Uae SITS RULE ae RUE aa eee Assisted Suicide — currently legal in only five states and the District of Columbia South Dakota has one of the highest suicide rates in the nation, including the 2015 outbreak of suicides on the Pine Ridge Indian Reservation '?'° LETHAL ADDICTIVE DRUGS GO UNUSED 10 patient fils he lethal prescription — typically a, 100 pills — but decides agoinst taking it, there are @ 1 safeguards to ensure the drugs stay out of the a. hands of children and pres drug dealers. The measure provides for patients fo obtain lethal drugs and then simply store them in their home. In Otegon, 554 people filed their prescriptions ‘and decided not to end their lives, leaving tens of thousands of highly addictive barpiturates unaccounted far? de. The MENTAL HEALTH CONDITIONS ARE IGNORED Teen Aer saa E ed ‘with the. most data, oniy 4% of patients who Ce eee Cee Peet eR esc) measure, doctors are oy teeter formenial health eterna) Peers Cee esac ere ial ee ee cea eee Ie eis WHOSE CHOICE |S IT? OPENS DOOR TO ABUSE OF ELDERLY OR INFIRM TORU ay aero Rue reer ae -olgl Petes Segue ene outed ae ena eel ea ne ofeach ea ony Nea ee sete meted takes SN eae etary Same ecg eee Mule ge ey Peteel eo tease ed iti hee lias \ Cee Maer ncaa Cer ge checa cle gh tear} (Section 3). Once lethal prescription is written, an abusive caregiver of relative Ren hares oa iq can pick it up and give it to the patient in erg ener) een cn eps atn Sea Eee et ot) Cie cai aaa! peeked | South | Citizens Aga Dakota Assisted SuicSerious Side Effects of Assisted Suicide Laws NO MENTAL HEALTH NO WAY TO PREDICT AN EVALUATION REQUIRED ACCURATE PROGNOSIS NO EDUCATION ON PROPER USE OR DISPOSAL NO FAMILY NOTIFICATION REQUIRED NO 1D NECESSARY FOR PICKUP suite th a NO PROTECTION FROM means ABUSE NO DOGTOR OR NURSE IS PRESENT rE a THESE ARE ONLY SOME OF THE FLAWS im IN BILLS WHICH LEGALIZE ASSISTED SUICIDE South | Citizens Against oskote, Assisted Suicide2017 Ai lysis of Proposed South Dakota Initiated Measure to Permit Doctor-Prescribed Suicide The South Dakota Initiated Measure would permit a physician to prescribe "medication for a patient to self-administer "to end the patient’ life in a humane and dignified manner." Many people assume that this would be " peacefully away." But that is totally false pill" that a patient would take and then "slip Jn Oregon, the vast majority of prescriptions for "death with dignity" are for secobarbital (a sedative). For use as a sedative, the usual dosage is one capsule. The usual prescription under ‘bed suicide law is for 90 to 100 eapsutes,? the state'y doctor-pres Under the South Dakota initiated measure: Physi ns could preseribe a lethal overdose of drugs to patients who could live for many years. Proponents of doctor-prescribed suicide invariably point to the requirement that a person must be terminally ill to obtain the prescription for what they call "death with dignity.” They further explain that the person must have been diagnosed with a six-month or less life expectancy. They call this a safeguard But they leave out the Fact that, in the proposed South Dakota law — as well as in all the assisted- suicide laws that have passed in the various states ~ the definition of "terminal" allows doctors to prescribe lethal drugs to individuals even if the patients could live for many years,” This is because the South Dakota measure defines "terminal disease” as an incurable or irreversible disease that will "produce death within six months."* But it does not specify that death will occur with or without appropriate treatment. There is documentation that this has occurred under Oregon’s assisted suicide law. In official reports from Oregon, diabetes is noted as the underlying terminal condition that made the patient eligible for a lethal prescription.’ If insulin-dependent diabetics do not take insulin, they will die within six months, So, they meet the requirements for the definition of "terminal." If they do take the medication. they can live for many years. Another such case was described by Dr. Charles Blanke, an oncologist and professor of medicine at Oregon Health and Science University. He explained that a young woman with Hodgkin lymphoma had a 90 percent chance of living for decades with recommended treatment, The woman, however, refused the treatment. "That was a very challenging situation," he said. "You have to ask yourself, "Why doesn’t that patient want to take a relatively non-toxic treatment and live for another seven decades?” Blanke ended up prescribing the deadly overdose for the wont anyway. Should doctors he able io prescribe assisted suicide for patients who could live for many years?Assisted suicide