Health professionals, disability, and assisted suicide: An examination of relevant empirical evidence and reply to Batavia (2000).

Abstract

Prominent disability rights groups have adopted positions opposing the legalization of assisted suicide. That physicians and other health professionals would assist in suicides of persons with incurable conditions while offering suicide prevention to "healthy" individuals is, they maintain, evidence of social discrimination and an unwarranted devaluation of the quality of life of people with disabilities. This article examines empirical literature relevant to the question, Is there evidence that disability affects life in a manner that justifies an exception to the general practice of preventing rather than endorsing suicide? Research findings are discussed in terms of their bearing on the disability rights opposition to physician-assisted suicide and the need for research addressing the dynamics of death requests of persons with disabilities.The Oregon Death with Dignity Act (1994) and various proposed statutes and referenda for legalizing assisted suicide give physicians primary authority to judge whether individuals who request suicide assistance qualify to receive it. The competence of health professionals as gatekeepers of assisted suicide and the professional propriety of that arrangement have been challenged in literature addressing physician fallibility in detecting treatable depression (Misbin, 1991;Muskin, 1998), the potential corruption of the physician's role as healer and the possible erosion of physician-patient trust (Gaylin, Kaas, Pellegrino, & Siegler, 1988), the conflict between managed care pressures and critically ill patients' needs for costly care (Russell, 1998;W. J. Smith, 1997), and healthcare professionals' biases regarding gender, class, race, and age (Asch, 1998;Wolf, 1997).This article examines a challenge raised by disability rights advocates regarding the fitness of healthcare professionals, particularly physicians, to referee requests for assisted suicide from persons with disabilities. Although some prominent individuals with disabilities have lobbied in favor of legalizing assisted suicide, most major disability rights organizations in the

Autonomy, vulnerability, and dementia: operationalizion of adult guardianship legislation in British Columbia

“…My literature review illustrated how public attitudes and societal structures reinforce ideas of paternalism for these populations (Gill, 2000;Gordon, 2012;Ray et al, 2009) and the need for solutions (e.g., personal planning and default system options) to protect PWDs' self-determination. As a result, I chose to explore the topic of BC adult guardianship and planning statutes applied to the population of PWDs for my MSW practicum because this legislation was the result of community efforts to create legislation that brought an alternative epistemology (ethics of care) into force that would empower PWDs.…”

“…As public attitudes and societal structures remove self-determination from older adults with dementia, finding ways to better protect their right to self-determination is important (Gill, 2000;Gordon, 2012;Ray et al, 2009). The adult guardianship reform was a reaction to concerns about the rights, self-determination, and safety of vulnerable populations within the context of adult guardianship and incapacity planning.…”

“…Structural and anti-oppressive theorists argue discriminative public attitudes based on ageist and ableist beliefs about people with disabilities, older adults, and PWDs, which result in these groups being perceived and treated as though they are homogenous, frail, dependent, and unproductive, are caused by the dominant culture's ideologies associated with normalcy that are upheld by institutions (Dalrymple & Burke, 2006;Gill, 2000;Gordon, 2012;Mullaly, 2010;Ray et al, 2009). These ideologies of normalcy cause groups who are considered normal to receive privileges and groups who are considered abnormal to experience oppression in society (Dalrymple & Burke, 2006).…”

“…Additionally, physicians often drastically underestimate the quality of life of older adult patients or patients with disabilities when compared to the patients' perception of their quality of life (Gill, 2000;Somerville, 2000). This skewed perception of older adults and persons with disabilities' quality of life furthers the need for self-determination protection for PWDs, as professionals' perceptions of these populations do not accurately reflect the populations' lived realities.…”

“…Public attitudes about older adults, persons with disabilities, and subsequently PWDs alongside societal structures often influence the roles and decision-making choices assumed by social support networks of PWDs (Gill, 2000;Goralewicz, 2015;Gordon, 2012;Ray et al, 2009). Structural and anti-oppressive theorists argue discriminative public attitudes based on ageist and ableist beliefs about people with disabilities, older adults, and PWDs, which result in these groups being perceived and treated as though they are homogenous, frail, dependent, and unproductive, are caused by the dominant culture's ideologies associated with normalcy that are upheld by institutions (Dalrymple & Burke, 2006;Gill, 2000;Gordon, 2012;Mullaly, 2010;Ray et al, 2009).…”