In this video, we take a closer look at the anatomy of an assisted suicide bill and how proposed expansion bills would change current statutes. There are expansion bills being heard in Vermont, Hawai’i, Washington, and Oregon.
Want to get involved with advocacy work to stop assisted suicide? Fill out this quick form and we’ll be in touch: https://secure.everyaction.com/8FDj6L…
Video link: https://youtu.be/bEreuFDEeQw
Note from Jules: My apologies for speaking so fast in this video! I must have been over-caffeinated when I recorded this. I’ll make a concerted effort to slow down for clarity in the future. Thanks for being patient with me!
Transcript
Hello and welcome back to the Not Dead Yet vlog. My name is Jules Good. I use they/them pronouns, and I’m the assistant director and policy analyst at Not Dead Yet. I’m a white person with short brown hair and today I have on a gray short sleeve T-shirt.
This week we’re taking a deeper dive into what we call assisted suicide expansion bills. If you saw our last video about legislative updates, you got a brief summary of some of these bills. Now we’re going to take a look at the anatomy of an assisted suicide bill to understand which parts are being changed in current proposed legislation and what risks those changes pose.
Part one, anatomy of an assisted suicide bill. We often use phrases like legalizing assisted suicide, but what exactly does that mean? What is being made legal that wasn’t legal before? What exactly changes in the law in medical facilities and in patient care when a state makes assisted suicide legal? Let’s break it down. Oregon was the first state to legalize assisted suicide back in 1997. Other assisted suicide bills in the years since have more or less copy and pasted Oregon’s bill language, so we’ll use Oregon’s law as it stands today as our model assisted suicide bill. There are five key pieces of information in every assisted suicide bill that detail rules and procedures for, one, eligibility, including prognostics and residency requirements. Two, making the request for lethal prescription and waiting periods. Three, evaluating the request for lethal prescription. Four, insurance. And five, immunities and liabilities.
Let’s start with eligibility. Oregon’s law says, quote, “An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease and who has voluntarily expressed his or her wish to die may make a written request for medication,” end quote. So, someone has to be deemed able to make decisions by a physician, be able to prove residency with appropriate forms of identification, and have a diagnosis from a physician indicating that they are expected to die within the next six months as a result of their condition. If someone meets these requirements, they can make a request for a lethal prescription. This requires two oral requests and one written request. The second oral request must be made no sooner than 15 days after the first oral request. The written request must be made using a special form, an example of which is provided in the last section of the statute.
In Oregon and a few other states, the 15-day waiting period can be waived if a physician medically confirms that the patient will likely die before the waiting period ends. The physician must make the patient aware of their ability to rescind their request after the second oral request is made. Once the request for lethal prescription is made, it has to be evaluated. The attending physician and a consulting physician have to review the patient’s medical records, examine the patient and verify that they do indeed have a terminal disease and are capable of making the request. If either physician is concerned that the patient may be, quote, “Suffering from a psychiatric or psychological disorder or depression causing impaired judgment,” end quote, they are are required to refer the patient for counseling, which basically just means a professional assessment and not necessarily ongoing mental health support. If the patient is cleared by both physicians and a psychological professional, if deemed necessary, their request for lethal prescription is approved.
The fourth main part of an assisted suicide bill is language about insurance. We talked more in depth about insurance policies and the relationship to assisted suicide in our video about the Kligler case, so check that out if you want a deeper explanation of this. But basically, most life insurance policies withhold payout of benefits if the policy holder dies by suicide. Assisted suicide legislation clearly states that an insurance company may not do that if the patient dies by assisted suicide, and many laws say that the death certificate must list the underlying illness as the cause of death so as to avoid complications with this or other issues. Lastly, assisted suicide legislation details the immunities of medical professionals and others involved in the death of the patient. The immunities are the most significant part of assisted suicide laws. If someone claims to act in, quote, “good faith compliance with the law,” they cannot be legally or professionally penalized. The exception to this is that if a facility or provider chooses not to provide assisted suicide and one of their staff does it anyway, that staff member can be punished or sanctioned by the facility. If a person alters or forges a request for lethal medication or interferes in the process with the intent of causing the death of the patient, that person can be convicted of a class A felony.
