Blog Testimony/Comments

Testimony on Delaware H.B. 140, Regarding Physician-Assisted Suicide

Testimony of Catherine Glenn Foster, M.A., J.D.

On H.B. 140

Submitted to the House Well being and Human Improvement Committee

Might 8, 2019

Pricey Chair Bentz
and Members of the Committee:

I function President and CEO of People United for Life
(AUL), America’s unique and most lively organization advocating for life-affirming
help and protections for probably the most weak members of our communities. Established in 1971, AUL has dedicated almost 50 years to
advocating for everyone to be welcomed in life and protected in regulation. In my
apply I focus on life- and health-related legislation, and am
testifying as an skilled in constitutional regulation usually and within the
constitutionality of end of life-related legal guidelines particularly. I have also written
extensively on the end-of-life challenge, most lately in The Human Life Evaluate.
I respect the opportunity to offer written testimony towards H.B. 140,
which might legalize suicide by medical means in Delaware.

I
have completely reviewed H.B. 140, and it is
my opinion that the Act locations already-vulnerable persons at even larger danger,
fails to guard the integrity and ethics of the medical career, and goes
towards the prevailing consensus that states have an obligation to protect life.

Suicide by Doctor Places
Already-Weak Individuals at Higher Danger

Delaware
has a duty to guard weak individuals—together with individuals dwelling in
poverty, elder adults, and those dwelling with disabilities—from abuse, neglect,
and coercion. Contemplating the danger posed to those weak individuals, legalizing
suicide might be thought-about neither a “compassionate” nor an applicable answer
for many who might endure melancholy or lack of hope on the end of life.

Indeed,
opposite to the prevailing cultural narrative, the rationale why individuals think about
in search of assistance of their suicide is neither ache nor worry of pain. In the
last 15 years, ache and worry of pain have never been in the prime five reasons cited
by these looking for assisted suicide in Oregon;[1] the newest knowledge from Washington State
reveal the same considerations.[2] As bioethicist
Ezekiel Emanuel has noted, “the primary drivers [of these considering suicide by
doctor] are melancholy, hopelessness, and worry of lack of autonomy and
control. . . . . In this mild, assisted suicide seems
less like an excellent dying in the face of unremitting ache and extra like plain previous
suicide.”[3]

Emanuel
is just not alone. Many within the bioethics, legal, and medical fields have raised
vital questions relating to the existence of abuses and failures in
jurisdictions which have authorised prescription suicide, including a scarcity of
reporting and accountability, coercion, and failure to guarantee the competency of
the requesting patient.[4] The
most weak amongst us, such because the poor, the aged, the terminally unwell,
the disabled, and the depressed, are equally worthy of life and much more in
need of equal protection beneath the regulation, and state prohibitions on promoting or
enabling suicide mirror and reinforce the well-supported policy “that the
lives of the terminally unwell, disabled and aged individuals have to be no much less valued
than the lives of the younger and healthy.”[5] Chatting with this disparate
remedy, Dr. Kevin Fitzpatrick wrote, “When non-disabled individuals say they
despair of their future, suicide prevention is the default service we must
present. Disabled individuals, against this, feel the seductive, straightforward arm of the few,
supposedly trusted medical professionals, around their shoulder; somebody who
says ‘Well, you’ve carried out sufficient. No-one might blame you.’”[6]

There was discussion of a “suicide
contagion,” or the Werther Impact.[7] Empirical evidence exhibits media coverage of suicide evokes others to commit
suicide as properly.[8] One
research, which included assisted-suicide statistics, demonstrated that
legalizing assisted suicide in certain states has led to a rise in general
suicide charges—assisted and unassisted—in those states.[9] The
research’s key findings show that after accounting for demographic, socioeconomic,
and other state-specific elements, physician-assisted suicide is associated with
a 6.three% improve in general suicide charges.[10] These
results are even higher for people older than 65 years of age—14%
improve.[11] And so
suicide prevention specialists have criticized assisted-suicide promoting
campaigns, writing that a billboard proclaiming “My Life My Death My Choice,”
which offered an internet site tackle, was “irresponsible and downright harmful;
it’s the equivalent of handing a gun to someone who is suicidal.”[12]

The Supposed Safeguards Are Ineffective in
Follow

Regardless of
the so-called “safeguards,” opening the door for suicide by way of prescriptive means
also opens the door to real abuse. For instance, H.B.
140’s mental health
evaluation requirement is woefully inadequate. The Act merely requires the
physician guarantee the person has
“decision-making capacity,” and refer the affected person to a mental well being
professional if he or she “believes the individual might not have decision-making
capacity.”

