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Doctor-assisted suicide bill in committee

Posted By January 12, 2016 | 1:08 pm | Featured Article #4
Dr. Paul Carpentier testifies before the Joint Committee on Public Health. 
Photo from State House News Service video
Dr. Paul Carpentier testifies before the Joint Committee on Public Health. Photo from State House News Service video

BOSTON – Opponents and supporters of  Massachusetts House Bill 1991, which would allow doctors to help patients end their lives, took part in a four-hour-long hearing on the proposed measure  before the Joint Committee on Public Health at the State House in October. The Joint Committee is studying the bill and expected to make a decision in March whether to bring it to the legislative body.

Members of the Witness for Life Committee in Worcester are launching a campaign to contact senators and representatives in the diocese to ask that they oppose the legislation if it comes out of committee.

The bill was introduced by Rep. Louis Kafka (D-Stoughton), long-time proponent of such legislation. He said he introduced it in honor of a constituent who had urged the legislator to support an assisted-suicide measure. That constituent died in 2009.
A similar bill that appeared on the 2012 ballot was narrowly defeated, 51 percent to 49 percent, by Massachusetts voters.
The State House News Service reported that lawmakers heard from their colleagues, health professionals, advocates for people with disabilities, religious leaders and the husband of Brittany Maynard, a 29-year old California woman with terminal brain cancer who moved to Oregon so she could obtain and take medication to end her life.
Dr. Henry Dorkin, vice president of the 25,000-member Massachusetts Medical Society, said allowing doctors to take part in assisted suicide would cause more harm than good.
“Physician-assisted suicide is fundamentally incompatible with the physician’s role as a healer. Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life in order that these patients continue to receive emotional support, comfort care, adequate pain control and good communication,” he said.
Dr. Paul Carpentier of Gardner said doctors should not be involved in killing. He said that medical insurance companies and Medicaid could use the law as an economic windfall and reduce patient choices.
Dr. Laura Lambert, a cancer surgeon at UMass Memorial Medical Center and Medical School, said “physician-assisted suicide is a detriment to all patients. In my professional opinion, physician-assisted suicide is the equivalent of a personal death panel in a bottle. The strongest point that I would like to make today is that it is also unnecessary.”
Dr. Jeffrey Gold of Swampscott said the “biggest harm I can ever do to a patient is to not give them a choice. There’s a reason why we have the term ‘rest in peace,’
and who are we to get in the way of that?”

Full testimonies follow:

Testimony from Pauline Morris, North Grafton

Good Afternoon,
Mr. Chairman, Madame Chairwoman, and Committee Members
My name is Pauline Morris and I am from North Grafton.  I am representing myself.  I do not support H 1991, An Act affirming a terminally ill patient’s right to compassionate aid in dying.
Forty-two years ago my husband committed suicide by shooting himself in the back of his head in our bed.  We were thirty-one, our daughter was eight-and-a-half and our three sons were seven-and-a-half, four-and-a-half, and two-and-a-half.  On that Sunday afternoon our lives were shattered and changed forever.  I was the widow of suicide.  Our children were the children of suicide.  They lost their innocence and their childhood.  They became over-protective of me, fearing something would happen to me and they would be alone.  The two oldest endured cruel taunts by older children in school.
We attended counseling and I was told their father’s suicide would affect every stage of my children’s lives.  What should have been normal conversations with new acquaintances in college, the work place, the military were “take your breath away” occasions when asked “How did your father die?”.  Filling out applications, insurance and medical forms asking father’s cause of death brought them back to that infamous day.  They all dreaded their thirty-first birthdays.  The nightmare continues when my grandchildren ask their mother and fathers how their biological grandfather died.
My husband’s parents were devastated.  He was their child.  They functioned day-to-day but the loss was forever visible in their eyes.  There is always that empty place where the loved one should be.  Time does not heal the wounds of suicide.  The act is never ever over for those left behind.  The stigma is forever and has the ripple effect for future generations.
I know many would point out the difference between my husband’s taking his life in his prime and another terminally ill person taking his life just months or weeks before an illness would anyway.  But how many of us think or say that we would give anything to have just one more day or hour with our loved one?  Letting someone die of natural causes, rather than helping him kill himself, gives the loved ones the peace of mind of knowing that it was not the sick person who chose to leave his loved ones and thus spares them the trauma I described previously.

