NY A02383 “Medical Aid in Dying Act” Analysis (2017-2018)

 A02383 (Identical to S03151)

The New York bill, if passed, would permit a doctor to prescribe “medication” to end the life of a patient if certain conditions are met. 

Many people assume that the “medication” would be “a pill” the patient could take and then “slip peacefully away.”  But this is false.

In states where doctor-prescribed suicide is legal, the vast majority of prescriptions for what is referred to in the New York bill as “medical aid in dying” are for secobarbital  a sedative). For use as a sedative, the usual dosage is one capsule.  The usual prescription under existing state doctor-prescribed suicide laws is for 90 to 100 capsules.[1]                                                                                                                                                     

Under the New York “medical aid in dying act”:  

New York could easily become a national suicide destination for individuals who are 18 years old or older.

Nothing in the proposal requires that an individual be a resident of New York to qualify for doctor-prescribed suicide in the state.  And, although an 18 year old would be too young to purchase alcohol, that same person could qualify for a deadly overdose of drugs in New York.[2]

Doctors in the same medical practice could diagnose and then confirm the diagnosis of a patient’s terminal illness on the same day.

Under the bill, one doctor called the “attending physician,”[3] could diagnose (or misdiagnose) a person as being terminally ill.  On the same day, a second doctor, called the “consulting physician,”[4] could confirm the diagnosis.  Nothing prevents the two physicians from being in the same medical practice.

The required oral and written requests make it possible for the patient to receive the lethal overdose within a day after the diagnosis of a terminal illness is confirmed. 

The individual is required to make one oral request and one written request.[5] Once the attending physician has made the diagnosis and it is confirmed by a consulting physician, the individual could make both requests on the same day.  There is no waiting period required.

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

Even if the patient is severely depressed or has a mental illness, a physician is not required to refer the patient to a mental health professional unless the physician believes that the patient lacks the “capacity to make an informed decision.”[6]    Such “capacity” means the ability to understand and appreciate the nature and consequences of health care decisions.[7]

This provision is similar to that contained in Oregon’s law where, according to an official report released in February 2017, fewer than 4 % of the patients who received lethal prescriptions were referred for counseling.[8]  A study about Oregon’s law found that it “may not adequately protect all mentally ill patients.”[9]

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 or the doctor’s office, must be witnessed by two individuals.[10]  Only one of those witnesses may not be a relative or someone entitled to any portion of the patient’s estate.[11]  One witness could be an abusive relative or an heir. The second witness could be the “best friend” of the relative or potential heir – and no one would ever know.

Why can a potential heir, who would gain from the patient’s death, be allowed to witness the written request?

Government bureaucrats and profit-driven health insurance programs would be given the opportunity to cut costs by denying payment for more expensive treatments while approving payment for less costly assisted-suicide deaths.

If health insurance programs in New York refuse to pay for treatments that a patient needs and wants and, as a result, a patient or the patient’s attending physician later asks about coverage for the prescription for lethal drugs, the insurer may provide information about such coverage.[12]

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

Family members or health care providers and others could advise, suggest, encourage or exert subtle and not so subtle pressure on vulnerable individuals 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 the bill could place abused individuals at risk of being persuaded to request doctor-prescribed suicide.

Individuals could request doctor-prescribed suicide based on fear of being a burden to others.   

In the last official Oregon report, fear of becoming a burden on others was given as a reason for requesting lethal drugs by 48.9% of those who died using that state’s assisted-suicide law.[13] That number exceeded those who cited pain or concern about pain as their reason.[14]

Patients would have no protection once the assisted-suicide prescription is filled. 

Like the Oregon law, the bill only addresses activities taking place up until the prescription is filled.  There are no provisions to insure that the patient is competent at the time the lethal drug overdose is taken or that he or she knowingly and willingly took the drugs.

Due to this lack of protection, the bill would put patients at enormous risk.  For example, someone who would benefit from the individual’s death could trick or even force the person into taking the fatal drugs, and no one would know.

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

There is an illusion of choice.  Yet, the bill would actually constrict patient choice.