This safeguard is
ineffective for two causes. First, H.B. 140 defines “decision-making
capacity” as the power to “understand and respect the character and
penalties of a specific health-care choice, including the advantages and
risks of that decision and options to any proposed well being care, and to
reach an informed health-care determination.” Act § 2508B(8). This does not
require any confirmation the individual shouldn’t be suffering from a psychiatric
situation that would influence his or her choice to decide on to end his or her
life. Even if the individual have been found to endure from such a condition, that
doesn’t preclude the psychiatrist or psychologist from figuring out the
individual can perceive the character and penalties of his or her determination to
finish his life. And so an individual affected by melancholy may by no means receive
remedy, but relatively be deemed able to understanding the decision to
request assistance in suicide, and be prescribed the deadly medicine.

Second, if the
physician does determine to refer the person—which he isn’t required to do—there
is not any requirement that the referred psychiatrist or psychologist meet with the
particular person more than once. As
the newest statistics from Oregon present, only 3 of the 168 patients who
died from ingesting end-of-life medicine in 2018 have been ever referred for a
psychiatric evaluation.[13] Equally, in Washington, only 4 of the 196 individuals who died in 2017 have been
referred for a psychiatric analysis.[14] One research from Oregon discovered that “[o]nly 6% of
psychiatrists have been very confident that in a single evaluation they might
adequately assess whether a psychiatric dysfunction was impairing the judgment of
a patient requesting assisted suicide.”[15] For these reasons, it’s troublesome to argue this
“safeguard” in H.B. 140 will take into
account or accurately assess an individual’s psychological well being.

Another example of the unreliability
of these “safeguards” is the requirement there be a minimum of two witnesses
to the request for life-ending medicine—but just one have to be a disinterested
get together, no less than in concept. The Act explicitly allows one of many parties to be a
relative, beneficiary, or other interested social gathering, simply circumventing the
alleged safeguard designed to protect the individual from strain, coercion, or
abuse.

In
addition, the Act assumes the physicians are capable of make the right analysis
that a patient is has an incurable and irreversible illness which can “outcome
in dying within 6 months.” However this fails as a safeguard as terminality just isn’t straightforward
to foretell. Present research have proven “specialists put the [misdiagnosis] fee at
round 40%,”[16] and
there have been instances reported where, regardless of the shortage of underlying signs,
the physician made an “error”[17] which resulted in the particular person’s demise. Prognoses may be made in error as
nicely, with one research displaying a minimum of 17% of sufferers have been misinformed.[18] Nicholas Christakis, a Harvard profess or sociology and drugs, agreed
“docs typically get terminality mistaken in figuring out eligibility for hospice
care,”[19] and Arthur Caplan, the director of the Middle for Bioethics at the College
of Pennsylvania, considers a six month requirement arbitrary.[20] Even the Oregon Health Authority admitted, “
disease be allowed to take its course, absent
further remedy, is the affected person more likely to die inside six
months? . . . [Y]ou might additionally argue that even when the
remedy [or] treatment might truly remedy the illness, and the affected person can’t pay for the remedy, then the illness
remains incurable.”[21]

Suicide
by Physician Erodes the Integrity and Ethics of the Medical Career

Prohibitions
on physician-enabled suicide also shield the integrity and ethics of the
medical career, including its obligation to serve its patients as healers,
as well as to the rules articulated in the Hippocratic Oath to “hold the
sick from harm and injustice” and to “refrain from giving anyone a deadly drug
if requested for it, nor make a suggestion to this effect.”[22] Likewise,
the American Medical Association (AMA) doesn’t help physician-assisted
suicide, even for individuals dealing with the top of life. The AMA states that “permitting
physicians to interact in assisted suicide would finally cause extra harm than
good. Doctor-assisted suicide is basically incompatible with the
doctor’s position as healer, can be troublesome or unattainable to regulate, and
would pose critical societal dangers.”[23] The truth is, the AMA states the physician should “aggressively respond to the needs
of the sufferers” and “respect patient autonomy [and] present applicable
comfort care and sufficient pain management.”[24]

Furthermore, the Act threatens the
integrity of the medical career and the conscience rights of healthcare
professionals. It requires that “attending physicians must present enough info to an individual with a
terminal illness relating to all
out there remedy options, and the options and the foreseeable risks and
benefits of every.” Act § 2503B(b) (emphasis added). It additionally states that the
failure to inform or refer the individual “who requests further info
about obtainable end-of-life remedies, together with medicine to finish their life”
is taken into account a “failure to obtain knowledgeable consent for subsequent medical
remedy.” Act § 2503B(c). While the terms “available treatment options” and
“alternatives” are ambiguous and undefined in subsection (b), they might more than likely
be interpreted to incorporate assisted suicide as an “available treatment option”
or “alternative treatment option,” since subsection (c) consists of “treatment to
end [] life” explicitly as an “available end-of-life treatment[].” Act §
2503B(c). Thus, physicians can be required to debate physician-assisted
suicide and explain its supposed benefits or refer a patient to another
physician who can provide that info.

