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Tuesday, March 25, 2014

For terminally ill 'Is There a Right to Die?'

Connecticut is one of many states debating whether or not the terminally ill can decide to end their own lives.

By Shannon Firth, US News & Report, March 24, 2014

Close-up of a younger person holding an the hand of an elderly person with an IV drip.
Gary Holder-Winfield says his mother was in terrible pain for years as a result of a multitude of ailments, including diabetes and cancer. She had suffered “off and on” for most of her life.
“I watched my mother actually at some points beg for death,” he says, thinking back on her final years of life, before she passed in 2012.
She was strong, both mentally and physically, and hardly ever missed church. “And I’m not just talking on Sunday,” he says.
“When faced with the pain she had to go through, she had to also wrestle with her belief system versus what she actually was dealing with,” Holder-Winfield, a state senator in Connecticut, says.
Doctors told him around 95 to 97 percent of patients have pain that can be managed, but the doctors at multiple hospitals could not quell the pain.
If his mother had been given the option to end her life sooner and taken it, Holder-Winfield says, “It would make perfect sense to me.”
A Divisive Issue
Assisted suicide is an issue that inflames both opponents and advocates. Nothing is more divisive or more personal than attempting to define the value of a human life and the right to end it.
Supporters of assisted suicide legislation, like Holder-Winfield, say it allows terminally ill patients to end their lives on their terms -- in their homes, if they choose, rather than at a hospital, unconscious or in pain.
But critics say the laws have the potential to cause tremendous harm.
Marilyn Golden, a senior policy analyst at the Disability Rights Education and Defense Fund, a national policy center focused on individuals with disabilities, says assisted suicide, particularly when it involves older patients, increases elder abuse.
“This does not promote patient choice. It invites coercion,” she says.
Golden points to legal experts who note that a patient must have a witness when requesting the self-administered life-ending medication, but no witness is required when the medication is taken.
But supporters of allowing those who are terminally ill to make their own end-of-life decisions say legislating the process would help ensure the elderly, and anyone else who is sick, would not be abused.
Barbara Coombs Lee, president of Compassion and Choices, a nonprofit whose mission is to expand end-of-life choices, says making the process transparent could actually mitigate the problem of elder abuse.
“Once you pass a law that has punishments for the felony of coercion and influence, I think that you diminish the likelihood that anyone will be coerced or influenced,” she says .
Still, Golden argues that multiple studies document examples of people who are terminally ill and “frightened into ending their lives,” when they may have had many meaningful years left. Incorrect medical predictions of abbreviated life expectancies are also frequently wrong, she says, particularly among the disabled.
t or a benefit is really discriminatory,” says Diane Coleman, president and founder of Not Dead Yet, a national disability rights group that opposes assisted suicide.
“We recognize [assisted suicide] for what it is. It’s contempt. Contempt for the value of our lives and we don’t see it as a benefit at all,” she says.
But Holder-Winfield disagrees. The Democrat has worked to pass legislation that would legalize physician-assisted suicide for adult patients who are terminally ill whose requests are deemed voluntary, and who themselves are found to be competent to make such a request.
The Latest Battleground
On March 17, a public health committee of the Connecticut State Senate met to discuss a bill that would allow terminally ill adult patients to bring about their own deaths using a self-administered medication prescribed by a doctor.
Legislators have tried to pass a law in Connecticut to support aid in dying since the late 1990s, according to Holder-Winfield.
If this most recent proposal passes and is signed into law, these patients -- once deemed competent -- would be able to submit two written requests to a doctor no less than 15 days apart and signed in front of two witnesses to procure treatment.
John Kelly, regional director of Not Dead Yet, argued against the Connecticut bill at the hearing. He talked about the financial influences that affect end-of-life decisions, and cited the example of two Oregon residents who received letters from Oregon Medicaid denying them coverage for chemotherapy, but agreeing to cover the cost of life-ending medication.
“Because assisted suicide will always be the cheapest treatment, its availability will inevitably affect medical decision-making,” Kelly said during the hearing.
During the same hearing though, state Attorney General George Jepsen refuted claims that assisted suicide laws would coerce people to die anymore than is done already.
“Coercion is an issue,” he said. “But it’s going on now, so I suggest we have a law.”
The History
Oregon was the first state to legalize assisted suicide in 1994. Three other states have laws that enable terminally ill patients to seek help in dying, according to the National Conference of State Legislatures.
Vermont passed its “End of Life Choices” bill through the legislature in 2013, allowing terminally ill patients to receive lethal prescription medications. Prior to Vermont, Washington passed a similar measure in 2008. Like Oregon, Washington used a popular ballot to enact the controversial policy.
And in 2009, Montana’s Supreme Court decided that patients have a right to “die with dignity” under its state law. The court also decided that state law would prevent doctors from being prosecuted if they helped terminally ill patients die, the NSCL reports.
report published by the Oregon Public Health Division in January examined roughly 16 years of data on assisted suicide cases compiled since 1997.
Critics say the Oregon study is flawed because it’s based on the prescribing doctors’ reports and not patients’ own views. Coleman, of Not Dead Yet, argues that these doctors are often affiliated with Compassion and Choices, and that the reports are not verified by the state.
Since the law was enacted, 1,173 patients have received life-ending medication and 752 of those patients died from using it, according to the study. In 2013, of the 122 people who were prescribed medication used to induce death, 71 of them took it— eight used medications prescribed in previous years.
Coombs Lee says 30 to 50 percent of the people who are prescribed end-of-life medicine never take it. They are able to manage their symptoms and eventually die of their diseases. Those that choose to die do so only when it is clear that death is “imminent and inevitable.”
But Kelly emphasizes that most patients who support and engage in the behavior belong to a clearly defined group: wealthy, educated and white.
Of the 71 patients who died in 2013, 94 percent were white, 54 percent had at least a college degree and nearly 44 percent had private health insurance, according to the Oregon study.
“This is not a human right that we’re talking about. This is an experience that is affecting one social class of people who happen to be very influential among institutions and media in the country and they want something specific,” Kelly says.
Kelly adds he is concerned people who aren’t in the right state of mind could make an irrevocable mistake.
“Depressed people will be harmed by this bill,” he said at Monday’s hearing in Connecticut.
But the belief that people who request life-ending medication are suicidal is one of the most misunderstood aspects of these laws, says Coombs Lee. “People don’t want to die. They don’t want to take this medication, but they are dying. There’s nothing they can do about that. And they want to have the medication in case that dying process is unbearable.” 
Corrected on March 24, 2014: This story has been amended to include the correct number of patients who use end-of-life medicine.

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