Nothing to See Here

On Friday, February 15, 2019, the Maryland House of Delegates heard testimony on the latest presentation of Physician Assisted Suicide legislation.  Little new came from the hearing, with the exception of the celebrity appearance of NPR host Diane Rehm, a longtime advocate of physician assisted suicide.  It is no surprise that the hearing was held on a Friday afternoon heading into a holiday weekend as, despite the claims of supporters, the legislation provides no new safeguards or changes to correct its many flaws and the majority of the testimony came from opponents of the legislation.

With regard to Diane Rehm’s appearance, the media generally reported her testimony similarly to this account from the Hagerstown Herald-Mail,

Rehm, a former NPR host, has supported assisted-death legislation since her husband, John, died while in hospice care in Maryland 2014. She told a crowded hearing room filled with supporters and opponents that her husband felt betrayed that the law would not allow a physician to end his suffering, even though he only had months to live. His doctor told him he could stop eating and drinking, and that’s what he did the next day.

The hearing, along with most media accounts, opened with Ms. Rehm’s emotional account of her husband’s frustration in getting physician assistance in killing himself. The appeal to emotion obscures both the serious consideration and the reporting of the issue and the serious criticisms of the legislation.

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As to Rehm’s claims, National Review’s Wesley J. Smith, a lifelong advocate in against physician assisted suicide, rebutted her case in this piece years ago where he identified her as an advocate for suicide.  As Smith put it,

I know many–including Diane Rehm–will be offended by the headline. But pushing assisted suicide, is pushing suicide, is pushing suicide.

People who kill themselves over health, disability, or mental illness issues commit suicide every bit as much as the mother who ends her live because her children died or a business does the deed after a business failure. 

The word “suicide” is simply descriptively accurate.

The question which we are engaging in the assisted suicide debate is how a loving community should respond to a desire to end it all by those who want to die because of illness, disability, or mental illness.

In my view, all suicidal people should be offered prevention services, not have their deaths facilitated. Otherwise, a strong statement is being made by society that the lives of the healthy suicidal are worth saving, but not those of the ill suicidal are not.

In any event, NPR radio personality Diane Rehm’s husband committed suicide by self-starvation with her support–he was anguished over his severe Parkinson’s disease–a process euthanasia activists refer to as VSED (voluntary stop eating and drinking). VSED is pushed by Compassion and Choices as a splendid way for the elderly to become dead.

Rehm was understandably upset at watching her husband dehydrate slowly over two weeks, so she is lending her voice to push assisted suicide.

…

Think of the message that Rehm unintentionally sent to those struggling with issues of physical decline or disability, with illnesses terminal and chronic, with mental anguish and pain, that if they are suicidal, they are right: Their lives are not worth carrying on.

It makes the lives of many such suffering people more difficult and harder to carry on! I know. I hear from them.”

(Do yourself a favor and follow Wesley J. Smith on twitter @forcedexit and read his Human Exceptionalism blog)

Of course, if you need to be swayed by compelling personal stories on this issue, consider  the testimony of former Raven O.J. Brigance as reported in the Baltimore Sun,

Also consider this profile of Stephanie Packer, a 29 year old mother of four diagnosed with terminal lung cancer,

“Wanting the pain to stop, wanting the humiliating side effects to go away — that’s absolutely natural,” Packer says. “I absolutely have been there and I still get there some days. But I don’t get to that point of wanting to end it all, because I have been given the tools to understand that today is a horrible day, but tomorrow doesn’t have to be.”

And it’s that kind of support — from family, friends and people in her community — that Stephanie says keeps her living in gratitude, even as she struggles with her terminal illness and the realization that she will not be there to see her children grow up.

“I know eventually that my lungs are going to give out, which will make my heart give out,” she says. “And I know that’s going to happen sooner than I would like — sooner than my family would like. But I’m not making that my focus. My focus is today.”

What a better message to send those despairing and facing a terminal disease diagnosis.

Opponents of the bill presented many compelling reasons to reject this legislation.  Maryland against Physician Assisted Suicide summarized the problems with the legislation this way:

No doctor, nurse, family member or independent witness is required to be present when the lethal dose is taken.

• This creates a huge opportunity for abuse of patients – coercion of the elderly by those with a financial stake; forcing of the lethal prescription on those who cannot self-administer (e.g. an ALS patient) or who do not have the mental capacity to understand (e.g. an Alzheimer’s’ patient)
• The large majority of assisted suicide does not take place in a healthcare setting. 89.5% of assisted suicides in Oregon in 2014 happened at home.[1] What if something goes wrong and the patient needs medical help immediately? There is no one there to help.

Patients will pick up their lethal prescriptions at their local pharmacies.

• That means you’ll be waiting in line at the pharmacy and the person in front of you may be waiting to pick up their 90-100 pills to kill themselves. 
• In California, patients are allowed to receive their lethal prescription via mail. This eliminates any controls to prevent the lethal drugs from falling into the wrong hands. 

There is no requirement that patients receive a psychological evaluation before doctors can authorize physician-assisted suicide. A screening from a doctor untrained in mental health is not sufficient.

