Assisted suicide bill would require doctors to lie

What a tangled web we weave, when first we practice to deceive.

In Senate Bill 165, which is intended to make assisted suicide legal in Nevada, the phrase “assisted suicide” appears but once. That’s when it states the proposal would not require a physician to “Condone, authorize or approve mercy killing, euthanasia or assisted suicide.”

The bill prefers language like “peaceful and dignified death” for persons with terminal illnesses.

It also requires doctors to lie on death certificates and report the cause of death was due to the terminal illness and not the self-administered controlled substance that caused the death and that it was not suicide or homicide.

This does seem to set up a conflict with existing law that requires:

  NRS 259.050  Investigation into cause of death; inquest.

      1.  When a coroner or the coroner’s deputy is informed that a person has been killed, has committed suicide or has suddenly died under such circumstances as to afford reasonable ground to suspect that the death has been occasioned by unnatural means, the coroner shall make an appropriate investigation.

Pay no heed to the fact Nevada is the state that has not put a death row inmate to death in years because the pharmaceutical company that makes one of the controlled substances objected. Might companies object to having their products used in this manner?

Further, the bill requires insurance companies to sell life insurance to those contemplating “assisted” suicide and does not allow insurers to deny claims to beneficiaries of someone who has committed “assisted” suicide. Additionally, it makes null and void any life insurance policy provisions now or in the future that would deny claims for those who committed “assisted” suicide. What will that cost?

Selling life insurance to the suicidal is like selling fire insurance to someone whose house is on fire. Well, they must sell health insurance to those with pre-existing conditions.

This might also pose a problem for those keeping track of just how many people have actually died due to certain illnesses.

 

18 comments on “Assisted suicide bill would require doctors to lie

  1. Anonymous says:

    Forcing a doctor to lie about the reasons for death can’t be a good thing. If that’s what the bill does then it’s wrong.

    Hard to figure someone being in favor of this enough to want to make a law legalizing it (although why it’s illegal is questionable) but yet want to hide what is really going on enough to put language in like this.

    Diminishes their credibility somewhat.

  2. Rincon says:

    First, let’s dispel the myths: There is a reason for the term, intractable pain. Not all pain is controllable with drugs. In addition, there is no drug to effectively alleviate the suffering of those who suffocate to death from say, COPD. This means that we presently force many, many people to go through suffering that would be considered cruelty if done to an animal, quite literally. I hope nobody considers the act of humane euthanasia on people to be unethical, if done properly. Even the Bible does not forbid it, if interpreted correctly (who decides correct? I’m willing :). The done properly part though, can be difficult and some would say, impossible. This is open to debate.

    “It also requires doctors to lie on death certificates and report the cause of death was due to the terminal illness and not the self-administered controlled substance that caused the death and that it was not suicide or homicide.” Depending on the language, this may need massaging, but it would be ridiculous to statistically lump together those who commit suicide on their own with those who benefit from humane euthanasia. Certainly, the act of euthanasia needs to be reported, probably on the death certificate, but to neglect calling say, cancer the cause of death for someone who is euthanized because of cancer is ridiculous. If someone dies from chemotherapy, do they call it a poisoning? Whatever the treatment is for this situation, the same can easily be done with euthanasia.

    “Might companies object to having their products used in this manner?” Let the companies decide this.

    “Further, the bill requires insurance companies to sell life insurance to those contemplating “assisted” suicide…” Selling or honoring? It would be surprising indeed, if insurance companies will be required to sell new policies, or increase coverage for those diagnosed with a fatal disease. If it really is required by this law, then that provision should be deleted.

    “Additionally, it makes null and void any life insurance policy provisions now or in the future that would deny claims for those who committed “assisted” suicide. What will that cost?” What will it cost? The same! We are talking about people with fatal illnesses. Do you really feel that an insurance company should be allowed to deny coverage for someone suffering from terminal disease because they chose a cheaper way of treating it?

  3. Rincon says:

    One more thought: Why is it often the same people that advocate allowing many to die because of air pollution for example (by relaxing or eliminating laws to limit said pollution), are intent on “saving” those same suffering individuals once they begin succumbing to the same COPD that was caused by allowing high pollution levels? Letting lots of people die is easy if you can’t tell which is which, but once you identify the victim, then by God, we’ll see to it that they don’t get an easy exit – in the name of saving lives, of course.

  4. An insurer shall not:

    2. Refuse to sell, provide or issue a policy of group life
    insurance that covers a person or charge a higher rate to cover a
    person solely because the person has, in accordance with the
    provisions of sections 3 to 29, inclusive, of this act, requested a
    controlled substance designed to end the life of the person or
    revoked such a request.

