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.
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.
