Indiana SB 273 Analysis (2017)

Indiana SB 273, patterned on Oregon’s assisted-suicide law, would give physicians the power to prescribe a deadly overdose of drugs for patients to end their lives.

If SB 273 is approved:

Doctors with little or no expertise in diagnosing or treating a patient’s terminal illness would be permitted to prescribe the deadly overdose.

The patient’s terminal condition must be diagnosed by an attending physician and a consulting physician must affirm that diagnosis.  However, the two physicians need not be specialists, nor do they need to have any long time relationship with the patient.

The two physicians need not have any expertise or even any experience in diagnosing or treating terminal illness.  As long as a physician is admitted to practice medicine, he or she can be the attending or consulting physician.

In California, soon after the state’s doctor-prescribed suicide law passed, a Bay Area physician opened a specialized right-to-die practice called “Bay Area End of Life Options” where he charges $200 for an initial patient evaluation and, for patients he considers qualified, the clinic will charge an additional $1,800 for expenses related to follow up visits, forms, etc.[1]  Prior to that, his medical expertise had been primarily as an emergency room physician before leaving medical practice to become a photo-journalist.

Doctors would be permitted to prescribe death for patients who could live for many years.

Doctors would be permitted to prescribe assisted suicide to patients who have a “terminal illness,” defined as a disease or illness from which there can be no recovery and from which reasonable medical judgment indicates death will occur within six months after the diagnosis.[2]

The bill does not say that death will occur with or without medical treatment.

There is no requirement that the condition be uncontrollable.  There are conditions that are incurable but controllable and, with treatment, the patient could live indefinitely.  For example, diabetes can be incurable but it is controllable.  An insulin-dependent diabetic patient who stops taking insulin will, within reasonable medical judgment, die within six months.  Thus, under the bill, diabetics could be eligible for doctor-prescribed suicide even though they could live virtually normal lives with insulin.

There is documentation that this has occurred under Oregon’s assisted-suicide law.  In an official report from Oregon, diabetes is noted as the underlying terminal condition that made the patient eligible for a lethal prescription.[3]

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

Even if the patient is suffering from depression or another psychological disorder, a physician does not need to refer the patient for counseling unless the physician believes the patient has “impaired judgment.[4]

If the depressed or mentally ill patient understands the nature and consequences of a health care decision as well as the relevant facts surrounding that decision, he or she would be considered capable of making an informed decision and need not be referred for counseling.

In the latest official report of deaths under the Oregon Death with Dignity Act, fewer than 4% of patients were referred for counseling prior to receiving the prescription for the life-ending drugs.[5]  A study about Oregon’s law found that it “may not adequately protect all mentally ill patients.”[6]

The most marginalized individuals – poor, hardworking people – would be in particular danger.

“Choice” is an appealing word but inequity in health care is a harsh reality.

Under the bill, before writing a prescription for death, a doctor must discuss “the feasible alternatives to the medication, including comfort care, hospice care, and pain control.”[7]  However, discussing all options does not mean the patient will have the ability to access those options.

Although more people than in the past have medical insurance, many still do not have coverage.

Even for those who have insurance, the stark reality is that time with a physician is greatly limited.  Physicians are forced to work within an economic system where they experience a time crunch like never before. Their interaction with patients may be limited to as little as 10 or 12 minutes a visit.[8]

The reality is that low income individuals face great difficulties when they attempt to receive necessary health care.  Those who are disenfranchised and underprivileged confront barriers to basic care and the reality of obtaining any and all “feasible options” is out of reach.

Doctor-prescribed suicide may well become a “choice” for the comfortably well off, but the only “medical treatment” the poor can afford.  The last to receive health care could be the first to receive doctor-prescribed suicide.

Doctor-prescribed suicide would be transformed from a crime into a “medical treatment.”

This would give insurance programs the opportunity to cut costs by denying payment of more expensive treatments while approving payment for the less costly prescription for a lethal drug overdose.  If the Indiana bill is approved, will health insurance programs do the right thing – or the cheap thing?

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.”[9]

Furthermore, authorization for treatment and care may depend upon cost effectiveness.   The cost of drugs for doctor-prescribed suicide is miniscule compared to the cost of providing treatment to make a patient more comfortable and to extend life.

What could be more cost effective than a prescription for a deadly overdose of drugs?

