The Pennsylvania “Compassionate Assisted Dignified Death Act” would permit individuals to self-administer a lethal injection.
The “Compassionate Assisted Dignified Death Act” would permit a prescription for “end-of-life medication” that the “patient may administer to end the qualified patient’s life.”[1] It does not specify the type of self-administration.
Thus, it would permit prescriptions for a deadly overdose that could be taken by mouth, by drinking drugs that have been mixed into liquid.[2] It would also permit mixing the drugs into a liquid which the patient could inject into a feeding tube as reported in the death of a patient in compliance with Washington State’s assisted-suicide law.[3]
Furthermore, it would permit a person to self-administer the lethal drugs by injection in the same way that a diabetic gives oneself an insulin injection.
Doctors in the same medical practice could diagnose a patient as having a terminal illness or condition and then confirm the diagnosis on the same day.
Under the bill, one doctor called the “attending physician,”[4] could diagnose (or misdiagnose) a person having a terminal illness or condition. On the same day, a second doctor, called the “consulting physician,”[5] could confirm that diagnosis. Nothing prevents the two physicians from being in the same medical practice.
An individual with a controllable medical condition could be considered terminal for purposes of the Pennsylvania bill.
To qualify for assisted suicide under the bill, a person is to have a “terminal illness,” defined as “an incurable and irreversible illness that will, within reasonable medical judgment, produce death within six months.”[6] However, the illness could be controllable and, yet, the patient would still be eligible for the life ending drugs.
This is similar to the situation in Oregon, on which the Pennsylvania bill is fashioned.
Examples of eligibility due to having a “terminal disease” in Oregon:
Official Oregon reports state that the “terminal diseases“ that qualified some patients for the lethal overdose included diabetes and arthritis.[7]
Also, in Oregon, patients who refuse treatment are eligible for the lethal prescription.
Dr. Charles Blanke, an 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.[8] In only one year, Blanke wrote about 15% of prescriptions for the lethal drug overdose in Oregon.[9]
The required oral requests could both take place on the same day.
Although the bill states that a patient must make two oral requests and a written request with at least 15 days between each of the oral requests,[10] the proposal contains an exception eliminating the time requirement of 15 days between the oral requests.[11]
Patients who are severely depressed or mentally ill are not required to have any counseling for their mental conditions.
“Counseling,” defined as “one or more consultations between a mental health care provider and a patient for the purpose of determining if the patient is capable.” [12] “Capable” is defined as the “ability to make and communicate informed health care decisions without impaired judgment.”[13]
A referral for “counseling” is not required even if the physician knows the patient is mentally ill or severely depressed, as long as the physician believes that the patient knows what he or she is requesting.[14] Thus, even patients who are severely depressed or mentally ill can still be given the prescription as long as they know what they are requesting.
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 lethal drug overdose prescription.
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.”[15]
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.[16]
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.”[17]
California pays for assisted-suicide drugs obtained by MediCal patients under the state’s doctor-prescribed suicide law.[18]
If the Pennsylvania bill becomes law, will insurance 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 ensure that the patient is competent at the time the lethal drug overdose is administered 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 aren’t there any safeguards at the most important stage of the process – at the time the patient takes the drugs that will cause death?
(December 2019)
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[1] Section 54B01 – Definition of “End-of-life medication.”
[2] Many people assume that the “medication” would be “a pill” the patient could take and then “slip peacefully away.” But this is false. Where doctor-prescribed suicide is legal, the vast majority of prescriptions for what is referred to in the Pennsylvania bill as “compassionate assisted death” are for secobarbital (a sedative). For use as a sedative, the usual dosage is one capsule. The usual prescription under existing state doctor-prescribed suicide laws is for 90 to 100 capsules.
For a fully documented description of drugs used for doctor-prescribed suicide, see: “Drugs Used for Doctor-Prescribed Suicide.” Available at: https://www.patientsrightscouncil.org/site/summary-of-drugs-used-for-doctor-prescribed-suicide. (Last accessed 12/6/19.)
[3] Gene Johnson, “In the face of death, the party of a lifetime,” Associated Press, August 26, 2019. Available at: https://apnews.com/2ee08672b8c1445ca09e0e09ab262c30. (Last accessed 12/6/19.)
[4] Section 54B01 – Definition of “attending physician.”
[5] Section 54B01 – Definition of “consulting physician.”
[6] Section 54B01 – Definition of “terminal illness.”
[7] Official report for 2016 deaths under Oregon’s Death with Dignity Act, Oregon Public Health Division, “Oregon’s Death with Dignity Act – 2016,” pg. 11, fn. 2. Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year19.pdf. (Last accessed 12/719) and Oregon “Death with Dignity Data Summary,” Released February 2019, p. 13, fn. 3. Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf. (Last accessed 12/7/19.)
[8] 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 12/7/19.)
[9] 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 12/7/19.)
[10] Section 54B03 (b).
[11] Section 54B06 (bb).
[12] Section 54B07 (a) (4)
[13] Section 54B01 – Definition of “capable.”
[14] Section 54B09.
[15] Oregon Dept. of Human Services, “FAQs about the Death with Dignity Act,” p.4. Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf. (Last accessed 12/9/19.)
[16] 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 12/9/19.)
[17] 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 12/9/19.)
[18] 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 12/9/19.)
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