Suicide is not compassionate, dignified or the best thing you can do for your loved ones.
Suicide deprives the family of a loving, caring dying process.
Suicide does not eliminate suffering.  It causes unbearable, unending pain.
Suicide is not normal or moral.
Suicide is a selfish permanent act.
Suicide is self-inflicted murder.
Every life matters!  Every moment until natural death matters!
I have a rare form of cancer and my husband has a slow progressing form of dementia.  We are not afraid to die.  We are not afraid to suffer.  We believe and trust in the mercy of redemptive suffering.  There is no way my children and grandchildren will go through another family suicide.
Thank you for the opportunity to testify before you today.  I would be happy to answer any questions.

After listening to other people’s testimony during the hearing I’d like to make several additional points.
•    As Rep. Lyons pointed out, patients intending to kill themselves are not required to notify their families.  While the people who are for so-called “death with dignity” paint a picture of a loving family surrounding the patient and all holding hands while they say their good-byes, the reality is that a man could kill himself without notifying his wife or children and they could be blindsided and devastated just as my family was.

•    Even if the family is notified, some in the family may support the patient’s decision to kill him or herself but others may be strongly opposed to the idea.  Those family members who shudder at the idea of their loved one taking his own life will likely suffer the repercussions of that suicide as my family did.  For an example of this see: http://www.newyorker.com/magazine/2015/06/22/the-death-treatment

•    I would also like to respond to the callous comment of the woman who spoke after me and said that my husband’s death might have been prevented with gun control.  Those who support gun control to keep a deadly weapon out of the hands of someone who may not be thinking straight should also be opposed to physician-assisted suicide for the same reason if they are to be consistent.  As JJ Hanson pointed out, people who have received a terminal diagnosis and are suffering great pain, may have moments in which they think they would like to kill themselves if a bottle of poison were on their bed stand…moments that they would greatly regret later on when their despair passed and they started feeling better.  Handing someone who is in distress a bottle of poison is no different than handing them a loaded gun.  And neither one is compassionate.

Testimony from Dr. Paul Carpentier

“Senator Lewis, Representative Hogan, distinguished Senators and Representatives of the Joint Committee on Public Health, thank you for this hearing regarding the dangers and serious unintended consequences of this bill.
We four physicians from Worcester County, like the Mass Med Society and the Mass Academy of Family Physicians, are representative of most of the physicians and concerned citizens of the Commonwealth as we speak out in opposition to this misinformed movement.
Like Margaret Meade the great medical historian, we understand the ground shaking consequences of what is being discussed today. We will strive to focus your attention on the PRINCIPLES which are superseded by this bill.
I am Paul Carpentier, an ICU physician at Heywood Hospital in Gardner.  I have two points.
The first is that doctors should not be involved in killing.
The second is that medical insurance companies and Medicaid would be allowed to use this law as an economic windfall and reduce patient choices.
The principle of SOLIDARITY insists that we, the physicians, the legislature and our citizens, care for the most vulnerable and protect them and strive to lift them up. That same principle of solidarity insists that those who need our help should not strive to change the principles of the entire establishment on which they depend.
The principle that physicians DO NOT KILL their patients is FOUNDATIONAL. It has led to all of the advances in medical science on which we rely today.
President JIMMY CARTER stated,  “We must adjust to changing times and still hold to unchanging principles.”
On my second and final critical note, our public needs to REALIZE that the proposed law would allow the insurance industry to extensively LIMIT PATIENT CHOICES for the severely ill and the disabled.
I have served as medical director for the largest and most successful ACO in our nation. Some think that this proposed law would increase patient choices by allowing the option of prescribed death. Rather, since it would be doctor prescribed, the medical insurance industry will rightly see this as a state approved TREATMENT.
Oregon Medicaid, I am told, has already sent letters to numerous patients, according to second hand reports saying “The treatment which your doctor recommended will not be covered but we do cover the suicide drugs.” This is not solidarity.
This why they need physicians to be involved in assisted suicide. If doctors are not involved, then they cannot call it a “teratment.”
In conclusion, suicide eliminated the person rather than alleviating the suffering. It can never be called a treatment.
Join me in opposing doctor prescribed suicide. Help us to focus the public’s attention on improving the excellence of palliative care in our Commonwealth.
Thank you to the committee and now on to my colleagues.

