NH HB 1659 “Death with Dignity Act” Analysis (2020)

New Hampshire’s 2020 Assisted-Suicide Proposal
HB 1659 “Death with Dignity Act”

Currently, assisted suicide is a crime in New Hampshire.  It is a class B felony, punishable for up to seven years in prison, if a person aids another to commit suicide and that aid results in suicide or in an attempt to commit suicide.   [N.H. Rev. Stat. § 630:4]  

New Hampshire’s proposed “Death with Dignity Act” is patterned after Oregon’s law by the same name.

Under the New Hampshire proposal:

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 prescription for a deadly drug overdose.

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.”[1]

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.[2]

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.”[3]

California pays for assisted-suicide drugs obtained by MediCal patients under the state’s doctor-prescribed suicide law.[4]

If the New Hampshire bill becomes law, will insurance programs do the right thing – or the cheap thing?

Severely depressed or mentally ill patients could receive a prescription for a deadly overdose of drugs without any counseling for their depression or mental illness.

Even if a patient is suffering from a psychiatric or psychological disorder or is depressed, a physician doesn’t need to refer them for “counseling” unless the physician believes they may have “impaired judgment.” [137-M:2 III]   But it is not “counseling” in the usual sense of the word.  It is merely an assessment for the purpose of determining that a patient who is depressed or mentally ill has the ability to know what they are requesting.

Even if the patient is found to have impaired judgment, doctor shopping can take place until a health care provider declares that the patient is “capable,” meaning they have the ability to make and communicate health care decisions. [137-M;2 III]

In Oregon, a woman who requested the lethal dose was found by her doctor to have early stage dementia and therefore incapable of making an informed decision.  Her daughter then took her to a second physician who questioned whether her daughter’s assertiveness may have been the agenda behind the request.  Finally, she was taken to a third health care provider who authorized the prescription.

In reports of the case, it was noted that a psychological disorder ‒ senility, for example ‒ does not disqualify a patient from receiving the lethal drugs in accordance with Oregon’s “Death with Dignity” law.[5]

Individuals who could live for many years would be eligible for doctor-prescribed suicide.

The patient must be diagnosed as having a “terminal disease,” defined as “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within 6 months.” [137-M:2 XIII] This is identical to Oregon’s definition of terminal disease.[6]

What if the condition is controllable?  This definition of “terminal disease” does not require that the condition be uncontrollable.

As in Oregon, patients who refuse treatment would be eligible for the lethal prescription.  There, 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.[7]   Blanke has written about 15% of prescriptions for the lethal drug overdose in Oregon.[8]    

Furthermore, according to Oregon’s official report issued in February 2019, the “terminal diseases” that qualified some patients for the lethal overdose included diabetes, arthritis, arteritis, sclerosis, stenosis, kidney failure, and musculoskeletal system disorders.[9]

Government health programs, managed care programs and others would have the opportunity to cut health care costs by encouraging vulnerable patients to request assisted suicide.

Tragically, elder abuse is a common occurrence in today’s society.  Elderly patients could easily be pressured by family members or unscrupulous health care providers into requesting assisted suicide.  The bill specifically states that it prohibits coercing or using undue influence on a patient to request the deadly drugs. [137-M:15, II]  However, coercion and undue influence have specific legal meanings.  Nothing in the bill prohibits anyone from suggesting or strongly encouraging a patient to request a lethal prescription.

Doctors would be permitted to prescribe deadly overdoses of drugs to 18-year-olds who are not a state residents. 

A person need not be a state resident to be assisted in committing suicide.  One need only be someone who is “regularly treated” in a New Hampshire health care facility. [137-M:2, XII]

An 18-year-old from another state who is attending college in New Hampshire and who is being treated for any ailment (such as a skin condition) could be considered “regularly treated” in a New Hampshire facility.  Then, if that individual has any condition that would meet the criteria of “terminal,” they could qualify for assisted suicide in the state.

Isn’t it ironic that an 18-year-old could not purchase beer or cigarettes in New Hampshire but could request and receive a prescription for an intentional overdose of drugs?

 There are no “safeguards” after the prescription is written.  

HB 1659 contains seven references to the fact that the prescription is to be “voluntarily” requested.  However, nothing in the proposal prevents a patient from being forced or tricked into taking the lethal overdose.  No witnesses need to be present and no one will know if the drugs were willingly or voluntarily taken.

