Testimony of Dr Sharon Quick: In opposition to New York assisted suicide bill.

Testimony of Sharon Quick, MD, MA (Bioethics)

President, Physicians for Compassionate Care Education (PCCEF)

In opposition to New York A 136 June 8, 2024

I am President of Physicians for Compassionate Care Education Foundation (PCCEF), an organization without religious or political affiliation that advocates for the vulnerable at end of life. I have expertise in pediatric anesthesia, critical care, and medical ethics. We oppose A 136.

Summary: A 136, like other medically-assisted suicide laws, inevitably violates (rather than upholds) patient autonomy; creates (based on subjective, often inaccurate, criteria) a class of marginalized patients with the disability of terminal illness from whom the standard of medical care can be withheld; allows lethal drugs to unnecessarily substitute for good palliative care and pain control; disproportionately preys on those with mental health problems and disabilities; and destroys the foundation of medical ethics, creating distrust among patients and the health care profession. In addition, A 136 is the most radical policy in the country because it has no waiting period for obtaining lethal drugs.

1. Pain should never be a reason to seek lethal drugs. Complaints of excessive symptoms indicate doctors lack palliative care knowledge, such as when to refer to pain management specialists. Lethal drugs should never be a solution for lack of education. In addition, those in significant pain lack capacity to consent for lethal drugs. Instead, improve palliative care access and expertise, which has been assessed as likely insufficient to meet the needs of New York.(1) There is evidence that minorities, the uninsured, those on Medicaid, and those living in disadvantaged communities may encounter barriers to receiving palliative care.(2) It would be a tragedy for these under served populations if this legislation made lethal prescriptions more accessible than palliative care.

2. This bill has no waiting period to obtain lethal drugs; no other law is so rash. Immediate death does not give adequate time for appropriate discussion and interventions for vulnerable patients who make rash decisions out of fear, depression, embarrassment, subtle pressure by a tired caregiver who makes them feel like a burden, or other reversible or transient concerns. Such patients often change their minds and no longer want to hasten death. Terminal illness is highly associated with depression, and suicidal thinking is highest when cancer is first diagnosed and becomes less frequent as time goes on and patients get support.

3. Physicians may be wrong about a patient’s prognosis, and they often miss depression and compromised decision-making capacity. Patients in WA and OR have died up to 5 years beyond their original “terminal” diagnosis and receipt of lethal drugs. Neither mental health status nor capacity are required to be assessed immediately before a patient ingests lethal drugs, which could be years after initial assessment; there is no guarantee that patients are not compromised at that time. 

4. Lethal drugs are not a proportionate means of achieving palliative care goals but devalue vulnerable patients in a way that violates the very goals palliative care aims to achieve. Assisted suicide is abandonment, not health care, and is not part of palliative medicine. Lethal cocktails are bitter-tasting, sometimes mouth-burning liquids, and patients must ice their mouths with popsicles and take anti-emetics just to get them down. Risks include nausea, vomiting, aspiration, seizures, and not dying. Palliative care can do far better.

5. Lethal drug prescriptions undermine autonomy and discriminate against the disability community. Requests for lethal drugs are not primarily for pain but because of concerns of losing autonomy or abilities or feeling like a burden. These may be symptoms of depression and are usually psychological responses to disabilities developed during terminal illness--which is itself a disability by both social security and ADA criteria. This bill grants new choices and power to health practitioners, not patients, allowing them to treat patients unequally, subjectively placing them into either (1) a protected group (getting standard mental health care) or (2) a marginalized group with the disability of terminal illness (who can be abandoned to lethal drugs). This discriminates against the disability community and undermines autonomy by violating equality of persons. New York does not need a two-tiered health system that devalues those with the disability of terminal illness. 

6. The slippery slope is real. Patients with depression and those with non-terminal diagnoses of anorexia, hernia, arthritis, and “medical complications” have received lethal drugs. Hundreds of doctors’ and patients’ consent forms are missing in Washington and Colorado.

a. In 2023, a dementia diagnosis led Cody Sontag to voluntarily stopping eating and drinking (called VSED) to kill herself. An Oregon doctor said dehydration from VSED would soon cause death; he waived the waiting period, prescribed lethal drugs, and Cody died from them.(3) Dehydration is not “incurable” or “irreversible,” as legally required. How many others with non-terminal diagnoses have used VSED to access lethal drugs? No one—least of all physicians whom the vulnerable must be able to trust—should be granted god-like powers to decide which disabilities make life worthless, prey on those who lack capacity, and assist with termination of those so judged.

7. There is no mechanism to enforce the law or detect abuse, which is perhaps why no sanctions have been reported. The design of this bill, like other assisted suicide laws, is a set-up for undetected elder abuse, coercion, or murder, given neither capacity re-evaluation nor the presence a neutral party are required when patients ingest lethal drugs (sometimes weeks, months, or years after initial evaluation).

8. Doctors often devalue those with disabilities. Protect the medical profession from acting on that bias by not granting them power to assist the suicides of patients disabled by terminal illness—especially a law with so little oversight that physicians are not disciplined for ending the lives of those with non-terminal illness (like Cody).

9. Protect the medical profession from distrust, both between patients and their doctors and among doctors. Patients in the northwest who are opposed to assisted suicide now have legitimate fears that doctors might overlook depression or compromised capacity, devalue them, and prescribe lethal drugs if they request hastened death while depressed or in a moment of vulnerable weakness. A death request is often a plea for help, and people often change their minds about hastening death with time, treatment, and support. Dr. Bentz lost trust in colleagues after referring a patient to an oncologist who, over Dr. Bentz’ objections, gave lethal drugs to his patient instead of treating his depression.

10. This bill contains potential conscience violations for physicians and health care employers:

a. Requires falsifying the death certificate, naming the underlying disease as the cause, rather than the actual cause of death—lethal drugs (p. 12, lines 12-14)
b. It is unclear whether an objecting health care employer can prohibit physician employees from providing information about lethal drug provision or referring patients for them, both of which would violate their conscience as participation in an unethical practice that is not medical care.
c. It is unclear whether objecting physicians could be forced to inform or refer for this process in violation of their conscience.

11. Finally, participants do not need to be New York residents, which may allow out-of-state residents to obtain lethal drugs. These participants may not receive adequate evaluation, especially of capacity and lack of coercion, by New York physicians who may not know them well. Because non-residents would be forced to take the lethal drugs in New York, it may pressure patients to take the lethal drugs immediately, when many patients hold on to the drugs for weeks, months, and even years, and some decide never to take them. Given the number of people who travel to New York from around the world, this may make New York an international assisted suicide tourism destination.

Please vote no on A 136. I am happy to answer any questions you may have.

Sincerely,
Sharon Quick, MD, MA (Bioethics)
President, Physicians for Compassionate Care Education Foundation (PCCEF)

1. CAPC. Palliative Care in New York. 2025. (Link).
2. Chambers B. How to Increase Awareness and Reduce Gaps in Palliative Care for Minorities July 9, 2020. (Link) (accessed 9-22-2024).
3. Pope TM, Brodoff L. Medical aid in dying to avoid late-stage dementia. Journal of the American Geriatrics Society 2024: 1-7. (Link).