What the Aid in Dying Movement Must Learn from Abortion Advocates.

I'll say this about the New Hampshire aid in dying bill, defeated yesterday in a House vote of 242-113: it wasn't written in a way that could pass.

The Death with Dignity laws, as legal in Oregon and Washington, do a couple of things that make legislators, oftentimes required to vote on private issues that they know little about, more comfortable with the laws: they restrict it to state residents only (no suffering patients from other states driving across borders for compassion), and they clearly stipulate who may use the laws (terminal patients with less than a year to live). If a humane state wants to pass an aid in dying law these days, they'd best do their Death with Dignity homework first.

And if the aid in dying movement wants to extend end of life rights in other states, they best pay very close attention to the strategies used by abortion rights activists over the past few decades. The two groups are fighting to protect or establish patients' rights against the same opponent, "pro-life" groups comprised of the Religious Right (Evangelical and Fundamental) and the Catholic hierarchy.

As to the cast of odd, infuriating, diligent, ideological "pro-life" characters who are enthusiastic about asserting their faith-based laws over the dying - using the public's fear of discussing death, complacent reverence for religion, and lack of knowledge about the dying process to shape ideological laws for the rest of us - I'm not so convinced of their compassion and loving kindness.

However sincere the movement may be regarding their belief in God's laws, there's a willful ignorance of statistics, facts and reality motivating their efforts. They're not very open to reason or discussion - or compromise, as we've seen with health care reform. Society is more than willing to give reverence to religious or "traditional" points of view but until public knowledge of end of life care is increased, aid in dying advocates are left to battle an organized, powerful, well-resourced, mobilized but ideological opponent.

Wesley J. Smith alludes here to the on-the-ground efforts "pro-life" groups are engaged in to limit access to Death with Dignity even where it is legal, sounding much like the anti-abortion activists who work tirelessly to prevent women from accessing legal abortion (and other reproductive services) where they can. Harassing doctors, shaming patients, relegating aid in dying services to special clinics, prohibiting federal funds for the poor (as with the recent health care bill) for end of life planning: this could be the future of aid in dying.

With the health care bill, women's rights groups have begun to recognize just how much ground they have lost over the past few decades by accepting the Hyde amendment as a compromise. What the amendment does effectively is eliminate poor and minority women from access to a legal health care service. But the poor are only one vulnerable group that's been picked off by "pro-life" activists.

The frame of the public conversation regarding women's rights today rests on decreasing the number of abortions instead of reducing the number of unwanted pregnancies. Women have been successfully shamed for having sex, for actively working to exercise their right to physical lives, and for making the difficult decisions about their reproductive health.

As Frances Kissling writes about abortion activists' early decision to put overturning Hyde on hold and focus on preventing a change in Roe v. Wade:

It accepted the racism that lay buried in middle class hostility to poor women, “welfare queens” and the “sexually promiscuous”—all those who might be expected to look to Medicaid to pay for abortions—whom the rest of us should not support.

Not concentrating on overturning Hyde was arguably the worst decision the mainstream choice movement made. No effort at a constitutional amendment ever got off the ground, but the largely unchallenged Hyde Amendment emboldened anti-abortion groups to pick off powerless constituencies one at a time. From poor women they went on to adolescents and secured “parental consent and notification” laws.

As many have noted, government - legislators, the courts and the Supreme Court - have failed to address discrimination against women on Establishment clause grounds. No precedent exits for seeing women's reproductive rights as a "separation of church and state" issue. Case decisions have choosen to protect the "conscience" rights of doctors or providers or the privacy of women (as was used for RvW).

There's much to learn from how anti-abortion groups have pressed their "pro-life" restrictions on access to legal services. The aid in dying movement would be wise to pay close attention to the lessons learned - and being learned - by women's rights advocates.

The aid in dying movement is now, for the most part, working alone against a machine that has a long-established revenue stream, power structure, organization, and stated platform. "Pro-life" groups have not only the powerful and organized Evangelical Right and the Catholic hierarchy to back them up, but they are able to force their religious ideology on the field of medicine because medicine has little incentive to discuss end of life care with patients. Medical associations have been the strongest opponents of a patients' bill of rights for decades. In short, the medical profession will do anything to prevent government regulation.

The recent decision in Montana to legalize aid in dying too was made on privacy and dignity grounds, capitalizing on an "independent" constitution that values such rights. Yet the primary opponents to aid in dying remain "pro-life" groups. Failing to address their established opposition, to ignore the strategies they have demonstrated regarding women's reproductive rights - and this is the big one - failing to educate the public about end of life care, will perhaps lead down the same road we've gone before: legal services that can't be accessed by those most in need.

All patients' rights advocates have one primary opponent: the "pro-life" movement. Forming a coalition that includes LGBT, elder, women's, and disability rights, along with groups like the ACLU, Women's Law Center, The MergerWatch Project, Americans United for Separation of Church and State, Catholics for Choice, and church leaders from the Religious Left, and like-minded medical associations (like OB/GYNs and nurses) will create a coalition broad enough to challenge the "pro-life" platform and their work to impose ideology on how medical care is delivered in this country. Until such a coalition exists, I worry that individual rights movements, like aid in dying, will be left to react to "pro-life" strategies, not anticipate and avert them.