“Alleviating suffering is different from eliminating the sufferer”: confronting the Massachusetts assisted-suicide bill

Undeterred by the defeat of a 2012 ballot initiative promoting physician-assisted suicide (PAS) in Massachusetts, legislators there are working to enact PAS via legislation. I went to Boston today to listen to the hearing on the bill, H.1998. I stayed only two hours, but that was long enough for me to see that the people who want to legalize PAS are relentless. Are those of us opposed to doctor-imposed death just as determined? We’d better be.

Today was one of those days when my social media skills fell flat. I tweeted throughout the hearing – or so I thought. I found later that the tweets never got past my valiant little phone. They’re all unsent drafts. They actually serve as decent notes.

At MA state house for assisted suicide hearing. Many people sporting “My life my choice my death” stickers.

Massachusetts Citizens for Life sent an email this morning claiming that pro-PAS groups were busing in supporters. I can’t verify that, but I can say that the crowd of more than 200 people included an awful lot of folks with those identical green stickers.

Committee chair cautions all to be respectful of those speaking on this “sensitive topic.”

Respect wore thin after the first 90 minutes at this hearing with the Joint Committee on Public Health. There were people testifying that there’s nothing compassionate about killing, and then there were people objecting to anyone saying that. The presiding officer, Rep. Jeffrey Sánchez (D-Jamaica Plain), finally made it clear that he didn’t want anyone accusing anyone else of lack of compassion.

Rep. Sánchez also made it clear that he favors the bill, although he has “struggled with it.”

MA Medical Society testifies in opposition to physician-assisted suicide. “Incompatible with physicians’ role as healer.”

Former Massachusetts Medical Society president Dr. Barbara Rockett, speaking for MMS, was brief and blunt in opposition to PAS. “This is incompatible with the physician’s role as healer.” She went on to say that MMS opposes legislative tinkering with the practice of medicine, which she sees in the bill’s assorted “requirements.” Dr. Rockett was active in the defeat of the PAS ballot initiative, saying during that campaign, “To substitute physician-assisted suicide for care represents an abandonment of the patient by the physician.” 

Interesting: one of the bills today would prohibit health care pros from participating in the torture/abuse of prisoners. Drs testify re Do No Harm ethic. Will same drs apply that Do Not Harm ethic to PAS?

H.1998 was one of twenty bills on the agenda, although it drew most of the day’s testimony. Two other bills, one from each chamber, would “prohibit the participation of health care professionals in the torture and abuse of prisoners.” Physicians and psychologists provided vivid and compelling testimony favoring such a ban. Several of these professionals related how the co-opting of medical professionals in the torture of prisoners violates the “do no harm” ethic. These same professionals did not apply that ethic to H.1998, and in fact were silent on PAS today.

state rep Adkins (sp?) supports PAS, comparing force-feeding against patients’ will to torture.

Rep. Cory Atkins (D-Concord) came out in strong support of PAS, asking “who is in charge of us at the end of life?” She evoked the specter of force-feeding of dying patients against the express wishes of those patients, calling it torture and saying that families who insist on feeding dying loved ones do so “to make themselves feel better.” Chairman Sánchez found nothing objectionable in that declaration, judging from his silence as his colleague spoke.

One could make the case that a dying person’s family members might support PAS “to make themselves feel better.” Or would that be an uncivil thing to say? Would the chairman have been moved to interrupt someone making that claim? I can only guess.

Rep. Atkins declined to say who’s force-feeding a patient if the patient has an advance directive barring such an activity. Massachusetts already has a durable power of attorney/advance directive law on the books. If the kind of force-feeding Rep. Atkins describes is happening, it’s happening in violation of the law. And if medical professionals and law enforcement officials can’t handle a written order regarding feeding, that gives me no confidence that a PAS law full of “safeguards” would promote patient safety.

If Rep. Atkins is right about force-feeding going on in violation of patient wishes, that means the durable power of attorney law is being ignored. Her colleagues did not question her about that today.

MACLU supports assisted suicide bill; right to be free of “unnecessary suffering.”

Carol Rose of the Massachusetts Civil Liberties Union testified in support of PAS, immediately after testifying in support of the anti-torture bill. She said we all have a right to be free from unnecessary suffering, which makes me wonder what “necessary” suffering looks like in the CLU’s eyes. She also warned of “scare tactics” from PAS opponents. She claimed that the experience in Washington and Oregon, where PAS has been legal for years, shows that abuse of the system Just Doesn’t Happen. Besides, she said, the state has no business being involved in end-of-life decisions.

Her assertion that abuse doesn’t happen requires taking a lot on faith. The Patients Rights Council has tracked euthanasia measures all over the world, including the ones in effect in the U.S. Their information about Oregon’s PAS law includes a warning about incomplete record-keeping regarding acts taken pursuant to the law.

One legislator, whose name I unfortunately did not catch, questioned Ms. Rose: if the state has no business being involved in end-of-life decisions, why do you want the state involved in encouraging suicide? Ms. Rose’s answer was as chilling as it was simple: if the patient is terminally ill, then it’s not suicide for the patient to take her own life.

