New Hampshire's Assisted-Suicide Proposal - Analysis of Amended H.B. 304
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Hampshire Page Currently, assisted suicide is a crime
in New Hampshire. It is a class B felony, punishable for up to seven years in
prison, if a person aids another to commit suicide and that aid results in
suicide or in an attempt to commit suicide. [N.H. Rev. Stat. § 630:4]
H.B. 304, called the "Death with Dignity Act," is modeled on Oregon's
assisted-suicide law.
It would transform the crime of assisted suicide into a medical treatment. The
original proposal, as amended, is analyzed below. NEW HAMPSHIRE'S ASSISTED-SUICIDE BILL:
◊ Gives
government health programs, managed care programs and others the opportunity
to cut health care costs by encouraging vulnerable patients to request
assisted suicide.
Tragically, elder abuse is a common occurrence in today's society. Elderly
patients could easily be pressured by family members or unscrupulous health
care providers into requesting assisted suicide. Although the bill
specifically states that it prohibits coercing or using undue influence on a
patient to request the deadly drugs [137-L:15, II], nothing in the bill
prohibits managed care providers, insurance companies or others from
suggesting assisted suicide to a patient or from encouraging a patient to
request a lethal prescription.
During debate on a similar proposal in California, Sen. Joe Dunn (D-Santa
Ana) cast the deciding "No" vote because the "power of
money" would influence HMO's, health insurers and the state to save money
while cutting back on patient care.
1
In Oregon, some patients have been told by their health insurance provider
that a costly drug prescribed by a doctor to treat the patient's illness
would not be covered but inexpensive lethal drugs for assisted suicide would
be.2
◊ Lets greedy heirs, exhausted
caregivers, or uncaring health care providers select
witnesses for a patient's written assisted-suicide request.
A patient's written request for assisted suicide must be witnessed by two
people who may not be a relative or a person who would
inherit the patient's property or an owner, operator or employee of the
health care facility where the patient is being treated. [137-L:4, II] But
individuals in those categories could select their own personal friends or acquaintances to
serve as
witnesses.
This sets the stage for elder abuse and premature transfer of assets. It
allows those who will benefit from the patient's death to play a key role in
facilitating an assisted-suicide prescription.
◊ Permits doctors to prescribe
assisted-suicide drugs to patients who are not New Hampshire residents.
A person need not be a state resident to be assisted in committing suicide.
One need only be someone who is "regularly treated" in a New Hampshire
health care facility. [137-L:2, XII] A person could travel to New Hampshire
several times seeking treatment for any ailment (such as a skin condition)
and be considered "regularly treated" in a New Hampshire facility. Then, if
that individual has any condition that would meet the criteria of
"terminal," he or she could qualify for assisted suicide in the state.
◊ Lets doctors help depressed or
mentally ill patients commit suicide without providing any type of
counseling or psychological evaluation.
A referral for counseling is only necessary "if, in the opinion of the
attending physician or the consulting physician, a patient may be suffering
from a psychiatric or psychological disorder, or depression causing impaired
judgment." [137-L:7; emphasis added] So, while a person may be depressed or
mentally ill, a referral for counseling is necessary only if the physician
believes the patient's judgment is impaired (i.e., The patient is unable to
make decisions regarding personal, interpersonal, financial and/or medical
affairs.) Many people who are depressed or mentally ill are certainly
capable of making such decisions.
According to Oregon's tenth annual assisted-suicide report, not one patient
was referred for a psychological or psychiatric evaluation before receiving
a lethal drug prescription.
3 Yet, a recent Oregon Health & Science
University study found that one in four Oregonians who request assisted
suicide are likely to be clinically depressed, and the assisted-suicide law
may fail to protect these patients.
4
◊ Lets a doctor help a patient commit
suicide even after the patient is found to have impaired judgment.
Counseling that is required if the physician believes the patient's judgment
is impaired consists of only one consultation between the patient and a
psychiatrist or psychologist. [137-L:2, V] Even if a patient is found to
have impaired judgment, the assisted-suicide bill does not prohibit a health
care provider, family member or other person from arranging for the patient
to be evaluated by other counselors until one is found who will declare the
patient capable of choosing assisted suicide.
In Oregon, it has been noted that "a psychological disorder - senility, for
example - does not necessarily disqualify a person" from receiving assisted
suicide. There, a woman who was suffering from early dementia died of
assisted suicide even though her own physician declined to provide the
lethal prescription. When counseling to determine her capacity was sought, a
psychiatrist determined that she was not eligible for assisted suicide since
she was not explicitly seeking it, and because her daughter seemed to be
coaching her to do so. She was then taken to a psychologist who determined
that she was competent but possibly under the influence of her daughter who
was "somewhat coercive." Finally, a managed care ethicist, who was
overseeing her case, determined that she was qualified for assisted suicide,
and the drugs were prescribed.
5
◊ Lets a doctor write an
assisted-suicide prescription for a patient without seeing the patient in
person after diagnosis of a terminal condition is made.
