Author: India Baker

An Examination of the Freedom of Choice in Healthcare in the Context of Right-to-Die Cases

            In the United States, the right-to-die through physician-assisted-suicide (“PAS”) and euthanasia has been hotly debated for years.  Scholars define PAS as the “prescription of lethal medication to be voluntarily self-administered.”  Conversely, euthanasia is defined as the “deliberate, direct causation of death by a physician.”  Although “medical assistance in dying” is legal in various countries, including Canada, PAS is only legal in eleven jurisdictions in the United States.

            Research has shown that by 2020, “about 5,330 people in the U.S. have died with medical assistance.”  Of the individuals who requested PAS, 95.6% were non-Hispanic White and 75% had been diagnosed with cancer.  According to a 2020 Gallup poll, 74% of Americans favor euthanasia, while 61% favor PAS.  Thus, while more Americans favor euthanasia than PAS, overall, Americans tend to support individuals’ right-to-die.

There are compelling ethical arguments for legalizing individuals’ right-to-die.  For example, advocates of PAS argue that PAS allows individuals to retain autonomy when making end-of-life decisions.  Moreover, medical professionals who perform PAS show individuals compassion because they prevent individuals from suffering.  Conversely, critics argue that the Hippocratic Oath forbids medical professionals from performing PAS because medical professionals must “do no harm.”  Thus, critics argue that medical professionals should not perform PAS because medical professionals serve as healers and PAS is antithetical to healing.

            The Supreme Court first analyzed the right-to-die under the Due Process Clause of the U.S. Constitution in Cruzan v. Missouri Department of Health.  In Cruzan, the Court held that individuals who lack decision-making capacity do not have the right-to-die unless there is “clear and convincing evidence” of their end-of-life care wishes.  The right-to-die was further examined in Washington v. Glucksberg, where the Supreme Court held that PAS is not a “fundamental right” protected by the Constitution.  Similarly, in Vacco v. Quill, the Court held that a state could outlaw PAS without violating the Equal Protection Clause.

            Advocates have pushed for change following the Supreme Court’s decisions in Cruzan, Glucksberg, and Quill.  For example, Dr. Jack Kevorkian, also known as “Dr. Death,” was an adamant supporter of PAS, after having performed approximately 130 PAS during his career.  Dr. Kevorkian, who was sentenced to prison in 1999, had “goaded prosecutors into coming after him so that the legality of assisted suicide and euthanasia could have a full airing in court – and in the news media.”  Following Dr. Kevorkian, other advocates have included Derek Humphry, who published his bestselling book, “Final Exit,” and Brittany Maynard, who requested PAS after being diagnosed with terminal brain cancer.

            Policymakers have made recent efforts to legalize PAS.  In February, the Illinois legislature considered SB3499, which would permit “aid-in-dying medication that will allow the patient to end the patient’s life in a peaceful manner.”  Additionally, the Pennsylvania legislature is considering legalizing PAS.

Although there are many states that remain opposed to PAS, advocates should continue to push for individuals’ freedom to choose their end-of-life care.  Ultimately, individuals should have the right-to-die in a safe and compassionate manner, provided that all safeguards are undertaken to prevent undue influence.

Redlining & Health Disparities: A Closer Look at Food Deserts

By India Baker

In the United States, people of color experience higher rates of health disparities compared to white individuals, much of which can be traced to historical redlining practices.  Redlining began in the 1930s when the Home Owners’ Loan Corporation (HOLC) aimed to increase suburban home ownership among white individuals.  To accomplish this goal, the HOLC drew maps that illustrated which neighborhoods they believed were safe to ensure mortgage loans.  If the HOLC believed that a neighborhood was safe for investment, they colored it green (best) or blue (still desirable).  If the HOLC believed that a neighborhood was risky for investment, they colored it yellow (declining) or red (hazardous).  In general, communities of color were colored red and white communities were colored green.

Due to redlining policies, people of color were prevented from accessing home loans, which they could have used to buy homes in the suburbs.  Consequently, communities of color were unable to acquire the same level of home equity as white individuals, which led to a substantial racial wealth gap in the United States.

Since the institution of redlining maps, elected officials have made some efforts to address and prohibit residential segregation.  In 1968, elected officials passed the Fair Housing Act, which prohibited discriminatory lending practices.  Although redlining practices are now illegal, the effects of discriminatory lending practices are still present as redlined communities remain hyper-segregated.

Elected officials should continue to address the effects of historic redlining practices to not only close the racial wealth gap, but also improve health outcomes.  Specifically, studies have established a link between redlining practices and poor health outcomes, as redlined communities experience, among other conditions, an “increased risk of diabetes, hypertension, and early mortality due to heart disease.” 

One reason redlined communities experience increased health disparities is because they are more likely to be food deserts.  Food deserts are communities that lack access to healthy food.  Specifically, “a census tract is considered a food desert if it meets a certain threshold of poverty, and if at least 500 people or one-third of the population reside more than a mile from a large grocery store.”  Communities of color tend to be food deserts due to “supermarket redlining.”  In general, chain supermarkets prefer to be located in the suburbs rather than in inner-cities because they want to avoid “perceived ‘urban obstacles.’”  In other words, chain supermarkets believe that it is more profitable to be in the suburbs due to increased demand and lower operating costs.

Recent efforts have been made to improve healthy food access in redlined communities.  For example, the United States Department of Agriculture (USDA) launched the Healthy Food Financing Initiative (HFFI) to help increase access to healthy food.  As of August 2023, the HFFI includes public-private partnerships.  Under President Biden’s American Rescue Plan, the HFFI Partnerships Program will be able to award $30 million in grants.  Once awarded, grant recipients can use the funding to facilitate “capacity building activities,” such as performing research, as well as “credit enhancement activities.”  While these initiatives are a start, elected officials should continue to make strides to expand healthy food access for underserved communities.  All individuals deserve access to healthy food, not just individuals who live in the suburbs.