the last five years — probably too soon to notice any real change in attitudes toward those with severe disabilities.
And even though physician-assisted suicide raises concerns, the public widely supports the option. Gallup says that 72 percent of Americans support a terminal patient’s right to end his or her life with the help of a physician. That’s understandable. I think most of us want that option available, even if we are extremely unlikely to use it.
Younger people, Democrats, liberals and those who seldom or never attend church are the strongest supporters, according to Gallup.
Will the expansion of physician-assisted suicide eventually chip away at the long-held belief that we should value and protect life, especially the lives of those society may consider marginal?
Now, with nearly 25 years under its belt, Oregon disabilities rights groups are seeing a growing callousness among some health care providers who seemingly don’t value some lives as much as others.
Notably, the NPR story makes no mention of Oregon’s physician-assisted suicide law. The story tries to connect the neglect to a broader problem: inequities in health care delivery for people with disabilities. “For the first time we see in a pressing and more public way how deadly that can be,” according to Sen. Gelser.
To return to the initial question, I don’t know if A (Oregon’s Death with Dignity Act) caused B (denial of some care to disabled COVID-19 patients). But I do know that 20 years ago many people predicted and feared it.
Merrill Matthews is a resident scholar with the Institute for Policy Innovation in Dallas, Texas. Follow him on Twitter @MerrillMatthews.