  5. Analysis: 2019 Nevada Doctor-Prescribed Suicide Bill (SB 165) from Patientsrightscouncil.org

    http://www.patientsrightscouncil.org/site/analysis-2019-nevada-doctor-prescribed-suicide-bill-sb-165-february-19-2019/

    This 2019 bill is an attempt by doctor-prescribed suicide activists to transform assisted suicide into a “medical treatment.” It is patterned after Oregon’s “Death with Dignity Act.”
    Under SB 165:
    Doctor-prescribed suicide would become a “medical treatment.”
    SB 165 specifically defines “dispensing a controlled substance designed to end the life of a patient” as a “medical treatment.”[1]
    Once assisted suicide becomes a medical treatment, it is the least expensive medical treatment that is available. This gives insurance programs the opportunity to cut costs by denying payment for more expensive treatments while approving payment for the least expensive “medical treatment” – a prescription for a lethal drug overdose.
    This has happened in Oregon – the state with the law upon which the Nevada bill is based – as well as in California. The Oregon Health Plan (OHP) has notified some patients that medications prescribed to extend their lives or improve their comfort level would not be covered, but that the OHP would pay for a lethal drug prescription.[2]
    Referring to payment for 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 other medical procedure.”[3]
    In California, after finding that her insurance company would not cover the chemotherapy her 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 medication.”[4]
    California pays for assisted-suicide drugs obtained under the state’s doctor-prescribed suicide law.[5]
    If the Nevada bill is approved, will health insurance programs do the right thing – or the cheap thing?
    Under SB 165, the most marginalized individuals – poor, hardworking people – would be in particular danger.
    “Choice” is an appealing word. But inequity in health care is a harsh reality.
    Under SB 165, before writing the prescription for drugs to end a patient’s life, the attending physician is to inform the patient of all “feasible alternatives.”[6] However, discussing all alternatives does not mean patients have the ability to access those options.
    Even patients who have insurance may find that it does not cover the “feasible alternatives.” So, if SB 165 passes, assisted suicide may become a “choice” for the comfortably well off, but the only “medical treatment” the poor can afford.
    An individual with a controllable medical condition could be considered to have a terminal condition, making him or her eligible for doctor-prescribed suicide.
    To be eligible for a suicide prescription, a patient is considered to have a terminal condition if the condition is “an incurable and irreversible condition that cannot be cured or modified” and “will, in the opinion of the attending physician, result in death within 6 months.”[7]
    There are many conditions (diabetes, certain types of leukemia, disabilities requiring ventilator support, etc.) that, although they cannot be cured or modified, they can be controlled. And, with medical treatment, individuals with those conditions could live for many years. Yet those individuals would be eligible for doctor-prescribed suicide.
    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.[8]
    Why is the definition of “terminal condition” so broad?
    Severely depressed or mentally ill patients could receive doctor-prescribed suicide, without having any form of counseling or mental examination.
    Even if the patient is severely depressed or mentally ill, a physician is not required to refer the patient for an examination by a psychiatrist or psychologist unless the physician believes the patient may not be “competent.”[9] “Competent” means the person has the ability to make, communicate and understand the nature of decisions concerning his or her health care.[10]
    This provision is similar to that contained in Oregon’s law where in the twentieth year of that state’s law, fewer than 4 percent of the 143 patients who received lethal prescriptions were referred for a psychological evaluation.[11] A study about Oregon’s law found that it “may not adequately protect all mentally ill patients.”[12]
    “Doctor shopping” could take place until a health care professional can be found to declare that the patient is qualified for the lethal prescription.
    If a patient is found to be unable to understand the nature of decisions about health care, the bill does not prohibit a health provider, family member or another person from arranging for the patient to be evaluated by other mental health professionals until one is found who would declare that the patient capable of choosing assisted suicide.
    This has taken place in Oregon where it has been noted that “a psychological disorder – senility, for example – does not necessarily disqualify a person.”[13]
    A woman died of assisted suicide under Oregon’s “Death with Dignity Act,” even though she was suffering from early dementia. Her own physician had declined to provide a lethal prescription for her. When counseling to determine her capacity was sought, a psychiatrist determined that she was not eligible for assisted suicide since she was not explicitly pushing for it and her daughter seemed to be coaching her to do so. She was then taken to a psychologist who determined that she was competent but possibly under the influence of her daughter who was “somewhat coercive. ”
    Finally, she was assessed by a managed care ethicist who determined that she qualified for assisted suicide, and the lethal dose was prescribed.[14]
    Family members or health care providers and others could advise, suggest, encourage or exert subtle pressure on vulnerable individuals to request doctor-prescribed suicide.
    The bill states that witnesses to the written request must attest to the fact that the patient “appears to be of sound mind and not under duress, fraud or undue influence.”[15] However, those words have a narrow legal meaning. The bill does not prohibit someone from suggesting, advising, or encouraging a patient to request doctor-prescribed suicide.
    Since victims of domestic abuse, including elder abuse, are extremely vulnerable to persuasion from their abusers, it takes little imagination to understand how the bill could put abused individuals at risk of being persuaded to request doctor-prescribed 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, which could be signed in the patient’s residence, must be witnessed by two individuals, only one of whom may not be someone who would be entitled to any portion of the patient’s estate.[16] 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.
    This places victims of elder abuse and domestic abuse 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.
    A person who would benefit financially from the person’s death could pick up and deliver the lethal prescription to the patient.
    The drugs can be dispensed to an expressly identified agent of the patient.[17] A potential heir could encourage the patient to authorize him or her to pick up the drugs for delivery to the patient’s residence.
    Individuals could request doctor-prescribed suicide based on the fear of being a burden to others.
    In Oregon’s twentieth official report, fear of being a burden on others was given as a reason for requesting lethal drugs by more than 55% of those who died using that state’s assisted-suicide law.[18]
    Patients would have no protection once the assisted-suicide prescription is filled.
    Like the Oregon law, the bill only addresses activities taking place up until the prescription is filled. There are no provisions to ensure that the patient is competent at the time the lethal drug overdose is taken or that he or she knowingly and willingly took the drugs.
    Due to this lack of protection, the bill would put patients at enormous risk. For example, someone who would benefit from the individual’s death could trick or even force the person into taking the fatal drugs, and no one would know.
    Why aren’t there any safeguards at the most important part of the process – at the time the patient takes the drugs that will cause death?
    The death certificate would not reflect the actual cause of death.
    The bill requires that the attending physician sign the death certificate of a “patient who dies after self-administering a controlled substance that is designed to end the life of the patient” and that the terminal condition with which the patient was diagnosed, rather than the lethal overdose, must be listed as the cause of death.[19]