A greedy heir could mix the drugs into his aunt’s food without her knowledge and trick her into eating it.  The proposal has no provisions to guard against such abuse.

Dr. Katrina Hedberg, lead author of most of Oregon’s official reports on that state’s “Death with Dignity” law, explained that the state’s job is to make sure that all the steps required up to the point the prescription was written were taken  She further stated, the “law itself only provides for writing the prescription, not for what happens afterwards.”[10]

Why aren’t there any safeguards at the most important part of the process – at the time the patient takes the drugs that will cause death?

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.

The measure states that the doctor must inform the patient of all feasible alternatives or additional treatment opportunities. [137-M:2 VIII].  However, discussing alternatives does not mean the patient will have the resources to access those other options.

Why should the comfortably well off have a choice of treatment options while the poor are left with the only one they can afford doctor-prescribed suicide?

Accurate language is banned.

“If thought corrupts language, language can also corrupt thought” was recognized many years ago.[11]  Corrupted language is prevalent in HB 1659 to legalize assisted suicide.

According to the bill, actions taken in accordance with it shall not constitute suicide or assisted suicide under the law. [137-M: IV]  Therefore, death certificates would not reflect the true cause of death.  This is occurring in other states where doctor-prescribed suicide has been transformed into a medical treatment.

For example, Washington State’s “Death with Dignity Act” requires physicians to falsify death certificates. The law does not allow deaths resulting from doctor-prescribed suicide to be listed as assisted suicide.  Physicians are required to list the underlying terminal disease as the cause of death.[12]

The State’s “Instructions for Physicians and other Medical Certifiers” are explicit:[13]

“If you know that the decedent used the Death with Dignity Act, you must comply with the strict requirements of the law when completing the death record.”

Words that are not permitted on the death certificate include: suicide, assisted suicide, physician-assisted suicide, death with dignity, Secobarbital, Seconal, Pentobarbital or Nembutal.

The instructions warn: “The Washington State Registrar will reject any death certificate that does not properly adhere to the requirements of the Death with Dignity Act.”

Thus, unless the death certificate falsifies the real cause of death, it will not be accepted and the physician will be required to submit a new death certificate that hides the facts.

 If the actions permitted under assisted-suicide laws are so good, why are those who promote them hiding what they are really about? If one calls suicide or assisted suicide by other names, does that change what they are?


[1]  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 1/16/20.)

[2]  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 1/16/20.)
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 1/16/20.)

[3]  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 1/16/20.)

[4]  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 1/16/20.)

[5]  “Physician-assisted suicide: A family struggles with the question of whether mom is capable of choosing to die.”  The Oregonian/Oregon Live, February 4, 2015.  Available at: https://www.oregonlive.com/health/2015/02/physician-assisted_suicide_a_f.html. (Last accessed 1/18/20.)

[6]   Oregon “Death with Dignity Act,” ORS 127.800 §1.01 (12). Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx  (Last accessed 1/16/20.)

[7] Tara Bannow, “Rural Oregonians Still Face Death with Dignity Barriers,” Bend Bulletin, September 5, 2017.  Available at: https://www.bendbulletin.com/lifestyle/health/rural-oregonians-still-face-death-with-dignity-barriers/article_e41a5836-8bd6-5680-b37d-07517d3b9335.html  (Last accessed 1/16/20.)

[8]   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 1/16/20.)

[9]  “Oregon Death with Dignity Act, Data Summary for Year 12, Pg. 11 and Pg. 13, fn 3.  Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf. (Last accessed 1/18/20.)

[10]  Testimony of Dr. Katrina Hedberg before the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, Assisted Dying for the Terminally Ill Bill [HL], Volume II: Evidence.   Apr. 4, 2005, p. 259, question 566.  Available at: https://publications.parliament.uk/pa/ld200405/ldselect/ldasdy/86/86ii.pdf. (Last accessed 1/21/20.)

[11]   “Politics and the English Language,” Collected Essays, Journalism & Letters of George Orwell, vol. iv, Harcourt, Brace and World, Inc. (1968) p. 137.

[12] Washington Death with Dignity Act, “Attending Physician Responsibilities,” RCW 70.245.040 (2).

[13]  “Instructions for Physicians and Other Medical Certifiers for Death Certificates: Compliance with the Death with Dignity Act,” Available at:  https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-151-DWDInstructionsForPhysicians.pdf. (Last accessed 1/18/20.)


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