This
Act harms the medical career, physicians, and people who could also be struggling
to course of the shock of a troublesome analysis. It opens the door for physicians
to be pressured to violate medical ethics, such as the Hippocratic Oath to “do no
harm,” in addition to their moral convictions or spiritual beliefs towards taking
one’s personal life or aiding one other to end her life. If passed, physicians who
object to physician-assisted suicide for ethical, spiritual, or moral reasons
might be pressured to choose between violating their conscience or violating the
regulation and probably dropping their medical license. This Act increases the danger
that patients will probably be coerced or pressured into prematurely ending their lives
when pitched with assisted suicide as a viable remedy choice along with its
alleged benefits. Additionally, a doctor is prohibited from continuing with
any life-affirming care even for a terminally unwell affected person until that patient has given informed consent, which underneath the Act,
should embrace details about
physician-assisted suicide.

The
U.S. Supreme Courtroom has said “
the integrity and ethics of the medical career.”[25] In Justice Antonin Scalia’s dissent to another Supreme Courtroom case involving a
ban on using managed substances for physician-assisted suicide, he
pointed out: “Nearly each related supply of authoritative which means confirms
that the phrase ‘legitimate medical purpose’ does not embrace deliberately
aiding suicide. ‘Medicine’ refers to ‘
prevention, remedy, or alleviation of disease’ . . . . [T]he
AMA has decided that ‘[p]hysician-assisted suicide is basically
incompatible with the doctor’s position as healer.’”[26]

The
Majority of States Affirmatively Prohibit Medicalized Suicide

At present, the overwhelming majority of states—at the least 39 states—affirmatively prohibit assisted suicide and impose felony penalties on anybody who helps one other individual end his or her life. And since Oregon first legalized the apply in 1996, “about 200 assisted-suicide bills have failed in more than half the states,” and extra states have moved to ban the follow than have decided it was well worth the danger.[27] In Washington v. Glucksberg, america Supreme Courtroom summed up the consensus of the states: “In almost every State—indeed, in almost every western democracy—it is a crime to assist a suicide. The States’ assisted-suicide bans are not innovations. Rather, they are longstanding expressions of the States’ commitment to the protection and preservation of all human life.”[28]

This longstanding consensus among the vast
majority of states is unsurprising when one considers, as the Courtroom did, that
“opposition to and condemnation of suicide—and, subsequently, of aiding
suicide—are consistent and enduring themes of our philosophical, authorized and
cultural heritages.”[29] Indeed, over twenty years ago, the Courtroom in
Glucksberg held there isn’t any
elementary proper to assisted suicide in the U.S. Constitution, discovering as an alternative
that there exists for the states “an ‘unqualified curiosity in the preservation
of human life[,]’ . . . in preventing suicide, and in learning, identifying,
and treating its causes.”[30]

Thus,
Delaware should reject H.B. 140 and proceed
to uphold its obligation to guard the lives of all its citizens—especially weak
individuals such because the unwell, elderly, and disabled—and keep the integrity
and ethics of the medical career. Thanks.

Sincerely,

Catherine Glenn Foster, M.A., J.D.
President & CEOAmericans United for Life


[1] Or. Well being Auth. Pub. Well being Div., Oregon Dying with Dignity Act 2018 Knowledge Summary
(Feb. 15, 2019) [hereinafter Oregon 2018 Data Summary], https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf.

[2] Wash. State Dept. of Well being Disease Control and
Health Statistics Div., Washington State
Dying with Dignity Act Report (Mar. 2018) [hereinafter Washington 2017
Report], https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf.

[3] Ezekiel J. Emanuel, 4 Myths About Doctor-Assisted Suicide, N.Y. Occasions (Oct. 27,
2012), https://opinionator.blogs.nytimes.com/2012/10/27/four-myths-about-doctor-assisted-suicide/.

[4] J.
Pereira, Legalizing Euthanasia or
Assisted Suicide: The Illusion of Safeguards and Controls, 18 Present Oncology e38 (2011) (discovering
that “laws and safeguards are
commonly ignored and transgressed in all the jurisdictions and that transgressions
usually are not prosecuted”); see also Washington 2017 Report, supra word 2 (In 2017, 56% of patients who died after ingesting a
lethal dose of drugs in Washington did so, at the very least partially, as a result of they
did not need to be a “burden” on relations, elevating the priority that
patients have been pushed to suicide.).

