Dr. Anne Hanson's Testimony Opposing Assisted Suicide

Suicide Contagion; Safeguard Failures; and Implications for the Practice of Psychiatry 

This article was published by Choice is an Illusion.

Anne Hanson MD

The Maryland Psychiatric Society opposes HB 643, the End-of-Life Option Act. Since this bill was first introduced in 2015, the Maryland Psychiatric Society has extensively deliberated the legislation within the organization through several listserv discussions, a member survey, and a four hour pro-con debate sponsored jointly with the Maryland somatic physician's organization, Med Chi. In addition to reviewing the legislation each year, we considered information contained in the American Psychiatric Association's resource document on assisted suicide (APA 2017) and other literature as cited in the references below.

The Maryland Psychiatric Society recognizes that this is a divisive issue and that some of our members disagree with the organization's position. Those members have been encouraged to contact their elected officials to contribute their thoughts and we welcome consideration of both sides of this serious policy.

The Maryland Psychiatric Society maintains its opposition to HB 643. There are three general areas of concern.

1. Suicide Contagion

Promotion of this bill, and assisted suicide laws generally, transmit a dangerous message to vulnerable Maryland citizens. According to the Centers for Disease Control,  at any given point in time 4% of people are experiencing suicidal thoughts. One-sixth of those individuals will attempt suicide (1.4 million Americans), and 3% will die (Shreiber and Culpepper 2020). Translated into Maryland numbers, this means that 242,000 people are presently thinking of killing themselves, 40,333 will attempt suicide, and 1210 will die.

Suicide clusters and contagion are well established phenomena with documented connections to media coverage and publicity (Blasco-Fontecilla 2013). The Centers for Disease Control and the World Health Organization both promulgate guidelines for the media coverage of high profiles suicides (Carmichael 2019). These guidelines advise against the portrayal of self-destruction as a “brave,” or “romantic,” and discourage reports which idealize suicidal behavior. They also caution against explicit discussion of suicide methods. These recommendations were developed in part due to a study which demonstrated that deaths by helium asphyxiation increased by more than 400% in New York following publication of the book Final Exit in 1991 (Marzuk 1993).

Proponents of assisted suicide laws violate these public health recommendations when they describe self-destruction as a “graceful” or “beautiful” expression of personal autonomy (Death With Dignity 2020). To date there have been no well designed studies to clarify the relationship, if any, between adoption of assisted suicide laws and states rates of un-assisted suicide. However, following the highly publicized death of Brittany Maynard in 2014 the number of assisted deaths by lethal medication in Oregon nearly doubled, from 71 in 2013 to 132 in 2015 (Oregon 2015). In a letter to the Colorado Springs Gazette, Dr. Will Johnston documented the case of a young man who was inspired to research suicide methods online after being impressed by, and admiring, Brittany Maynard's suicide video (Johnston 2016).

Here in Maryland, two people with serious mental illness have sought psychiatric help to die on the basis of their mental illness. One was a resident of the Maryland state hospital system and made a request for lethal medication on the day the 2019 bill failed in the Senate (Hanson, personal communication). Another was a resident of the Eastern Shore with schizophrenia who contacted several forensic psychiatrists for a capacity assessment in order to apply for euthanasia in Switzerland (Neghi and Crowley, personal communications).

Adoption of this law carries serious implications for people with mental disorders who would demand equality under the law. People with serious and treatment-resistant eating disorders could qualify, since qualification is based upon prognosis rather than diagnosis.

2. Safeguard Failures

The Maryland Psychiatric Society considers the statutory safeguards to be inadequate. Furthermore, they historically have been ignored without consequences to the negligent physicians.

Between 1998 and 2012 a total of 22 Oregon physicians were referred to the Board of Medical Examiners for non-compliance with the provisions of the Death With Dignity Act. None could be sanctioned due to the “good faith” protections of the law, even when required witness attestations were missing. No attempt has been made by Oregon, or any independent researchers, to document unreported cases in Oregon since the entry into force of the DWDA. The true reporting rate in Oregon is therefore unknown (Lewis 2013).

Similarly, in the first year of the Colorado law all prescribing physicians attested that they followed the law even when 42 cases were missing the consultant's evaluation, 22 had no written request, and nine of 69 cases were not reported at all by the physician (Colorado 2017).

In 2016 the Des Moines Register investigated ten years of data in Washington and Oregon, and found that in 40% of cases the reports were missing key data.

Failure to submit required reports, or to hold physicians accountable for reporting failure, is a substantial weakness of this legislation. Even if all required documents were accounted for, there has been no study to date to confirm the accuracy and specificity of these statutory safeguards.

In Maryland, one physician was even willing to violate our state's criminal prohibition. The late Dr. Lawrence Egbert admitted participation in the assisted suicide deaths, by helium asphyxiation, of six non-terminally ill Maryland residents. Three of those patients had co-existing clinical depression. His actions were discovered purely by accident. He was never charged or prosecuted in Maryland. He admitted in an interview with the Baltimore Sun that he had been involved in 15 suicides in Maryland and 300 nationwide (Dance 2014).

If Maryland is unwilling to enforce criminal prohibitions, the enforcement of statutory safeguards is even less likely. Connecticut's Division of Criminal Justice acknowledged that the statutory construction of their legislation would have prohibited prosecution for murder (Connecticut 2015).