Testimony from Dr. Laura Lambert

My name is Laura Lambert. I am a cancer surgeon and palliative care physician at the UMass Memorial Medical Center and University of Massachusetts Medical School in Worcester.
I am taking time away from serving individual patients UMass Memorial today because physician-assisted suicide is a detriment to all patients. In my professional opinion, physician-assisted suicide is the equivalent of a personal death panel in a bottle. The strongest point that I would like to make today is that it is also unnecessary.
The stories of Brittany Maynard and Lauren Hill illustrate both of these points.
As many of you know, Brittany Maynard was a beautiful 29-year-old woman who moved from California to Oregon to avail herself of Oregon’s physician-assisted suicide law after being diagnosed with an incurable brain cancer.
Brittany made a promise to her family and the world that she would end her life on Nov 1, 2014.
Despite the fact that Nov. 1 was, in her husband’s own words, a good day for Brittany – she ate breakfast and went for a hike with her family and her dogs – she took the pills that were waiting for her and committed suicide, just as she had promised she would do.
Base upon my personal experience with many advanced cancer patients, I know that Brittany did not WANT to die that day. Indeed, she told us this on a video on Oct. 29, 2014. I cannot imagine the pressure that she felt to follow through on her promise.
Contrast Brittany with Lauren Hill. Lauren was 18-years-old when, just like Brittany, she was diagnosed with an incurable brain cancer. Rather than move to Oregon though, with support from her doctors and family, Lauren overcame incredible physical and psychological challenges and accomplished her lifelong dream of playing college basketball for half a season. She also raised over $1.5 million dollars for brain cancer research. Lauren lived every day until, supported by hospice services, she died a peaceful death at her home about a year later in April 2015.
The stories of Brittany and Lauren exemplify the words of Dr. Atul Gawande from his recent book “Being Mortal,” “Assisted living is far harder than assisted death, but its possibilities are far greater.”
Recent medical studies have clearly demonstrated that adding early, concurrent palliative care, including advanced care and end-of-life planning, to treatment for people with terminal cancers not only decreases suffering, but significantly prolongs life despite people getting less cancer treatment.
There is no reason not to expect similar outcomes for other terminal conditions.
If used properly, palliative and hospice care can relieve the concerns and fears of those in our society who are demanding the “right to die.” If passed, rather than utilizing palliative and hospice resources properly, Bill H. 1991 runs the risk of changing this so-called “right to die” to a societal expectation of a “duty to die.”
Imagine yourself, personally, with a terminal illness. Bill H 1991 has passed in Massachusetts. It’s a good day, but you have a bottle of pentobarbital sitting on your night stand. (Pentobarbital, by the way, is the same drug used in executions in capital punishment, banned in Massachusetts for 33 years). You see how tired your spouse looks. You wish your children could just get on with their lives. It is easy to imagine feeling pressure to commit suicide in this circumstance.
If wealthy, well-supported people like Brittany and you can be compelled to commit suicide for reasons other than true physical suffering, how much more so will the people who don’t have nearly as many resources or as much support feel pressured to commit suicide?
As our state’s leaders, it is your duty to protect all citizens of Massachusetts from these personal death panels in a bottle by not passing Bill H. 1991. It is also your duty to ensure that we all have access to adequate palliative care and hospice services for which this state is world-renowned.

