Maryland Right to Life, Inc.
420 Chinquapin Round Rd. Suite 2-I
Annapolis, MD 21401
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HELP US STOP PHYSICIAN ASSISTED SUICIDE IN MARYLAND
“Those promoting assisted suicide promised Oregon voters that it would be used only for extreme pain and suffering. Yet there has been no documented case of assisted suicide being used for untreatable pain. Instead, patients are being given lethal overdoses because of psychological and social concerns, especially fears that they may no longer be valued as people or may be a burden to their families.”
— Dr. Greg Hamilton, Portland psychiatrist. He commented on a model of
Physician Assisted Suicide some are advocating in Maryland.
What is "Physician Assisted Suicide"?
The phrase "Physician Assisted Suicide" refers to the procedure commonly known as "assisted suicide".
In such a procedure, a doctor prescribes a concoction of drugs intended to cause death when ingested. There may be several drugs necessary in this process. What differentiates this policy from formal euthanasia is that the concoction is administered by the patient him or herself.
It is important to note that current law allows any patient to reject treatment. That is, if one decides that a certain treatment is not desired or is not perceived as beneficial, one may always choose not to have it. This can include various means of life support, resuscitation, or treatment for a condition, terminal or otherwise. Physician Assisted Suicide is very different from choosing not to have a particular treatment because it specifically administers a drug intended to cause death. We urge all Marylanders to complete a Will to Live advance directive to specify treatment wanted in various circumstances.
Whereas suicide advocates argue that such a policy is limited to extreme cases of terminal illness and requested voluntarily by the patient, data from the state with the longest history of legal Physician Assisted Suicide to indicate that this is not the case.
What's Wrong with the "Safeguards"?
The problem is simple: the "safeguards" don't actually work.
In the Oregon model legislation, there is no requirement that the patient is given a psychiatric evaluation. Over nearly two decades, Oregon's Department of Health statistics shows that only 5.3% of patients were referred for an evaluation. That number falls recent years.1 The Oregonian, a major state newspaper, documented patients suffering from depression and dementia receiving prescriptions for Physician Assisted Suicide.2
There is no requirement for a witness at the time of death. Thus, it is unknown if the person is still competent at the time she or he actually ingests the lethal prescription. Oregon data show that the range of time between the first request for the prescription and actual death is between 15 and 1009 days (nearly 3 years).3 A lot can happen in that time. Did the person's mental state deteriorate? Did caregivers tire of caring for a sick relative?
There is no requirement that the doctor has any knowledge of or relationship with the patient. "Doctor shopping" is common. A network of doctor prescribed death proponents ensures that patients will receive lethal prescriptions4 even when their family doctor knows their desire for death is transient or could be alleviated.
The patient does not truly have to be terminally ill. Terminal illness is often difficult to predict. Further, there is evidence that many non-terminally ill patients receive the lethal prescriptions. The Oregon Department of Health reports that the range of time between the first request and death has been as long as almost 3 years.5
The definition of terminal illness in this model includes a "person with an incurable irreversible disease that will...produce death within six months." Looking at one example under this definition, insulin reliant diabetics who stop taking their medication could qualify, even though they could live decades with treatment.
The request is not necessarily voluntary. There is no language in the Oregon law prohibiting anyone from pressuring the patient to accede to Physician Assisted Suicide. The Oregon Health Plan notified state health insurance recipients, Barbara Wagner and Randy Stroup, that the wanted treatment they needed to survive would not be covered, but informed them that doctor prescribed death was available and would be covered.6
There is insufficient protection from improper motives of family or friends who apply pressure. In some proposals, an heir can actually serve as a witness for the request for doctor prescribed death.7
In Oregon, studies and official reports show that people are regularly requesting doctor prescribed suicide because they fear becoming a burden on family and friends.8,9
Although the law states doctors must give patients "feasible alternatives" to assisted suicide - like pain control, and hospice - there is no requirement these are covered under insurance.
Legalizing doctor prescribed suicide today is one court case away from euthanasia. Although the statute claims to allow only those who can "self-administer" to request the lethal prescription, many legal observers argue that this is one court challenge away from being overruled. If for example, there was a person with disabilities who could not swallow, there is an official legal opinion from the Oregon Attorney General's office stating that this is unconstitutionally discriminatory.10 This means that lethal injection might be one legal challenge away. This could be the case in any state that legalized the practice of Physician Assisted Suicide.
