Analysis Maine Doctor-Prescribed Suicide Bill (2015)

(LD 1270) S.B. 452 (2015)

This 2015 bill is the 7th attempt by doctor-prescribed suicide activists to transform a prescription for a lethal dose of drugs into a “medical treatment.”[1] It is patterned after Oregon’s law permitting doctor-assisted suicide.  This latest attempt comes at a time when Maine’s suicide rate is already alarmingly high. For every homicide in the state, there are 7 suicides.[2]

Under the “Patient-directed care at the end-of-life” bill (S.B. 452):

An individual with a controllable medical condition could be considered to have a terminal condition, making him or her eligible for doctor-prescribed suicide.

To be eligible for a suicide prescription, a patient is considered to have a terminal condition if the condition is “an incurable and irreversible disease that will, within reasonable medical judgment, result in death within 6 months.”[3]

There are many conditions (diabetes, certain types of leukemia, disabilities requiring ventilator support, etc.) that, without medical treatment, would result in death within six months.  However, with medical treatment, individuals with those conditions could live for many years.  Yet those individuals would be eligible for doctor-prescribed suicide.

There is documentation that this has occurred under Oregon’s assisted-suicide law.  In the latest official report from Oregon, diabetes is noted as the underlying terminal condition that made the patient eligible for a lethal prescription.[4]

Why is the definition of “terminal condition” so broad?

Severely depressed or mentally ill patients can receive doctor-prescribed suicide, without having any form of counseling.

Even if the patient is severely depressed or has a mental illness, a physician is not required to refer the patient for counseling unless the physician believes that the patient has “impaired judgment.”[5]  As long as the patient can make and communicate decisions and understands what he or she is requesting, no counseling is required.

This provision is similar to that contained in Oregon’s law where, in 2014, only 3 of the 155  patients who received lethal prescriptions were referred for a psychological evaluation.[6]  A study about Oregon’s law found that it “may not adequately protect all mentally ill patients.”[7]

“Doctor shopping” could take place until a health care professional can be found to declare that the patient is qualified for the lethal prescription.

If a patient is found to have “impaired judgment,” the bill does not prohibit a health provider, family member or another person from arranging for the patient to be evaluated by other counselors until one is found who would declare the patient capable of choosing assisted suicide.

This has taken place in Oregon where it has been noted that “a psychological disorder — senility, for example — does not necessarily disqualify a person.”[8]

A woman died of assisted suicide under Oregon’s “Death with Dignity Act,” even though she was suffering from early dementia. Her own physician had declined to provide a lethal prescription for her. When counseling to determine her capacity was sought, a psychiatrist determined that she was not eligible for assisted suicide since she was not explicitly pushing for it and her daughter seemed to be coaching her to do so.

She was then taken to a psychologist who determined that she was competent but possibly under the influence of her daughter who was “somewhat coercive.” Finally, she was assessed by a managed care ethicist who determined that she was qualified for assisted suicide, and the lethal dose was prescribed.[9]

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

Under the bill, patients are considered capable of requesting doctor-prescribed suicide not only by communicating the decision on their own but also by “communication through persons familiar with the patient’s manner of communicating if those persons are available.”[10]

This could lead to a patient’s wishes being misunderstood, misinterpreted, or disregarded.  There is no requirement that such communication assistance be independently verified.

How would anyone know if the translation is accurate?

Family members or health care providers and others could advise, suggest, encourage or exert subtle and not so subtle pressure on vulnerable individuals to request doctor-prescribed suicide.  

The bill states that witnesses to the written request must affirm that they believe the patient to “be free from duress or undue influence at the time of signing the document.”[11]  However, those words have a narrow legal meaning.  The bill does not prohibit someone from suggesting, advising, or encouraging a patient to request doctor-prescribed suicide.

Since victims of domestic abuse, including elder abuse, are extremely vulnerable to persuasion from their abusers, it takes little imagination to understand how the bill could put abused individuals at risk of being persuaded to request doctor-prescribed suicide.  Furthermore, victims of elder abuse and domestic abuse are in great danger since they are unlikely to share their fears with outsiders or to reveal that they are being pressured or abused by family members.[12]

Individuals could request doctor-prescribed suicide based on fear of being a burden to others.   

In the last official Oregon report, fear of becoming a burden on others was given as a reason for requesting lethal drugs by 40% of those who died using that state’s assisted-suicide law.[13]

Government bureaucrats and profit-driven health insurance programs would be given the opportunity to cut costs by denying payment for more expensive treatments while approving payment for less costly “treatment” of assisted suicide.

This has already been documented in Oregon – the state with the law upon which the Maine proposal is based.

The Oregon Health Plan (OHP) has notified some patients that medications prescribed to extend their lives or improve their comfort level would not be covered, but that the OHP would pay for a lethal drug prescription.[14]

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.”[15]

If the Maine bill is approved, will health insurance programs and government health programs do the right thing – or the cheap thing?

Patients would have no protection once the assisted-suicide prescription is filled. 

Like the Oregon law, the bill only addresses activities taking place up until the prescription is filled.  There are no provisions to insure that the patient is competent at the time the lethal drug overdose is taken or that he or she knowingly and willingly took the drugs.

Due to this lack of protection, the bill would put patients at enormous risk.  For example, someone who would benefit from the individual’s death could trick or even force the person into taking the fatal drugs, and no one would know.