Every statute and bill has its own quirks, but I’m hoping this rundown gave you some insight into what a given assisted suicide bill actually does if it passes. Now that we have a baseline, let’s take a look at some current proposed expansion bills and the impacts they would have in relation to current assisted suicide statutes.
Part two, understanding current expansion bills. This legislative session, there are expansion bills being heard in Oregon, Washington, Vermont, and Hawaii. Vermont’s bill deals primarily with abolishing the residency requirement while Washington and Hawaii’s bills aim to expand the definition of, quote, “what a qualified medical professional is” so that healthcare providers other than physicians can evaluate patient’s eligibility for assisted suicide and to reduce the waiting period between a request for lethal drugs and getting the prescription. Oregon’s bill aims to do all three of those things. Let’s talk through what this means and the threats these forms of expansion pose to vulnerable patients. In Oregon, non-residents are already able to pursue assisted suicide due to a settlement in a court case last year. The Oregon Health Authority and the Oregon Medical Board voluntarily agreed to stop enforcing the residency requirement and asked the legislature to remove it from the law, which is part of what this bill, SB891, would do. Removing the residency requirement undermines the authority of other states that have decided assisted suicide is unsafe for their residents. It expands the pool for doctor shopping where people who want to pursue assisted suicide switch doctors until they find one who will help them die that way. This is especially dangerous because someone could be under the care of a doctor for only a few short weeks before they really have a chance to get to know the person and accurately gauge their decision-making capacity and any external pressures on them to die.
Vermont is considering two similar bills, HB2 and SB26, which would remove the residency requirement from its bill. The House bill passed through committee and the Senate bill is still awaiting a hearing. The situation in Vermont has recently been complicated by the settlement reached in Bluestein versus Scott in mid-March, which allows the plaintiff, a Connecticut resident, to die by assisted suicide in Vermont when she becomes eligible. Unfortunately, this means the Vermont bill is even more likely to pass.
Hawaii, Oregon and Washington are considering bills that would increase the pool of healthcare providers who are eligible to assist in a patient’s suicide. Currently, in these states, only physicians are able to evaluate a patient’s eligibility. The bills would extend this ability to physician assistance and advanced practice registered nurses, APRNs, which means that people with less diagnostic experience and often less experienced practicing medicine in general would be determining patient eligibility under requirements that already have a lot of room for error given the imprecise nature of prognostics. Research has shown that 12 to 15% of people outlive a six-month prognosis, and rushing to pursue assisted suicide toward the beginning of this period is especially risky because people could have several more months or even years of life left. Jeanette Hall, an Oregonian diagnosed with terminal cancer, sought out assisted suicide, but was encouraged by her doctor to try other treatment options before going that route. She has now lived more than 20 years post-diagnosis. In an article for the Boston Globe she said, quote, “If my doctor had believed in assisted suicide, I would be dead.”
Equally concerning is the reduction of the waiting periods between requesting and receiving lethal drugs. Research shows that depression is a common reaction to a terminal prognosis, obviously, especially at the early stages. It takes weeks or months for antidepressants to work. Insufficient palliative care and in-home personal care services, an unfortunate reality for most disabled people, can also lead to despair. Official data shows that concerns about loss of autonomy and feelings of being a burden on others are major factors in requests for assisted suicide, but it takes time to put in-home services in place. There is no excuse for abandoning people with advanced illnesses by hastening their deaths rather than addressing their needs. When this happens, it’s not compassion, it’s disposal.
These expansion bills are indicative of a dangerous trend in assisted suicide advocacy. The safeguards that aided in getting the legalization bills passed initially are now being reframed as barriers to accessing end of life care. The less stringent the process is, the more room there is for error, abuse and coercion. Thanks for watching. If you want to get involved in advocating against assisted suicide, fill out the quick form in the video description below and we’ll be in touch with you. To learn more about us and our work, please visit www.notdeadyet.org. See you next time.