The economic force of gravity is obvious and has already been experienced under Oregon’s assisted-suicide law.  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.[10]

Oregon patients’ experiences are not unique.  Take, for example the case of a young California mother who was diagnosed with a terminal form of scleroderma.  Her doctor prescribed treatment that would be less toxic than other drugs and her insurance company indicated that it would cover the cost.    But, then, California’s “End of Life Option Act” went into effect and the insurance company notified her that its approval had been withdrawn. They would not pay for the treatment she wanted and needed.

She then asked if assisted suicide would be covered under her plan.  The response was, “Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication.”[11]

Her experience was not unique.  Similar cases have been reported in other states where doctor-prescribed suicide is considered a medical treatment.[12]  And there is no way to know how many other cases have gone unreported.

Family members or health care providers and others could advise, suggest, encourage or exert subtle and not so subtle pressure on patients to request doctor-prescribed suicide, setting the stage for elder abuse and pressure on vulnerable patients.

The bill would penalize anyone who “coerces or exerts undue influence”[13] on a patient to request the lethal prescription.  However, those words have a very narrow legal meaning.

The proposal does not prohibit someone from suggesting, advising, pressuring or encouraging a patient to request doctor-prescribed suicide.

Since victims of domestic abuse, including elder abuse, are extremely vulnerable to persuasion from their abusers, it takes little imagination to understand how abused patients could be persuaded to request doctor-prescribed suicide.

A patient could be led to request assisted suicide based on fear of being a burden on others.   

Many families are under tremendous strain.  At a time of rising gas prices, home foreclosures and general economic uncertainty, it would be foolhardy to ignore the role that finances would play when making life and death decisions.

Would some patients feel that they should request doctor-prescribed suicide so that they wouldn’t be a financial or emotional burden on their family?

Even in families where there would be emotional and practical support for a patient diagnosed with a terminal illness, patients could feel that they are being selfish for not sparing their family.  This has been documented in Oregon as a reason for requesting the prescription for death.

According to Oregon’s latest official report, 48 percent of patients who died using that state’s assisted suicide law did so to avoid being a burden on their family, friends or caregivers.[14]

Furthermore, while we would all like to believe that family means warmth, love and protection, we need to face the reality that dysfunctional families are not rare and elder abuse – much of it at the hands of a family member – is a fact of life.

Persons responsible for completing and signing death certificates would be required to falsify the cause and manner of death. 

If the patient dies after taking the lethal drugs, the prescribing doctor – who need not be present at the time the drugs are taken – may sign the patient’s death certificate[15] and the death “shall be deemed to be a death from natural causes, specifically as a result of the terminal illness from which the qualified individual suffered.”[16]

“Doctor shopping” could take place until a health care professional can be found to declare that the patient is qualified for the lethal prescription.

If an attending physician believes a patient does not have the ability to make an informed decision or that the patient is being pressured to request the prescription for assisted suicide, nothing in the bill prohibits a health care provider, family member or another person from arranging for the patient to be evaluated by other health care professionals until one is found who will declare the patient capable of choosing assisted suicide.

This has taken place in Oregon where it has been noted that “a psychological disorder — senility, for example — does not necessarily disqualify a person.”[17]

A woman died of assisted suicide under Oregon’s “Death with Dignity Act,” even though she was suffering from early dementia. Her own physician had declined to provide a lethal prescription for her. When counseling to determine her capacity was sought, a psychiatrist determined that she was not eligible for assisted suicide since she was not explicitly pushing for it and her daughter seemed to be coaching her to do so. She was then taken to a psychologist who determined that she was competent but possibly under the influence of her daughter who was “somewhat coercive.”

Finally, she was assessed by a managed care physician-ethicist who determined that she qualified for assisted suicide, and the lethal dose was prescribed.[18]

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

 The bill states that the person requesting the prescription for the lethal overdose must “voluntarily” express a wish to die.[19]  However, nothing in the proposal states that the drugs, once prescribed, must be knowingly or voluntarily taken.

The laws and proposals related to doctor-prescribed suicide only address activities that take place up until the prescription is filled. According to the legal guidance regarding the Oregon law, “The Act merely regulates the conduct of all parties up to the point of the drug prescription.”[20]

There are no provisions to ensure that the patient is competent at the time the drug overdose is taken or that the patient knowingly and/or willingly takes the drugs.

Due to this lack of protection, patients are at enormous risk.  For example, someone who would benefit from the patient’s death could trick or even force the patient into taking the lethal drugs. No one would know that the patient’s death was not voluntary.