would be transformed from a crime into a "medical treatment.” This would cause emotional and financial pressure on patients. It would give insurance programs the ‘opportunity to cut costs since they could deny payment for treatments that patients need and want while approving payment for the Far less eostly prescription for a lethal drug overdose. ‘This has happened in states that permit doctor-preseribed suicide. Referring to payment tor assisted suicide, the Oregon Department of Human Services explains, ‘Individual insurers determine whether the procedure is covered under their policies, just as they do any oter medical procedure." There is documented information about teminally ill patients in Oregon and California who were denied coverage for treatinent by insurance providers and, instead, were told that doctor prescribed suicide would be covered.* In Calitornia, after finding that her insurance company would not cover the chemotherapy het doctor had prescribed. a woman asked if assisted suicide was covered under her plan. She was told, "Yes, we do provide that to our patients, and you would only have to pay $1.20 for the California pays for assisted-suicide drugs obtained by MediCal patients under the state's doctor- prescribed suicide law." Uthe SD measure becomes law, will insurance programs do the right thing — or the cheap thing? Severely depressed or mentally ill patients could receive doctor-preseribed suicide without receiving any type of counseling. Even if a patient is suffering from depression or another psychiatric or psychological disorder a physician needs to refer a patient for counseling only "if appropriate,""! meaning that either the z or consulting physician believes that the patient’s mental condition is "causing impaired jucigment.”"" The patient's medical record will include a report of any determinations made during performed.” attendi counselin This provision is similar to that contained in Oregon's law where, in 2014, only 3 of the 155 patients who received lethal prescriptions were referred for a psychological evaluation." A study about Oregon's [aw found that it "may not adequately protect all mentally ill patien Whe wouldn't counseling be required for every patient before a doctor prescribes a lethal dose of drugs? ‘The most marginalized individuals — poor. hardworking people — would be in particafar danger. “Choice” isan appealing word but inequity in health care is a harsh reatity, The measure states that the doctor must inform the patient of all "feasible alternatives."'* However, discussing alternatives dees not mean the patient will have the resources to access those options.Why should the comfortably well off have a choice of treatment options while the poor are left with the only one they can afford — doctor-preseribed suicide? The written request for doctor-prescribed suicide could be witnessed by someone who would gain financially from the patient's death The written request must be witnessed by two individuals. Only one individual may not be someone who is entitled to any portion of the patient's estate.'” Thus, one witness may be a potential heir who is encouraging or pressuring the patient to sign the request. The second witness could be the "best friend” of the potential heir The written request could even be signed in the patient’s home. This places elder abuse and domestic abuse victims in great danger since they are unlikely to share their fears with outsiders or to reveal that they are being: pressured by family members to "choose" doctor-prescribed suicide. Why ceun a potential heir, who would gain from the patient's death, be allowed fo witness the written request?” A person who would benefit financial trom the person's death could pick up the tethal prescription and deliver it to the patient. ‘The drugs can be dispensed to an expressly identified agent of the patient.'* A potential heir could encourage the patient to authorize him or her to pick up the drugs for delivery to the patient's residence. An interpreter could inaccurately convey the patient's request as well as any statement about feeling coerced or unduly influenced by another person. Under the bill, a patient must be "competent," defined as the "ability to make and communicate ai informed decision." This includes “communication through persons familiar with the patient's manner of communicating."”” This could lead to a patient's wishes being misunderstood, misinterpreted, or disregarded. There is ‘no requirement that such communication be independently verified. Nor is there any requirement that the interpreter be an individual who would not gain from the patient's death How woulel anyone know if