New America Media, News Feature, Julie Pham, Ph.D.
The Death With Dignity Act—only the second such law in the nation—allows terminally ill patients with less than six months to live to end their lives with the help of a physician. Neighboring Oregon became the first state to legalize physician-assisted suicide back in 1998.
Advocates for such laws admit that enacting them is slow going. No states have similar propositions to I-1000 on this November’s ballots. But Melissa Barber, of the Death with Dignity National Center, said the group is “laying the groundwork” in New England states to try adopting a similar law.
However, Barber says, almost no ethnic elders have used these laws so far. “Even in Oregon,” she said, “you'll find 97.5 percent of the people using the law over the last 12 years identify as white.”
The rapid aging of America means that facing the modern challenges at life’s end will become increasingly important. The miracles of medical science have raised, for the first time in history, concerns about what choices people should have when modern technology can prolong life--and the dying process—for months or years.
Interviews with Vietnamese, Latino and Somali seniors, as well as service providers in the Seattle area, show that ethnic elders are keenly interested in learning more about their health care options at the end of their lives, often to avoid having their lives artificially prolonged or become a burden for their families, but most are wary of even discussing, much less voting on, doctor-aided suicide.
Little Knowledge, Mixed Views
Unlike most people at the Vietnamese Senior Association (VSA) in Seattle, Tam recalled learning about I-1000 after she attended a hospital seminar about end-of-life decision making. “I read about it in the voters’ pamphlet in the general election in 2008. I found out they had it in Oregon and I thought, I want to have this right here,” she said.
However, Tam is rare among Vietnamese voters, who usually vote only for candidates and overlook the election literature.
More typically, Thi Nguyen, 82, said, “I only vote for senators and presidents. People don’t have the level of understanding to vote for those other items. How am I supposed to understand that voter packet?”
In Seattle’s Latino community, few agreed to talk openly about assisted suicide. Those who did reflected the divided viewpoints of other groups interviewed for this article.
Cirilo Hernandez, 62, who immigrated to the United States from Mexico 40 years ago and is Roman Catholic, does not think his community should know about I-1000 because “people should not have that right to choose when they die.”
But, Elizabeth, 56, a naturalized citizen from Chile, who asked that her surname not be used, said, “It’s an alternative. Now that it’s legal, people don’t have to go to jail when they take that alternative. It’s better for people to have a choice.” She said she has no formal religious affiliation.
Meanwhile, at the Somali Community Center of Seattle, 20 male elders gathered to talk before they went to pray. The center’s leader, Sahra Farah, said women she spoke with did not wish to discuss end-of-life issues, but she arranged and translated the interviews with the men.
Most in the Somali group did not know about the law. But the interview questions prompted a lively debate. One 80-year-old man who immigrated to the United States in 2004 said, “My religion doesn't allow us to persecute a life and to remove a person. We all have a natural time limit.”
Only two men in the room said they had voted on I-1000. One voted against the measure in 2008, but said, “If I could do it again, I would vote yes, to support a choice.”
As with the Vietnamese and Hispanics interviewed, a desire to “not waste money” influenced some of the men’s end-of-life planning. “I don’t want to live on life support,” said a 70-year-old Somali man who immigrated in 1996. “It’s expensive. Why continue to live? Why bother?”
Ethnic Support for Initiatives Negligible
According to CNN exit polls, whites made up 83 percent of Washington state residents who voted in the 2008 election; 4 percent of voters were African American, 7 percent Latino, and 3 percent Asian. But the level of ethnic support for the law was virtually negligible.
Robb Miller, director of Compassion and Choices, said that when the group started to campaign for passage of I-1000 in 2007, “we did not concentrate on the ethnic minorities.” Instead, the group focused its limited resources on “moving the moveable middle,” he said.
Miller added that his organization’s pre-election survey showed, “it wasn’t going to be worthwhile trying to move people with strong religious affiliations.”
Eileen Geller, the director of True Compassions, which opposed I-1000, said that although her organization “connected to get the ethnic and minority votes,” the measure's proponents had five times as much funding as the coalition against physician-assisted suicide.
Although many faith-based organizations volunteered to translate materials into Spanish, Vietnamese and Tagalog, Geller said, Washington state’s ethnic turnout was light.
Since the Death With Dignity Act went into effect, of the 47 people who ended their lives during the law’s first year, 98 percent were non-Hispanic whites.
In Oregon, the percentages have been similar, according to George Eighmey, former director of Compassion and Choices in Oregon. From 1998 through 2009, the organization facilitated access to the law for 1,517 Oregonians.
Most ended up not choosing suicide. Experts say that most people who apply for the option want to have it available if, for instance, pain becomes unbearable, but few end up taking that action.
However, 375 people did choose to end their lives with a doctor’s help using designated medications. Of those people, only 13 were Asian American, eight Hispanic, seven African-American, seven biracial and six were Native American.
What;s more, very few ethnic minorities volunteer to support either side of the Death with Dignity Act provisions. Of the three staff members and 33 volunteers at Compassion and Choices, Eighemy, said there are two Hispanics, one Asian and one African American.
Eighemy added that they would most likely decline to speak with the press because “there are still people out there”—referring to the possibility that extremists might harm anyone involved with facilitating physician-aided suicide.
Religion May Not Determine Vote
Most Vietnamese in America are Buddhist, with a large and active Roman Catholic minority as well as growing Baptist and Cao Dai communities.
Faith is not always a predictor of one’s voting patterns, however. The CNN exit poll showed that 47 percent of Catholics and 49 percent of Protestants in the state voted yes on I-1000.
For instance, Phi Khanh Nguyen, a medical interpreter in Olympia, Wash., said, “As a Catholic, I should be against this law. But I think people should have a choice.”
Thai Quang Pham, 68, who opposed I-1000 and is active in the Catholic community, remembers that before the election, the Vietnamese Catholic Church of Washington made a proclamation to reject the Death With Dignity Act.
Thien Chan Quan, the directing monk at Nam Quang Temple in Portland, Ore., noted, “Buddhism allows for a choice, unlike in the Catholic Church.”
“I believe people should have the choice to opt for this," he continued. "However, I also believe that unless someone is in incredible pain, it would be better to stay alive for those six months, because it would give them the opportunity to prepare and change their attitude for the next life.”
Julie Pham, Ph.D., wrote this series as part of a New America Media Fellowship sponsored by the Atlantic Philanthropies. She researched the article with assistance from Seattle’s 1680 AM Radio Luz, 1360 AM El Rey and the El Mundo newspaper. She is the editor of Nguoi Viet Tay Bac.
What Washington’s Law Says
Washington state voters approved the Death with Dignity Act in 2008 by a 58 percent majority, and it became law on March 5, 2009. Washington is the only the second state to have passed such a law. Oregon was the first a dozen years ago. More recently, the Montana Supreme Court ruled that no state law precludes an individual from seeking medication to end his or her life.
The Washington law states: “This measure would permit terminally ill, competent, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity.”