Telemedicine

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Since the 1960s, some have predicted that video visits with doctors would eventually become a common way that patients receive care.  However, it took the Covid-19 pandemic to bring that prediction to reality.

Referred to by many as telehealth, remote access to medical care went mainstream in March 2020 when the Department of Health and Human Services declared that, because of the pandemic, Medicare would pay doctors and hospitals for a broad range of telehealth services.   Those services would include care by physicians but also by nurse practitioners, clinical psychologists, social workers and other health care providers.

It allows providers to use technology to diagnose and to provide care that, previously, had been only available through in-person visits.

It has been, and still can be, a welcome method for individuals.  Rather than driving long distances to medical appointments, sitting in a waiting room with other sick patients or even having to access an emergency room, diagnosis, treatment and care can now be obtained from the comfort of one’s own home.

However, it also brings up the possibility that assisted-suicide advocates will use it to further expand access to prescribed suicide.
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Activists promote telehealth services
Compassion & Choices (C&C), the former Hemlock Society, quickly adjusted the spin and direction of its assisted-suicide efforts by using the pandemic lockdown to advance its goals. On March 20, President and CEO Kim Callinan sent out an email message pushing telehealth conferencing so patients and healthcare providers can have “office visits” online without face-to-face meetings. She wrote that the pandemic provides the opportunity “to make sure health systems and doctors are using telehealth… for patients to access end-of-life care options.” “These efforts,” she added, “should improve access to medical aid in dying [assisted suicide] in the short and long term.” [Kim Callinan, Email to supporters, 3/20/20; emphasis added]

Meanwhile, the newly formed American Clinicians Academy on Medical Aid in Dying (ACAMAID) issued a policy statement calling for the use of telemedicine by doctors to evaluate the assisted-suicide eligibility of death-requesting patients, conduct physical exams, and even be remotely present when the patient takes the lethal drugs. The six committee members who wrote the policy are all assisted-suicide proponents. One is Dr. Lonny Schavelson, who runs a clinic that provides only prescribed death. [ACAMAID, Telemedicine Policy Statement, 3/25/20]

Establishing telehealth as an essential mode of medical delivery certainly greases the skids for access to assisted death without the doctor ever seeing the patient in person.
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Overlooked absence of requirement of in-person diagnosis of terminal condition

As of May 2020. eight of the nine jurisdictions where assisted suicide has been transformed from a crime into a “”medical treatment” do not require that either the attending physician or the consulting physician diagnose the patient in person.  (Those jurisdictions are Oregon, Washington, Colorado, California,  Hawaii, Maine, New Jersey and the District of Columbia.)

Only Vermont requires that the diagnosis of a terminal condition be made in person by an attending physician and that it be confirmed, in person, by a consulting physician.
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New Mexico attempt to specifically allow telemedicine for assisted suicide

Even before the pandemic, New Mexico legislators had attempted to specifically permit assisted suicide via telemedicine when, in 2019, they introduced HB 90 , the “Elizabeth Whitefield End-of-Life Act.” (See: Section 2 J; Section 3 G (2) (a); and Section 4 B.)  The bill was subsequently amended, leaving out references to telemedicine.  [See: Analysis of original 2019 version of HB 90]
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Articles

“Telehealth can be life-saving amid COVID-19, yet as virus rages, insurance companies look to scale back”
(USA Today — July 8, 2020)
…”For Cynthia Peeters, who stopped driving because of COVID-19-induced anxiety, telehealth meant she didn’t have to ask family members or her working husband to drive her to the doctor.
“After COVID, telehealth should still be around,” Peeter said.  “There’s too much goodness — it resolved me finding a rider to the doctor’s appointment and makes doctors more available to people in the community who can’t drive themselves.”

“Assisted Suicide By Zoom”
(First Things — June 5, 2020)
“The American Clinicians Academy on Medical Aid in Dying– a newly formed association of doctors who assist suicides — recently published formal guidelines that permit doctors to assist suicides via the Internet. These guidelines state that examination should include a review of medical records and a video meeting via Zoom or Skype.  The second opinion can simply be done by phone.  This means that assisted suicides will be facilitated by doctors who never actually treated patients for their underlying illness, who may be ignorant of their family situations and personal histories, and who have never met their patients in the flesh.”

“Medical Aid in Dying by Telehealth”
Konstantin Tretyakov
(Health Matrix: The Journal of Law-Medicine, Case Western Reserve School of Law; Vol. 30, Issue 1)
[Written before the pandemic, the author concluded]
…”the concept of ‘in person’ examination should be expanded to encompass examinations conducted in real time through modern means of electronic communication, such as Tele-MAiD [the author’s  label for Telehealth Medical Aid in Dying]. Such communication establishes a valid doctor-patient relationship between the patient seeking MAiD and his attending physician.  Ultimately, these conclusions compel the finding that MAiD by telehealth is not only feasible, but also beneficial.”

“A Pandemic Benefit: The Expansion of Telemedicine”
(New York Times — May 11, 2020)
“Even if no other good for health care emerges from the coronavirus crisis, one development — the incorporation of telemedicine into routine medical care — promises to be transformative.  Using technology that already exists and devices that most people have in their homes, medical practice over the internet can result in faster diagnoses and treatments, increase the efficiency of care and reduce patient stress….
“For the benefit of us all, doctors as well as patients, let’s hope these new rules long outlast the pandemic.”

“Doctor on Video Screen Told a Man He Was Near Death, Leaving Relatives Aghast”
(New York Times, March 9, 2019)
A doctor on a video conference explained to Ernest Quintana that he did not have long to live. Mr. Quintana’s family members criticized the use of telemedicine in that circumstance….’I just don’t think critically ill patients should see a screen,’ she said. ‘It should be a human being with compassion.'”