2020 Connecticut “Aid in Dying” Proposal (HB 5420) Analysis

The Connecticut measure would permit “aid in dying,” giving a physician the right to prescribe “medication” to end the life of a patient if certain conditions are met. It is modeled on Oregon’s law permitting assisted suicide.

Many people assume the prescription would be for “a pill” that a patient could take and then “slip peacefully away.”  But that is totally false.

In states where doctor-prescribed suicide is legal, prescriptions have often been for secobarbital (a sedative).  For use as a sedative, the usual dosage is one capsule.  The usual prescription under state doctor-prescribed suicide laws is for 90 to 100 capsules.[1]

Under the Connecticut act to permit “Aid in Dying”:

Individuals who could live for many years would be eligible for doctor-prescribed suicide.

The patient must be diagnosed as having a “terminal illness,” defined as the “final stage of an incurable and irreversible medical condition that an attending physician anticipates, within reasonable medical judgment, will produce a patient’s death within six months.”[2]  This is virtually identical to Oregon’s definition of terminal disease which states that the disease will, “within reasonable medical judgment, produce death within six months.”[3]

But what if the illness is controllable?  This definition of “terminal illness” does not require that the terminal condition be uncontrollable.

Examples of eligibility due to having a “terminal disease” in Oregon:

The latest official Oregon report states that the terminal diseases that qualified some patients for the lethal overdose included diabetes and arthritis.[4]

 As in Oregon, Connecticut patients who refuse treatment would be eligible for the lethal drugs.

Dr. Charles Blanke, an Oregon oncologist and professor of medicine diagnosed a young woman with a condition that gave her a 90 percent chance of survival with recommended treatment.  The woman, however, refused the treatment.  In an interview, Blanke said, “Why doesn’t that patient want to take relatively non-toxic treatment and live for another seven decades?”  He ended up prescribing the deadly overdose.[5]   Blanke has written about 15% of prescriptions for the lethal drug overdose in Oregon.[6]

There are no “safeguards” after the prescription is written.

HB 5420 contains eight references to the fact that the prescription is to be “voluntarily” requested.  However, nothing in the proposal prevents a patient from being forced or tricked into taking the lethal overdose.  No witnesses need to be present and no one will know if the drugs were willingly or voluntarily taken.

Why aren’t there any safeguards at the most important part of the process – at the time the patient takes the drugs that will cause death?

Severely depressed or mentally ill patients could receive a prescription for a deadly overdose of drugs without any counseling for their depression or mental illness.

Even if a patient is depressed or mentally ill, physicians don’t need to refer them for “counseling” unless the physician believes they may not be “competent,” defined as meaning that the patient “has the capacity to understand and acknowledge the nature and consequences of health care decisions…to make  an informed decision.” The purpose of that “counseling” is not to provide treatment for the patient’s depression or psychiatric or psychological disorder but only to make certain that the patient has the ability to make the decision.[7]  It is solely for the purpose of determining that the patient’s depression or disorder is not causing “impaired judgment.”[8]

As noted in the required reports by the prescribing physician, the physician is to file “a report of the outcome and determinations made during counseling, if counseling was recommended and provided.[9]

In the latest official report on Oregon’s “Death with Dignity Act,” only 1.8% of patients were referred for such an assessment.[10]

A person “familiar with the patient’s manner of communicating” could convey (translate) the patient’s requests for the lethal dose.[11]

There are no requirements for the person to have any expertise at conveying the patient’s request. This could lead to a patient’s wishes being misunderstood, misinterpreted, or disregarded.  There is no requirement that such communication be independently verified.  Nor is there any requirement that the interpreter be an individual who would not gain from the patient’s death.

How would anyone know if the translation is accurate?  How would it be possible to know if the patient is really requesting doctor-prescribed suicide?

There are no penalties for non-reporting or for inaccurate or incomplete reporting.

Those who are promoting HB 5420 point to Oregon’s more than twenty-year experience.  They claim that safeguards protect patients and that annual official reports prove that there have been no problems or abuses.  But all information in official reports is provided by those who carry out assisted suicide. Oregon officials say that the state has no authority and no funding to examine the accuracy of the reports.[12]

Are we really naïve enough to believe that doctors will report that they have broken the law and violated the guidelines?

If the Connecticut bill becomes law, actions taken in compliance with it could not be referred to as ” suicide” or “assisted suicide.”

