Analysis of 2015 Wisconsin “Compassionate Choices” Bills

SB 28 & AB 67 are Identical Bills 

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

A person (referred to as a “requester”[1]) would be eligible for a suicide prescription if he or she has a “terminal disease,” defined as “an incurable and irreversible disease that has been diagnosed by an individual’s attending physician and medically confirmed and that will, within reasonable medical judgment, cause death within six months.”[2]

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 same 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.[3]  Furthermore, that same report noted that some patients who took the suicide drugs in 2014 had received the prescription in 2012.[4]

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

If the bill is approved, doctor-prescribed suicide would become a “medical treatment.”

This would give insurance programs the opportunity to cut costs by denying payment of more expensive treatments while approving payment of the less costly prescription for a lethal drug overdose.

This has already been documented in Oregon – the state with the law upon which the Wisconsin  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.[5]

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.”[6]

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

Severely depressed or mentally ill individuals would be able to receive doctor-prescribed suicide, without having any form of counseling.

Counseling is only required “if appropriate.”[7]  Even if the requester is severely depressed or has a mental illness, a physician does not need to refer the requester for counseling unless the physician believes the patient has “impaired judgment,” that prevents the patient from making an informed decision.[8]  If the depressed or mentally ill patient understands and acknowledges the relevant facts related to the request for doctor-prescribed suicide, he or she is considered able to make an informed decision and would not be referred for counseling.

Oregon’s assisted-suicide law, on which the Wisconsin “Compassionate Choices” bill is modeled, has a similar counseling requirement.  According to official Oregon reports, in the last reporting year, fewer than 3% of patients were referred for counseling before receiving the lethal drug prescription.[9]

The bill requires that the requester make two oral requests and one written request.  However nothing in the bill requires that such requests be made in person.

Given the current climate in which medical care takes place, a patient’s time with a physician is greatly limited, with interactions often limited to 10 or 12 minutes per visit and with much information being transmitted by telephone.

The written request, which could be signed in the requester’s residence, must be witnessed by three persons[10], none of whom would benefit financially by the person’s death.[11]  However, the three witnesses could be friends of the potential heir.

This places victims of elder abuse and domestic abuse in great danger since they are unlikely to share their fears with outsiders[12] or to reveal that they are being pressured by family members to “choose” doctor-prescribed suicide.

Those who live in nursing homes or community based residential facilities could be placed in particular risk.

Although the bill prohibits employees of health care facilities from being one of the three required witnesses to a written request for doctor-prescribed suicide, an exception is made, permitting chaplains and social workers to witness the request.[13]  In addition, if the requester lives in a nursing home or community-based residential facility, one of the witnesses must be a residents’ advocate.[14] Such an advocate is to be appointed by the board on aging and long term care and shall speak on behalf of the requester.[15]  Therefore, vulnerable residents of such facilities are less protected than other requesters.

Nothing in the bill permits health care facilities to prohibit the prescription and/or provision of doctor-prescribed suicide on the premises.

Facilities would not be able to have enforceable principles and policies that prohibit prescribing and assisting in carrying out necessary steps leading to the doctor-prescribed suicide of a patient or resident.

The bill would force every physician to facilitate doctor-prescribed suicide.

Doctors would be forced to prescribe assisted-suicide drugs or to find another physician who would do so.[16]

The bill gives the illusion of choice.  Yet, it would actually constrict patient choice.

Under the bill, before writing a prescription for death, a doctor must discuss “the feasible alternatives,” including comfort care, hospice care, and pain control.”[17]  However, “discussing” all options does not mean that requesters will have the ability to obtain those options.  It only means they must be told about them.  This would be similar to informing a homeless person that an alternative to his homelessness is renting an apartment.  Yet, if he does not have the resources to do so, informing him of the option would be meaningless.

The bill requires extensive state-developed promotional material regarding doctor-prescribed suicide.   

The Department of Health Services must prepare and provide copies of written request forms and other information related to obtaining doctor-prescribed suicide.  The information is to be distributed in quantities to health care providers, hospitals, nursing homes, multipurpose senior centers, etc.[18]

All of the “safeguards” in the bill cease the moment the prescription is received.

 The bill contains numerous references to the fact that the prescription is to be “voluntarily” requested.  However, nothing in the proposal states that the drugs, once prescribed, must be knowingly or voluntarily taken.

Due to this lack of protection at the time of their deaths, the bill would put requesters 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 a person takes the drugs that will cause death?
………………………