3. Implications for the Practice of Psychiatry

This legislation has the potential to significantly complicate the practice of psychiatry in Maryland, for both the treating clinician and when functioning as an evaluator of decision-making capacity.

This law would carve out a class of people who theoretically could be categorically exempt from emergency evaluation procedures or civil commitment. Given that some individuals live for more than one year after receiving a lethal prescription, and that capacity may deteriorate over that time, it is unclear whether a qualified patient who has lost capacity could be assessed and treated for mental illness under this law.

There is no provision to correct an error if lethal medication is given to a patient who has concealed his or her psychiatric history from a prescribing physician. A treating psychiatrist who discovers an error would have no legal means to take custody of or dispose of the medication given to a patient. There is no procedural mechanism to challenge a faulty or erroneous capacity assessment.

A psychiatrist charged with assessing capacity must also rule out the possibility of coercion. In order to do this, the evaluator must be at liberty to interview any individual with relevant information. Under this law, a coerced individual could refuse permission for the evaluator to speak with anyone who has knowledge of the coercion.

The law allows the patient to ingest the medication at the time and place of his or her choosing. Thus, a participating facility could require an inpatient psychiatric unit to allow ingestion on the ward in violation of ward suicide prevention policies. This would be particularly detrimental on units designed for the treatment of eating disorders or in geriatric units, where it would be most likely to occur. People with mental illness also develop co-occurring serious medical conditions such as diabetes; since the law does not require the patient to accept any treatment, this condition would qualify as “terminal” if the individual refuses insulin (Oregon Health Authority 2018). California's health department regulations mandate that state psychiatric facilities must carry out assisted suicides within their units under certain conditions (9 CCR §4601).

Conclusion

Several additional deficiencies have been identified by other opponent groups, and the Maryland Psychiatric Society endorses these concerns. These include:

1.  No requirement for decisional capacity at the time of ingestion.
2.  No requirement for an independent or law enforcement observer at the time of ingestion.
3.  No mechanism to detect a negligent, incompetent, or malicious prescriber.
4.  The risk to third parties in the home (depressed or mentally ill family members).
5.  Detrimental psychological effects on the involved medical professional.
6.  No requirement for a doctor to notify a power of attorney or guardian that a prescription has been requested.
7.  Potential federal civil rights violations if the eligible person is institutionalized in a correctional facility or state hospital where prevention of suicide is an affirmative obligation.
8.  The lack of mental health screening instruments validated in this population for this purpose.
9.  No mandatory reporting or whistleblower protection for healthcare providers aware of negligent or malicious prescribers

References:

Anfang S et al. APA Resource Document on Physician Assisted Death. American Psychiatric Association 2017.

Blasco-Fontecilla, Hilario. “On Suicide Clusters: More than Contagion.” The Australian and New Zealand Journal of Psychiatry 47, no. 5 (May 2013): 490–91. https://doi.org/10.1177/0004867412465023.

California. Petitions to the Superior Court and Access to the End of Life Option Act. 9 CCR §4601 (2016).

Carmichael, Victoria, and Rob Whitley. “Media Coverage of Robin Williams’ Suicide in the United States: A Contributor to Contagion?” PLOS ONE 14, no. 5 (May 9, 2019): e0216543. https://doi.org/10.1371/journal.pone.0216543.

Colorado End-of-Life Options Act, Year One 2017 Data Summary. Available at: https://drive.google.com/open?id=1kBXgAFzHl6kcfsvtLHfOQ94Unk9mDa-  Accessed February 2, 2020

Connecticut Division of Criminal Justice. Written Testimony Regarding HB7015. 2015. Available at https://www.cga.ct.gov/2015/JUDdata/Tmy/2015HB-07015-R000318-Division%20of%20Criminal%20Justice%20-%20State%20of%20Connecticut-TMY.PDF. Accessed February 4, 2020

Dance, Scott. 2014. “Maryland Strips Doctor of License for Assisting in Six Suicides - Baltimore Sun.” Baltimore Sun, December 30, 2014. https://www.baltimoresun.com/health/bs-hs-suicide-doctor-20141230-story.html.

Death with Dignity National Center. Stories. Available at: https://www.deathwithdignity.org/stories/  Accessed February 2, 2020.

Johnson, Will. 2016 “Brittany Maynard’s Story Sends the Wrong Message to Young People.” Accessed February 2, 2020. https://www.choiceillusioncolorado.org/2016/10/brittany-maynards-story-sends-wrong.html.

Lewis, Penney, and Isra Black. “Reporting and Scrutiny of Reported Cases in Four Jurisdictions Where Assisted Dying Is Lawful: A Review of the Evidence in the Netherlands, Belgium, Oregon and Switzerland.” Med Law Int 13, no. 4 (2013): 221–39.

Marzuk PM, Tardiff K, Hirsch CS, Leon AC, Stajic M, Hartwell N, Portera L (1993) Increase in suicide by asphyxiation in New York city after the publication of Final Exit. N Engl J Med 329:1508–1510.  https://doi.org/10.1056/NEJM199311113292022

Munson, Kyle, and Jason Clayworth. 2016. “Suicide with a Helping Hand Worries Iowans on Both Sides of ‘Right to Die.’” Des Moines Register, November 25, 2016. https://www.desmoinesregister.com/story/news/investigations/2016/11/25/too-weak-kill-herself-assistance-legal/92407392/.