  6. Anonymous says:

    Life insurers pay out for death from suicide…policy needs to be in force and premiums paid in full for 2 years, the suicide clause expires at the 2 year mark.

    https://www.policygenius.com/life-insurance/does-life-insurance-cover-suicide

    Forcing insurers to sell policies to people who are very close to death, from whatever cause, or to pay (in the case of suicide) a week after selling a policy; is simply wrong.

    This is a law in search of a problem. Read your policy.

  7. Steve says:

    And, yet again, this new “feature” sucks.

  8. Rincon says:

    The law says the insurance company can’t refuse to sell SOLEY because the patient elected euthanasia. I suspect there’s no requirement for insurance companies to sell new life policies to people with terminal illnesses. Since only those with terminal illnesses are eligible for euthanasia, that renders this whole objection moot.

    The article from the Patients Rights Council is pretty much what you might expect from an advocacy group: Seriously slanted, one sided coverage of the issue – essentially fear mongering. I’ll dissect it as follows:

    “Once assisted suicide becomes a medical treatment, it is the least expensive medical treatment that is available. This gives insurance programs the opportunity to cut costs…” This is another moot point. The patient has to approve, and there would necessarily have to be an approval process. This fear mongering is the same as the so called death panels, which never existed and were never proposed in any way similar way to the caricature drawn by opponents.

    “The Oregon Health Plan (OHP) has notified some patients that medications prescribed to extend their lives or improve their comfort level would not be covered, but that the OHP would pay for a lethal drug prescription.[2]”
    We need some clear thinking here. Buried in the ABC article: “The state-run Oregon Health Plan generously paid for thousands of dollars worth of chemotherapy, radiation, a special bed and a wheelchair, according to Wagner. The cancer went into remission, but in May, Wagner found it had returned. Her oncologist prescribed the drug Tarceva to slow its growth, giving her another four to six months to live.
    But under the insurance plan, she can the only receive “palliative” or comfort care, because the drug does not meet the “five-year, 5 percent rule” — that is, a 5 percent survival rate after five years.”

    The argument is about the 5% rule. Euthanasia has NOTHING to do with this case! It is almost certain that hospice care would also have been covered. Fear mongering. DESPICABLE!

    More of the same drek follows, until I get to, “In official reports from Oregon, diabetes is noted as the underlying terminal condition that made the patient eligible for a lethal prescription.[8]” Checking, I find that this was merely on a list of conditions that were cited as the terminal illness, with no details of the case, whatsoever.

    Most readers have never seen a terminal diabetes case. I have, and it can be very ugly. “Around 50% of diabetic patients develop peripheral neuropathy in 25 years. Painful diabetic neuropathy manifests as burning, excruciating, stabbing or intractable type of pain…”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116956/ INTRACTABLE! Definition: “Intractable pain, also known as Intractable Pain Disease or IP, is a severe, constant pain that is not curable by any known means…”

    This is exactly why people need euthanasia. This cockamamy organization prefers that the patients cited should be writhing in agony until their bodies just can’t take it anymore. Marquis de Sade wasn’t as cruel as this organization. He tortured a much smaller number of people.

