Monday, February 5, 2018

Oregon legislation deceptively dehydrates incompetent people to death.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

(HB 4135 passed on February 27, 2018)

The Oregon legislature is debating a deceptive bill (HB 4135) that is reported as simply "cleaning-up" the Oregon advanced directives legislation, but in fact HB 4135 promotes the withholding or withdrawal of nutrition and hydration (food and water) from people who are incompetent and not necessarily dying.

Even though Oregon legalized assisted suicide 20 years ago, euthanasia is a prohibited. Euthanasia is an act whereby one person directly and intentionally causes the death of another person, whereas assisted suicide is an act whereby one person directly and intentionally assists another person in causing their own death. HB 4135 opens the door to euthanasia of incompetent people in Oregon.

HB 4135 is deceptive and dangerous piece legislation because it is sold as a bill to update current legislation but in fact it changes current legislation to ensure that incompetent people, who may or may not be otherwise dying, can be intentionally killed by dehydration.

Advanced directives are only relevant when a person is incompetent to make decision for themselves. Therefore HB 4135, by definition, does not ensure that competent people can die by dehydration, but rather that incompetent people can be dehydrated to death.

HB 4135 states:

____ I do not want my life to be prolonged by life support. I also do not want tube feeding as life support. I want my health care provider to allow me to die naturally if my health care provider and another knowledgeable health care provider confirm that I am in any of the medical conditions listed below.
So what are the conditions that are listed below?
a. Close to Death.   
b. Permanently Unconscious. 
c. Advanced Progressive Illness.
d. Extraordinary Suffering.
If a person is incompetent then the person cannot consent to death by dehydration. To withhold fluids, even if the person while competent expressed this desire, dehumanizes the person by denying that person the basic necessaries of life. Withholding or withdrawing fluids from a person, who is not otherwise dying, will cause the person to die by dehydration. Dehydration is often a horrible death, even when the symptoms are masked by analgesics. It is also a form of abandonment to deny a person the basic necessaries of life.

If a person is actually dying and nearing death, withholding or withdrawing fluids may be appropriate but this decision must be based on a factual assessment that providing fluid has ceased to benefit and may harm the person. We do not oppose withholding or withdrawing fluids from a person, when providing it has become useless, burdensome or without benefit.
HB 4135 opens the door to euthanasia by dehydration of incompetent people in Oregon.

HB 4135 must be defeatedIt is dangerous to incompetent people and it specifically promotes death by dehydration. 


Jos Welie said...

I share the concern about the social devaluation of human life, including that of disabled, elderly, or incompetent individuals. There is no shortage of evidence that such devaluation is occurring. Policies that limit PAS/euthanasia to those who are severely ill, handicapped, or over 75 reflect on this dangerous trend. But we have to be careful not to undermine important patient rights in our attempt to fight this devaluation.

One such right is the right to refuse any and all medical interventions, including ordinary life-sustaining medical treatment. When assessing such a refusal against certain religious tenets, we may conclude that such a refusal is immoral. That may lead us to enter into a conversation with the patient to understand the source of that refusal and respectfully attempt to change the patient's view. But we are not justified in forcing medical treatment into the patient. Along similar lines, we may characterize the patient's refusal as a form of suicide, but the health care team that abstains from forcing the refused treatment onto the patient is not guilty of assisting in that suicide.

A real conundrum arises when a patient becomes incompetent to make health care decisions. Except in true emergencies, consent may not simply be presumed. So unless an authoritative source of substitute consent can be identified, health care providers may not initiate or continue non-consented-to medical interventions. Living Wills are a flawed mechanism to extend a patient's autonomy into the phase of incompetence. But it is one of the rare mechanisms we have. Thus, if a patient by means of a LW consents to a particular treatment in advance of becoming incompetent, the health care team may initiate that treatment even if the now incompetent patient cannot explicitly consent. It's a flawed mechanisms, because we do not really know whether the patient in her new condition of incompetence still would have wanted to undergo the treatment and would have consented had she been competent. For example, she may suffer much more from the side-effects than she had foreseen. But a carefully crafted, properly informed LW is still the closest we can come to a real explicit informed consent.

Note that the primary purpose of a LW is not -- or should not be -- to refuse treatment. After all, any and all treatments (except emergency treatments) are presumed to have been refused, unless the patient consents. That situation does not suddenly change when the patient has slipped into incompetence. The incompetent patient retains the same fundamental patient rights. Hence, a patient in her LW may explicitly consent, or explicitly withhold consent, for any and all medical interventions. That refusal may be sinful or foolish from a religious perspective. But the patient's sinfulness or foolishness does not generate a right on the health care provider to force treatment onto the patient. The health care provider who diligently informs the patient while still competent about various life-extending treatment options, all of which the patient next foolishly or sinfully refuses in her LW, is not guilty of either assisted suicide or euthanasia if the health care provider next respects that LW and does not force the refused treatments onto the patient.

Again, LWs are flawed instruments. But their shortcomings apply just as much to treatments consented-to by the patient as refused by the patient. And, by the way, Power-of-Attorney documents are not without flaws either.

PS: Because of said flaws, I have decided neither to issue a LW nor to issue a PoA document for myself.

Alex Schadenberg said...

I agree with your comments about the right to refuse medical treatment or interventions. The concerns arise when dehydration of incompetent persons is permitted. These people cannot consent to this form of death and it is then imposed upon them by society or some "ethics committee."

I agree that you cannot force feed, but denial of fluids to an incompetent person who is not otherwise dying is an abandonment not a freedom.

Unknown said...

I don't consider eating and drinking to be a "medical treatment". I agree the person should not be force fed or intravenously hydrated, but appropriately textured food and water should always be offered in the regular pattern of life.

Jos Welie said...

The Sheila Pouliot case* makes very clear that artificial hydration can also result in great suffering. Unfortunately, I have heard of too many similar stories from hospice nurses about patients quite literally drowning as a result of AN. For sure, health care professionals should take great pains to inform patients about the benefits as well as possible harms when addressing the issue of artificial hydration in their living will. I readily acknowledge that such informing of patients (to make sure their LWs are not even more flawed than they inevitably will be) may reflect an ethical ideal rather than real life. Still, if a patient explicitly refuses both artificial nutrition and artificial hydration in his/her LW, I don't see how we can justify forcing AN onto the patient.

PS: I do not believe it is helpful to malign (hospital) ethics committees. For sure, such committees have many shortcomings, but most individual health care professionals are not without their own shortcomings either, including limited expertise in ethical decision making.