Oregon. Death With Dignity Annual Reports. Available at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ar-index.aspx Accessed February 2, 2020
Oregon Health Authority. 2018. Responses to Fabian Stahle. Available at: https://drive.google.com/file/d/1XopTDjBA2SAVBGBxpDazNN899eTHixSe/view. Accessed February 4, 2020

Shreiber, J, and L Culpepper. 2020. “Suicidal Ideation and Behavior in Adults.” Up-to-Date, January. https://www.uptodate.com/contents/suicidal-ideation-and-behavior-in-adults.

Assisted suicide by Zoom

This article was published by First Things on June 5, 2020

*Sign the petition: Healthcare regulations must not permit assisted suicide approvals by telehealth (Link).

By Wesley J Smith

Those who advocate the legalization of physician-assisted suicide always claim that doctor-prescribed death will involve a meticulous process of intimate conversations and hands-on examinations by qualified physicians. They promise that patients who request assisted suicide as a solution to illness or disability will receive a physical to determine the extent of the disease. If declared terminally ill, the patient must next be referred for a second opinion. Only then can the doctor dispense the lethal prescriptions.

But once it’s legal for doctors to prescribe poison, opinions about death and suicide quickly change. Assisted suicide boosters come to see “protections” as unjust “barriers” to attaining a “peaceful death.” This leads to cutting legal corners and breaking public policy promises.

The COVID-19 crisis has provided a pretext for further eroding supposedly ironclad guidelines. When the crisis first hit, assisted suicide advocates wrung their hands because people would be unable to access the medical examinations necessary to obtain doctor-prescribed death. Technology to the rescue! The American Clinicians Academy on Medical Aid in Dying—a newly formed association of doctors who assist suicides—recently published formal guidelines that permit doctors to assist suicides via the Internet. These guidelines state that examination should include a review of medical records and a video meeting via Zoom or Skype. The second opinion can simply be done by phone. This means that assisted suicides will be facilitated by doctors who never actually treated patients for their underlying illness, who may be ignorant of their family situations and personal histories, and who have never met their patients in the flesh.
 

Tele-assisted suicides have already been done. An article published in The Conversation quoted a doctor who quietly began doing streamed suicide consultations years before the COVID pandemic began.

“My patients love telemedicine,” Dr. Carol Parrot, a physician who lives on an island in Washington, told me during a Skype interview in 2018. “They love that they don’t have to get dressed. They don’t have to get into a car and drive 25 miles and meet a new doctor and sit in a waiting room.”

Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing. “I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.”

Parrot told the interviewer that she “sometimes” consults the suicidal patient’s primary care physician. This means that she sometimes does not even bother to discuss the patient with the medical professional most familiar with the patient’s case. 

*Sign the petition: Healthcare regulations must not permit assisted suicide approvals by telehealth (Link).
 
The dichotomy between advocates’ easy promises and actual practice was apparent long before the COVID crisis. In Oregon, where assisted suicide has been legal since 1994, one of the so-called “protective guidelines” requires doctors to refer patients for psychological “counseling” if the prescribing physician suspects that the patient has a mental condition “causing impaired judgment.” Alas, this supposed protection has proved specious. Few physicians ever make these referrals, and when they do, the resulting consultation is often superficial.

Here’s an example. In 2008, an article in the Michigan Law Review—written by the late suicide expert Herbert Hendin and Kathleen Foley, perhaps the nation’s foremost palliative care doctor—described the assisted suicide of Joan Lucas. Lucas tried to kill herself after being diagnosed with Lou Gehrig’s disease, but failed. She next sought assisted suicide. The death doctor referred her to a psychologist only “to protect my ass.”

The consultation was hardly a professional interaction. From the article:

The doctor and the family found a cooperative psychologist who asked Joan to take the Minnesota Multiphasic Inventory, a standard psychological test. Because it was difficult for Joan to travel to the psychologist’s office, her children read the true-false questions to her at home. The family found the questions funny, and Joan’s daughter described the family as “cracking up” over them. Based on these test results, the psychologist concluded that whatever depression Joan had was directly related to her terminal illness, which he considered a completely normal response.

In other words, the psychologist never personally saw the patient and never considered suicide prevention. As Foley and Hendin wrote, “The psychologist’s report in Joan’s case is particularly disturbing because ‘on the basis of a single questionnaire administered by her family, he was willing to give an opinion that would facilitate ending Joan’s life.’”

Promises were broken in Oregon's very first doctor-prescribed death in 1997. Assisted suicide boosters always depict such deaths as taking place in the context of long-term, caring relationships between doctor and patient. But according to Issues in Law and Medicine, when “Mrs. A” was diagnosed with cancer and asked for assisted suicide, her treating physician refused. So she simply went doctor shopping. A second doctor also declined and diagnosed her as depressed. She then contacted an assisted suicide advocacy organization that referred her to a new doctor—one known to be a proponent of physician-assisted suicide. This doctor gave Mrs. A the deadly injection a mere two and a half weeks after first meeting her.