    I’ll stop here because it is abundantly clear that this reference is completely untrustworthy. I must say though, I find it curious that those who claim to uphold individual freedom to the point that they advocate allowing thousands of murders every year because they don’t want to restrict the individual freedom of gun owners, are the same people who argue to deny others the right to decide the circumstances of their own demise.

    Side note: In my profession, I have had many conversations with medical professionals, who tell me that euthanasia already goes on everywhere. The medical professionals are only human and cannot stand to see the suffering that commonly occurs near death. They often administer pain killers more and more, in the name of pain control, until the patient succumbs, but only in the absolute worst cases. Less extreme individuals are allowed to suffer until they die on their own. No approval process, no consent, no controls. Is that better than a careful evaluation of each patient by a number of professionals?

  9. Anonymous says:

    Rincon I think some of the problem is a fear that euthanasia will be used to kill people that aren’t suffering and don’t want to die. Now, we both know that insurance companies do this today if not by design, then certainly with the knowledge that this is what they’re doing by deed.

    IF, and it’s a big if, you could guarantee that only people who sincerely wanted their life to end were given the drugs to accomplish it, I sure wouldn’t have a problem with it. People live too long for their own good anyway….mostly.

    So many issues. Like, if you allow it, should anyone be able to encourage it? I say absolutely not, and guys like Thomas would say absolutely. So, there’s that but if encouraging it is allowed, just imagine the consequences and even the incentives that might be offered; “sell out your remaining Medicare benefits (after Medicare has been privatized of course)” or some other such thing. Or your private healthcare insurance telling you constantly how they’re going to have to cut off all your benefits because your costing them too much as it is, and force you, as Thomas’ post pointed out, to either live in terrible pain or…not.

    It’s a very difficult issue for me and that’s without any consideration of the moral/religious issues. Ugly.

  10. As a lowercase libertarian, I am for free speech and free choice, but this bill is filled with government dictates as to both.

  11. Rincon says:

    What government dictates? That insurance companies can use euthanasia as an excuse to wiggle out of a life insurance benefit that was already promised? Please don’t forget the YUGE government dictate that this bill would remove: Thy government denies individuals the choice to die without great suffering. How can you fret about insurance companies to the point that you prefer people to writhe in agony, sometimes for weeks, before they die? This is clearly not compassionate conservatism, if there ever was any such thing.

    As for possible future abuses, I have to call it a slippery slope argument. I almost always reject these because they can be used to obstruct almost any change. For example, I’m sure someone said when the government imposed speed limits on cars, that officials would (rightly) observe that slower speeds save lives and so, would continue to reduce speed limits until autos would just crawl along. Never happened, because reasonable judgement was used to strike a balance between safety and practicality. Without at least some faith that reasonable limits will be placed (in the case of euthanasia, by our Constitution and justice system along with reasonable legislative actions), we would be afraid to change anything.

  12. Steve says:

    Rincon, read your policy (if you have one) after 2 years any suicide clause is expired and the company will pay in the case of death from suicide.
    https://www.policygenius.com/life-insurance/does-life-insurance-cover-suicide
    This language needs to be struck from the bill.

  13. Rincon says:

    Good point Steve. I think we all can agree that insurance companies should not be forced to provide new life insurance coverage for people diagnosed with a terminal illness. As long as that’s the case, it’s just a matter of making sure that this bill does not create any unintended consequences. If it does, by some chance, then it would need amending. Hardly a deal breaker.

  14. Steve says:

    It’s also worth noting, suicide is completely legal.
    It’s ATTEMPTED suicide that comes with legal repercussions.
    It should be simple to legalize assisted suicide. More so because a medical professional will be involved and might prevent unnecessary suicides from happening in the first place.
    There is no need for anything more in this. It smells like sideways attempt to enact more insurance regulation while staying under the radar and out of the public eye.
    So far, the only place this side of the bill is being mentioned in local news is right here, oy this site has any coverage detailing it. Everyone else is silent on this part of the bill.

  15. Rincon says:

    As I’ve always said, anything you do, do it right 🙂

    As I had opined, I believe the life insurance provision is just to prevent insurers from denying coverage for legitimate policies. The word solely should easily protect the companies. Any business that won’t sell new life insurance to the terminally ill can safely continue their existing policies with or without the euthanasia, but I don’t think it should be an issue. Even if that provision is removed, I can’t imagine an insurance company denying coverage because of the negative publicity. On second thought though, if they framed it as a political protest, religious fanatics and Conservative minions would probably flock to them. Better to keep it intact or if need be, clear up the language to prevent anyone from trying to enrich their families illegitimately. As you said, it should be simple.

  16. Anonymous says:

    If there is a need to enhance insurance regulation, it should be done as a separate measure.

  17. HighflyinBrien says:

    Spot on Mr. Mitchell!

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