Persons Living with HIV/AIDS: Is This What You Want?

By Margaret Dore, Esq

This is an updated version of an article I wrote three years ago in response to HIV/AIDS groups that had endorsed Ballot Question 2, seeking to legalize assisted suicide in Massachusetts. The ballot question failed, but there is now a similar proposal pending in the Massachusetts legislature (H.1991). I suggest that these groups and persons living with HIV/AIDS give the new proposal a close look. 

1.  "Terminal" does not mean dying. 

H.1991 applies to persons with a "terminal illness," defined in terms of less than six months to live with or without treatment.[1] 

In the 1980's, HIV/AIDS was a death sentence. Today, we have people living with HIV/AIDS, who do well, but who are dependent on treatment to live. Some of these persons are "terminal" under H.1991, i.e., if, without treatment, they "can reasonably be expected to die within 6 months."[2] 

2.  The significance of a terminal label.

Once a person is labeled "terminal," an easy justification can be made that his or her treatment should be denied in favor of someone more deserving. In Oregon, where assisted suicide is legal, "terminal" patients have not only been denied treatment, they have been offered assisted suicide instead. In a 2012 affidavit, Oregon doctor Kenneth Stevens put it this way:

Under the Oregon Health Plan [Medicaid], there is . . .  a financial incentive towards suicide because the Plan will not necessarily pay for a patient’s treatment. For example, patients with cancer are denied treatment if they have a "less than [two years] median survival with treatment" and fit other criteria. . . . 

All such persons . . .  will . . . be denied treatment. Their suicides under Oregon’s assisted suicide act will be covered."[3]

He also noted that some persons denied treatment as "terminal" would, if treated, in fact have years, even decades, to live. He stated: 

Some of the patients living longer than two years will likely live far longer than two years, as much as five, ten or twenty years depending on the type of cancer. This is because there are always some people who beat the odds.[4] 

3.  Coverage to die, but not to live.

His affidavit concluded:

If assisted suicide is legalized in [your jurisdiction], your . . . health plan could follow a similar pattern. If so, the plan will pay for a patient to die, but not to live.[5] 

In Oregon, the most well known persons denied treatment and offered suicide are Barbara Wagner and Randy Stroup.[6] Neither saw this event as a celebration of their "choice."  Wagner said: "I'm not ready to die."[7] Stroup said: "This is my life they’re playing with."[8] 

4.  Proposals for Expansion.

I live in Washington State, where assisted suicide is legal under an act passed in 2008.[9] Three years later, there was a newspaper article suggesting expansion to non-terminal people.[10]  Four months after that, there was a column suggesting euthanasia as a solution for people without money for their old age, which would necessarily be involuntary euthanasia for those who want to live.[11]

Prior to our law's being passed, I never heard anyone talk like this.

Earlier this year, there was an actual bill to expand Oregon's eligibility criteria.[12]

Legal assisted suicide puts anyone with a significant health condition, at risk of being steered to suicide. I hope that HIV/AIDS groups and people living with HIV/AIDS reconsider any support of legal assisted suicide.  Thank you.

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Margaret Dore is a lawyer in Washington State where assisted suicide is legal. She is also President of Choice is an Illusion, a non-profit corporation opposed to assisted suicide and euthanasia. Ms. Dore has been licensed to practice law since 1986. She is a former Law Clerk to the Washington State Supreme Court. She has several published court cases and many published scholarly articles. Her viewpoint is that people should be in control of their own fates, but that assisted suicide laws do not deliver. Recently, she had an article published in JURIST: "California's New Assisted Suicide Law: Whose Choice Will It Be?," at http://jurist.org/hotline/2015/10/margaret-dore-physician-assisted-suicide.php  For more information see www.margaretdore.com and www.choiceillusion.org

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[1]  H.1991, § 1 states: “'Terminally ill' means having a terminal illness or condition which can reasonably be expected to cause death within 6 months, whether or not treatment is provided." To view the entire act, go here: https://malegislature.gov/Bills/189/House/H1991
[2]  Id., and per my discussion with Kenneth Stevens' MD.

[3]  Affidavit of Kenneth Stevens, ¶¶ 9 & 12, can be viewed here: http://choiceisanillusion.files.wordpress.com/2012/10/signed-ken-stevens-affidavit_001.pdf 

[4]  Id., ¶11.

[5]  Id., ¶13.

[6]  Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, August 6, 2008, available at http://abcnews.go.com/Health/Story?id=5517492&page=1 and "Letter noting assisted suicide raises questions,"  KATU TV, July 30, 2008, available at http://www.katu.com/news/26119539.html

[7]  KATU TV article at Note 6.

[8]  ABC News article at Note 6.

[9]  Washington State's assisted suicide law can be viewed here: http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245

[10]  See e.g.,  Brian Faller, "Perhaps it's time to expand Washington's Death with Dignity Act, The Olympian, November 16, 2011, available at http://www.theolympian.com/2011/11/16/1878667/perhaps-its-time-to-expand-washingtons.html

[11]  Jerry Large, "Planning for old age at a premium," The Seattle Times, March 8, 2012 at http://seattletimes.nwsource.com/text/2017693023.html  ("After Monday's column, some readers were unsympathetic [to people who couldn't afford their own care], a few suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out. At least a couple mentioned euthanasia as a solution.") (Emphasis added).

[12] HB 3337, see https://olis.leg.state.or.us/liz/2015R1/Measures/Overview/HB3337