According to HB 5420, actions taken in accordance with it would “not constitute suicide, assisted suicide, mercy killing or homicide for any purpose under the law.”[13]   Furthermore, it states that the person signing the death certificate “shall list the underlying terminal illness as the cause of death.”[14]

Thus, the death certificate of a person who dies from assisted suicide would not reflect the true cause of death. This also provides a mechanism that would allow a beneficiary to collect on a life insurance policy that otherwise excludes coverage for suicide.

The requirement to use Orwellian manipulation of language is similar to that in states that have passed doctor-prescribed suicide laws. For example, Washington state’s “Death with Dignity Act” requires physicians to falsify death certificates. The law does not allow deaths resulting from doctor-prescribed suicide to be listed as assisted suicide.  Physicians are required to list the underlying terminal disease as the cause of death.[15] 

The Washington State “Instructions for Physicians and other Medical Certifiers” are explicit:[16]

“If you know that the decedent used the Death with Dignity Act, you must comply with the strict requirements of the law when completing the death record.”

Words that are not permitted on the death certificate include: suicide, assisted suicide, physician-assisted suicide, death with dignity, Secobarbital, Seconal, Pentobarbital or Nembutal.

The instructions warn: “The Washington State Registrar will reject any death certificate that does not properly adhere to the requirements of the Death with Dignity Act.”

Thus, unless the death certificate falsifies the real cause of death, it will not be accepted and the physician will be required to submit a new death certificate that hides the facts.

If the actions permitted under assisted-suicide laws are so good, why are those who write them and promote them hiding what they are really about? If one calls suicide or assisted suicide by other names, does that change what they are?

The most marginalized individuals – poor, hardworking people – would be in particular danger.

“Choice” is an appealing word but inequity in health care is a harsh reality.

The measure states that the patients must be made aware of all “feasible alternatives,”[17] to prescribed suicide.    However, discussing alternatives does not mean the patient will have the resources to access those other options.  The patient may not have insurance coverage for those alternatives.

Why should the comfortably well off have a choice of treatment options while the poor are left with the only option they can afford doctor-prescribed suicide?

A person who would benefit financially from the person’s death could pick up the lethal prescription and deliver it to the patient. 

The drugs can be dispensed to an expressly identified agent of the patient.[18]  A potential heir who encouraged the patient to request the deadly “medication” could persuade the patient to designate him or her to pick up the drugs and deliver them to the patient.

Assisted suicide would be transformed from a crime into a “medical treatment.”

This would cause emotional and financial pressure on patients.  It would give insurance programs the opportunity to cut costs since they could deny payment for treatments that patients need and want while approving payment for the far less costly prescription for a lethal drug overdose.

This has happened in states that permit doctor-prescribed suicide.

Referring to payment for assisted suicide, the Oregon Department of Human Services explains, “Individual insurers determine whether the procedure is covered under their policies, just as they do any other medical procedure.”[19]

There is documented information about terminally ill patients in Oregon and California who were denied coverage for treatment by insurance providers and, instead, were told that doctor-prescribed suicide would be covered.[20]

In California, after finding that her insurance company would not cover the chemotherapy her doctor had prescribed, a woman asked if assisted suicide was covered under her plan.  She was told, “Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication.”[21]

California pays for assisted-suicide drugs obtained by Medi-Cal patients under the state’s doctor-prescribed suicide law.[22]

If the Connecticut bill becomes law, will insurance programs do the right thing – or the cheap thing?

The prescribing physician may have very little relationship with the patient.

In Oregon, the latest official report indicates that the duration of the patient-physician relationship may be as short as one week.[23]  Furthermore, the report indicates complications after the patient took the drugs were unknown in 63% of the deaths.[24]
………………

Note:  Supporters of the bill point to Oregon in their claim that there are no problems with the law and that safeguards contained in the law are meticulously followed and monitored.  Yet, in closed-door sessions, those supporters acknowledge that this is not true.  For documented information about this contradiction, see “The Oregon
Experience.”[25]
………………………….
Isn’t it ironic?  At a time when there are warnings about the danger of opioids killing people, there is also a campaign to promote opioids to kill a certain category of people?

 3/6/2020

[1]  For a full documented description of drugs used for doctor-prescribed suicide, see: “2017 Summary of Drugs Used for Doctor-Prescribed Suicide.”  Available at: http://www.patientsrightscouncil.org/site/2017-summary-of-drugs-used-for-doctor-prescribed-suicide.  (Last accessed 3/5/20.)