Even when patients do not qualify legally for doctor-assisted death based on the nature or extent of their illness, advocates for euthanasia and assisted suicide manage to find ways around the diagnostic impediment. Canada permits lethal injection euthanasia only if death is “reasonably foreseeable.” But what about people whose deaths are not foreseeable? No worries—they can receive a lethal jab too. An ethics opinion from the College of Physicians and Surgeons of British Columbia decided that patients who are not eligible under current law for euthanasia can become eligible by starving themselves until they are sufficiently weakened and death becomes “reasonably foreseeable.”

What can we learn from all of this? “Protective guidelines” serve mainly to give a wary society a false sense of security about assisted suicide. But once we accept suicide as an acceptable answer to suffering caused by illness or disability, our attitudes toward death become so warped that obtaining suicide for requesting patients quickly becomes the overriding priority. Over time, practices become progressively unregulated—and nobody much cares.

Because many state legislatures are not in session due to the COVID crisis, attempts to legalize assisted suicide in states like New York, Massachusetts, and Maryland are temporarily paused. But these proposals have not gone away. When the political battle resumes, we will again hear many blithe assurances of strong protections. But history demonstrates that “protections” matter little once it is legal for doctors to help patients kill themselves.
More articles on this topic:

• Stop assisted suicide by telehealth (Link).
• Assisted suicide by telehealth and medical misdiagnosis (Link).

Maryland assisted suicide bill will be decided by three undecided Senators.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Maryland Senate

In 2019, the Maryland assisted suicide bill failed in the Senate by a tie vote of 23 to 23.

David Collins with WBALTV reported that the fate of this years assisted suicide House Bill HB 0643 and Senate Bill SB 701 will be in the hands of three undecided Senators. According to Collins:

Three senators who are on the fence may control the bill's fate: Sen. Jim Rosapepe, a Democrat who represents District 21, which encompasses portions of Prince George's and Anne Arundel counties; Sen. Obie Patterson, a Democrat who represents Prince George's County's 26th District; and Sen. Charles Sydnor, a Democrat who represents Baltimore County's 44th District.

Contact these three Senators and encourage them to oppose assisted suicide.

Jim Rosapepe: Jim.Rosapepe@senate.state.md.us

Obie Patterson: obie.patterson@senate.state.md.us

Charles Sydnor:  charles.sydnor@senate.state.md.us

Collins reported on the supporters and members of the group Maryland Against Assisted Suicide.
According to the report:

"You'll hear proponents of this law say, 'It's all about freedom of choice, it's my right, my life.' Well, I can tell you firsthand that these laws reduce your rights to care," said Dr. T. Brian Callister, a professor at the University of Nevada, Reno School of Medicine, and director of Medical Student Rural Education. 

"The lethal drugs used in assisted suicide have never been scientifically tested, and the U.S. (Food and Drug Administration) has never approved any drugs for this purpose," Dr. Joseph Marine, vice director of the division of cardiology at Johns Hopkins University. 

"No one who claims to be a healer should offer death as if it is an option on a menu to choose from depending on how one feels in the moment," said Sherman Gillums Jr., chairman of the federal Veterans' Families, Caregiver and Survivors Advisory Committee.

House Bill HB 0643 and Senate Bill SB 701 may permit euthanasia. Most of the new assisted suicide bills have language that allows a wider interpretation.

The Maryland bill is designed as an application process for obtaining a lethal dose. Most assisted suicide bills state that the person self-administer the lethal dose, making it an assisted suicide.

The Maryland assisted suicide bill does not require the person to "self-administer" the lethal drugs but rather the bill says "may self-administer."

When examining the bill further the potential for euthanasia becomes more clear. The assisted suicide bill § 3–103 states:

A licensed health care professional does not violate § 3–102 of this subtitle by TAKING ANY ACTION in accordance with Title 5, Subtitle 6A of the health – general article.

This paragraph can be interpreted to provides full legal protection for Health Care Professionals who administer the lethal drugs.

Another addition to the recent assisted suicide bill is the acknowledgement that it may take at least 3 hours to die.

Current lethal drug cocktails may cause painful assisted suicide deaths that may take many hours to die.

Assisted suicide lobby researchers are working on their third generation of lethal drug cocktails. The results of the first two experimental lethal drug cocktails were:

The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.The first two lethal drug cocktail experiments failed to provide a painless, fast death.

People who participate in these lethal drug experiments have consented to ingesting the lethal drugs, but are they consenting to participate in human experimentation?

Vote no to assisted suicide.

Marylanders need health care, not assisted suicide

This article was published by the Frederick News Post on February 17, 2020.

By Katie Collins-Ihrke is the executive director of Accessible Resources for Independence, the Center for Independent Living in Anne Arundel and Howard counties.

The Maryland Legislature is expected to again consider an “end-of-life option” bill in its new session. Once again, disability activists will be a prominent part of the coalition to oppose the bill as a discriminatory overlay to a beleaguered and inequitable health care system.
The bill, an assisted-suicide bill, authorizes health care providers to write lethal prescriptions for people who are considered terminally ill, and grants broad legal immunity to everyone involved in their deaths. It does not provide medical and palliative alternatives. The only course of action it facilitates is death.

People have every right to say no to treatment they don’t want. However, there is a sharp distinction between a patient deciding when not to have life-prolonging treatment and a doctor actively prescribing lethal drugs for the purpose of directly causing the patient’s death. As Dr. Joseph Marine, professor at Johns Hopkins University School of Medicine, has stated, assisted suicide:

“is not medical care. It has no basis in medical science or medical tradition ... the drug concoctions used to end patients’ lives … come from the euthanasia movement and not from the medical profession or medical research.”

