Problems with H.B. 391

By Margaret Dore, Esq., MBA

H.B. 391 seeks to legalize physician-assisted suicide in Utah.  I am a lawyer in Washington State where we have a similar law.  Our law is based on a law in Oregon.  

Problems include:

1.  HB 391, if enacted, will encourage people with years to live to throw away their lives.

HB 391 seeks to legalize assisted suicide for persons with a "terminal disease," which is defined as having less than six months to live.  In Oregon's law, which uses the same definition, young adults with chronic conditions, such as diabetes, are "eligible" for assisted suicide.  Such persons can have years, even decades, to live.  See https://choiceisanillusion.files.wordpress.com/2014/12/a-2270-3r-memo-12-02-14.pdf   "Eligible" patients can also have years to live because doctors can be wrong.  See https://choiceisanillusion.files.wordpress.com/2013/10/terminal-uncertainty.pdf and https://choiceisanillusion.files.wordpress.com/2014/08/signed-john-norton-affidavit_001.pdf

2.  HB 391, if enacted, will allow health care providers/institutions to use coverage incentives to steer patients to suicide.

In Oregon, that state's Medicaid Plan steers patients to suicide through coverage incentives.  If HB 391 is enacted, Utah health care providers/institutions will be able to do the same thing.  For more information about Oregon's situation, see the affidavit of Kenneth Stevens, MD, at this link:  https://maasdocuments.files.wordpress.com/2014/08/dr-stevens-affidavit_001.pdf 

3.  Legalization is a recipe for elder abuse. 

HB 391, like Washington's law, has no oversight at the death.  No doctor is required to be present. Not even a witness is required.  This situation creates the opportunity for an heir, or another person who will benefit from the patient's death, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?

4.  Increased suicide

In Oregon, other suicides have increased with the legalization of physician-assisted suicide.  See http://www.choiceillusion.org/2014/03/the-high-financial-cost-of-regular.html Legalization, regardless, sends the wrong message to young people that suicide is an acceptable solution to life's problems. Utah already has one of the highest suicide rates in the nation.  See http://www.standard.net/Health/2014/05/22/Utah-suicide-rate-soars

5.  Washington's similar law.

For a short article about Washington's similar law, please go here (non-lawyers tell me they like it):  https://www.kcba.org/newsevents/barbulletin/BView.aspx?Month=05&Year=2009&AID=article5.htm

New England Journal of Medicine Article Misleading

Dear Editor:

I am a lawyer in Washington State, one of two states where assisted-suicide is legal.  The other state is Oregon, which has a similar law.  Lisa Lehmann's article, "Redefining Physicians' Role in Assisted Dying," is misleading regarding how these laws work.

First, the Oregon and Washington laws are not limited to people in their "final months" of life.[1,2]  Consider for example, Jeanette Hall, who in 2000 was persuaded by her doctor to be treated rather than use Oregon's law.  She is alive today, twelve years later.[3]

Second, these laws are not "safe" for patients.[4][5]  For example, neither law requires a witness at the death.  Without disinterested witnesses, the opportunity is created for the patient's heir, or someone else who will benefit from the patient's death, to administer the lethal dose to the patient without his consent.  Even if he struggled, who would know?  

Third, the fact that persons using Oregon's law are "more financially secure" than the general population is consistent with elder financial abuse, not patient safety.  Do not be deceived. 

* * *

[1]  Margaret K. Dore, "Aid in Dying: Not Legal in Idaho; Not About Choice," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 18-20, September 2010, available at http://www.margaretdore.com/pdf/Not_Legal_in_Idaho.pdf.
[2]  Kenneth Stevens, MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 16-17, September 2010, available athttp://www.margaretdore.com/info/September_Letters.pdf 
[3]  Ms. Hall corresponded with me on July 13, 2012.
[4]  See article at note 1.  See also Margaret Dore, "Death with Dignity": A Recipe for Elder Abuse and Homicide (Albeit Not by Name)," at 11 Marquette Elder's Advisor 387 (Spring 2010), original and updated version available at http://www.choiceillusion.org/p/the-oregon-washington-assisted-suicide.html 
[5]  Blum, B. and Eth, S.  "Forensic Issues: Geriatric Psychiatry." InKaplan and Sadock's Comprehensive Textbook of Psychiatry, Seventh Edition, B. Sadock and V. Sadock editors.  Baltimore, MD: Lippincott, Williams and Wilkins, pp. 3150-3158, 2000. 