[5] Glucksberg, 521 U.S. at 731–32.

[6] Kevin
Fitzpatrick, Assisted Suicide for
Disabled Individuals – Democracy in Britain?, Euthanasia Prevention Coalition
blog, June 23, 2015, out there at http://alexschadenberg.blogspot.com/2015/06/assisted-suicide-for-disabled-people.html.

[7] See, e.g., Vivien Kogler &#zero38; Alexander
Noyon, The Werther Effect – Concerning the
Dealing with of Suicide within the Media, Open
Access Authorities (Might 17, 2018), https://www.openaccessgovernment.org/the-werther-effect/42915/.
There’s, nevertheless and extra positively, a converse Papageno Effect whereby media
consideration surrounding individuals with suicidal ideation who choose to not commit
suicide evokes others to comply with go well with. See,
e.g., Alexa Moody, The Two Effects:
Werther vs Papageno, Please Stay
(Jun. 5, 2015),
http://www.pleaselive.org/blog/the-two-effects-werther-vs-papageno-alexa-moody/.

[8] See id.; see additionally S. Stack, Media
Protection as a Danger Think about Suicide, 57
J. Epidemiol. Group Well being 238 (2003); E. Etzersdorfer et al., A Dose-Response Relationship Between
Imitational Suicides and Newspaper Distribution, eight Arch. Suicide Res. 137 (2004).

[9] See David Albert Jones &#zero38; David
Paton, How Does Legalization of
Physician-Assisted Suicide Have an effect on Rates of Suicide, 108 S. Med. J. 10 (2015) https://pdfs.semanticscholar.org/6df3/55333ceecc41b361da6dc996d90a17b96e9c.pdf.

[10] Id.

[11] Id.

[12] See Nancy Valko, A Tale of Two Suicides: Brittany Maynard and My Daughter, Rejoice
Life, Jan-Feb 2015, out there at
https://www.clmagazine.org/topic/end-of-life/a-tale-of-two-suicides-brittany-maynard-and-my-daughter/.

[13] Oregon
2018 Knowledge Summary, supra notice 1.

[14] Washington
2017 Report, supra observe 2.

[15]

Linda Ganzini et al., Analysis of Competence
to Consent to Assisted Suicide: Views of Forensic Psychiatrists, Am. J.
Psychiatry 157:4, 595 (2000) https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.157.4.595.

[16] Trisha
Torrey, How Widespread is Misdiagnosis or
Missed Analysis?, VeryWell Well being (Aug. 2, 2018),
https://www.verywellhealth.com/how-common-is-misdiagnosis-or-missed-diagnosis-2615481

[17] See, e.g., Malcom Curtis, Physician Acquitted for Aiding Senior’s Suicide,
The Local, revealed Apr. 24, 2014 (reporting the docto was not held accountable
for his negligence).

[18] Nina
Shapiro, Terminal Uncertainty, Seattle Weekly, Jan. 13, 2009,
http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty/.

[19] See id.

[20] See id.

[21] Fabian
Stahle, Oregon Well being Authority Reveals
Hidden Problems with the Oregon Assisted Suicide Mannequin, Jan. 2018 (emphasis
added), obtainable at https://www.masscitizensforlife.org/oregon-health-authority-reveals-hidden-problems-with-the-oregon-assisted-suicide-model.

[22]

The Supreme Courtroom has recognized the enduring value of the Hippocratic Oath: “[The
Hippocratic Oath] represents the apex of the event of strict ethical
concepts in drugs, and its influence endures to this
day. . . . [W]ith the top of antiquity …
nucleus of all medical ethics’ and ‘was applauded as the embodiment of truth’” Roe v. Wade, 410 U.S. 113, 131-132
(1973).

[23]AMA
Code of Medical Ethics Op. 5.7 (Physician–AssistedSuicide),
https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-5.pdf.

[24] Id.

[25] Glucksberg, 521 U.S. at 731.

[26] Gonzales v. Oregon, 546 U.S. 243, 285–86
(2006) (Scalia, J., dissenting) (third inner citation citing Glucksberg 521 U.S. at 731).

[27] Catherine Glenn Foster, The
Fatal Flaws of Assisted Suicide, 44 HUMAN LIFE REV. 51, 53 (2018).

[28]

521 U.S. 702, 710 (1997).

[29] Id. at 711.

[30] Id. at 729–30.