Assisted suicide bill opposed by disability advocates, doctors

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PROVIDENCE — A Rhode Island House bill that would legalize physician-assisted suicide has raised concerns about its impact on those with disabilities and the elderly and the potential that it would lead to euthanasia, despite claims that it is a measure that shows compassion to the dying and empowers patients.

The bill, named after former state Senator Lila Mansfield Sapinsley, allows doctors to prescribe lethal medications to terminally ill patients who are deemed to be within six months of death. Patients must submit a written request for the drugs and also ask for them in person twice. The bill would take effect upon passage.

The measure came before the House Committee on House Health, Education and Welfare on April 4, drawing more than an hour of testimony. So far, the committee has taken no action on the bill, holding it for further study.

At the hearing, Dr. Timothy Flanigan, an infectious disease specialist at The Miriam Hospital and Rhode Island Hospital, contended that assisted suicide is not necessary to avoid the pain of death, given advances in palliative care over the last 20 years.

“Rarely a patient can experience intractable pain which does not respond to our medications. In that case there is now a treatment called palliative sedation in which high-dose intravenous medications are used even though they have significant side effects and can suppress respiration,” Flanigan said. “The point is that our treatment of pain is significantly advanced so that physician assisted suicide or physician assisted death is not an appropriate response to the fear of physical pain.”

Flanigan also warned that many severely ill and terminal patients experience depression. “Yet this is exactly the time when we value the support and care of others around us. Speaking from personal experience both in my family and with my patients, the time at the end of life in retrospect is most precious,” Flanigan said. “Yet in the middle of it, it is painful — not the physical pain that can be treated with medications, but the anguish and the guilt of being a burden although that burden can express great love.”

In a previous interview with the Rhode Island Catholic, one physicians advocate said that legalizing physician-assisted suicide undermines what it means to be a doctor.

“All bills to legalize physician-assisted suicide or euthanasia must be rejected, as these practices are fundamentally inconsistent with the physician’s role as healer,” said Dr. Michelle Cretella, a Rhode Island resident and the president of the American College of Pediatricians.

“All physicians take an oath to first do no harm,” Cretella added. “As medical professionals and patient advocates we recognize a request for suicide as a desperate cry for help. We answer that cry by providing thorough medical and psychological assessments, proper medical treatment, counseling, optimal pain management, and most importantly, our presence. We honor the dignity of all patients by helping them live life to the fullest and accompanying them through to their natural death.”

One of the arguments in favor of assisted suicide is that it shows compassion towards the dying, hence the name of one of the leading national organizations that is backing the Rhode Island bill, Compassion and Choices. But a retired nurse who testified said that reflects a distorted understanding of what true compassion is.

“Compassion is to suffer with the patient, not to kill them. This is a perversion of the idea of love,” Marilyn Brennan said, according to a copy of her testimony.

The measure is also opposed by some advocates for those with disabilities. One opponent at the hearing was Emily Titon, a local Rhode Islander who has autism who is a board member of The Association for Severely Handicapped and an active member of the Autism Self-Advocacy Network. Titon warned that an assisted suicide law would render those with disabilities particularly vulnerable in a for-profit health care system. Those who depend on Medicaid might find that state authorities will only authorize cheaper euthanasia drugs rather than pay for expensive treatments, she said.

“This bill will put people in harm’s way,” Titon said.

The bill’s sponsor, Rep. Edith Ajello, D-Providence, said she believes the legislation has the necessary protections to ensure that no one would be pressured into ending their lives against their will. Instead she said the bill gives comfort to anyone facing the end of their life that it will not have to be in “extreme pain.”

That message was echoed by Marie Manis, the Rhode Island Campaign Manager for Compassion and Choices, the national organization backing the legislation.

In a fact sheet, Compassion and Choices says that there have been no disability rights complaints filed in Oregon in the 20 years since that state passed its assisted suicide law. (Compassion and Choices also denies that what the legislation does is legalize assisted suicide. The organization instead refers to the prescribing of lethal medication as “medical aid-in-dying.”)

However, Bradley Kehr, an official at Americans United for Life, said the experience of Belgium and the Netherlands show how such laws can be abused leading to a slippery slope of unintended consequences. He said a Dutch government commission had found that “more than half of euthanasia and assisted-suicide-related death were involuntary in the year studied.” Likewise, in Belgium 120 out of 1,265 nurses said that “their last patient was involuntary euthanized” according to a medical study.

Also, in Oregon an attorney who represents Choice Is an Illusion, Margaret Dore, said that there is little state oversight over its assisted suicide law. She said the state does not disclose the names of those who have used the law, precluding law enforcement investigations into its possible abuses.

The Rhode Island State Right to Life Committee is also against the bill. Barth Bracy, the executive director, highlighted a number of loopholes in the bill. In particular, he noted that it does not bar family members, relatives, or doctors from suggesting assisted suicide nor does it stop them or others who might have a financial interest at stake from being witnesses to the written request for the lethal medication. The bill also has no requirement that those with depression or mental illness seek counseling. That is only mandated if the doctor believes the patient has “impaired judgment,” Bracy said.

Assisted suicide is opposed by the Catholic Church and viewed as inconsistent with its teachings on the sanctity and dignity of all human lives.

“The Catholic Church teaches that as human beings, you and I are made in the image and likeness of God. Because of this we have no price. Rather we have dignity, an intrinsic dignity that reflects the incalculable worth of the human person. Because of this dignity, we are not allowed to kill the innocent human being because doing so would deprive him of a gift that is not ours to take,” Father Nicanor Pier Giorgio Austriaco, O.P., a professor of biology and theology at Providence College, said in an interview with the Rhode Island Catholic. “For the same reason, because of this dignity, we are not allowed to kill even ourselves because our lives are a gift that we have received that we simply cannot discard.”

“From a human perspective I find it completely offensive. The mere suggestion is offensive to me as a person,” state Rep. Mike Chippendale, R-Foster, said in an interview. “We don’t have the right or the ability to determine who dies and when. That’s not our lot in life.”

Chippendale noted that he was speaking both as a faithful Catholic and as someone who has spent a lot of time thinking about how his life will end. Chippendale suffers from conditions that all are life-shortening, including a form of muscular dystrophy and liver disease. “I have put serious thought into what the end of my life might be and at no point in that thought process did me prematurely ending my life come up,” Chippendale said.

Father Bernard Healey submitted testimony against the measure on behalf of the Rhode Island Catholic Conference, which advocates and educates on public policy issues for the Catholic Church.

“For Christians and other religious believers and many people of good will, dying is not an evil to be avoided at all costs. It is a step in a journey that continues in the next life with God. But even those without faith can recognize the intrinsic value of human life. They can see that suffering persons need solidarity and support more than a loaded syringe and an easy exit; they need their dignity affirmed by being loved and encouraged to hope, not attacked by allowing their hopelessness to reach its limit in self-killing,” Father Healey said in his remarks.

One woman who testified said that the proposed law would have spared her father a horrific death with a neuromuscular disease. But another speaker, Safieyatu Lamin, who is the education and services director at Rhode Island Right to Life, said she valued the additional time she had had with her grandmother who had long battled cancer. That additional time she said allowed her to meet her great-grandchild just days before she passed away.