Physician-assisted suicide is depicted by its supporters as a choice for patients who have tried everything; however, many Marylanders do not have access to “everything.” The medical system is focused on reducing costs as it remains profit-driven. Many people struggle to obtain basic care. Yet there still are “quality of life” prejudices against elders and people with disabilities, and people of color still cope with deadly health disparities. Survival rates for cystic fibrosis, for example, vary depending on the type of insurance a person has available. With the system so broken and no consensus about solutions either on the state or federal level, it is inherently dangerous to legalize assisted suicide for any class of patients.

Data from Oregon indicates that the leading reasons people request lethal prescriptions are unrelated to pain or unbearable suffering, but rather to factors such as perceived lessening of autonomy or dignity. These issues are difficult but they can be addressed by programs promoting greater access to consumer-directed home aide support and respite care, and a change in attitudes about human interdependence. The disability community has shown that severe physical limitations can be managed to maintain one’s enjoyment of life.

It is telling that supporters of last year’s assisted-suicide bill were critical to the point of abandoning the bill when quite minimal patient protections were added to it. Their concern seemed to be not in avoiding needless premature deaths, but in preventing delays and expenditure of resources. For example, a desire to die may be fueled by depression or other psychosocial factors causing suicidal ideation. But some proponents objected to a requirement that a person get a psychiatric evaluation before being given a lethal prescription because “There is a severe shortage of mental health professionals in Maryland,…[especially] in rural areas.” This seems like a tacit admission that Maryland residents may be underserved in their mental health needs at a time when they need services the most.

“End-of-life option” bills are consistently marketed to the public as applying only to people who are expected to die within six months, not to people with chronic illnesses or disabilities. But buyer, beware! Apart from the fact there is no way to prevent mistakes in diagnosis, even when more than one doctor is involved, the term “terminal illness” can be surprisingly elastic. An Oregon health official has written that conditions can be deemed terminal even if there is lifesaving treatment, but the person is uninsured or cannot afford it. This includes diabetes and other serious conditions which can be medically managed.

Curiously, last year’s proponents of the Maryland bill opposed an amendment to add terms like “irreversible” and “progressive” to the definition of terminal illness. Moreover, a recent medical commenter in the Baltimore Sun has urged that Maryland follow not Oregon, but Canada, which allows both assisted suicide and active euthanasia and which is dropping any requirement that death be “reasonably foreseeable,” thus offering assisted death to anyone with a significant health problem or permanent disability.

Disability advocacy organizations are against giving doctors the authority to write lethal prescriptions, regardless of how an assisted suicide bill is written. Catchphrases can’t change the fact that mistakes, coercion and abuses will occur. We aim for a more equitable and supportive health system which gives people true options so they can live as well as they can for as much time as they naturally have.

Assisted suicide bills are not what they appear to be.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The assisted suicide lobby has introduced assisted suicide bills in at least 18 States in 2020. All of these bills include "safeguards" that appear to provide oversight of the law.

Recently I published an article explaining how the "safeguards" are written with loosely defined language to permit the laws to be redefined over time. I also explained that the "safeguards" are designed to convince legislators to legalize assisted suicide, while the assisted suicide lobby intends to remove them overtime. 

For instance, the Hawaii legislature passed an assisted suicide bill in 2018 that came into effect on Jan 1, 2019. There were 27 assisted suicide deaths in 2019.

The assisted suicide lobby is proposing to expand the assisted suicide law after only one year. The Hawaii legislature is debating bills SB 2582 and HB 2451 to expand the assisted suicide law by:

• permitting nurses to prescribe the lethal drugs,
• shortening the waiting period in general, and 
• waiving the waiting period when someone is "nearing death."

The Hawaii legislature also debated bill SB 3047 that would have allowed:

• assisted suicide for incompetent people who requested death in an advanced directive,
• physicians to waive the counseling requirement, 
• assisted suicide to be approved by "telehealth" and 
• require insurance companies to pay for assisted suicide.

Its hard to believe that the assisted suicide lobby wants death by "Telehealth."

The Washington State legislature is debating Bill 2419, a bill to study the "safeguards" in their assisted suicide law. One of the issues to be studied is allowing euthanasia (lethal injection) rather than limiting it to assisted suicide.

Last year the Oregon legislature expanded their assisted suicide law by waiving the 15 day waiting period.

Assisted suicide may not be a peaceful death.

The assisted suicide lobby has been using experimental lethal drug cocktails as they attempt to find a cheaper way to kill. The current assisted suicide drug cocktails have caused painful deaths that may take many hours to die. A recent article stated:

The (first drug mix) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.

The assisted suicide lobby is working on their third experimental lethal cocktail. Assisted suicide is not guaranteed to cause a "peaceful or painless death."

Our greatest concern is the New York assisted suicide bill. Governor Cuomo stated that he will sign an assisted suicide bill into law.

New York Assembly Bill A2694 and Senate Bill S3947 where introduced as the Medical Aid in Dying Act.