The bill requires patients to make three requests for assisted suicide - two
oral requests which do not need to be witnessed and one written witnessed
request. [137-L:9] However, none of those requests must be made in person.
The two oral requests could be made by telephone and the written request
could be sent by mail or fax.
◊ Allows drugs for suicide to be sent
to the patient by mail or courier.
Nothing in the bill requires that the drugs be provided in person to the
patient. In one known Oregon assisted-suicide death, the patient received
his lethal overdose by Federal Express.
6
◊ Forces hospitals, nursing homes and
other care facilities to allow doctors to prescribe lethal drugs or
otherwise participate in patients' assisted-suicide deaths on the premises.
The bill states that providers shall not be under any duty to participate in
assisted suicide. [137-L:14, IV] However, under the bill, no health care
provider may subject a person to any penalty, including loss of privileges
at the facility, for participating in assisted suicide. [137-L:14, II]
◊ Contains no safeguards for the patient at the
time the drug overdose is taken.
The attending physician is to counsel the patient about the importance of
having someone else present when the drugs are taken and of not taking the
drugs in a public place. [137-L:5, VI] However, there are no protective
measures to insure that the patient knowingly and/or willingly takes the
overdose.
A greedy heir who arranged for his friends to witness his elderly aunt's
death request could mix the drugs into her food without her knowledge. The
proposal has no provisions to guard against such abuse.
According to Dr. Katrina Hedberg, lead author of most of Oregon's official
reports, the state's job "is to make sure that all the steps happened up to
the point the prescription was written and the "law itself only provides for
writing the prescription, not for what happens afterwards."
7
◊ Has no provisions to investigate
inaccurate, incomplete and misleading reports or to investigate abuse
surrounding assisted-suicide deaths.
Although assisted-suicide advocates claim that Oregon's official reports
about the practice of assisted suicide prove that there have been no
problems or abuses, those claims are, at best, misleading. According to data
provided by Compassion & Choices -- the assisted-suicide advocacy group that
is the chief promoter of "Death with Dignity" bills -- the organization has
participated in three quarters of Oregon's assisted-suicide deaths.
8
According to Oregon's largest newspaper, "Essentially, a coterie of insiders
run the program, with a handful of doctors and others deciding what the
public may know." 9
As with Oregon's assisted-suicide law, the New Hampshire bill requires that
assisted suicide cases be reported [137-L:12] but, as in Oregon's law, there
are no penalties for non-reporting or for inaccurate or incomplete
reporting.
From the time that Oregon's law went into effect, state officials have
acknowledged that "it is difficult, if not impossible to detect accurately"
whether reports are complete.
10 State officials have acknowledged that they
"assume, however, that physicians were their usual careful and accurate
selves" when filing reports about their involvement in assisted suicide.
11
Oregon's Dr. Hedberg explained that investigation into potential
assisted-suicide irregularities cannot take place since "not only do we not
have the resources to do it, but we do not have any legal authority to
insert ourselves." 12
__________________________
1 Greg
Lucas, "Committee votes down assisted-suicide bill," San Francisco Chronicle,
June 27, 2006. 2
KATU TV; "Letter noting assisted suicide raises questions," Portland, OR;
July 31, 2008.
3 DHS, "Tenth Annual Report on
Oregon's Death with Dignity Act," March 18, 2008, Table I.
4 Linda
Ganzini, Elizabeth Goy, Steven Dobscha, "Prevalence of depression and anxiety in
patients requesting physician' aid in dying: cross sectional survey," British
Medical Journal, Oct. 8, 2007, pp. 973-975.
5 Erin Barnett, "A family struggle:
Is Mom capable of choosing to die?" Oregonian, Oct. 17, 1999.
6 Erin Hoover, "Dilemma of assisted
suicide: When?" Oregonian, Jan. 17, 1999.
7 Testimony of Dr. Katrina Hedberg
before the House of Lords Select Committee on the Assisted Dying for the
Terminally Ill Bill, Assisted Dying for the Terminally Ill Bill [HL], Volume II:
Evidence. Apr. 4, 2005, p. 259, question 566.
8
"Compassion & Choices of Oregon Summary of Deceased Patients, 1/1/98 through
9/25/08" distributed by George Eighmey, Executive Director of C & C of Oregon,
Vancouver, WA Public Library Forum on I-1000, Sept. 25, 2008.
9 Editorial Board, "Washington
state's assisted-suicide measure: Don't go there," Oregonian, Sept. 20, 2008.
10 New Eng. J. Med, Feb. 18, 1999, p.
583.
11 OHD,
CD Summary, vol. 48, no. 6, March 16, 1999.
12
Testimony of Dr. Katrina Hedberg before the House of Lords Select Committee on
the Assisted Dying for the Terminally Ill Bill, Assisted Dying for the
Terminally Ill Bill [HL], Volume II: Evidence. Apr. 4, 2005, p. 266, question
615.
Updated March 16, 2009 International Task Force
on Euthanasia & Assisted Suicide
P.O. Box 760, Steubenville, OH 43952
740-282-3810 or 1-800-958-5678
www.internationaltaskforce.org
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