[2]   HB 5420, Section 1 (19).  Definition of “Terminal illness.”  Emphasis added.

[3]   Oregon “Death with Dignity Act,” ORS 127.800 §1.01 (12). Available at: https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/ors.aspx.  (Last accessed 3/5/20.) Emphasis added.

[4]   Oregon “Death with Dignity Data Summary,” Released February 2019, p. 11 and p. 13, fn.3.  Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf. (Last accessed 3/6/20.)

[5]  Tara Bannow, “Rural Oregonians Still Face Death with Dignity Barriers,” Bend Bulletin, August 14, 2017.  Available at: http://www.bendbulletin.com/health/5512373-151/oregonians-can-choose-how-their-roads-end.  (Last accessed 3/5/20.)

[6]   Markian Hawryluk, “Bill reopens debate over assisted suicide in Oregon,” Bend Bulletin, April 27, 2019.  Available at: https://www.bendbulletin.com/localstate/7117862-151/bill-reopens-debate-over-assisted-suicide-in-oregon. (Last accessed 3/5/20.)

[7]   HB 5420. Section 1 (4) and (6).

[8]   HB 5420, Section 8.

[9]   HB 5420, Section 10 (6).

[10]   In the latest report of Oregon’s “Death with Dignity Act,” only 1.8% of patients were referred for such an assessment.  “Oregon Death with Dignity Data Summary,” Released February 2019, p. 11  Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf. (Last accessed 2/6/20.)

[11]  HB 5420, Sec.1 (4).

[12]  Statements of Dr. Katrina Hedberg (he lead author of many of Oregon’s official reports on the Death with Dignity Act) made to a delegation of the British House of Lords that visited Oregon to learn about the Oregon law.   House of Lords Report, “Assisted Dying for the Terminally Ill Bill,” Vol. II, Evidence, 4/4/05, pp. 259,262 and 266.

[13]  HB 5420, Section 12 (c).

[14]  HB 5420, Section 9 (b).

[15]  Washington Death with Dignity Act, “Attending Physician Responsibilities,” RCW 70.245.040 (2).

[16]  “Instructions for Physicians and Other Medical Certifiers for Death Certificates: Compliance with the Death with Dignity Act,” Available at:  https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-151-DWDInstructionsForPhysicians.pdf. (Last accessed 2/7/20.)

[17] HB 5420 Section 1 (9) (D), Section 4, Section 6 (3) (E).

[18] HB 5420 Section 9 (a) (6) (B) (ii).

[19] Oregon Dept. of Human Services, “FAQs about the Death with Dignity Act,” pg. 4. Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf.  (Last accessed 3/5/20.)

[20]  See, for example:  Bradford Richardson, “Assisted-suicide law prompts insurance company to deny coverage to terminally ill California woman,” Washington Times, October 20, 2016.  Available at: http://www.washingtontimes.com/news/2016/oct/20/assisted-suicide-law-prompts-insurance-company-den. (Last accessed 3/5/20.)
Also see: Susan Donaldson James, “Death Drugs Cause Uproar in Oregon,” ABC News, August 6, 2008.  Available at:  http://abcnews.go.com/Health/story?id=5517492&page=1. (Last accessed 3/5/20.)

[21]  Bradford Richardson, “Assisted-suicide law prompts insurance company to deny coverage to terminally ill California woman,” Washington Times, October 20, 2016.  Available at: http://www.washingtontimes.com/news/2016/oct/20/assisted-suicide-law-prompts-insurance-company-den. (Last accessed 3/5/20.)

[22] Kimberly Leonard, “Californians Can Choose to Die – With the Help of Taxpayers,” U.S. News & World Report, March 21, 2016.  Available at: https://www.usnews.com/news/articles/2016-03-21/in-california-government-to-pick-up-the-tab-for-death-with-dignity.  (Last accessed 3/5/20.)

[23]  Oregon “Death with Dignity Data Summary,” Released February 2019, p. 13.   Available at:  https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf. (Last accessed 3/5/20.)

[24]  Oregon “Death with Dignity Data Summary,” Released February 2019, p. 12.   Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf. (Last accessed 3/5/20.)

[25] “The Oregon Experience.”  Available at: http://www.patientsrightscouncil.org/site/the-oregon-experience (last accessed 3/5/20.)

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