Legislative Report 5/9/2013 - End of Life Choices

I have heard from constituents for and against S.77, Choices at the End of Life.  It has been one bill that I have been very conflicted about, and I have put a lot of thought into it.  I listened to testimony from both perspectives during the Senate hearing a couple of months ago.  I have read the emails, the editorials and the handouts on both sides of the issue.  Before coming to a final decision on whether to support it or not, I wanted to wait until the House Human Services Committee completed its work.  That time arrived last week.

In thinking about this concept, I believe that the patient is the highest priority to be considered.  I know that palliative care and hospice are good alternatives as one approaches an end to life under potentially painful, drawn-out circumstances.  I believe that each person has a right to approach death in a manner that they feel best suits their belief system and circumstances.  I believe that patients must be able to make such decisions free of overt or subtle coercion.  I believe that participation in administration of the treatment proposed by S.77 must not be required of physicians or institutions that have philosophical objections or policies prohibiting such treatment. 

It is with these criteria that I evaluated S.77 and made my decision to support its passage.  The House Human Services Committee carefully constructed the bill to take into consideration these same criteria.  S.77 places heavy emphasis and requirements for the protection of the rights of the patient, much more so than Oregon's law and more than what were originally proposed in the Senate.  It requires that the patient have a terminal illness with a prognosis of life expectancy of less than 6 months as diagnosed by a physician and be informed that the prognosis is just an estimate.  It requires a second opinion on the prognosis from another physician who must also determine that the patient is capable of acting voluntarily. It provides strict requirements to ensure that the patient is making the request multiple times of their own free will, and it requires waiting periods between the two oral and one written request by the patient to participate before the drugs can be dispensed to the patient.  Rather than exclude the patient's family from the process, the patient must be encouraged to notify a next of kin or someone with whom the patient has a significant relationship after they make their initial decision.  And, importantly, it requires the physician to inform the patient of all feasible alternatives for end of life care, including palliative care and hospice.  Furthermore, it allows the patient to rescind their request at any time should they change their mind.

Under the status quo a patient with a terminal illness who has concerns about pain, cost of care, burdens on their family members, etc., can decide to end their lives without this bill by any number of methods.  They may not have taken the opportunity to find out what alternatives to taking their life are available, or to talk to family members out of fear of upsetting them or being talked out of what they are doing, and they may not be fully aware of what could go wrong with their plans and the consequences.  But if they are determined to do so, they may go ahead with their plans.

S.77 lays out a process that would provide an opportunity to make the same plans, but with the advantage of a second opinion, counseling on hospice and palliative care alternatives, requirements for multiple requests requiring multiple reconsiderations of their decision, and the considered involvement of loved ones who might also have the opportunity to let the patient know that they are still loved and valued. If they decide to go ahead anyway, they will have the assurance that it will be effective based on medical knowledge. 

S.77 does not encourage suicide.  On the contrary, it involves the state in the patient's decision only to insure that the decision they are making is well informed and well thought out.  To this extent it is, in my opinion, an improvement over the status quo.  And that is why I voted for its passage.

Note: While I supported the version of S.77, I was disappointed that the House-Senate conference committee changed the bill  by inserting a section that repeals the House version in 2016 and replaces it with the Senate language that deleted most of the safeguards I described above.  For this reason I did not support the conference committee report and declined to vote on the final measure.