The D.C. Council is poised to approve legislation making the District the nation’s sixth jurisdiction to allow doctors to prescribe lethal drugs to terminally ill residents, adding momentum to a practice that had long been controversial but is gaining acceptance among elected leaders, the medical community and the public.
But chances for enactment are unclear. The council will have to vote on the bill twice more by the end of the year. Mayor Muriel E. Bowser (D) has not indicated whether she will sign the legislation, although her health director has testified against it, saying it violates the Hippocratic oath. It is not certain that proponents have enough votes for an override. And Congress could also strike down the legislation; a spokeswoman for House Speaker Paul D. Ryan (R-Wis.) did not answer requests for comment.
Although the law has been enacted in a handful of states with a mostly white population, it faces particular opposition in the nation’s capital, home to a large African American community. In national surveys, African Americans have consistently stood against assisted suicide.
Critics say the notion of doctors hastening death for terminally ill patients runs counter to religious teachings about the sanctity of life.
Among them is Pamela Wandix, a 59-year-old African American woman with esophageal cancer who lives east of the Anacostia River. She saw her sister die of bone cancer last year and has buried nine other siblings. Death is often on her mind.
“I watch hundreds of people come and go at the oncologist’s office,” said Wandix, who has undergone chemotherapy. “They are not trying to give up. They want to live. We believe in God. That’s not even a question. I’m fighting for my life, and my God is going to show me how.”
Many in the black community distrust the health-care system and fear that racism in life will translate into discrimination in death, said Patricia King, a Georgetown Law School professor who has written about the racial dynamics of assisted death.
“Historically, African Americans have not had a lot of control over their bodies, and I don’t think offering them assisted suicide is going to make them feel more autonomous,” King said.
Some worry that blacks, who tend to have less access to treatment and preventive care, may think that ending their lives early is their best option when given a terminal diagnosis.
Rev. Eugene Rivers III, a black minister from Boston with a national reputation for his work against urban violence, is helping a group of opponents called No DC Suicide. Rivers has called the legislation “back end eugenics” aimed at eliminating poor blacks. No DC Suicide is endorsed by organizations including the Arc, the advocacy group for people with disabilities, the Jewish Community Relations Council of Greater Washington and the D.C. Catholic Conference.
Some African American residents have said the legislation reminds them of the Tuskegee experiments, in which hundreds of black men with syphilis in Alabama unwittingly participated in a 40-year federal study of the disease's long-term effect. The men were told they were being given "free health care" and were being treated for the disorder, when in fact they were not.
“They are afraid that somebody is going to take advantage of them the way they have been taken advantage of in the past,” said Omega Silva, the black D.C. physician working with Compassion and Choices, a national advocacy group trying to pass the legislation. “We have to assure them they are in control of everything.”
African Americans, who make up nearly half of the population in the District, have been the group most consistently opposed to the practice.
In 2013, the Pew Research Center found 65 percent of African Americans and Latinos nationwide opposed aid-in-dying, compared with 42 percent of whites. Although D.C. polling isn’t available, a Washington Post survey last year found that four in 10 black Marylanders supported similar legislation, about 20 percentage points lower than the state overall.
Right-to-die measures were first passed in Oregon, followed by Washington state and Vermont. The practice was authorized by court ruling in Montana and it also was cleared in June in California, despite protests from Latino lawmakers and Catholics. Voters in Colorado will be asked to approve a right-to-die referendum next month, and lawmakers in Michigan are set to discuss it in January. The American Medical Association, which has formally opposed such measures since 1993, has said it will consider taking a “neutral” position in 2017.
Some in the District are counting on the council to pass the law.
“Medical aid-in-dying is not suicide — it’s the cancer that’s killing me,” said Mary Klein, a supporter and 68-year old resident of the Crestwood neighborhood whose ovarian cancer has metastasized. “I would like the option because I am dying, and I’m so close to death’s doors and I’ve done everything possible to extend my life. . . . I would like the option of a peaceful and dignified death.”
Klein has endured surgery that split open her abdomen, weekly hospital trips and chemotherapy with side effects that left her feeling like she was “struck by a hurricane.”
“I don’t believe it’s compassionate to say to someone who only has a very short time left to live that they need to suffer intolerable pain,” she said.
Lawmakers from the District’s most heavily African American wards are split on the bill. Council member LaRuby May (D-Ward 8) supports the measure but Council member Yvette M. Alexander (D-Ward 7) says voters, not the council, should decide the matter through referendum.
The full council is expected to approve legislation that would allow doctors to prescribe lethal drugs to patients who are mentally sound and have less than six months to live.
That is likely to put the council’s relatively young, progressive members at odds with the city’s older black residents, said Barbara Morgan, a longtime Ward 7 resident.
“I guess I’m from the old school. We just don’t believe in taking your own life,” said Morgan, 83. “If you want to go to heaven, you live right. It is a known fact if you commit suicide, you won’t.”
Activists on both sides of the issue say African Americans are apprehensive about discussing options in the face of terminal illness.
“End of life is not a discussion in my community that people want to have. Period,” said Donna Smith, an African American organizer for Compassion and Choices. “It’s almost as if talking about it will hasten it.”
Compassion and Choices has been trying to sway black residents in the District by enlisting volunteers in all eight wards to hold house parties to discuss the legislation and by recruiting Silva, a black physician, and James Jones, a bioethicist, to assure that no one would be coerced into an early death.
At one outreach event Monday at the predominantly black Faith United Church of Christ in the Michigan Park neighborhood, only three congregants showed up.
Across the country, some of the most high-profile representatives of the right-to-die movement have been white, including the terminally ill California woman Brittany Maynard who publicized her decision to end her life on widely viewed YouTube videos and in national media appearances.
Most of the demonstrators at a recent rally outside the D.C. Council building for the “Death with Dignity” legislation were white.
“They are not people who look me,” said Leona Redmond, a 64-year-old longtime District community activist who has been organizing other African American seniors against the legislation.
She’s concerned that low-income black senior citizens may be steered to an early death. When she hears politicians discussing end-of-life care, she fears they are mainly concerned with reducing government health-care costs. And she notes that African Americans are less likely to be able to afford expensive treatment when faced with a terminal prognosis.
“Because of Jim Crow laws . . . we didn’t have the opportunity to have the same jobs to have the same insurance, the same retirement benefits,” said Redmond, who lives in senior citizen housing in the Northeast Washington neighborhood of Fort Lincoln. “It’s really aimed at old black people. It really is.”
Aid-in-dying advocates say fears about coercion haven’t been realized in states that have the laws.
In fact, just one African American has chosen to exercise the provisions of the law in Oregon, which became the first state in the country with such a law in 1997.
Similar legislation has failed in at least 20 other states in recent years — including Maryland, where it encountered opposition from the state's large black and Catholic communities.
Right-to-die advocates say passage in the District, especially after their California victory last year, would help break a key racial barrier in their national campaign.
“We need to show that this just isn’t a ‘white’ issue,” said Smith, the Compassion and Choices organizer. “This issue is for everyone whose facing unbearable suffering at the end of life.”
Emily Guskin contributed to this report.
Due to an editing error, an earlier version of this story said the American Medical Association, which has formally opposed such measures since 1993, has said it will consider taking a “neutral” position in 2017. The AMA has no such plans, a spokesman said.