As Margaret Dore, the President of Choice is an Illusion stated in her article: New York: Reject Medical Aid in Dying Act:

“Aid in Dying” is a euphemism for euthanasia.[3] The Act, however, purports to prohibit euthanasia. On close examination, this prohibition will be unenforceable.

If enacted, the Act will apply to people with years or decades to live. It will also facilitate financial exploitation, especially in the inheritance context. Don’t render yourself or someone you care about a sitting duck to heirs and other predators. I urge you to reject the proposed Act.

Assisted suicide is an act whereby one person (usually a physician) provides a prescription for a lethal drug cocktail knowing that the other person intends to use it for suicide.

Euthanasia is an act whereby one person (usually a physician) lethally injects another person, usually after a request.

Several of the assisted suicide bills have language that can be interpreted to permit euthanasia.

Assisted suicide bills are usually designed as an application process for obtaining a lethal dose.

For instance the Maryland assisted suicide bill HB 0643 may permit euthanasia (homicide) because it doesn't require the person to self-administer. The Maryland bill doesn't protect the conscience rights of medical professionals either.

The Massachusetts assisted suicide bill can also be interpreted to permit euthanasia.

The New Hampshire assisted suicide bill gives physicians the right to write a lethal prescription but the term self ingest is not found in the main text of the bill. Only within the life insurance section is there a statement that may be construed as limiting the act to assisted suicide where it states:

Neither shall a qualified patient’s act of ingesting medication to end such patient’s life in a humane and dignified manner have an effect upon a life, health, or accident insurance or annuity policy.

Even this statement does not refer to self-ingestion.

The New Hampshire bill permits euthanasia by giving a physician the right in law to write a lethal drug prescription, but it does not limit how the lethal drugs can be used.

New Hampshire assisted suicide bill will create a perfect crime (Link).

Assisted suicide bills are intentionally written in a deceptive manner, so that if legalized, the legislation can be interpreted in a wider manner. Further to that, the assisted suicide lobby has no intention of maintaining the "safeguards" in the bills. These "safeguards" are simply mean't to sell assisted suicide to the legislators.

Hawaii is debating the expansion of its assisted suicide law only one year after it came into effect, and Washington State is examining all of the safeguards, while Oregon expanded its assisted suicide law last year.

Clearly assisted suicide bills are not what they appear to be.

Maryland assisted suicide bill may permit euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In 2019, the Maryland assisted suicide bills passed in the House by a vote of 74 to 66 but failed in the Senate by a vote of 23 to 23.

In 2020, the Maryland assisted suicide House Bill HB 0643 and Senate Bill SB 701 may permit euthanasia. Most of the new assisted suicide bills have loose language to allow a wider interpretation.

The Maryland bill is designed as an application process for obtaining a lethal dose. Most assisted suicide bills state that the person self-administer the lethal dose, making it an assisted suicide.

The Maryland assisted suicide bill does not require the person to "self-administer" the lethal drugs but rather the bill says "may self-administer."

You may be told that "may self-administer" means that the person may change their mind. The term, may self-administer means that someone else can administer the lethal drug cocktail, allowing euthanasia or homicide.

When examining the bill further the potential for euthanasia becomes more clear. The assisted suicide bill § 3–103 states:

A licensed health care professional does not violate § 3–102 of this subtitle BY TAKING ANY ACTION in accordance with Title 5, Subtitle 6A of the health – general article.

The Maryland assisted suicide bill allows another person to administer the lethal drugs, which is euthanasia, and it provides full legal protection for the Health Care Professionals who do so.

Another addition to the recent assisted suicide bills is the acknowledgement that it may take at least 3 hours to die.

Current lethal drug cocktails may cause painful assisted suicide deaths that can take many hours to die.

For more than a year, the assisted suicide lobby has focused on eliminating "safeguards" in assisted suicide legislation.

Assisted suicide lobby researchers are working on their third generation of lethal drug cocktails. The results of the first two experimental lethal drug cocktails were:

The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.

The first two lethal drug cocktail experiments failed to provide a painless, fast death. 

People who participate in these lethal drug experiments have consented to ingesting the lethal drugs, but are they consenting to participate in human experimentation?

Maryland assisted suicide bill dies in the Senate.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Maryland Senate, defeated the assisted suicide bill today in a tie vote. The Baltimore Sun reported:

Wednesday’s vote in the state Senate was on a rare roll call vote on second reading. Customarily, a second reading vote is a voice vote without a record made of who is voting which way. 

The vote was 23-23, one vote shy of the 24 votes needed in the 47-member Senate to advance the bill to a final vote.

A few days ago, the Baltimore Sun reported that the assisted suicide lobby were opposed to the amendments to the assisted suicide bill.

Even after the amendments, the bill was opposed by disability leaders who recognize how assisted suicide devalues and threatens the lives of people with disabilities.

Congratulations to everyone who worked so hard to defeat the Maryland assisted suicide bill.

Sheryl Grossman: Letter to Maryland Senators opposing assisted suicide bill.

Published by the disability rights group, Not Dead Yet, on March 25, 2019.

Dear Senator:

As a disabled MD resident, I implore you to vote no on this very harmful legislation. What has been marketed as a bill increasing choice of those with terminal illness (who almost always meet the federal definition of disability) in actuality reinforces stereotypes and systemic ableism that will do irreparable harm to disabled constituents and Marylanders as a whole.

