The man’s three minutes at the microphone was just the beginning of an extremely long day of testimony at the state capitol in Hartford, Conn., March 20. A bill was introduced this week to allow, according to the Connecticut General Assembly website, “a physician to prescribe medication at the request of a mentally competent patient that has a terminal illness that such patient may self-administer to bring about his or her death.”
Though it may be too early for a prognosis on the bill’s chances for passage, if enacted, it would be the fourth such law in the United States, though the first passed by a legislature. Oregon and Washington State legalized assisted suicide by public referenda, while Montana ended up with it because of a court decision.
Assisted suicide bills are also advancing through the New Jersey and Vermont legislatures. In fact, there have been about 100 attempts to pass assisted suicide bills in various states by a representative body – all ending in failure, leading one person to suggest at the Hartford hearing this week that it’s easier to get a law on the books while relying on the votes of the populace, many of whom form their opinions listening to TV and radio sound bites than it is to pass it through a long, deliberative process in a statehouse. A referendum failed last November in Massachusetts, but only by a margin of two percentage points, and only after a very intense campaign by the Catholic Church and pro-life organizations.
“These laws add an element of acceptability in transforming the crime of assisted suicide into a medical treatment,” said Rita Marker, executive director of the Patients Rights Council in an interview this week, “and it makes it doggone cheap medical treatment at that.”
The hearing on the Connecticut bill, held before the Public Health Committee, dragged on until late into the night March 20. Much of the discussion focused on nuts and bolts and what safeguards the bill would provide. The proposal would allow a competent, adult resident of Connecticut who has “been determined by [his or her] attending physician to have a terminal illness… and has voluntarily expressed his or her wish to receive aid in dying” to request a prescription for lethal medication that he or she can “self-administer.”
The bill defines “self-administer” as “a qualified patient’s act of ingesting medication.” This worries Stephen Mikochik, emeritus professor of constitutional law at Temple Law School in Philadelphia and a visiting professor of jurisprudence at Ave Maria Law School. “The definition of self-administer is only that [the patient] has to ingest it. If somebody gives it to you or jams it down your throat you’ve ingested it,” Mikochik said in a press conference before the hearing.
The bill requires doctors to inform patients of their diagnosis and prognosis, the potential risks and probable result of taking the lethal medication, and “feasible alternatives and health care treatment options, including but not limited to palliative care.” Critics feel that palliative care and other means to help the dying should be increased in place of the assisted suicide option, instead of having it be merely one option along with suicide.
Lorraine ZuWallack, a hospice nurse from Connecticut, said at the press conference that in her long experience, no hospice patient ever asked to hasten his or her death. That’s because “we afforded our patients excellent end-of-life care,” she said. “We addressed their spiritual, psychological, social and especially symptom control issues, [including] excellent pain control.”
ZuWallack said that patients who are given a terminal prognosis and are cared for in a dignified and humane way can sometimes return to good health, are discharged from hospice and live several years longer. “Suicide certainly removes that possibility forever,” she said.
Some critics also worry about certain “Orwellian” aspects of the bill. It says that the action of the patient in requesting “aid in dying” would not be considered suicide, and the attending physician “may sign the patient’s death certificate that shall list the underlying terminal illness as the cause of death.”
As for conscience protection measures, the bill affords healthcare providers a choice of whether to participate in the “aid in dying.” A health care facility may prohibit healthcare providers to participate in it.
The bill also seeks to protect patients against abuses. Anyone “without authorization of a patient [who] willfully alters or forges a request for aid in dying… or conceals or destroys a rescission of such a request…with the intent or effect of causing the patient’s death” would be charged with murder, it says. The bill also stipulates that it would not authorize anyone to “end a patient’s life by lethal injection, mercy killing, assisting a suicide or any other active euthanasia.”
But Mikochik, of Ave Maria Law School, said that under the legislation, an “interested heir can be a person testifying that the patient is competent and can be the only person present at the time the lethal dose is taken. The possibility for elder abuse is enormous.”
Are the disabled at risk?
Mikochik also wonders whether the bill can be extended to disabled people. “After all, a terminal condition is just another disability,” said Mikochik, who is blind. Several disabled persons in wheelchairs also testified against the bill at the hearing.
In fact, according to James McGaughey, Executive Director of the Connecticut Office of Protection and Advocacy for Persons with Disabilities, many organizations advocating for the disabled are strongly opposed to legalizing assisted suicide, even though they are “progressive” on other social issues. Furthermore, such bills are often couched in terms of autonomy and personal choice – values that these groups typically espouse. But they understand that the disabled sometimes can go through a “very rough patch” in their lives, a time when suicide might be an attractive option, he said.
“Advocates worry that some people would never get to the other side of a difficult adjustment if assisted suicide becomes legal,” McGaughey said. “People who have personal histories of trauma or unresolved personal issues… or who have difficult relationships with caregivers, or who just feel like they are a burden to family members would be especially vulnerable. If the mechanism laid out in this bill becomes law, we believe we will lose people who would otherwise have many years of life ahead of them. [They may be] influenced by unconscious value judgments about what they believe to be an unacceptable quality of life.”
And that, in general, is the danger of legalizing assisted suicide, in the opinion of Deacon Thomas Davis, Associate Director of the Pope John Paul II Bioethics Center at Holy Apostles College and Seminary in Cromwell, Conn.
“What you’re doing is introducing a concept as a parallel social imprimatur,” Deacon Davis said in an interview. “We have this principle of non-abandonment in palliative care, which says [to terminal patients] we will never leave you; we will walk the walk with you. We are going to absolutely bind ourselves to you in a commitment of love.” Linked with that is the ability to relieve even the worst pain with strong medication, he said. But if assisted suicide is legalized, he warned, “behind every non-abandonment promise will lurk in the psychology of every patient – and it will seep into the medical profession, family members, culture and society – the shadow of a quick exit. Proponents say you need the possibility of a quick exit, but you’re undermining the concept for so many people. A dual principal will just suck away people’s confidence.”
Marker added that such laws give the illusion that it gives the terminally ill person greater control. “But it really doesn’t. Let’s say somebody gets the prescription because their best friend or their family member says, ‘It would be good to have, just in case.’ But once they have it, there’s no way to know whether they knowingly and willingly took it, because there’s nothing [in the laws] that says that. It says they have to knowingly and willingly request it. There’s no requirement for anyone to be present when they take it.”
Deacon Davis didn’t get to testify until nearly midnight. His written testimony offered a sort of bookend to the story with which the day began – the son who helped his father kill himself.
“Three years ago, I accompanied my own father on his walk to the end of this life,” Davis said. “His was a difficult and arduous final illness for various reasons, including the onset of mild dementia. Yet his physical pain, which would otherwise have been excessive, was well managed and he was able to share a deeper relationship with me and many people as death approached. It was instantly apparent that personal visits and commitment to non-abandonment encouraged him to find deeper resources of meaning and joy in his final weeks and months. How many more are there who will benefit from love? Physician-assisted suicide is a failure of love. A better course for legislative action would be promoting greater access to pain specialists as well as the entire range of other specialists that make up palliative care in nursing homes, hospitals, other treatment locations and residential settings.”