Testimony from William J. Lawton, M.D. FACP

I am Dr. William Lawton, a doctor in internal medicine and specialist in kidney disease.  I have cared for patients facing end-of-life decisions for 50 years. Today, I represent the American College of Physicians, the largest physician specialty group in the United States, which strongly opposes physician assisted suicide.
I will focus on two areas:
1) Bill H. 1991 is dangerous to doctors
2) The bill is dangerous to our patients

1) This bill is not about giving patients the right to die.  It is about giving doctors the right to kill.  It gives too much power to doctors to be the judge, jury, and assistant executioner, unprecedented in our society.  Doctors are not perfect and are not held liable when giving lethal pills, which are known to have complications. And worse, in Oregon the prescribing doctor was only present at death for 14 of 100 patients.
2) This bill is dangerous for patients:
a) First, hope for a medical breakthrough is abolished: I return to Brittany Maynard who suffered from a glioblastoma brain cancer.  Four months after her death, in March 2015, the cover of TIME magazine featured Mary Ann Anselmo, a 59-year-old woman, also suffering from a glioblastoma. TIME reported that with a new therapy at Sloan Kettering Cancer Center, her tumor had not grown in a year. The latest update two months ago (Aug 19, 2015): her doctor, Dr. (David) Hyman, stated, “The latest scan doesn’t show any tumor any more.”
b) Doctors are frequently wrong in their prognosis. The bill specifies a patient must have less than six months to live. We in Massachusetts remember Senator Ted Kennedy and his brain tumor. He was given a few months to live. The doctors were clearly wrong.  We remember Vicky Kennedy’s ringing condemnation. Sen. Kennedy returned to Congress and had 15 months of productive life and time with his family.
c) Patients in Oregon are living in fear in a new culture of death.  Dr. (William L.) Toffler, a physician in practice in Oregon for 35 years recently wrote that the proponents of assisted suicide are wrong and there are problems.  Patients live in fear not knowing which physicians are now death doctors.
d) The so-called safeguards are an illusion:  In the Massachusetts bill, there is no waiting period. The lethal prescription can be written the same day as requested.
e) Finally, as written in H. 1991, counseling is not required. Despite what supporters of the bill want you to believe, there are contradictions regarding psychiatric or psychological counseling. The bill mentions “report of counselling if performed.”
In closing, we in the Commonwealth of Massachusetts have been at the center of our nation’s history. First among our unalienable rights is LIFE!  The committee that drafted these words included John Adams who lived in Quincy, 11 miles from where we sit.
I implore you to oppose H. 1991 and to not destroy the dedication to LIFE that is our medical profession and the heritage of our Commonwealth.  Thank you.

Testimony from Dr. Mark Rollo

My name is Mark Rollo and I am a family physician in Fitchburg where I have practiced for almost 25 years.  I am strongly opposed to H. 1991 for many reasons but I will focus on just two.
First, this bill would pressure the vulnerable to choose death.
Secondly, it attempts to coerce physicians to violate their conscience if they refuse to participate in assisted suicide.
As a family physician I am privileged to care for people of all ages many of whom are elderly, frail and fearful of losing their faculties.  “Doc, don’t get old.”  “I’m tired of living.” “I feel like giving up.” “I don’t want to be a burden.”  I hear statements like this all the time.  Depending on the mindset of the physician and the legal environment, these statements can be taken down two entirely different pathways; either a pathway of encouragement, hope and support or one of despair, abandonment and death.
It is easy to see how the suicide scenario would repeatedly play out in Massachusetts.  Recently a 93-year-old patient of mine who lived independently with her husband was admitted to the hospital for a very treatable heart rhythm problem.  Treatable though it was, the episode was very exhausting to this woman who was in a psychologically vulnerable state due to the recent suicide of her son.  She refused intervention and asked for comfort measures only from the ICU physician.
This busy doctor, who did not know my patient, complied and withdrew treatment.   When I learned what was happening I visited her at the hospital.  Because I knew her and her struggles I was able to have her reconsider her refusal for care and within a day her condition was stabilized much to the relief of her husband and family.  She is now back at home with her husband who said to me “thank you for giving me my wife back.”
If assisted suicide were legal, she could have requested a lethal script, a second opinion could have been obtained on the same day, and a psychiatric consult would have found her competent, even if depressed.  Since this bill does not require treatment of depression, a lethal prescription could have been administered.  All of this could have taken place without me as her primary care physician even being aware.
Furthermore, if the ICU doctor refused to participate, he would have been pressured to violate his conscience because this bill requires transfer of the patient, at the doctor’s expense, to a facility that would provide a lethal script.
Massachusetts has a proud tradition of protecting the vulnerable.  Studies show that it is the white, wealthy and well-insured who favor assisted suicide because it is their choice that will be expanded.  However it is the poor, people of color, the dispossessed and disabled who will inexorably be steered toward suicide.  It is this ill-advised bill that should be killed.