I understand that several changes were made to the bill that some legislators believe will help protect disabled people from the harms of this bill, but they will not.

1. Raising the age that you can get the prescription from 18-21. This will not protect the most vulnerable–our elders who most report a fear of being a physical and/or financial burden on others. These folks are also most at risk of being pressured, or outright abused, by family members, or caregivers when they may not otherwise do so. Those who have intellectual/developmental disabilities who can pass the psychiatric test of knowing what can kill them or not, can still be easily swayed by those whom they trust to make decisions with them to take their lives when they may not otherwise do so. Nothing in this change will prevent these deaths.

2. Removing the shield that would protect Dr’s from being sued for prescribing the lethal drugs. Since the intended recipient of the lethal prescription dies after taking it, who will be there to sue the Dr? Especially considering that the pressure to take one’s life will likely be coming from a family member, or caregiver.

3. Adding a requirement for a mental health evaluation. This does not mean the provision of crisis intervention services, nor long-term mental health treatment. The kind of evaluation that is possible in the timeframe that this situation presents, is, as described in the original bill, enough time to determine that the person understands that taking this prescription will kill them. Cognitively understanding the consequences of taking this action is very different from psychologically making an informed decision based on all the facts. When someone acquires a life-changing diagnosis, it takes time to gather the available information and even more time to process this information and to connect with others and begin to cope with the new reality. When coupled with the addition of treatments or medications or therapies, the time needed to adjust to a new reality of life is often lengthened. This bill puts bookends on what services can be provided and in what timeframes while if someone in the general public says they want to kill themselves, we rush in crisis intervention services and usually follow-up mental health services. When someone acquires a disability, there are professionals available to assist with the adjustment to the “new normal” no matter how long that is, from a day to a few weeks or months, to forty years or more. As children, this function is often served by Child Life Specialists. As adults, this service is often provided by Centers for Independent Living. This bill undermines the efforts of these whole professions to assist disabled people to live our best lives. It reinforces the stereotype that our quality of life is poor and that we are not worthy of life, without giving us the chance to use all of the resources there for us.

4. Requiring that Dr’s give patients written information about treatment options available for their condition. First, they should be doing this already and if not, then that should be addressed in a different piece of legislation, that is a Dr.’s job. However, when someone receives a terminal diagnosis, treatment is no longer the major issue, adjusting to the new situation and living with the best possible quality of life should be the top priority. This is not a Dr.’s job, nor specialty. Nothing in this bill requires this piece, as I stated above. There are whole professions dedicated to helping people adjust to life situations. This bill makes the assumption that because of terminal diagnosis (presence of progressive disability), these services should not be required. This is ableist and discriminatory and will turn back the clock on the progress disabled people have made in Maryland.

5. Setting a stricter definition of who can qualify. Despite the tweak in the language, it is an established fact that accurately diagnosing someone as having an irreversible condition and that will result in death within 6 months is near impossible. I wasn’t expected to live past 2 and am 43 now. I wasn’t expected to survive the first 12 hours after chemotherapy and I am here 6 years and 2 cancers later. We have all heard of miraculous recoveries and I urge you to see that making a mistake is one thing, but allowing that mistake to lead to the prescribing of a lethal overdose is something completely different and should not be allowed.

I am including here my testimony from two years ago, most of which is still relevant to the bill before you now: (Link to previous testimony).

I urge you to vote NO on S311.

Thank you:

Sheryl Grossman
Community Living Advocate, National Organizing Project
National Council on Independent Living

Wesley Smith: Assisted-Suicide Advocates Oppose Restrictions in Assisted Suicide bill.

This article was published by National Review online on March 25, 2019

Wesley Smith

By Wesley Smith

Assisted-suicide advocates sell their hemlock by promising “strict guidelines” to protect against abuse.

The thing is, the guidelines are never really “strict,” and they don’t offer much protection.

Convincing people of that can be daunting because it takes a lot of explaining. But something just happened in Maryland that illustrates the con in which the suicide pushers engage.

The usual kind of phony-baloney legalization bill passed the House of Delegates, but members of a Senate committee decided to add some — very soft — teeth to otherwise pretty meaningless guidelines. As a consequence, Compassion and Choices (formerly, the Hemlock Society) withdrew its support for the bill.

What were the protections C & C opposed? From the Baltimore Sun story:

Under the bill heading to the full Senate, a terminally ill patient with a prognosis of six months or less to live could request a prescription of fatal medication from their doctor. To qualify, the patient must: 

• Be at least 21 years old, a change from 18 in the original bill. 

• Have their diagnosis confirmed by their attending physician and a consulting physician. Those two physicians cannot be in the same practice or have a financial relationship. 

• Ask for the prescription three times, including once in private with a doctor and with witnesses. 

• Undergo a mental health evaluation. 

The senators also set a stricter definition of who would qualify, saying they must have an “irreversible” condition that affects their quality of life and that “within a reasonable degree of medical certainty” will result in death within six months. The original bill’s standard was “reasonable medical judgment” that the individual is likely to die within six months. 

Doctors also would be required to give patients written information about treatment options that are available for their condition. 

And the senators stripped a requirement in the original bill that would have shielded doctors from civil lawsuits related to prescribing the fatal drugs.