Her answer was not an aberration. A retired psychiatrist, who is also a former medical director of a hospice, echoed her thought, saying PAS is “not suicide as we understand it.”

Several pro-assisted suicide people testifying re agony of watching a parent die. I’ve been there. Not easy.

Not easy, indeed. Yet PAS is supposed to be about the patient, not the patient’s loved ones, if I understood the bill’s supporters today.

Every supporter of H.1998 who was not affiliated with a group testified about a loved one’s suffering and death. I saw today, and I’ve seen at similar hearings in my own state, that people promoting suicide have no reluctance to tell their stories. People opposed to state-sanctioned, physician-aided death will learn to speak up about their own experiences and those of their loved ones – or else they will lose the political argument, plain and simple.

MCFL: bill encourages lying on death certificate by saying “suicide” won’t be listed as cause of death in PAS cases.

I’m glad Massachusetts Citizens for Life got this into today’s record. This is a feature of every assisted-suicide bill I’ve ever read, including those that have been introduced in my own state: deaths pursuant to PAS are not to be listed as “suicide” on the patient’s death certificate. Whose delicate sensibilities are offended by recording the truth? Does the medical community honestly think that such subterfuge will prevent distrust between patient and provider?

 “Alleviating suffering is different from eliminating the sufferer.” – John Kelly

“To have power of life and death over a person is criminal.” – Kate Ryan

Powerful testimony against PAS came from John Kelly of Second Thoughts, a disability-rights advocacy group, and from Kate Ryan, an advocate for people with autism. I tweeted (well, thought I tweeted) their best lines, which beautifully crystallize the passionate concern for human dignity shared by opponents of H.1998. In their own ways, Kelly and Ryan defended inherent human dignity, not a dignity that depends on being healthy or physically independent or mentally intact. Kelly actually got the attention of the committee, and most of the people in the room – I was sitting in back and could see this – when he started his testimony by taking legislators to task for not making sure sidewalks were cleared around the State House. “That kept some of our people from getting here today.”

#boom, as the social-media saying goes.

Also supporting the bill: Compassion and Choices, a PAS-advocacy group active nationwide. No surprise. C&C sends a lobbyist to any state contemplating end-of-life legislation. Oh, that name! The euthanasia movement has come a long way (and learned a lot about marketing) since the days of Derek Humphry’s Hemlock Society. The C&C lobbyist today said that the ballot initiative failed because PAS opponents outspent pro-assisted-suicide forces 5 to 1  on a “media blitz” of misinformation. (That’s the same figure claimed by assisted-suicide supporters the night the ballot initiative failed, before the final expenditure reports had to be filed.) He considers the legislative route for PAS to be a more considered, more measured way to get the job done.

Keep the public at a distance, in other words. The Massachusetts legislature and governor may yet manage to do just that.

So what’s on your state’s agenda?

 

 

 

 

Five reasons (so far) to watch NH legislators in 2014

New Hampshire State HouseJanuary’s still three months off, and as of this writing 355 proposals for bills have been filed in Concord. The complete list of these LSRs, or legislative service requests, is here.  It’s always interesting to get a preview of coming attractions. This is a simple list of sponsors and topics; the texts of the bills haven’t been prepared yet. Other sponsors will undoubtedly sign on to these proposals later in the drafting process.

Abortion. Rep. Kathleen Souza (R-Manchester) is proposing bills regarding licensure of abortion facilities and collection of abortion statistics. An aside: A post I wrote recently mentioning the lack of a stats bill in NH drew an objection from a reader, who said I had no statistics about abortion’s effect on women to support my concern that we need statistics to measure abortion’s effect on women. Got that?

Death penalty. Rep. Robert “Renny” Cushing (D-Hampton), whose father was murdered in 1988, is once again introducing a bill to repeal the death penalty in New Hampshire. I oppose the death penalty, after years of being ambivalent about it. I have attended hearings on death-penalty bills before, and I am always struck by how many abortion advocates oppose the death penalty and how many defenders of the unborn support it. Time after time, the most consistent voice, defending the right to life for preborn children as well as for condemned murderers, comes from representatives of the Catholic Diocese of Manchester.

Another Dominick’s Law? Rep. Leon Rideout (R-Lancaster) has an LSR to “include ‘fetus’ in the definition of ‘another’ for the purpose of certain criminal offenses.” Another fetal homicide bill, perhaps? If so, recall that in 2012, only a last-minute desperation move by abortion advocates prevented an override of Gov. Lynch’s veto of a similar bill.

Suicide. Rep. Donna Schlachman (D-Exeter) wants to see suicide prevention programs in schools. Rep. Tim O’Flaherty (D-Manchester) has submitted a pair of LSRs relative to suicide, including one to create an affirmative defense for a person who aids or assists someone to commit suicide. Interesting juxtaposition there.

Establishing a committee to study end-of-life decisions. Rep. Charles Weed (D-Keene) is back. Recall what one of his colleagues had to say the last time Weed sponsored an “end-of-life” bill.

