The Policy Committee of the Disability Section has had a challenging year.  As many of you know we learned of a proposed revision of a longstanding APHA end of life policy and spent the summer and early fall disentangling both the process and the implications of the proposed policy on the lives of people with disabilities. As the process unfolded it became clear that an APHA member advocate for physician-assisted dying proposed a revision of a 1981 policy on end of life issues.  In the revision the concept of physician-assisted dying was integrated throughout policy.  Prior to the November meeting we were able to communicate with our membership about the proposed policy, and many of you responded. 

With a clear mandate from our membership to oppose the revised policy, based on failure to show that people with disabilities would not be negatively impacted we banned together in Washington to make our point of view clear and compelling.  Our primary approach was to review the literature that describes the Oregon experience with physician-assisted dying, which became legal in 1996. Oregon is the only state in the United States with a law of this type, and a number of other states have had legislation introduced and rejected.  Thus we read the literature and learned that in Oregon data have been carefully collected about race, age, income and other characteristics of the individuals who request physician prescription of lethal doses of medications, but there was no data about pre-existing disability. There is a 2007 published paper that reports “vulnerable groups” are not disproportionally represented as users of physician-assisted dying in Oregon, and some have used this as an argument to say people with disabilities are not disproportionally impacted. This is not the case since the data are not available about disability status.  Other published reports are not conclusive about the unintended consequences of the law.  For example, some report increases in hospice use following the law, and others report reduced pain management -- seemingly contradictory findings.

At the November meeting we spoke in behalf of the Disability Section at the Public Policy Hearing. Our concerns were heard, and the Joint Policy Committee revised the proposed policy.  We reviewed the modified policy and concluded the language about physician-assisted dying still permeated the proposed policy.  We then went to the Governing Council to oppose passage, and we were successful.

As a result of these efforts we now need to quickly come together again since there will be another round of policy negotiation. We anticipate the revised policy will come up again, and we are developing a strategy.  Those of you who want to get more informed about the issues are encouraged to read the existing policies by going to the advocacy and then policy section on the APHA Web site to read policy 8123 and 2005-9. For further information, or to make your point of view known, please contact Suzanne McDermott at: Suzanne.mcdermott@palmettohealth.org.   

Suzanne McDermott, PhD

Policy Chairperson

Professor of Family and Preventive Medicine

University of South Carolina School of Medicine

Columbia, South Carolina