Why are there no safeguards at the most important part of the process – at the time the patient takes the drugs that will cause death?

There is an illusion of choice.  Yet, the bill would actually constrict patient choice.

Under the bill, before writing a prescription for death, a doctor must inform the patient of “the range of treatment options” and “all feasible end-of-life services, including palliative care, comfort care, hospice care and pain control.”[16]  However, “informing” someone of all options does not mean the patient will have the ability to access those options.  It only means the person must be told about them.

Patients may find that their insurance will not cover the “feasible alternatives” their doctors informed them about but, instead, will pay for doctor-prescribed suicide as has already happened in Oregon.[17]

If doctor-prescribed suicide becomes just another treatment option, and a cheap option at that, the standard of care and provision of health care changes.  There will be less and less focus on extending life and eliminating pain, and more and more focus on the “efficient and inexpensive treatment option” of death.

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

If doctor-prescribed suicide is legalized in Maine, it could become the only “medical treatment” to which many people have equal access.  The last to receive health care could be the first to receive doctor-prescribed suicide.

A health care facility cannot prevent doctors from prescribing the lethal dose to residents or inpatients.  

S.B. 452 states, “With regard to a patient who is a resident or inpatient in a health care facility, the facility may adopt a policy that prohibits a health care provider from issuing a prescription to a patient for medication or providing medication that the health care provider knows the patient intends to self-administer in a lethal dose while in the health care facility.”[18]

However, the physician could prescribe the deadly overdose or provide the lethal drugs to a resident or inpatient with instructions to carry out the death process outside the facility grounds.  The patient could disregard those instructions.

As long as the health care provider claimed that he or she did not know the resident or inpatient was planning to self-administer the lethal dose on the premises, there would be no recourse for the facility.

Additionally, a physician could prescribe the suicide drugs which could be picked up by a designated agent at a pharmacy off the premises.  The designated agent could bring the drugs to the resident or inpatient who could then the lethal overdose at the facility.

A facility would not be able to ban others from bringing a lethal drug prescription to an inpatient or resident to take on the premises; would not be able to prevent the witnessing of the written requests for doctor-prescribed suicide; and would not be able to prohibit a pharmacy on the premises from dispensing the drugs as long as directions were included to take them off of the premises of the health care facility.

Maine could become a national assisted-suicide destination.

The bill states that a patient is to be a resident of Maine.[19]  It contains no information about requirements to prove residency.  Essentially, an individual could claim to be a resident and no proof of the claim is required.
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Note:  Supporters of S.B. 452 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.”[20]
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[1]  Prior to 2015, five legislative attempts (HB 552 in 1995; LD 916 in 1996; HB 663 in 1997; IB 3, IB 10 in 1999; LD 1065 in 2013) failed.  In 2000, a ballot initiative, “Question 1, the “Maine Death with Dignity Act,” was defeated by voters.

[2]  Maine Department of Health and Human Services, “Maine Suicide Prevention Program.” Available at: http://www.maine.gov/suicide (last accessed 4/20/15).

[3]  §2908 (1) J.

[4]  Official report for 2014 deaths under Oregon’s Death with Dignity Act, p. 6, fn. 6.  Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/ year17.pdf (last accessed 4/6/15).

[5]  §2908 (4) B (2) (f).

[6] Official report for 2014 deaths under Oregon’s Death with Dignity Act, p. 5.  Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/

year17.pdf (last accessed 4/6/15).

[7] Linda Ganzini, Elizabeth R. Goy, Steven K. Dobscha, “Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey,” British Medical Journal, Oct. 25, 2008, pp. 973-978.

[8]  “Physician-assisted suicide: A family struggles with the question of whether mom is capable of choosing to die,” Oregonian, February 4, 2015. Available at: http://www.oregonlive.com/health/index.ssf/2015/02/physician-assisted_suicide_a_f.html (last accessed 4/20/15).

[9]   Ibid.

[10]  §2908 (1) B. (Definition of “capable.”)

[11]  §2908 (4) A (3).

[12]  For example, statistics indicate, “Only four percent of reported elder abuse cases come from the elder person; 96 percent of the reports come from somewhere else.” Gazette.net (Maryland), “A safe place for abused seniors,” February 9, 2015. Available at http://www.gazette.net/article/20150209/NEWS/150209456/1007&source=RSS &template=gazette (last accessed February 16, 2015).

[13]  Official report for 2014 deaths under Oregon’s Death with Dignity Act, pg. 5.  Available at:     http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/ year17.pdf  (last accessed 4/6/15).

[14]  KATU Television, “Letter noting assisted suicide raises questions” (interview about one such case and the response of the Oregon Health Plan). Available at: http://www.katu.com/news/26119539.html (last accessed 1/29/15).

[15]  Oregon Dept. of Human Services, “FAQs about the Death with Dignity Act.”  Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/faqs. aspx (last accessed 12/30/14).

[16]  §2908 (2) and §2908 (4) B (2) (c) (iii) and (iv).

[17]  KATU Television, “Letter noting assisted suicide raises questions” (interview about one such case and the response of the Oregon Health Plan). Available at: http://www.katu.com/news/26119539.html (last accessed 1/29/15).

[18]  §2908 (7). (Emphasis added.)

[19]  §2908 (1) H.

[20]  “The Oregon Experience.” Available at: http://www.patientsrightscouncil.org/site/the-oregon-experience (last accessed 1/30/15).