I used to be for medically assisted suicide until I read the take of a disability rights activist: “there are so many who are happy to expend efforts in helping us die but not in enabling us to live.” In an ideal system, medical aid in dying is a very reasonable policy. But the US has never been an ideal system. And while I’m sure there are many who will swear up and down that it will only be used in those who have no chance of survival or who face a slow and painful death, the fact of the matter is that people who have been the victims of the American medical system at various points in history give plenty of reason to doubt that that is how things will happen in practice.

If you’ve never been the victim of willful malpractice and abuse by the medical system, it can be hard to fathom how people could be coerced to choose to die. but there are countless experiences of neglect and abuse that have been shared by those with disabilities, chronic illness, and mental illness as well as those who are minorities or are fat. many people with disabilities or mental illnesses already lack advocates in medical spaces and tend to have smaller support systems—this means a greater likelihood of being isolated if they are hospitalized. There are lots of ways nurses and doctors can impose casual cruelty on a patient to push them towards hopelessness—just one example being “missing” the vein a dozen times when placing an IV or constantly making comments about how alone, or worthless, or costly or wasteful a patient is, or placing their phone/computer/connection to the outside world out of their reach. It’s easy to say “oh that’s not so bad” but when you are a trapped audience dependent on someone else for survival in an already emotionally and mentally fragile state (which is inherent in being hospitalized) that behavior can have immense psychological consequences and lead someone to choose to die who otherwise might not have. While the vast majority of medical personnel would never fathom doing this purposefully, it takes very few people with deep prejudices and hatred to do immense harm. Further because of the norms of the medical field, it’s very possible for neglect to be imposed without the medical practitioner being aware that they are doing it. Not to mention the gatekeeping of healthcare due to insurance gouging and costs. Why are we accepting “people should be able to choose to die so they don’t saddle their relatives with debt” as an acceptable view point? Why are we not demanding that medical care be made more accessible so that no one has to choose between debt and death?

Until we give people real practical options for survival—until we make sure that the disabled can earn a reasonable stable living, and that people won’t risk homelessness and bankruptcy by choosing to get all the medical care they would need to survive—and until we address the rampant casual abuse that occurs within the medical field, medical aid in dying is just another tool for coercion, abuse, and cruelty of those who are already neglected by the medical field.