A/HRC/43/41 34. Persons with disabilities often face discrimination in organ transplantation. Some medical professionals believe that a person’s impairment will impact the likelihood of transplant success, while others consider that some persons with disabilities, particularly those with intellectual and psychosocial disabilities, will be unable to comply with the necessary post-operative care.27 However, there is plenty of evidence debunking such myths and stereotypes about the medical suitability of persons with disabilities for organ transplants.28 The impairment will generally have little or no impact on the likelihood of the transplant being successful and if a person with disabilities receives adequate support, there should be no impact on their ability to follow a post-transplant care regime. 35. The disability community has expressed significant concerns about the potential dangers of withdrawal and withholding of life-sustaining treatment on the basis of disability. While withdrawal and withholding of treatment can be ethical and medically appropriate in some circumstances, it has been reported that physicians may exert pressure on critically ill patients and their families to withhold or withdraw life-sustaining treatment based on the belief that further treatment would be futile, non-beneficial or potentially inappropriate, particularly for patients with severe impairments. 29 That subjective assessment, based on the physician’s opinion and values, includes an assumption on the resulting quality of life of the individual and thus involves a risk that it is influenced by ableist views of living with a disability.30 Similarly, cost-effectiveness considerations may also result in the denial of life-sustaining treatments to some persons with disabilities. 31 36. Assisted dying, whether through euthanasia or assisted suicide, is a contentious issue within the disability community. Euthanasia generally entails the consented administration of a lethal substance by a third person, usually a physician, to end a person’s life; assisted suicide refers to the prescription of a lethal substance for self-administration by the individual.32 To date, assisted dying is legal in only eight countries, but many others are considering its implementation. 33 The practice and requirements for assisted dying vary across jurisdictions; in some, euthanasia performed by physicians is predominant, whereas in others only assisted suicide is permitted. Additionally, while in some jurisdictions assisted dying is restricted to adults who are terminally ill, some countries offer assisted dying for anyone with a medical condition who experiences severe physical or mental pain and suffering. Countries where assisted dying is performed by physicians and that have broad access criteria have higher percentages of assisted dying and have experienced a significant expansion of the practice over the last decade. 34 37. From a disability rights perspective, there is a grave concern that legalizing euthanasia and assisted suicide could put at risk the lives of persons with disabilities. If assisted dying is made available for all persons with a health condition or impairment, regardless of whether they are terminally ill or not, a social assumption might follow that it is better to be dead than to live with a disability. Therefore, a first concern is that persons 27 28 29 30 31 32 33 34 See National Council on Disability, Organ Transplant Discrimination against People with Disabilities: Part of the Bioethics and Disability Series (Washington, D.C., September 2019). See Katherine L. Cahn-Fuller and Brendan Parent, “Transplant eligibility for patients with affective and psychotic disorders: a review of practices and a call for justice”, BMC Medical Ethics, vol. 18 (2017); Alexander N. Goel and others, “Heart transplantation in children with intellectual disability: an analysis of the UNOS database”, Pediatric transplantation, vol. 21, No. 2 (March 2017). See John M. Luce and Douglas B. White, “The pressure to withhold or withdraw life-sustaining therapy from critically ill patients in the United States, American Journal of Respiratory and Critical Care Medicine, vol. 175, No. 11 (June 2007). See Maneka A. Braganza, Alastair J. Glossop and Vandana A. Vora, “Treatment withdrawal and endof-life care in the intensive care unit”, BJA Education, vol. 17, No. 12 (December 2017). See Dominic Wilkinson, Stavros Petrou, Julian Savulescu, “Expensive care? Resource-based thresholds for potentially inappropriate treatment in intensive care”, Monash Bioethics Review, vol. 35, Nos. 1–4 (July 2018). These practices differ from refusing treatment and withdrawing life-sustaining treatment where the disease process is what leads to the patient’s death. Assisted death is legal in Belgium, Canada, Colombia, Luxembourg, Netherlands, Switzerland, the State of Victoria in Australia and 10 jurisdictions within the United States of America. See Trudo Lemmens, “Charter scrutiny of Canada’s medical assistance in dying law and the shifting landscape of Belgian and Dutch euthanasia practice”, Supreme Court Law Review (2nd series), vol. 85 (2018). 9