Don’t get me wrong. Assisted suicide should never be legalized. Dying people who ask for suicide should receive suicide-prevention services like all other suicidal patients. Their lives are just as important and valuable.

But when very modest additions to the usual “strict guidelines” pabulum — like the doctor having to provide written treatment options — are decried by activists as, “Too tough!”, the lipstick is off the pig.

C & C and I agree. Don’t pass the bill. Let assisted suicide die in the Maryland Senate.

Post Script: New Mexico just defeated assisted suicide. So did Arkansas. Let’s keep that string of successes going!

Fabian Stahle: A letter from Sweden to Maryland Senators concerning assisted suicide.

Dear Senator,
 

Maryland Senate.

I write to you from Sweden regarding HB 399 and SB 311 because these bills are similar to the Oregon law that is proposed here in Sweden. After contact with Oregon Health Authority I found disturbing information that was not available before and is highly relevant for HB 399 and SB 311 (below referred to as the ”Bills”).

In this letter I would like to draw your attention to a dangerous passage in the Bills regarding the eligibility criteria that the patient shall be diagnosed with a ”terminal illness” that will result in death within 6 months.

Regarding how this 6 months criteria must be interpreted, I have crucial information revealed from a correspondence I had with the Oregon Health Authority (OHA) in the end of 2017. I believe this information is very significant as the Bills definition of "terminal illness" is almost identical with the Oregon definition.

In my correspondence the OHA acknowledged – for the first time officially - that they always had interpreted the 6 months criteria as ”without administration of life-sustaining treatment”, A3 and A8 in the correspondence (Link to the correspondence).

See also my comments (Link to the comments).

This interpretation is counter-intuitive because most people would take for granted that the meaning of ”terminal illness” is a disease for which there is no treatment or medication, i.e. that all hope is gone. But the interpretation is logically inevitable also for the Bills - and
the implications are far reaching.

As a patient has the right to refuse to receive treatment, any patient having a disease that potentially may develop into a terminal condition can make themselves eligible for assisted death – 'for any reason whatsoever'. Hence a trap-door for suicidal patients is imbedded in the Bills.

This is unavoidable because the patient's autonomy ensures that it must be the patient himself who has to decide when enough is enough.

For those who believe in the basic idea of these Bills, it is obviously unreasonable to request that, for example, a cancer patient who is exhausted by radiation and several unsuccessful chemotherapy treatments should be forced to undergo additional painful treatments with dubious results to gain access to assisted death.
But where should we draw the line? Isn’t it also obviously unreasonable that a patient who has very good prospects to be cured can get assisted death by refusing treatment? Shouldn’t we require that a cancer patient accept at least one treatment before talking about assisted death – or at least to account for reasonable motives for their wish to die? Or what about a young diabetic who, in the despair of a broken relationship, wants to die and stops insulin so as to be able to obtain legal suicide assistance - shouldn't we regard that as unacceptable and ask for some sort of limitation?

However, all such attempts to conditions intrude on patient autonomy – the very autonomy the Bills are intended to expand, not decrease – and leads to insoluble demarcation problems. The Oregon Health Authority has also come to this conclusion. (Link to the conclusion). (A4 and A5).

So in the face of these two contradictory positions the Bills must surrender to the patient's autonomy - just as all other laws like the one in Oregon already have.

As a result the obvious interpretation of the central concepts of “terminal” does not apply – but is left open to the patient's own decision, and hence the door is also opened to pure absurdities as to which people can be legally killed:

A cancer patient who has very good prospects to be cured, but denies treatment. An important reason is that she does not want to lose her hair. We are now in Oregon a while after their law for physician-assisted suicide came into force and the patient in question is Jeanette Hall. Her physician, Dr. Stevens is opposed to the law but was forced to acknowledge that his patient would be eligible to get the death pills she wanted because her cancer was likely to lead to death within 6 months if she was not treated. He managed however to convince her to take treatment and many years later Ms. Hall said: "It is great to be alive."

But nor all doctors are like Dr. Stevens.
Dr. Charles Blanke, an oncologist with Oregon Health and Science University, told The Bulletin about one of his cases, a young patient with Hodgkin lymphoma with a more than 90 percent chance of survival with treatment. She did not believe in chemotherapy and feared its toxicity, despite Blanke’s efforts to convince her otherwise. After cleared by a psychiatrist Blanke approved her for assisted death, holding firm to his belief that doctors should not force patients to receive treatment. But afterwards Blanke asked himself:

“Why doesn’t that patient want to take relatively non-toxic treatment and live for another seven decades?”

The answer to Dr. Blanke’s question is just as simple as disturbing in the context of medical killing:

It is because a law that encourages sick people to commit suicide - by the obvious reason that for a suicidal person a socially accepted and smooth death administered by society is much more attractive than dying on one's own in loneliness, just as the young suicidal Belgian woman testifies in this video (Link to the video).

For any reason whatsoever.
 
A person could, as Dr. Blanke’s cases, fear the possibility of side effects or future disabilities. But it could also be a parallel life crisis that is indirectly linked to the disease. And what about those patients who cannot pay for a potentially effective treatment? These Bills allow and encourage people that are not necessarily dying to commit suicide.

These Bills allows and encourages people that are not necessarily dying to commit suicide. Please reject these dangerous Bills!

Sincerely
Fabian Stahle, Sweden