Part 1 of 2
When nearly six in 10 voters in Washington state approved Initiative 1000, the 2008 Death with Dignity Act, Seattle resident Tam Hue, 73, was one of the few Vietnamese elders who was not only aware of the ballot measure, but also voted for the controversial law.
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. 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. 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 becoming a burden to 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 said he had voted against the measure in 2008, but “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, white people 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, there were 460 Oregonians who died using a lethal dose of medication prescribed under Oregon's aid-in-dying law, according the state's records. Among them were only seven Asian-American, two Hispanics, one Native-American, one African-American. The remainder were white.
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.
Compassion and Choices keeps its own records showing that in the 12 years since 1998, the group facilitated access to the law for 1,517 Oregonians who died. Of that number 375 died taking the medication. Of the 1517, 13 were Asian-American, 8 Hispanic, 7 African-American, 7 Bi-Racial, 6 Native-American and the remainder Caucasian.
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.
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, 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, 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."
Tomorrow on Crosscut: Ethnic seniors' end-of-life options include the 'Five Wishes' program and, for some, returning to their homeland.
Julie Pham 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. The story has changed since it first appeared to clarify distinctions among different sets of Oregon statistics.