Testimony of Sandra Kucharski, a nurse practitioner

Care of any patient is based on a foundation of knowledge which includes diagnosing disease states and prescribing medications. Treatment methods are based on a standard of practice and  it is called “evidence based medicine.” This means that rigorous research studies have been conducted, and that because of the research there is evidence that one method of  treatment  is better than all others. H. 1991 does not meet the test of evidenced-based care.
As you know, H. 1991 calls for the patient to take a presumably lethal dose of a sedative. Any drug’s effectiveness depends first on its absorption into the body. Next it has to be distributed throughout the tissues, organs, and brain.  So the question we need to ask is, “Does it work?” We just think it should, because the doctor writes a prescription for 100 times more than the standard dose, and the entire prescription is taken all at once.
Anecdotal evidence in the literature indicates that assisted suicide does not always work quite the way we plan. In some instances, the drug didn’t work because the patient vomited the pills and did not ingest and absorb enough of a dose to kill themselves. There are cases where it has taken up to four days for an individual to die, in fact there are some individuals who did not die at all, and when they did not die, decided they did not really want to die after all.
I know of a patient who checked into a hotel and swallowed 100 pills of a prescribed sedative in a suicide attempt and simply slept for 36 hours. By the time the hotel staff found her, she suffered extensive and severe tissue damage to her entire left side because she was so heavily sedated she did not move once she fell asleep.
We could see more of this scenario played out in Massachusetts, since H. 1991 does not require witnesses to be present when the pills are ingested.
Today, we have all that we need to provide excellent care at the end of life. We have palliative care and hospice programs which research evidence shows improve care at  the end of life.
H. 1991 is not evidenced-based practice. It is bad medicine and bad legislation. I ask that you vote “No” on this bill. Thank you

Testimony of  Kristine Correira, PA-C, MHP is a physician assistant in emergency medicine, an online educator, and a homeschooling mom

Legalizing assisted suicide is highly problematic for a wide variety of reasons. Massachusetts is considering bill H. 1991 to legalize assisted suicide.  The bill contains many flaws but I will specifically address its attack on religious liberty.
I am a physician assistant who works in the emergency department of a Catholic hospital. I chose to practice emergency medicine to comfort and care for all people, regardless of how sick they are or how close to death they may be. Patients with terminal illnesses frequently need emergency care, placing their lives in the hands of strangers like me. They are weak and not functioning well, their health is out of their control, they are fearful they may die.
What are the top reasons people choose assisted suicide?
•    Feeling weak, tired, or uncomfortable
•    A loss of function
•    A need for control
•    Fears about their future quality of life and of dying
Catholic hospitals will not offer assisted suicide. Patients can refuse treatments, stop treatments, or even decide to leave the hospital as death draws near and we will support them, but we will not assist them in actively killing themselves.
H. 1991 directly attacks religious freedom by punishing those who object to it based on conscience.  It requires us to inform patients in writing (which costs money) that we will not assist in suicide but does not require others to inform patients that they will. Hospitals must notify every patient that is admitted, not just those with advanced illness, a time when patients are vulnerable to suicide. This bill has no waiting period from the time of diagnosis until an overdose can be prescribed. It is as if those who wrote the law want vulnerable people to choose assisted suicide.
Furthermore, H. 1991 forces us to act directly against our consciences by mandating that we refer patients to those who will assist in their suicides. It even makes us pay to transfer patients to another facility. It is as if those who wrote the law do not want anyone trying to protect the vulnerable from assisted suicide.
Massachusetts had one of the best conscience protection laws in the country, balancing both religious freedom and patient care. Its protection has been eroded by laws that specifically deny it; H. 1991 would be yet another.
Bill H. 1991 is touted by its supporters for offering choice, but it does so while denying religious freedom.  It prevents those opposed to assisting suicide from acting in accordance with our faith to do no harm and to care for all human life until natural death.