The state can't truly punish violations. The doctor prescribing death is held only to a "good faith standard" which is far lower than the malpractice standard applied to other health providers.11 Additionally, there is no mechanism to ensure that doctors report (they self-report) or comply with reporting requirements. Reported data in Oregon and Washington is even destroyed by the state yearly!12
In Oregon and Washington, the death certificates of those patients who ingest the suicide concoction are falsified by statute, listing only the underlying illness as the cause of death, making the real number of suicide unknowable.13
This seems like an issue which affects the elderly or the sick. Why should I be concerned?
You are correct that the issue affects the elderly and the sick. However, legalizing Physician Assisted Suicide affects everyone in society.
Anyone can become sick or injured. Even if the illness or injury isn't terminal, Physician Assisted Suicide has shown to threaten those seeking wanted treatment.
Barbara Wagner and Randy Stoup were each diagnosed with cancer they desire to treat. In requesting that the Oregon Health Plan cover the wanted healthcare, they were appalled to discover Oregon's answer.
The Oregon Health Plan said that the wanted lifesaving treatment would not be covered, and in the same letter, offered them doctor prescribed suicide, a legal, and covered treatment.6
Additionally, the widely reported case of Kate Cheney shows the same can occur with private insurance. Kate requested a lethal prescription from her Oregon physician. The physician was hesitant given Kate's ongoing dementia and requested a psychological evaluation, something which only occurs in 5.3% of patients receiving a lethal prescription. The review's report indicated her dementia had decimated her short term memory, damaging her ability to weigh the deep questions of ending one's life. Additionally, the report noted Kate's daughter was more interested in doctor-prescribed suicide than she was. Kate's daughter was undeterred, pursuing yet another doctor to rubber stamp her preference. Sadly, she found one referred to her by Kate's own HMO, who found no concern with the undue influence or underlying advanced dementia and authorized the lethal prescription. After going on vacation, tiring of caregiving, Kate's daughter returned to her mother wanting to end her life.
The mere legalization of Physician Assisted Suicide empowers public and private insurance providers to reject potentially expensive wanted healthcare. Sadly, ending the life of a patient can be less paperwork and cost than treating the patient, forever damaging access to wanted healthcare and generating suspicion between patients and their doctors.
What You Can Do to Stop Physician Assisted Suicide.
1: Oregon Public Health Division, 2015 Report on Oregon's Death with Dignity Act, released 2/4/16. The annual reports are available online at: https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf.
2: Erin Barnett, "A family struggle: Is Mom capable of choosing to die?" Oregonian, Oct. 17, 1999.
3: Oregon Public Health Division, 2011 Report on Oregon's Death with Dignity Act, released 3/6/12.
4: Erin Barnett, "A family struggle: Is Mom capable of choosing to die?" Oregonian, Oct. 17, 1999.
5: Under the law, a patient is supposed to have 6 months to live or less. However, patients are holding onto lethal prescriptions for nearly 3 years. Oregon Public Health Division, 2011 Report on Oregon's Death with Dignity Act, released 3/6/12.
6: Susan Donaldson James, "Death Drugs Cause Uproar in Oregon," ABC News, Aug. 6, 2008, and Susan Harding and KATU web staff, "Letter noting assisted suicide raises questions," July 20, 2008.
7: See petition language: http://www.mass.gov/ago/docs/government/2011-petitions/11-12.pdf.
8: Ganzini et al: Journal of General Internal Medicine (J Gen Intern Med) 2008 Feb; 23(2):154-7
9: 41.1% of respondents selected "Burden on family, friends/caregivers" as a reason for requesting doctor prescribed death. Oregon Public Health Division, 2015 Report on Oregon's Death with Dignity Act, released 2/64/16.
10: Letter from Oregon Deputy Attorney General David Schuman to State Senator Neil Bryan, March 15, 1999, "Oregon controversy: How assisted can suicide be?" American Medical News, April 12, 1999.
11: See statutory language available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/
12: See statutory language available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/
DeathwithDignityAct/Pages/ors.aspx and the Oregon Health Department Press release at: http://www.oregon.gov/DHS/news/2005news/2005-0304a.shtml which states "The state law authorizing physician-assisted suicide neither requires nor authorizes investigations by DHS, said Barry S. Kast, DHS assistant director for health services."
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