Pennsylvania 2017 “Death with Dignity Bill” (SB 238) Analysis

Patterned on Oregon’s doctor-prescribed suicide law, this bill differs, in part, with that law. It creates additional loopholes that place vulnerable patients at great risk.

Under the bill:

A doctor would be able to prescribe a massive overdose of drugs for a person to take to end his or her life.

The bill refers to “qualified patient” as a person who satisfies the requirements “to obtain a prescription for medication to end the adult’s life in a humane and dignified manner.”[1]   Many individuals erroneously assume that this means a patient would take “a pill” for that purpose.

According to the latest official report from Oregon, 97.5% of prescriptions since that state’s “death with dignity” law went into effect were for either of two barbiturates (sedatives): secobarbital or pentobarbital.[2]

In recent years, pentobarbital has been difficult to obtain due to growing opposition to its use in capital punishment.  This has led to increased use of the more expensive secobarbital for assisted suicide.[3]

The therapeutic dosage of secobarbital is one to three 100 mg. capsules.  The usual lethal dose prescribed for doctor-assisted suicide is 90 to 100 capsules![4]

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

To be eligible for a suicide prescription, a patient is considered to have a terminal disease if the condition is “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.”[5]

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.

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

Government bureaucrats and profit-driven health insurance programs could cut costs by denying payment for treatment that patients need and want, while approving payment for less costly assisted suicide deaths. 

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.[6]

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.”[7]

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

A health care facility could not prevent deaths from doctor-prescribed suicide on its premises.  Furthermore, a facility willing to permit assisted-suicide deaths could require nurses, pharmacists and certain other individuals to facilitate such deaths.

SB 238 states that “a health care facility may prohibit another health care provider from participating under this chapter on the premises” if certain notification is provided.[8]

It also states that “no health care provider may be under any duty, whether by contract, by statute or by any other legal requirement, to participate in the provision to a qualified patient of medication to end the qualified patient’s life in a humane and dignified manner.”[9]

However, the phrase “participate under this chapter” is very narrowly defined in the bill.[10]  It refers only to performing the duties of the attending physician, the consulting physician or one who carries out the counseling, if performed.  It does not include nurses, pharmacists and other individuals.

Therefore, facilities permitting doctor-prescribed suicide could require pharmacists to dispense the lethal drugs and nurses to bring the drugs to a patient since such activities would not constitute “participation” as defined in the proposal.

Likewise, facilities would not be able to ban others from bringing a lethal drug prescription to a patient or resident to self-administer on the premises.  Facilities would not be able to prevent the witnessing of the written requests for doctor-prescribed suicide; would not be able to prohibit a pharmacy on the premises from dispensing the drugs; and would not be able to prevent nurses or others from bringing them to a patient or resident.

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

This could include translating various languages as well as facilitated communication[12]  which could lead to a patient’s wishes being misunderstood, misinterpreted, or disregarded. There is no requirement that the accuracy of such communication assistance be verified.

What, if any, professional expertise will be required of those communicating on behalf of the patient?  How would anyone know if the translation or interpretation is accurate?  How would it be possible to know if the patient is really requesting doctor-prescribed suicide?

The written request for doctor-prescribed suicide could be witnessed by someone who would gain financially from the patient’s death.

The written request, which could be signed in the patient’s residence, must be witnessed by two individuals, only one of whom may not be someone who would be entitled to any portion of the patient’s estate.[13]  Thus, one witness may be a potential heir who is pressuring the patient to sign the request.  The second witness could be the “best friend” 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 or to reveal that they are being pressured by family members to “choose” doctor-prescribed suicide.[14]

The bill permits a person who would benefit financially from the person’s death to pick up and deliver the lethal prescription.

The drugs can be dispensed to “an expressly identified agent of the patient.”[15]  A potential heir could encourage the patient to authorize him or her to pick up the drugs for delivery to the patient’s residence.

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

Counseling is only required “if appropriate.”[16]

Even if the patient is severely depressed or has a mental illness, a physician does not need to refer the patient for counseling unless the physician believes the patient has “impaired judgment,” that prevents the patient from making an informed decision.[17]  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.

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.

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?
………………………….

[1]  SB 283, Sec. 54B01. (Definition of “qualified patient.”)

[2]  Oregon Public Health Division: Death with Dignity Act – Year 18, p. 7.  Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf.  (Last accessed 1/30/17.)

[3]  Kimberly Leonard, “Drug Used in ‘Death with Dignity’ Is the Same Used in Executions,” US News and World Report,  October 16, 2015.  Available at: http://www.usnews.com/news/articles/2015/10/16/drug-shortage-creates-hurdle-for-death-with-dignity-movement. (Last accessed 2/2/17.)

[4]  Jennifer Fass and Andrea Fass, “Physician-assisted Suicide: Ongoing Challenges for Pharmacists,” Am. J. Health Syst. Pharm. 2011:68(9): 846-849.  Available at: http://www.medscape.com/viewarticle/742070_print.  (Last accessed 1/31/17.)   For more information on drugs used for doctor-prescribed suicide, see: http://www.patientsrightscouncil.org/site/doctor-prescribed-suicide-drugs. (Last accessed 2/1/17.)

[5]  SB 283, Sec. 54B01.  (Definition of “terminal disease.”)

[6]  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 1/27/17.)
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 1/28/17.)

[7]  Oregon Dept. of Human Services, “FAQs about the Death with Dignity Act.”  Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf. (Last accessed 2/1/17.)

[8]   SB 283, Sec. 54B19 (b). (Emphasis added.)

[9]   SB 283, Sec. 54B19 (a). (Emphasis added.)

[10]  SB 283, Sec. 54B01. (Definition of “participate.”)

[11]  SB 283, Sec. 54B01. (Definition of “capable.”)

[12]  Facilitated communication occurs when a person, called a “facilitator,” supports the hand or arm of a person who is impaired, using a device such as a keyboard to help the individual communicate.

[13]  SB 283, Sec. 54B03 (b).

[14] 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.

[15]  SB 283, Sec. 54B04 (a) (12) (ii) (B).

[16]  SB 283, Sec. 54B04 (a) (5).

[17]  SB 283, Sec. 54B06.

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