the communication accurately expresses the patient's decision? Patients would have no protection once the assisted-suicide prescription is filled, Like the Oregon law, the bill only addresses activities taking place until the prescription is filled. There are no provisions to assure that the patient is competent at the time the lethal drug overdose is taken af that he or she knowingly and willingly took the drugs. Due to this luck of protection, the bill would place patients at enormous risk. For example, someone ‘who would benefit trom the individual's deati could trick or even force the person into taking the fatal drugs. And no one would ever know. Why uren'r there any sofeguards at the most important stage of the process — at the time the patient rakes the deugs that will cause death?Death certificates would be fa ed. The attending physician who wrote the prescription (who would not need to be present when the patient takes the drugs) may sign the patient's death certificate, which "shall list the underlying ‘erminal disease as the eause of d Isn't it ironic, that at a time when there are warnings about the danger of opioids illing people, there is also a campaign to promote opioids to kill a certain category of peopie? hts Council consultant, has noted, there is a mixed "Don't abuse opioids, because they can kill you ~ unless you have a terminal illness and want them to kill you, in which case your overdose will be considered ‘death with dignity." Initiative. Section 111) > Fora fll documented description of drugs used for doctor-prescribed suicide, see : "2016 Summary of Drugs Used for Doctor-Prescribed Suicide." Available at: http:/www.patientstightseouncil.org/site/2017-summary-of- Urugs-usedfor-doctor-prescribed-suicide. (Last accessed 9/15/17.) ‘See "Comparison of State Laws Permitting Doctor-Prescribed Suicide: Laws as of September 2017," Available at: i www. patientsrightscouneil orgsite/eomparison-of state-aws-permitting-doctorpreseribed-sueide Initiative, Section 1 (12). * ieial repor for 2016 deaths under Oregon's Death with Dignity Act, Oregon Public Health Division, "Oregon's Death with Dignity Act ~2016, ” pg. 1, fa. 2. Available at hutp: public health oregon. gov/ProviderPartnerResources/EvaluationResearchyDeathwithDignityAcvDocuments! year pdf. (Last avcesved 8/17/U7.) * Tara Bannow, "Rural Oregonians Sill Face Death with Dignity Barriers," Bend Bulletin, Avgust 14,2017 Asailable at: brtp//6w 4 bendbutletin.com/health’5312373-15 Horegonians-can-choose-how-their-roads-end, (Last avcessed 8/17/17.) Oregon Dept, of Human Services, "FAQs about the Death with Dignity Act.” Available a: hp: public-health orezon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAcl Documents! faq spat. Last aceessed 8/9/17.) “See, for example: Bradford Richardson, "Assisted-suicide law prompts insurance company to deny coverage 10 terininally ill California woman," Washington Times, October 20, 2016. Available at Inepe- www cashinatontimes.com/news/2016foct/20/assisted-suicide-law-prompts-insorance-company-den. (Last accessed 8/3/17.) Aso see: Susan Donaldson James, “Death Drugs Cause Uproar in Oregon." ABC News, August 6, 2008. Available ahi adenews.vo.comfealth/story?id-5517497&page~I. (Last accessed 8/3/17.) Bradtord Richardson, "ASsisted-suieide law prompts insurance company to deny coverage to terminally ill Calitoria woman,” WFayhigion Times, October 20, 2016, Availabe at itp: 4996 swashingtontimes.convinews/201 6/00 20/assisted-suicide-law-prompts-insurance-company-den, (Last svessed 833/17.) Kimberiy Leonard, "Californians Can Choose to Die ~ With the Hetp of Taxpayers,” U:S. News & World Report, March 21, 2016. Available at: hitps:!/www.usnews.com/news/articles/2016-03-2 |/in-califoraia-zovemment-to- ith-dignity. (Last aceessed 8/3/17.) pich-upethe-tab-For-a Init Initiative, Seetion 6 Inigiative, Seetion 12 (3). Oficial report tor 2014 deat hip: public-health. oregon gov/ProviderParinerRe: weit! Ppa, (Last aevessed 3/15/17.) ive, Section 4 nler Oregon's Death with Dignity Act, p. 5. Available at uurces/E valuationResearchDeathnwithDignity Act/Documents!Linda Ganzini, Elizabeth R. Goy, Steven K. Dobscha, "Prevalence of depression and anxiety in patients ‘requesting physicians’ aid in dying: eross sectional survey,” British Medical Journal, Oct. 25, 2008, pp. 973-78. '"jnitiative, Section 4 (3) (e) "Initiative, Section 3, "Initiative, Section 412} (b), "Initiative, Seetion 1 (2) © Initiative, Section 4 (12). " Wesley J. Smith, "Stop Assisied-Suleide Opioid Abuse, ‘st Things, August 4, 2017. Coppright © 2097 Patents Rights Couse PO. ox 760 Stexhonvile, OH #3982 74282-3810 gr RUC ISHS ups paontihtscouncl one