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?

Flaws in the Oregon law are repeated in the Indiana proposal.

Advocates of laws and proposals related to doctor-prescribed suicide dismiss any of the concerns described above.  They point to Oregon’s eighteen-year experienceThey claim that safeguards protect patients and that annual official reports prove that there have been no problems or abuses.  But there is no way to assure what is actually happening in Oregon since all information in annual reports is provided by those who carry out assisted suicide. Furthermore, there are no penalties for non-reporting or for inaccurate or incomplete reporting.

Those responsible for issuing official annual reports have acknowledged from the very beginning of the Oregon law’s implementation that official reports may not be accurate or complete.  According to the Oregon Health Division, “The entire account [given by reporting doctors] may be a cock and bull story.  We assume, however, that physicians were their usual careful and accurate selves.”[21]

Not Dead Yet, a national disability rights organization, has documented the fact that claims of no abuse under the Oregon law are demonstrably false.[22]

Likewise there would be no way to determine what is really happening if SB 273 were to become law.

[1]  Tracy Seipel, “Bay Area physician opens right-to-die practice,” San Jose Mercury News, June 7, 2016.

[2]   Section 2.

[3]  Oregon Public Health Division, “Oregon Death with Dignity Act: 2015 Data Summary,”  February 4, 2016, p. 6 and p. 7, n. 2.   Available at:  (Last accessed January 9, 2017.)

[4]  Section 6 (a).

[5]  Oregon Public Health Division, “Oregon Death with Dignity Act: 2015 Data Summary,”  February 4, 2016, p. 6 and p. 6.   Available at:  (Last accessed January 9, 2017.)

[6]  Linda Ganzini, Elizabeth R. Goy, Steven K. Dobscha, “Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey,” British Medical Journal, October 25, 2008, pp. 973-978.

[7]  Section 4 (a) (5) (E).

[8]  Roni Caryn Rabin, Kaiser Health News, “You’re on the clock: Doctors rush patients out the door,”  USA Today, April 20, 2014.  Available at: (last accessed January 9, 2017).

[9]  Oregon Dept. of Human Services, “FAQs about the Death with Dignity Act.”  Available at:  See pg. 4 (last accessed January 9, 2017).

[10]  Sue Donaldson James, “Death Drugs Cause Uproar in Oregon,” ABC News, August 8, 2008. Available at (last accessed January 9, 2017).

[11]   Bradford Richardson, “Assisted-suicide law prompts insurance company to deny coverage to terminally ill California woman,” Washington Times, October 20, 2016.
See also: Allie Sanchez, “Insurer offers to pay for assisted suicide but not chemotherapy,” Insurance Business America, October 21, 2016. Available at:  . (Last accessed January 17, 2017)

[12]   Sue Donaldson James, “Death Drugs Cause Uproar in Oregon,” ABC News, August 6, 2008. Available at:  (Last accessed January 9, 2017.)

See also: Dan Springer, “Oregon Offers Terminal Patients Doctor-Assisted Suicide Instead of Medical Care,” Fox News, July 28, 2008. Available at: (Last accessed, January 9, 2017.)

[13]  Section 13 (b).

[14]  Oregon Public Health Division, “Oregon Death with Dignity Act: 2015 Data Summary,”  February 4, 2016, p. 6 and p. 6.   Available at:  (Last accessed January 9, 2017.)

[15]  Section 4 (d).

[16]  Ibid.

[17]  “Physician-assisted suicide: A family struggles with the question of whether mom is capable of choosing to die,” Oregonian, February 4, 2015. Available at: (Last accessed January 17, 2017.)

[18]  Ibid.

[19]  Section 3 (a) (5).

[20]  Barbara Coombs Lee, Eli D. Stutsman, Kelly T. Hagen, “Physician Assisted Suicide,” Oregon Health Law Manual, Volume 2: Life and Death Decisions, (Oregon State Bar, 1997) pp. 8-13. (Emphasis added.)

[21]  Oregon Health Division, CD Summary, vol. 48, no. 6 (March 16, 1999) p. 2, Study Limitations. (Emphasis added.)  Available at: (Last accessed January 9, 2017.)

[22]  Not Dead Yet, “Oregon State Assisted Suicide Reports Substantiate Critics’ Concerns,” October 4, 2016. Available at: (Last accessed November 8, 2016.)


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