• We know that patients with a terminal diagnosis have much higher rates of depression[2]. Why shouldn’t a depressed person receive treatment for that condition before they are even allowed to consider suicide?
• During a 2016 legislative hearing in Maryland, a top supporter of this bill claimed a required mental health check would “unnecessarily slow down” patients access to lethal drugs. 

Accurately predicting a six-month terminal diagnosis is next to impossible – even doctors admit that it is simply an educated guess.

• The Oregon “Death with Dignity” data makes this argument for us: 7 patients receiving a PAS prescription in years prior to 2015 took the lethal dose in 2015. That means they outlived a 6 month terminal diagnosis by more than a year, at least.
• We all know people who have outlived their terminal diagnosis by months to years.
• New treatments for once incurable diseases are being discovered every day. 

Suicide contagion is a real problem that proponents refuse to answer for.

• A new study in the Southern Medical Journal shows a direct link between legalizing physician assisted suicide and an increase in non-PAS suicides statewide[4].

PAS is seen as a cost savings measure for insurance companies, including state Medicaid programs.

• In states like Oregon, both private and public insurance cover the cost of assisted suicide drugs. This increases pressure on insurance companies and the state to offer PAS instead of life saving treatments that are likely much more expensive.
• In the fiscal note prepared for the 2016 Maryland legislation, they implicitly argue this bill may save the state money: “The Medicaid program may realize savings to the extent a qualified individual dies sooner than would otherwise occur”

Pain is not even in the top 5 reasons why patients wanted physician-assisted suicide (it’s 6th) 

• As noted in the most recent Oregon “Death with Dignity” report (2015), the three most frequently mentioned end-of-life concerns were: less able to engage in activities making life enjoyable (96.2%), losing autonomy (92.4%%), and loss of dignity (75.4%). Inadequate pain control ranked 6th with only 28.7% of patients reporting this as a reason why they wanted a lethal prescription.  

Maryland Residents Already Have Excellent End of Life Care Options 

• Palliative care is available to all patients dealing with a serious illness, whether terminal or not, and is a multidisciplinary approach to providing relief from pain, stress, etc. that comes with serious illness.  
• Hospice care is available to all with a terminal illness and provides pain relief and symptom management – all of which is paid for by Medicare/Medicaid and almost all private insurance plans.
• Why isn’t the Maryland Legislature doing everything it can to increase use of palliative and hospice care before it even considers legalizing suicide? The Workgroup Report on Hospice Care, Palliative Care and End of Life Counseling[5] summarized this issue well and helped implement a number of changes in Maryland to increase access. However, more can still be done on this issue.
• Medicare is now covering end of life counseling. This should increase the number of Medicare patients who are fully educated about existing end of life care options such as palliative care and hospice care. We know from Oregon that 60.2% of those receiving a PAS prescription in 2014 were on Medicare or Medicaid[6].

If the proponents were serious about addressing the issues with this legislation, they would address the concerns raised by Maryland Against Physician Assisted Suicide as well as these:

• Why the bill requires doctors to lie on the death certificate about the cause of death when there is an assisted suicide.  This is a clear indication of the duplicity of the movement behind this bill.  Similar bills in other states are calculated to lead to a one third increase in the suicide rate.
• How they expect Maryland to avoid the “dark fusion of socialized medicine and institutionalized medical euthanasia” that is already occurring in Oregon as exemplified by the examples of Barbara Wagner and Randy Stroup.
• How they reconcile the fact that the nation faces a crisis in suicide and a lack of suicide prevention at the same time that bills such as this, especially with the championing of the idea of  “autonomy”, promote suicide generally. Suicide is already the 10th leading cause of death in America with more suicides every year than homicides.
• They will also need to convince their progressive colleagues why they should ignore the Progressive Case Against Assisted Suicide.

My guess is they won’t ever get around to rebutting these arguments.  Instead, they will trot out the same tired tropes  like that made by the O’Malley cronies at Center Maryland:

According to Gallup, around 70 percent of Americans believe physicians should be able to legally end a patient’s life by some painless means. Citizen perceptions toward right-to-die legislation have remained consistent during the time period demarcated by the high-profile Terri Schiavo and Brittany Maynard cases. Although question wording and framing matters—support diminishes when the word “suicide” is present in the question—a majority of Americans support it, no matter how the question is asked.

 

Some of them have now migrated to Maryland Matters who, true to form, is touting a new poll showing similar numbers in support.  They ignore that this poll, with all due respect to Dr. Kroemer and the good folks at Goucher polled adults (not likely or even registered voters) and presented a question on the issue that buys into all the deceits of the supporters of the legislation (like never using the word suicide at all).

As the numbers in Maryland have not changed over the years, there is no expectation that the outcome will either. Moreover, while Governor Hogan has not stated a firm position on the bill, there would never be enough support to override his likely veto.

As this fight continues, and the State Senate hears SB 311 tomorrow, I urge everyone who opposes this bill to join the Maryland Coalition Against Physician Assisted Suicide, continue to follow us here at Red Maryland as well as the other voices defending life. Please share the information these outlets have provided and educate your friends and neighbors about this important issue.