“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 inform the patient of “the feasible alternatives or additional treatment opportunities, including but not limited to palliative care and hospice care.”[15]   However, “informing” someone of all options does not mean the patient will have the ability to access those options.  It only means the person must be told about them.

If doctor-prescribed suicide becomes just another treatment option, and a cheap option at that, the standard of care and provision of health care changes.  There will be less and less focus on extending life and eliminating pain, and more and more focus on the “efficient and inexpensive treatment option” of death.

Patients may find that their insurance will not cover the “feasible alternatives” their doctors informed them about but, instead, will pay for doctor-prescribed suicide as has already happened in Oregon.[16]

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?

Death certificates would be falsified.

The attending physician who wrote the prescription (who would not need to be present when the patient takes the drugs) may sign the patient’s death certificate,[17] which will list the cause of death as the “underlying terminal illness,”[18] instead of the true cause: a lethal overdose.

There is no way to know what is really happening once a doctor-prescribed suicide bill is passed. 

Advocates of doctor-assisted suicide point to official reports from Oregon, claiming that the data in those reports proves that the law is working well and is free of problems or abuse. But that claim is subject to skepticism since all information is from self-reporting by the very individuals who are carrying out doctor-prescribed suicide.

Those responsible for issuing official annual reports have acknowledged from the very beginning of Oregon’s assisted-suicide law, 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.[19]
Note:  Supporters of the bill point to Oregon in their claim that there are no problems with the law and that safeguards contained in the law are meticulously followed and monitored.  Yet, in closed-door sessions, those supporters acknowledge that this is not true.  For documented information about this contradiction, see “The Oregon Experience.”[20]

Isn’t it ironic. At a time when there are warnings about the danger of opioids killing people, there is also a campaign to promote opioids to kill a certain category of people?

As Wesley J. Smith, a Patients Rights Council consultant, has noted, there is a mixed message being sent:

“Don’t abuse opioids, because they can kill you – unless you have a terminal illness and want them to kill you, in which case your overdose will be considered ‘death with dignity.'”[21]

[1]  For a fully documented description of drugs used for doctor-prescribed suicide, see: “2017 Summary of Drugs Used for Doctor-Prescribed Suicide.”  Available at: https://www.patientsrightscouncil.org/site/2017-summary-of-drugs-used-for-doctor-prescribed-suicide.  (Last accessed 1/15/18.)

[2]  Section 2899-d.1 defines an “adult” as being an individual who is 18 years old or older.

[3]  Section 2899-d.2.

[4]  Section 2899-d.4.

[5]  Section 2899-e.1.

[6]  Section 2899-f.1 (c).

[7]  Section 2899-d.3.

[8]  Official report for 2016 deaths under Oregon’s Death with Dignity Act, p. 9.  Released in February 2017. Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year19.pdf. (Last accessed 1/14/18.)

[9]  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, Oct. 25, 2008, pp. 973-978.

[10] Section 2899-e.3 (a).

[11] Section 2899-e.3 (b) (ii).

[12] Section 2899-n.4.

[13] Official report for 2016 deaths under Oregon’s Death with Dignity Act, p. 10.  Released in February 2017. Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year19.pdf. (Last accessed 1/14/18.)

[14] Official report for 2016 deaths under Oregon’s Death with Dignity Act, p. 10.  Released in February 2017. Available at: http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year19.pdf. (Last accessed 1/14/18.)

[15] Section 2899-f.1 (e) (v).

[16] KATU Television, “Letter noting assisted suicide raises questions” (interview about one such case and the response of the Oregon Health Plan). Available at: http://www.katu.com/news/26119539.html. (Last accessed 1/29/15.)

[17] Section 2899-p. 1.

[18] Section 2899-p. 2.

[19]  Oregon Health Division, CD Summary, pg. 2 (See section titled “Study Limitations”).  Available at: http://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/CDSummaryNewsletter/Documents/1999/ohd4806.pdf.  (Last accessed 1/15/18.)

[20] “The Oregon Experience.”  Available at: https://www.patientsrightscouncil.org/site/the-oregon-experience. (Last accessed 1/15/18.)

[21] Wesley J. Smith, “Stop Assisted-Suicide Opioid Abuse,” First Things, August 4, 2017.

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Patients Rights Council
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