Testimony of Rosalie Berquist
Good afternoon. My name is Rosalie Berquist and I am opposed to H. 1991.
I worked as the Prevention Director for the Massachusetts Brain Injury Association for 18 years. Although my focus was on preventing these injuries I worked with survivors long enough to recognize how damaging this legislation would be to people with disabilities. The most frequent thing I heard from survivors of brain injury was, “The doctors told my parents I would never walk or talk again or be able to be a productive member of society.”  But because of excellent medical care these individuals survived. No one made a decision to end their lives. Once beyond the coma stage the work of rehabilitation can be long and arduous.
Depression can be a natural consequence after brain injury and it is not uncommon for survivors to want to end their lives. An assisted suicide law sends the message to people with disabilities that killing yourself is a good solution to your troubles.
Bonnie, one of the survivors I worked with, told me that she had attempted suicide several weeks before walking into my office. Fortunately, the attempt failed and she went on, among other achievements, to be a member of Phi Beta Kappa at Quinsigamond Community College in Worcester.
Despite life’s difficulties all of the survivors of traumatic brain injury I worked with were happy to be alive.
Studies indicate that depression is the most common reason for people facing death to want to end their lives. Wouldn’t it be better to help these individuals deal with depression rather than offer what may seem to them to be an “easy way out?” Evidence indicates that once the depression is treated patients are better able to deal with the issues that come at the end of life.
Do doctors already underrate the quality of life of people with disabilities? Should we be giving doctors the right to kill? Should we be afraid to go to a hospital if we become seriously ill knowing that we might encounter a “death doctor” there?
I oppose H. 1991 because it will destroy the trust that patients place in their doctors to “do no injury.”  I urge you to vote “No” on this bill.

 

Testimony of Massachusetts Medical Society

The Medical Society wishes to be recorded in opposition to H. 1991, “An Act Affirming a Terminally Ill Patient’s Right to Compassionate Aid in Dying.”

The Medical Society has long-standing policy in opposition to physician-assisted suicide. Like the debate today, there remains great passion expressed by both sides of this issue within our membership.

As the AMA’s Code of Medical Ethics states, “It is understandable although tragic, that some patients in extreme duress…may come to decide that death is preferable to life. However, allowing physicians to participate in assisted suicide would cause more harm than good. Physician assisted suicide is fundamentally incompatible with the physician’s role as healer. Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life… in order that these patients continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.”

What is very clear to all is that there needs to be great compassion for our patients who suffer from terminal and debilitating diseases. The Society is committed to providing physicians treating terminally-ill patients with the ethical, medical, social, and legal education, training, and resources to enable them to contribute to the comfort and dignity of our patients and their families.

The Medical Society would also like to go on record in opposition to the level of disclosure and the documentation in the patient’s medical record when a physician does not participate in assisted suicide. There are long standing protocols for any patient handoff or transfer and these requirements only serve to disrupt the physician patient relationship and further takes away from direct patient interface, consultation and treatment. The Society also has concerns about safe storage and disposal of the dangerous medication, proof of residency provisions, and witness requirements.