Sunday, August 18, 2019

How a palliative care bill negatively affected conscience rights in Vermont.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

In 2012, Vermont passed bill § 1871 Patient's bill of rights for palliative care and pain management bill. This bill seemed straight forward and it was seen as  seen as helping to prevent the legalization of assisted suicide in Vermont. This bill stated:
(a) A patient has the right to be informed of all evidence-based options for care and treatment, including palliative care, in order to make a fully informed patient choice. 
(b) A patient with a terminal illness has the right to be informed by a clinician of all available options related to terminal care; to be able to request any, all, or none of these options; and to expect and receive supportive care for the specific option or options available. 
(c) A patient suffering from pain has the right to request or reject the use of any or all treatments in order to relieve his or her pain. 
(d) A patient suffering from a chronic condition has the right to competent and compassionate medical assistance in managing his or her physical and emotional symptoms. 
(e) A pediatric patient suffering from a serious or life-limiting illness or condition has the right to receive palliative care while seeking and undergoing potentially curative treatment. (Added 2009, No. 25, § 3.)
In May 2013 Vermont legalized assisted suicide. The assisted suicide statute (Act 39) states:
The rights of a patient under section 1871 of this title to be informed of all available options related to terminal care and under 12 V.S.A. § 1909(d) to receive answers to any specific question about the foreseeable risks and benefits of medication without the physician’s withholding any requested information exist regardless of the purpose of the inquiry or the nature of the information. A physician who engages in discussions with a patient related to such risks and benefits in the circumstances described in this chapter shall not be construed to be assisting in or contributing to a patient’s independent decision to self-administer a lethal dose of medication, and such discussions shall not be used to establish civil or criminal liability or professional disciplinary action.
Notice how the Patient bill of rights for palliative care and pain management and the assisted suicide act require physicians to provide all information and answers to any questions. Both statutes obligate physicians to provide information, even when the physician opposes one of the options.

Does requiring a physician to provide information also require the physician to prove a referral?

On May 23, 2017, Alliance Defending Freedom (ADF) reported a victory, stating that Vermont physicians who object to assisted suicide are not required to provide information or refer for assisted suicide. 

The ADF signed an agreement with Vermont's Attorney General ensuring that physicians were not required to provide information or refer for assisted suicide.

According to Patient Choices Vermont, on December 18, 2017 US District Court Judge Geoffrey Crawford decided that:
“The agreement does not represent the views of the court on the merits of the parties' dispute … The consent agreement is a purely private agreement-not a judicial ruling-and not subject to review on appeal. But it is far from inconsequential and maintaining it on the court's docket has value in informing the public of the terms of the settlement struck by the parties.”
Patient Choices Vermont argues that the language of the Patients bill of rights for palliative care and pain management statute, the assisted suicide statute and the decision by Judge Crawford requires Vermont physicians to provide assisted suicide information.

It is not completely clear whether the agreement between ADF and Vermont's Attorney General stands and it is not clear whether the language of both statutes require Vermont physicians to refer for assisted suicide.

Nonetheless, the concern about being forced to provide information about assisted suicide began with the language in the Patients bill of rights for palliative care and pain management act. 

In this case, a good intention resulted in a problematic outcome.

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