Patient Choices Vermont (PCV) appears to be trying to drum up users for Act 39. It seems that some 108 requests for a lethal prescription (87 of which were used) since 2013 aren’t enough, and they hope that S.74 will help make it easier to end the lives of more people using doctor-prescribed lethal drugs.
Briefly, the changes proposed under S.74 are as follows:
- Eliminate the in-person requirement to request a lethal prescription
- Eliminate the requirement that the prescribing physician have conducted a physical examination of the patient in order to confirm the terminal diagnosis
- Eliminate the 48-hour waiting period between when a patient is approved to receive the lethal medication and the writing of the prescription
- Grant explicit civil and criminal immunity to anyone who participates in Act 39
What problem is being solved here? In an email to True Dignity, the bill’s chief sponsor, Sen. Richard McCormack (D-Windsor) said that “safeguards against imagined abuses and oversights” were put into the original law, in part in response to objections by opponents of the bill. He said that these have proven to be unnecessary impediments to those seeking to end their lives with the help of a doctor’s prescription. He boldly adds that, “Compassionate professional caregivers require protection from prosecution as much as do physicians. The bill protects them and expedites their service to dying people.”
One might ask who stands to gain the most by expediting the dying process? Safeguards in Act 39 (which we believe are still grossly inadequate) were intended to protect those who might be coerced or pressured to end their life early and to guard against the erosion of good palliative care options. S.74 seeks to undermine these goals.
Alarmingly, a chief proponent of loosening safeguards in this already unsafe law, is Diana Barnard, MD, a Porter Hospital palliative care physician connected with the University of Vermont Health Network. It is not reassuring that a doctor in charge of providing compassionate end of life care would consider death by suicide to be a desirable treatment option.
PCV uses the story of Dee Allen, who used Act 39 to end her life in December, to highlight what they claim are unnecessary obstacles to obtaining a lethal prescription. In a video of Allen available on the PCV website, Allen says that her doctor told her that death from her disease, “Is the most horrifying way to die I’ve ever seen, even worse than Ebola.” One might ask what kind of a “compassionate caregiver” tells that to a patient struggling with a terminal diagnosis, and what the motive might be for doing so, particularly when there are known effective palliative care treatments available.
When Act 39 was being debated, we were repeatedly promised that there would be adequate safeguards to prevent abuse. And yet, in the years since Act 39 was enacted, it has already become a “standard of care” to offer assisted suicide to patients as simply another “treatment option,” (euphemistically called “aid in dying”), which arguably applies subtle pressure on a patient when proposed by a medical care professional.
S.74’s proposed loosening of restrictions seems tailor made for abuse. For example:
- How would a doctor on a telehealth call know whether there is someone in the room with the patient, monitoring the call and pressuring them to request the drugs? How can a doctor adequately evaluate the physical and social-emotional needs of a patient in a telehealth setting? What kind of doctor would prescribe life-ending drugs to a patient based on a video call? There does not appear to be a requirement that the doctor even be in Vermont or have a prior relationship with the patient; this alone seems to encourage a market for online for-profit physicians to operate.
- Shortening the timeline to accommodate patients ostensibly in a hurry to get the prescription before they die naturally, or, in the one case highlighted by PCV, to use the drugs before they become unable to self-administer them, does not take into account the reason for the timeline in the first place.
To illustrate, consider some parallels with the birthing process: Both are life transitions, both benefit from prior planning, and both are natural processes that sometimes call for help with pain management and emotional support. Many women who give birth plan carefully in advance, often writing detailed birth plans outlining their wishes regarding pain management and other aspects of the experience. Similarly, well in advance of death, adults frequently fill out advance directive forms with specific instructions on what kinds of treatment they may want (or not). In both cases, when the unexpected happens, these written directives can be invaluable tools for determining the best course to follow for an individual patient.
Unlike the birthing process, which has a predictable timeline; the dying process usually progresses much more slowly. There can be several points along the way when a person might succumb to doubt, depression or even despair, and potentially make a request contrary to earlier expressed preferences. It may come from a place of worry about being a burden, or coercion from others. At such moments, what is needed is not to immediately be handed a metaphorical loaded gun, but rather to be offered ways they can be emotionally and physically supported, and at the very least, be asked to wait a short time before finalizing their decision.
- There is already legal immunity written into Act 39 for physicians. Adding immunity for anyone—including non-medical people such as family members, increases the opportunity for abuse. As it is, there are no provisions in Act 39 requiring oversight or documentation of the ingestion of the prescription; there is no inquest into the death in order to determine that the death was actually carried out according to the law. Extending immunity to literally anyone involved, opens the door even further to the possibility of abuse, euthanasia and murder.
If advocates of Act 39 are worried that not enough people are “making use of” Act 39, then perhaps organizations like Patient Choices Vermont would do better to spend their public relations efforts on educating those who support assisted suicide for themselves about the steps involved in the process, than lobbying for dangerous and unnecessary legislation such as S.74 that puts vulnerable people at risk.