Physician Assisted Suicide -- Is it "Murder?"

In Montana, the elderly have had "Death with Dignity" advertisements continually before them.  When they've opened the Montana Senior News, there it is-- a full or half page ad, imploring the elderly to act to keep Death with Dignity legal.  The ad doesn't have much information, just a statement saying that the Montana Supreme court ruled that aide in dying was allowed in Montana, which is accompanied by a picture of an older couple, looking dignified and happy.  The newspaper is available on-line: 
http://issuu.com/montanaseniornews/docs/msnarchieved313#embed

 

As the bills for and against physician assisted suicide hit the legislature, it became time to make a decision as to whether it was wrong or not.  The Compassion and Choices' (successor of the Hemlock Society) ads claim relatives grieved at not being able to stop the pain of a loved one because they could not use physician assisted suicide to die. Or, that their death was undignified, and that physician assisted suicide should have been given them.  So, is it wrong to just give them a fatal dose that will kill them?

Is it Legal?

 

In Montana there is a great deal of pressure to legalize physician assisted suicide.   A controversy exists that revolves around whether the Baxter case, in Montana,  makes it legal for a physician to assist  in a suicide with the consent of the patient.   It is not a constitutional  right--assisted suicide is an illegal act. The court raised the defense that consent could be used (not guaranteed) by physicians in assisted suicide cases.  This does not protect the physicians, as there are a large number of qualifiers, that must be reached, to even raise the defense.  See the following article, written by Greg Jackson, Esq. & Matt Bowman, Esq: 
http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html 

After the 2009 Baxter case, bills have been drafted (2009, 2011, 2013 and 2015) to get physician assisted suicide into Montana.  So far, they have not passed.

Should physician assisted suicide become law in Montana, where will we end up 5-10 years down the road?   Physician Assisted Suicide is a slippery slope, once the door is opened, there is no turning back.

In 2014, Quebec passed Bill 52, allowing a doctor to administer medication to cause death upon having the consent of the patient.  By February 2015, the Canadian Supreme Court ruled that there is a constitutional right to termination of life for anyone with an irremediable medical condition that wants to die.  This covers illnesses, disabilities and psychological pain that the individual finds intolerant.

Belgium passed a law that legalized adult euthanasia in 2002, and by 2014 a law was passed allowing euthanasia for terminally ill children, with no age limit. 

In the Netherlands the Dutch legalized euthanasia in 2002.  The law left open the possibility of psychological pain, and by 2012 the Life-Ending Clinic began to help those whose personal physicians refused euthanasia or assisted suicide, including dementia and psychiatric patients.

In Switzerland assisted suicide includes non-resident foreigners, and is allowed to be done by non-physicians. A terminal illness is not a requirement, only that the motive be unselfish.

 

If we have no boundaries, or move our boundaries, then, in the name of  "compassion", we will start down the road to define other classes of people that are allowed to die.  Further down the road, their "choice" is no longer needed as boundaries expand and they are euthanized for their own "good", or the "good" of society, family, etc., or just eliminated because they are burdens.

What does God say?

The Bible says it is wrong.  In the Fifth Commandment,  God tells us we are not to murder.   

Exodus 20:13  Thou shalt not kill.
 

God held Cain accountable in the first act of murder committed.  In Genesis, God told Cain that his brother's blood was on his hands:

 

Genesis 4:8 And Cain talked with Abel his brother: and it came to pass, when they were in the field, that Cain rose up against Abel his brother, and slew him.⁹ And the Lord said unto Cain, Where is Abel thy brother? And he said, I know not: Am I my brother's keeper?

¹⁰ And he said, What hast thou done? the voice of thy brother's blood crieth unto me from the ground.

¹¹ And now art thou cursed from the earth, which hath opened her mouth to receive thy brother's blood from thy hand;

¹² When thou tillest the ground, it shall not henceforth yield unto thee her strength; a fugitive and a vagabond shalt thou be in the earth.

¹³ And Cain said unto the Lord, My punishment is greater than I can bear.

What problems are there with Physician Assisted Suicide?
 

This year, SB 202 was introduced in the legislature, which would have made physician assisted suicide legal.  The bill did not make it out of committee, but we will use it to look at what we should expect, if physician assisted suicide becomes law in Montana.  The bill is found at:  http://leg.mt.gov/bills/2015/billhtml/SB0202.htm   Although modeled after the Oregon Death With Dignity (DWD) law, the bill introduced in Montana adds additional language.  For comparison, the Oregon law can be found at:
https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx

 

The Oregon DWD law requires that an Annual Report be filed.  We are going to take a look at that annual report and see exactly what has happened with the patients.  Then we will use those statistics to see how the "safeguards" of the bill introduced in the Montana legislature would have failed the patients.   For the Oregon DWD Annual report, see: 

http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year16.pdf

 

