Thursday, December 14, 2023

The Final Countdown to Euthanasia?

By Lisa Blumberg

The usual line of the organizations promoting the legalization of assisted suicide (or medical aid in dying (MAID) as they like to call it) in New York and elsewhere is as follows: the sole reason for such laws is to prevent “end of life” suffering, that the laws only apply to people close to death and contain stringent guidelines. Moreover, they claim, in states which have such laws, there have never been abuses, meaning assisted suicide laws are safe.

Kaitlin Puccio, a New York attorney and supporter of “MAID”, says it’s time to move things forward and then some. Her simplistic and Orwellian piece “The Final Countdown to Medical Aid in Dying in New York” in New York Law Journal tells it as she sees it. 

She notes that New York has failed multiple times to pass an assisted suicide bill but thinks this go around it may be different. There is a lawsuit going on in New Jersey challenging the residency requirement of its assisted suicide law, thus creating the possibility that New York’s assisted suicide business could be siphoned off by its neighbor. She writes, “New York’s financial incentive to keep its residents from using out-of-state services when they could be provided in-state may be enough to spark a sense of urgency to pass the New York Medical Aid in Dying Act…if New Jersey removes its residency requirement for MAID, New York will need to make its move or risk New York residents making theirs.” This is rather a bald admission of the economic gain that could come from allowing this industry in the state.

Puccio is quick to say that besides the financial commerce incentive, she thinks that there are ethical reasons to pass the act. Indeed, she uses the word “ethical” five times in her 1118 words piece but then admits that due to existing economic incentives in the healthcare system, some people could be steered to choose death. This is unfortunate but she writes that, “such misuse or overuse of MAID must not be permitted to poison the ethical analysis of its proper use in determining whether to pass the pending legislation.” So much for being leery of legalizing assisted suicide because of the potential for abuse under our already biased and broken healthcare system.

Midway in the piece, her “ethical” arguments move from economics to anti-disability rhetoric. Puccio wants New York to hurry up and pass an assisted suicide law but not the one that has actually been introduced in the legislature which is based on the Oregon model (although Puccio does not use that term). She writes, “the New York legislature should not only consider the ethical implications of passing the New York Medical Aid in Dying Act, but it should take steps to ensure that the qualification requirements are not overly exclusionary or discriminatory.” 

She thinks that limiting eligibility to persons who are judged to be within six months of death fails to recognize a distinction between “living” and “being alive.”  She doesn’t say what this distinction is but just that she would extend eligibility to people with chronic conditions because doctors “have not found a way to preserve or extend their quality of life.”  

She also would extend eligibility to people with cognitive decline, which creates concerns about lack of consent and involuntary euthanasia. Although she finesses when eligibility should be triggered for such folks, she asks “When considering the appropriate time for patients in cognitive decline to have access to MAID, the question that must be answered is: If there is a death of the self, what is left to keep alive?” For Puccio, it appears that an individual who has reduced cognitive abilities may no longer have the protections of personhood. Perhaps she’s adopted Peter Singer’s theories in that regard.  

Last but not least, Puccio is opposed to a requirement that the lethal drugs be self-administered because that would make things onerous for people with disabilities. She has already acknowledged that abuse may occur but doesn’t think that should be a concern when discussing the merits of removing the self-administration requirement. What Puccio is advocating is for New York to legalize euthanasia for a broad swath of the population. Without stating it in so many words, she is asking proponents of assisted suicide to re-draft their bill so that it is as broad as the euthanasia laws in Canada and Belgium. It is unlikely that this will happen quickly. Proponents will probably try once again to pass the bill they already have while touting the supposed safeguards. However, her piece does provide a warning on how assisted suicide, once legalized in a jurisdiction, can morph. 

Reading her piece in the holiday season reminds me of Dickens’ The Christmas Carol and the disturbing ghost of Christmas Future who foretells terrible things to come to pass – unless people step in to stop them.