Ken Stevens MD: "legalizing assisted suicide can result in decreased patient choice"

Assisted Suicide
http://www.sltrib.com/sltrib/opinion/53280042-82/suicide-patients-assisted-oregon.html.csp

Updated Jan 19, 2012 01:01AM

Patty Henetz' "Do Utahns have the right to choose how they die?" (Tribune, Jan. 8) refers to the legalization of assisted suicide in Oregon. Utahns should understand that legalizing assisted suicide can result in decreased patient choice.

I have been a cancer doctor in Oregon for more than 40 years. The combination of assisted-suicide legalization and prioritized medical care based on prognosis has created a danger for my patients on the Oregon Health Plan (Medicaid).

The plan limits medical care and treatment for patients with a 5 percent or less likelihood of surviving five years. Patients in that category who have a good chance of living another three years and who want to live cannot receive surgery, chemotherapy or radiation therapy. However, the plan will cover the patient's suicide.

Oregon law says only patients with no more than six months to live are eligible for voluntary suicide, but the plan nonetheless offers suicide to patients in this category.

The mere presence of legal assisted suicide steers patients toward suicide. One patient was adamant to use the law. I convinced her to be treated. Eleven years later she is thrilled to be alive.

Kenneth Stevens, M.D.

Sherwood, Ore.

"The mere presence of legal assisted-suicide steers patients to suicide"

November 27, 2011

To Massachusetts Medical Society 

Dear House of Delegates Officers and Other Interested Parties:

I understand that the Massachusetts Medical Association will be voting on changing its policy against physician-assisted suicide. I have been a cancer doctor in Oregon for more than 40 years.  The combination of assisted-suicide legalization and prioritized medical care based on prognosis has created a danger for my patients on the Oregon Health Plan (Medicaid).

The Plan limits medical care and treatment for patients with a likelihood of a 5% or less 5-year survival.  My patients in that category, who say, have a good chance of living another three years and who want to live, cannot receive surgery, chemotherapy or radiation therapy to obtain that goal.  The Plan guidelines state that the Plan will not cover “chemotherapy or surgical interventions with the primary intent to prolong life or alter disease progression.”  The Plan WILL cover the cost of the patient’s suicide.

Under our law, a patient is not supposed to be eligible for voluntary suicide until they are deemed to have six months or less to live.  In the well publicized cases of Barbara Wagner and Randy Stroup, neither of them had such diagnoses, nor had they asked for suicide.  The Plan, nonetheless, offered them suicide.

In Oregon, the mere presence of legal assisted-suicide  steers patients to suicide even when there is not an issue of coverage.  One of my patients was adamant she would use the law.  I convinced her to be treated.  Eleven years later she is thrilled to be alive.  Please, don’t let assisted suicide come to Massachusetts.

 [Support for this letter regarding Barbara Wagner and Randy Stroup can be found in these articles:  http://www.katu.com/news/26119539.html & http://abcnews.go.com/Health/story?id=5517492&page=1  My patient’s letter in the Boston Globe describing her being alive 11 years later can be read here: http://articles.boston.com/2011-10-04/bostonglobe/30243525_1_suicide-doctor-ballot-initiative   ]

Kenneth R.Stevens, Jr., MD
Sherwood, OR 
Professor Emeritus and former Chair, Radiation Oncology Department, Oregon Health & Science University, Portland, Oregon