SUICIDE AND DEPRESSION: The CMS.gov booklet,  Screening for Depression, lists symptoms of major depression to include "feeling sad and empty", "feelings of worthlessness", "less ability to think or concentrate", "less interest in daily activities", and "thoughts of death or suicide."  Oregon’s DWD Report lists the reasons given for their physician assisted suicides as being:  

• Losing autonomy” (independence) 91.4%
• Less able to engage in activities making life enjoyable 88.9%
• Loss of dignity 80.9%
• Losing control of bodily functions 50.3%
• Burden on family, friends/caregivers 40.0%
• Inadequate pain control or concern about it 23.7%
• Financial implications of treatment 2.9%

As we can see, pain control was not the driving force for the overwhelming majority of the suicides in Oregon. Using Medicare’s description of depression, we must summarize that most of the patients, if not all, were suffering from depression, even though, in the last year, only 2.8% were referred for counseling. Furthermore, we do not know if the patients that received counseling were the ones that went on to commit suicide, as out of a total of 1,173 patients who had prescriptions written, "only" 752 patients died from ingesting the fatal dose.

TIME OF INGESTION:  In SB 202, "self-administer" was described as an “act of ingesting."  The bill did not require the patient to be the one administering or giving/taking the drug, but, instead, that the patient was the one swallowing the drug, or "ingesting" it.   There is no way to know if the patient was knowingly given the lethal drug, or forcefully given the lethal drug.  Oregon’s DWD  annual report shows, out of 682 patients, that those present with the patient, at time of ingestion, was:

• 119-prescribing physician,
• 238—no prescribing physician, but a health care provider,
• 76- no physician or health care provider, and for
• 249 there is no documentation as to who was present. 

Another statistic, in the Oregon DWD State Report, is that 95.3% died at home.  We just do not know what happened to 325 of the patients in that last moment when they "ingested" the fatal drug--who was with them, or what the circumstances were.  In addition, there was no doctor available, in these cases,  if something went wrong. 

HEALTH COVERAGE REDUCED:   Insurance coverage on expensive treatment or drugs has been denied to extend life, and instead, coverage for assisted suicide has been offered in states with legalized assisted suicide.  Here is an affidavit of Kenneth R. Stevens, Jr., MD, who treated Jeanette Hall:  http://maasdocuments.files.wordpress.com/2012/09/signed-stevens-aff-9-18-12.pdf    A doctor, other than Dr. Stevens, had diagnosed her with Cancer.  She was given six months to live, without treatment.  She was steered into making the decision to commit suicide by their state DWD law.  Ms Hall then went to Dr. Stevens, who got her to change her mind and go to treatment.  She received treatment and, at the time of the affidavit, has been alive for twelve years and has been happy to be alive.

INCREASED RATE IN SUICIDES, OTHER THAN ASSISTED SUICIDE:  We already have one of the highest suicide rates in the U.S., with Montana ranking as no. 3 in the nation.  Legalizing assisted suicide would be a green light to those who are suffering from depression—whether young, old or disabled, but not limited to any age, or condition-- to use suicide as a means to get through their problem.   Suicide.org reports that over 90% of suicides have a mental illness, with depression being the most common.   Yet, despite these statistics, the Oregon Death with Dignity (DWD) Annual Report records that only 2.8% of patients requesting physician assisted suicide were referred for counseling.   Over-all 5.9% were referred during the total 16-year period covered by their report. 

CONSULTING DOCTOR NOT REQUIRED:  The prescribing physician can waive the “requirement” of having a consulting doctor.   The duties of the consulting physician is to examine the patient and patient’s relevant medical records; confirm attending physician’s  diagnosis that  patient is suffering from a terminal illness;  and verify patient is competent, acting voluntarily and has made an informed decision.   The is no safety net of having a consulting doctor for the patient, if the requirement can be waived.  

TERMINAL ILLNESS:   Montana law describes “terminal” as having a life expectancy of up to six months until death.   The Oregon DWD Annual Report statistics show that the time, between the first request and death of the patient, ranged from 15-1009 days.   These statistics give us a picture of at least one patient that lived almost three years after requesting assisted suicide.   How many years did the other “terminal” patients actually have?  How many of the other patients received a terminal diagnosis that was wrong.  See the Jeanette Hall case above, under the HEALTH COVERAGE REDUCED section.  She was diagnosed as terminally ill and signed up for physician assisted suicide.  She saw another doctor, who convinced her to receive treatment and she went on to live. 

