Neurologic Diseases and Medical Aid in Dying: Aid-in-Dying Laws Create an Underclass of Patients Based on Disability

With clinicians, philosophers, and law professors, I recently published a target article in the American Journal of Bioethics, titled "Neurologic Diseases and Medical Aid in Dying: Aid-in-Dying Laws Create an Underclass of Patients Based on Disability." We argue that the eleven U.S. state laws permitting medical aid in dying violate the Americans with Disabilities Act (ADA) to the extent they prohibit assisting self-ingestion for a physically disabled individual (who already obtained a MAID prescription) who cannot complete MAID self-ingestion by themselves.

While the journal will solicit and print Open Peer Commentaries, some responses have already been posted. One comes from Not Dead Yet. I offer this rebuttal to that response.

(1) The opening line of the NDY post states: "Legal assisted suicide puts disabled people in danger of being killed on the basis of disability alone." But this is false. First, MAID requires the individual's free, voluntary, and informed consent. So, it is never disability "alone." Second, not just any disability is qualifying, only the small subset that are terminal illnesses.

(2) The second line of the NDY post states: "This is especially true when assisted suicide laws allow someone other than the patient to administer the drug." There is no U.S. evidence to support this, since clinician-administered MAID (or euthanasia) has never been allowed in the United States. Nor is there evidence from anywhere else.

(3) In the next paragraph, the NDY post states: "There is a much more compelling case for invoking the ADA here that focuses . . . more on making it easier for us to live life on our own terms." This misses the point that U.S. MAID is available to only those who are terminally ill. Most individuals obtain prescriptions within weeks of their death (typically from cancer). It is literally impossible for them to "live life on their own terms."

(4) In the final paragraph, the NDY post states: "Disabled people do not need more help dying." Again, this is just false. Not only do many "need" help, they "want" help. It is true that we will all die with or without help. But most of us need help to die "better" (more peaceful, comfortable) deaths. While hospice and palliative care will be sufficient for most of us, some determine that MAID is their best option.

I readily concede that disability bias is a big problem in U.S. healthcare. As the NDY post itself notes, that manifests in situations where healthcare is denied contrary to wishes of the person with disabilities. That happened with crisis standards of care. It happens in medical futility conflicts. For example, I am not sure why Louisiana includes Trisomy 13 and 18 on this list of "medically futile" pregnancies.

But those are involuntary and unwanted denials. In contrast, MAID is offered only in response to a capacitated, voluntary, and informed request. Denying these persons with disabilities access to MAID under the guise of "protecting" them is insulting, offensive, and paternalistic.

I invite NDY members (and others) to consider writing an Open Peer Commentary on our article in AJOB. That way, the discussion will be indexed and archived.