Physician Assisted Suicide’s Demographic Divide

On November 1, 2014, Brittany Maynard ingested lethal medication to commit physician-assisted suicide (PAS). Her decision to take her own life made her the face of the PAS movement and gave Compassion and Choices — a nonprofit specializing in end-of-life advocacy — unprecedented media coverage. So why did Maynard receive so much attention and why was she able to successfully advocate for her unpopular cause? BPR’s Kristine Mar explains, “Her story sold well in the media and to the general public because she — a young, white, good-looking, well-off, well-educated, recently-married woman — appeared to be the last kind of person who would have reason to take her own life.” More importantly, though, Mar goes on to say that except for her young, recently-married status, Maynard fit the bill of the typical PAS patient. In 2013, PAS patients who took advantage of Oregon’s Death With Dignity Act were 94.4 percent white and 53.3 percent held undergraduate degrees.

PAS is one of the many options for end of life treatments. Physician-assisted suicide is a medical procedure where a physician helps a patient commit suicide by providing pills or an injection at the patient’s wishes. In Oregon, where physician-assisted suicide was legalized in 1997, 89.5 percent of patients died at home. Other options for end of life medical treatment include euthanasia and suicide. Euthanasia can be either passive and active and is colloquially referred to as “mercy killing” because of its goal to provide relief from extreme pain. Active euthanasia is similar to PAS and can be achieved by lethal injection, but does not require patient permission.

Approval for PAS has risen over the past year, 68 percent of the American population supports doctor-assisted suicide (Physician-assisted suicide and doctor-assisted suicide are used interchangeably). From 2010 to 2013, just more than half of Americans approved of doctors helping patients commit suicide. But ever since 2013, the year after Maynard’s fateful wedding, approval has steadily increased. However, this statistic aggregates demographic data. When taking race into account, attitudes differ regarding assisted suicide and similar end of life treatment like passive euthanasia.

While 65 percent of whites said they would “cease all medical treatment” in cases of incurable disease or extreme pain, sixty percent of African-Americans and 55 percent of Hispanic-Americans prefer that doctors save their lives at all costs.

Pew Research Center defines passive euthanasia as “withholding medical treatment that would keep a patient alive, such as life-support machines to feed or assist a patient in breathing” or effectively ceasing all medical treatment. While 65 percent of white respondents said they would “cease all medical treatment” in cases of incurable disease or extreme pain, sixty percent of African-American respondents and 55 percent of Hispanic-American respondents prefer that doctors save their lives at all costs. When religion is held constant, there are still visible differences across race. The Pew Research Center conducted a survey in 2013 and asked what Americans would do “if they had a disease with no hope of improvement and were suffering a great deal of pain.” Sixty-six percent of white Protestants preferred the option of “stopping treatment so they could die.” Only 32 percent of black Protestants preferred to stop treatment. Among Catholics, 65 percent of white respondents and 38 percent of Hispanic respondents elected to stop treatment.

Approval of doctor-assisted suicide laws differs by race and ethnicity as well. US adults were asked to either disapprove or approve of “laws to allow doctor-assisted suicide for terminally ill patients.” Compared to the 53 percent of white respondents that approve of PAS laws in recent surveys, 32 percent of Hispanic respondents and 29 percent of black respondents approved of these laws. Like passive euthanasia, opinions on doctor-assisted suicide were different within the same religion. 55 percent of white Catholics and 33 percent of Hispanic Catholics approved of PAS laws.

Georgetown law professor Patricia King, in discussing inequalities and assisted suicide, writes that disabled people, low-income Americans, and racial minorities fear being viewed as “throwaway people” within the healthcare system—less valued in society and often not treated with respect and dignity. According to King, these segments of society are vulnerable to being taken advantage of in many aspects, including assisted suicide abuse. Thus, if racial prejudice pervades health care as a whole, it can also affect assisted suicide. King believes that stigmatization of racial minorities in health care has resulted in skepticism of assisted suicide. Doctor-prescribed suicide or doctor-assisted suicide is just as it sounds—a prescription from a doctor that a patient chooses to take. Without doctor permission and examination, PAS is essentially suicide, a felony. PAS is also a more economical treatment compared to traditional end of life care — a fact health insurance companies know well. For example, Oregon Health Plan covers assisted suicide but not newer chemotherapy drugs like Tarceva. Given enduring prejudice in an American health care system defined by economic incentive, fear of assisted suicide is a reflection of those issues that continue to plague the system.

However, there are existing studies from the past five years that disagree with the national findings from Pew Research. “Physician-assisted suicide attitudes of older Mexican-American and non-Hispanic white adults: does ethnicity make a difference?”, a study published in the Journal of the American Geriatrics Society, reported that older Mexican Americans (52.7 percent) agreed with PAS more so than non-Hispanic whites (33.7 percent) of the same age group. Results from this study are the first of its kind: “This study is the first to find positive attitudes among community-dwelling older Mexican Americans toward PAS that are higher than those of older non-Hispanic white adults,” is written in the abstract. The study, conducted in San Antonio, Texas, collected data from Mexican, Mexican-American, Chicano, and Anglo (non-Hispanic white) adults that were at the average age of 72.

California Governor Jerry Brown’s signing of the End of Life Option Act this year will offer insight into these studies. The End of Life Option Act is California’s version of Oregon’s Death with Dignity Act, and allows the terminally ill to request aid in dying, or lethal prescribed medication. California has one of the most diverse populations in the United States. In 2014, it became the third state, following Hawaii and New Mexico, to possess a plurality of residents that are not white. Comparatively, the other states that have already legalized PAS through legislation have drastically different racial and ethnic proportions; Oregon, Vermont, Montana and Washington are all more than 70 percent white.

California’s unique legislation will be one insightful way to see who will choose end of life treatment like physician-assisted suicide. The passing of the End of Life Option Act may change the data on who uses and supports physician assisted suicide and could bring new revelations to the racial and ethnic differences in perceptions of end of life treatment.