The U.S. Department of Health and Human Services stepped in and stopped it.
Among several states that agreed to rewrite their triage guidelines: Tennessee revised rules that let care be denied to people who already use a ventilator, those with advanced neuromuscular conditions like ALS, and some people with dementia and traumatic brain injuries. Officials in Pennsylvania changed standards that told hospitals it was OK to cut off care to some people with chronic lung disease or cancer. Alabama rewrote rules that allowed the denial of ventilators to people with “moderate to severe dementia.”
People who work with California’s assisted suicide law acknowledge that disabled people often struggle to get adequate medical care, but they say the state’s end-of-life law is set up to avoid precisely that kind of discrimination.
“Having a disability would not qualify someone for aid-in-dying,” says Nathan Fairman, a psychiatrist and palliative care doctor who oversees cases at UC Davis Health in Sacramento. “Someone who’s disabled and has end-stage cancer would potentially qualify. And they would have to step through all of the safeguards that are set out in the law.”
Two doctors, he notes, need to confirm that someone is terminally ill and mentally competent to choose to die. Health care systems like his, Fairman says, add psychological and other evaluations that go beyond the state law to further protect against abuse.
Oregon went first and other states followed
The lawsuit was filed by four disability rights groups — United Spinal Association, which advocates for veterans and others with spinal cord injuries; Not Dead Yet and the Institute for Patients’ Rights, two groups that oppose assisted suicide laws; and CALIF, a Los Angeles nonprofit run by people with disabilities.
A spokesperson for the California Department of Public Health, the agency that keeps the statistics on who uses the assisted suicide law, said it “does not comment on litigation.”
Oregon was the first state to implement a right-to-die law, in 1997. Washington state was next, in 2009. Since then, such laws have spread quickly. Now, 10 states and the District of Columbia allow assisted suicide for terminally ill people who are competent to make that choice.
In California, between 2016, when the law took effect, and the end of 2021, 3,766 people got prescriptions for the medications and 64.3% of them are known to have taken those pills, according to the most recent annual report (PDF) by the California Department of Public Health.
The lawsuit, filed in the U.S. District Court for the Central District of California, argues that the state’s assisted suicide law violates due process protections guaranteed by the U.S. Constitution and violates the anti-discrimination provisions of the Americans with Disabilities Act.
Some want to use the law to end their lives — but can’t
But that’s not the only challenge to the law under the ADA. Dr. Lonny Shavelson, a proponent of assisted suicide laws, recently sued California on behalf of disabled people who want to use the law to end their lives but can’t.
The End of Life Option Act says that a person who gets lethal medications must be able to take those pills themselves. That’s a common safeguard in assisted suicide laws, to prevent coercion by family members or others.
But Shavelson, a co-founder of the American Clinicians Academy on Medical Aid in Dying, says it ends up discriminating against some of the people who most clearly want to use the law — but can’t take the pills themselves because of the progression of their disease, such as people with ALS and Parkinson’s.
They are denied “the same access to the law that able-bodied people receive because they’re unable to self-administer the medications, ” he says. “We’ve denied them assistance to a legal medical procedure.”
Shavelson’s lawsuit was rejected by one U.S. District Court in California and is now on appeal.
Today, Ingrid Tischer is working again, helping nonprofits do fundraising. She looks back at the time two years ago when she was hospitalized, having difficulty breathing and ready to give up. She says she was driven then by fear — of dying or moving to a nursing home and of a “mass of misplaced guilt” that she’d become a burden to her husband. “I just wanted out,” she says. “I don’t think I was thinking very clearly.”
But Tischer had resources that turned her around — that supportive spouse, a solid family income, a house, reliable health insurance and her long personal experience navigating the medical system.
“There are many people in this world who are a lot more vulnerable than I,” she says, and — as a result — more likely, she believes, to seek assisted suicide.