Stay tuned for more clues about the 2014 session. At this point, no LSR has been posted online about repealing New Hampshire’s parental notification law.

 

 

 

 

Do Not Even Think About Trying To Resuscitate

A nurse at an assisted-living facility in California followed her employer’s rules last week and stood by as an 87-year-old woman lay dying. A 911 dispatcher urged the nurse to help the woman anyway. According to station KCAL in Los Angeles (a CBS affiliate), the dispatcher asked the nurse who had made the call, “Are we just going to wait and let this lady die?” The nurse replied, “Well, that’s why we’re calling 911.”

I would like to shake that dispatcher’s hand. End-of-life care is a challenge; there was a policy at the facility in question not to perform CPR; the deceased woman, unnamed in the KCAL story, may have had a Do Not Resuscitate (DNR) order through her own choice. Even so, how can we not cheer for someone whose gut-level reaction to a moment of crisis is to care, not to abandon?

A question has been nagging at me after learning of this woman’s death: how far are we from DNR being everyone’s default medical order? More questions arise. If a facility’s DNR policy is appropriate for an 87-year-old, how about someone who’s 85? or 65? Someone has to decide if there’s a cut-off age. No-CPR was the facility’s policy. The news carries no word on whether the deceased woman voluntarily signed a DNR, or if signing one was a requirement for admission to “assisted living.” Assisted? Really?

I heard about this story briefly on NECN this morning, and I went online to find more information. There are blog posts a-plenty, but it took me some time to find the hard news story. CBS Los Angeles has already moved on to other things, with this story no longer on the home page of the web site as of this morning, although it’s available via the link above.

I was with both my parents in their dying days. My father died in a hospital, from cancer.  My mother died in hospice after two weeks in a hospital, after a fall and fracture that led to multiple organ failure. Their wishes for no CPR were clear and, in accordance with our Catholicism, absolutely appropriate. Their wishes were not dictated by a medical facility. There was therefore no hint of denial of care. I am under no mandate, religious or otherwise, to seek physical immortality for myself or for anyone else. That’s the stuff of horror stories.

Even so, I’m haunted by what we don’t know about that woman in California, who died in the hospital after being transported from the “assisted living” facility. Where was she when her heart stopped?  If the facility has a DNR policy on all residents, why even call 911? Was she dead on arrival at the hospital, or did she die sometime later?

CBS Los Angeles’ news story quoted both an attorney and a physician who were appalled by the action, or inaction, of the nurse on the scene and by the facility’s policy. The woman’s family apparently has no issue with the policy, so litigation is unlikely. Ethicists will argue about this case, and that’s about it.

Perhaps this goes on at facilities all over the country, and most 911 operators find such calls unremarkable. We are all the poorer if that’s the case. If a facility makes the decision about denial of care, that is a far cry from the patient autonomy that used to drive public policy debates about end-of-life care.

Rep. Rowe’s straight talk: “The total thrust of this bill is euthanasia”

Rep. Robert Rowe (R-Amherst)

Rep. Robert Rowe (R-Amherst); photo by Ellen Kolb

New Hampshire advocates of physician-assisted suicide have finally learned what some public-policy activists never figure out: sometimes it’s more productive to go after a big goal one little slice at a time. Rep. Charles Weed (D-Keene) has seen the light, allowing his HB 403 to be amended by the House Judiciary committee into a bill to “study end-of-life decisions.” The original bill sought to set up a commission full of “experts” to investigate “death with dignity.” The House passed HB 403 this week, where it awaits a Senate hearing.

Rep. Robert Rowe (R-Amherst), ranking Republican member of the Judiciary committee, wasn’t having any of it. Rowe used to lead Judiciary when the Republicans were in the majority. He is not a man to pick fights. He values collegiality. He also values plain speaking.

At the conclusion of the debate before the February 20 House vote, Rowe spoke up despite Speaker Norelli’s attempt to gavel him down. “The total thrust of this bill is euthanasia.” He is absolutely right. He knows that Rep. Weed has tried twice since 2009 to promote physician-assisted suicide. I consider it unlikely that Weed has abandoned his goal.

The House passed HB 403 on a division vote, 212-140, with no roll call. This comes after inexpedient-to-legislate votes on Weed’s earlier assisted-suicide bills by votes of 242-113 in 2010 and 234-99 in 2011.

Rowe was joined by Rep. (and physician) Joseph Hagan (R-Chester) on the House floor to speak against the bill. They were countered by Rep. Rick Watrous (D-Concord), Judiciary committee member and co-sponsor of the bill, who attempted to allay fears. “This will study end-of-life decisions, including hospice and end-of-life care,” he said. “It’s been awhile since the legislature has looked at this. It’s time to do so again.”

What has changed since the last time the legislature “looked at this”? In a word, money. The legislature should not be open to everything. It ought to come down hard & fast against any move toward legalizing physician-assisted suicide. If that option is on the table, in a world of spiraling health care costs, it will prove irresistible. Care is expensive; ending it is cheap.

That debate is yet to be joined in full here in New Hampshire, but it’s coming.