Analysis Maryland HB 1021 (2015)

Under the “Richard E. Israel and Roger ‘Pip’ Moyer Death with Dignity Act” (HB 1021):

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

A person “familiar with the patient’s manner of communicating” could inaccurately convey (translate) the patient’s request for the lethal dose.[1] How would anyone know if the translation is accurate?  How would it be possible to know if the patient is really requesting doctor-prescribed suicide?

An individual with a controllable medical condition could be considered to have a terminal illness, making him or her eligible for doctor-prescribed suicide.
A patient is considered to have a terminal illness, making him or her eligible for a suicide prescription if the condition “involves a prognosis for a patient that likely will result in the patient’s death within six months.”[2]   There are many conditions (diabetes, certain types of leukemia, etc.) that, without medical treatment, would likely result in death within six months.  However, with medical treatment, patients with those conditions could live for many years.  Yet, under HB 1021, those patients would be eligible for doctor-prescribed suicide.

The written request for doctor-prescribed suicide could be witnessed by someone who would gain financially from the patient’s death.[3]
The written request, which could be signed in the patient’s residence, may be witnessed by a relative who is pressuring the patient to sign it.  The second witness could be the “best friend” of the potential heir – and no one would ever know.

Severely depressed or mentally ill patients can receive doctor-prescribed suicide, without having any form of counseling. [4]

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.”  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.[5]

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 pharmacists, nurses and others to facilitate such deaths. The proposed bill states that a health care provider may prohibit “participation” on the premises.[6]  It provides that no one can be subjected to a penalty for “participating or refusing to participate;”[7] that participation is voluntary;[8] and that a “health care facility may not require the physicians on the medical staff to participate in aid in dying.”[9]

However, the word “participate” is very narrowly defined in the bill.[10]  It refers only to performing the duties of the attending physician, consulting physician or mental health professional.  It does not include nurses, pharmacists, etc.  Therefore, facilities could require pharmacists to fill prescriptions and nurses to bring the drugs to a patient since such activities would not constitute participation.  Furthermore, facilities would not be able to ban pharmacies on the premises from filling prescriptions for the lethal drugs and would not be able to prohibit nurses from providing them to a patient or resident.

All of the safeguards in the bill cease the moment the prescription is received. The bill contains six 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]  §5-6A-01 (E) (3)

[2]  §5-6A-01 (T)

[3]  §5-6A-03 (B) (1) (ii)

[4]  §5-6A-06 (A)

[5]  §5-6A-01(E)

[6]  §5-6A-14 (B) (1)

[7]  §5-6A-13 (A) (2)

[8]  §5-6A-15 (A) (1)

[9]  §5-6A-15 (A) (2)

[10] §5-6A-14 (A) (3) (i)