According to MedPage Today, misdiagnoses are a big problem in medicine.   It is believed that 10% of diagnoses are in error.  Yet, under the physician assisted suicide bill, introduced in Montana, the prescribing doctor does not have to send the patient for a second opinion, or for a psychological consultation, as to the competency of the patient, if he deems it is not necessary.   For unscrupulous doctors, assisted suicide would cover many misdiagnoses, or malpractice actions.  See:
http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/47232    

ELDER ABUSE AND ABUSE OF DISABLED:  Oregon's DWD Annual Report Statistics show that 120 patients died with no notification to family and that 95.3% died at home.  Loss of eyesight, dementia, disabilities, emotional and physical abusive situations, loss of control of patient’s life to family and caregivers, desire to inherit patient’s property and money by family and caregivers, depression, guilt of being a burden, all leave the patient vulnerable to being coerced, or forced into committing suicide.  We don’t need to go any further than the local paper to see how vulnerable our elderly are:  http://www.greatfallstribune.com/story/news/crime/2015/01/26/thompson-falls-man-convicted-elder-abuse/22356405/   Assisted suicide does not just pose a danger for the elderly, but for all, from 18 on up.

LETHAL DRUGS:    The time from ingestion to death in Oregon's 2013 DWD Annual Report is 1 minute to 104 hours.  It should also be noted that for 299 patients, there were no providers at the time of death.   What they experience may not, and more than likely, is not documented.  Pentobarbital and  Secobarbital are the most used drugs.

According to the Oregon 2013 DWD Annual Report, the drug second most used was Pentobarbital (45.5%) Symptoms for an overdose include the following and are  found at:
 http://www.nlm.nih.gov/medlineplus/ency/article/002508.htm 

• Heart and blood vessels:◦Heart failure
• Low blood pressure
• Weak pulse
• Kidneys and bladder◦Kidney failure (possible)
• Lungs◦Difficulty breathing
• Slowed or stopped breathing
• Pneumonia (possible)
• Nervous system◦Coma
• Confusion
• Decreased energy
• Delirium
• Headache
• Sleepiness
• Slurred speech
• Unsteady gait
• Skin◦Large blisters
• Rash"

According to Oregon's latest DWD Annual Report, the most used lethal drug is Secobarbital.  Overdose symptoms include and are found at:
 http://www.rxlist.com/seconal-sodium-drug/overdosage-contraindications.htm

• "Symptoms of oral overdose may occur within 15 minutes and begin with central nervous system depression, underventilation, hypotension, and hypothermia, which may progress to pulmonary edema and death. Hemorrhagic blisters may develop, especially at pressure points.
• "In extreme overdose, all electrical activity in the brain may cease, in which case a “flat” EEG normally equated with clinical death cannot be accepted as indicative of brain death. This effect is fully reversible unless hypoxic damage occurs. Consideration should be given to the possibility of barbiturate intoxication even in situations that appear to involve trauma. 
• "Complications such as pneumonia, pulmonary edema, cardiac arrhythmias, congestive heart failure, and renal failure may occur. Uremia may increase CNS sensitivity to barbiturates if renal function is impaired. Differential diagnosis should include hypoglycemia, head trauma, cerebrovascular accidents, convulsive states, and diabetic coma."

When use of drugs to kill hardened criminals can bring us to tears for the pain the prisoners must endure, how can we even think of giving it  to a vulnerable and fragile loved one?  Here is a report on the use of pentobarbital as a drug used in executions,  from Mother Jones:
http://www.motherjones.com/politics/2013/11/ohio-lethal-injection-cocktail-execution-drugs

 
PROTECTING YOURSELF IN WILLS, AGREEMENTS AND CONTRACTS:   SB 202 stated:

 "Effect of contracts, wills, and agreements. (1) A provision in a contract, will, or other agreement, whether written or oral, to the extent the provision would affect whether a person may make or rescind a request for medication to end the person's life in a humane and dignified manner is not valid.

"(2) An obligation owing under any currently existing contract may not be conditioned or affected by a person making or rescinding a request for medication to end the person's life in a humane and dignified manner"

Would the above section leave the patient powerless to prevent the future use of assisted suicide on him/her, should some unforeseen circumstances arise, that would leave all medical decisions in the hands of another, or another to speak for, or interpret for him/her? 

WHAT YOU CAN DO?

 

HB 477 is being heard in the Montana Senate Judiciary Committee today.   It is a bill designed to make it illegal for a physician to use the "consent" defense for assisted suicides.   You can follow the bill, and read it, at the following link: 
http://laws.leg.mt.gov/legprd/LAW0203W$BSRV.ActionQuery?P_SESS=20151&P_BLTP_BILL_TYP_CD=HB&P_BILL_NO=477&P_BILL_DFT_NO=&P_CHPT_NO=&Z_ACTION=Find&P_ENTY_ID_SEQ2=&P_SBJT_SBJ_CD=&P_ENTY_ID_SEQ=

Contact the Senate Judiciary Committee, or the senators, if the bill passes and continues to the Senate floor, by on-line message, telephone, or e-mail.  See:
http://leg.mt.gov/css/About-the-Legislature/Lawmaking-Process/contact-legislators.asp    

Encourage the legislators to VOTE YES on HB 477.