End-of-Life Choice, Palliative Care and Counseling

New Legislation

Compassion & Choices Montana Unsurprised That Latest Polling Confirms Support for End-of-Life Choices Regardless of Party Affiliation

by Compassion & Choices staff
April 8, 2013

73% of Montanans Oppose “Physician Imprisonment Act”

(Helena) The overwhelming majority of Montanans, to the tune of 82 percent, believe that end-of-life choices are private decisions that should be made without government interference, according to an April 2013 poll of likely voters conducted by Global Strategy Group.

A memo released by Global Strategy Group reveals that “Voters want to know they have a legal option to end their own life in a humane and dignified way: More than 7 of 10 voters (71%) say that if they were terminally ill and in severe distress, they would want the legal option to end their own life in a humane and dignified way.” The memo further goes on to say, “Broad majorities of Montanans strongly support legal end-of-life choices and strongly reject any efforts to criminalize doctors for complying with their patients’ wishes. Furthermore, these data suggest that legislators will pay a real price for supporting efforts to penalize and criminalize doctors for doing so. Ultimately, Montanans support the choice for others, want to be able to make the legal choice for themselves, and believe there is no role for government when it comes to making that choice.”

Nearly three-quarters of voters across party lines oppose HB505, which would send doctors to prison for providing medication that would allow the patient to end his or her own life in a humane and dignified way. 67 percent of voters say they would be less likely to vote for a legislator who supported such a proposal, including 53 percent who said they would be much less likely.

Emily Bentley, Campaign Manager for Compassion & Choices Montana, says, “This latest polling is consistent with what we know about Montana values. People in our state agree that privacy is important and individual freedom is worth protecting. They do not want to see their doctor imprisoned for providing what they believe is good medicine. Lawmakers should pay attention.”

Dedicated to a Cause

by Barbara Coombs Lee
March 26, 2013

Last Wednesday, March 20, the Connecticut Assembly’s Public Health Committee began its consideration of a bill modeled after Oregon’s Death with Dignity Act. What a day! In my 22 years of legislative work, this hearing was the most grueling — and the most inspiring — I have ever witnessed.  Compassion & Choices volunteers and supporters showed themselves to be as passionate, judicious, intelligent and dedicated as citizens can ever be. They are committed to a world of justice and mercy. And they trust in democracy to make it so.

They came because they want choice and control in their own mortal endings. But mostly, they came for others who could not — their neighbors and loved ones and people unknown to them. They came that others need not suffer against their will, and that all may have the opportunity to face death in comfort and peace of mind. My heart swelled as I sat with them and heard the witness of these decent, altruistic, dedicated people.

The day began early, as aid-in-dying supporters travelled hours to Hartford by bus, car and train to be in line by 7:00 am.  Sign-up began at 9, but being in line by 7 helped ensure an opportunity to speak. The hearing began at 10 and our bill, Compassionate Aid in Dying for Terminally Ill Patients (HB 6645), came up about noon. Representative Betsy Ritter, the bill’s chief sponsor, spoke with eloquence and authority. Other legislators followed, and then the committee shifted gears and heard unrelated bills.

For many hours our supporters kept each other’s spirits up as they sat patiently through testimony about nursing technicians, dental hygienists, something called advance practice collaboration agreements, and tattoo artist licensure.

Some of our valiant and dedicated supporters just had to leave when their bus departed or their backs gave out. But others stayed until 1 am for their chance to speak. Yes, you read that right — they endured this process from 7 am until 1 am without complaint!!

Here are a just few of the heroes:

Shannon Sanford, a Yale-educated nurse who did her masters thesis on Oregon’s Death with Dignity Act.  ”Compassion & Choices were great to me when I was working on my thesis.  I can stay to the bitter end,” she told us. She had to, attending the entire 15-hour hearing as the last person to testify at approximately 1:30 am.

It fell to Shannon to present the committee with letters from all over the state. The stack was nearly a foot high, making a thump on the table.

Placing her hand on this tower of paper, Shannon said:  ”I brought my friends who are all in support of House Bill 6645″.  A legislator asked, ”I have to know, how many people signed letters?”  Shannon had a snappy response despite sitting 15 hours in a hearing room:  ”I stopped counting after 1500.”

Hunt Williams traveled over an hour to the state Capitol and waited twelve more to tell his story.

Hunt told the committee the story of his manslaughter arrest for merely cleaning a weapon his terminally ill friend, John Welles, used when he was dying of cancer. Only due to the overwhelming support and advocacy in his community of Cornwall, Connecticut, was Hunt sentenced to accelerated rehabilitation, a process that took over a year. The committee and the entire room sat in complete silence as they listened to Hunt’s riveting experience.

“Thank you sir, thank you for giving testimony.  I think I was taken aback by what you had to say,” a stunned co-chair of the committee, Senator Terry Gerratana, said.

Gloria Blick, aged 91, is a passionate advocate for end-of-life choice, as is her son Dr. Gary Blick.

When called to testify, Gloria and Dr. Blick held hands and both walked confidently to the microphone and sat together supporting each other.  Luckily, Gloria has not had a significant illness, but with her active volunteerism in the senior community, she has witnessed first-hand the pain and suffering of those at end of life, and it disturbs her greatly.

She made it clear to the committee she had been too active and too well to see her life end in a slow, relentless spiral of deterioration. Nor would she want her family, including Dr. Blick, to suffer unnecessarily with her.  ”I would never want to do that to my son,” she said.

Lillian Kaplan sat for hours waiting for her opportunity to speak out in favor of HB 6645, offering moving testimony regarding the difficult and painful death of her son-in-law Steven Kahn, who wanted to die on his own terms.  Lillian read into testimony a letter Steven wrote prior to his death.

“I am writing to you so you will not have to wonder…I’m not asking for your approval, only that you honor my judgment,” he wrote.

At the conclusion of her testimony, the Senate Chair of the Committee respectfully asked her age:  ”Well, in a year and a half I will be 100.”

Lillian, Gloria, Gary and Shannon and so many others showed themselves to be amazing and inspiring advocates. It is an honor to be able to work beside them for choice and control at life’s end.

Support grows in Vermont for an end-of-life bill

Janice Lloyd, USA TODAY
March 22, 2013

Most states ban physician-assisted death, but a movement is growing to give terminal patients the right to choose their fate.

Dick and Ginny Walters envision a new approach to dying for Vermont residents: They want terminally ill patients with a prognosis of less than six months to live to have the right to request and take life-ending medication.

The Shelburne, Vt., retirees — he’s 88, she’s 87 — say they are both healthy and fit. They have devoted the past 10 years to the cause, meeting with supporters in their living room to track legislation — including the bill “Patient Choice and Control at End of Life.” It passed the Vermont Senate in February and goes to the House this month.

Although assisted dying is illegal in most states and opponents have been fighting proposals for the past 15 years, support is growing in Vermont and other parts of the Northeast. Connecticut and New Jersey legislators are also examining measures.

“It makes ultimate sense to people who have lived their lives in an independent way and don’t want to be reduced to an infantile existence and having other people make decisions for them,” Dick Walters says. “It’s taken us a long time, but we think Vermont will do this now.”

Vermont would be the first state to pass a doctor-assisted-death bill through the legislative process. Oregon and Washington voters passed similar bills in voter referendums. Massachusetts voters defeated a measure, 51% to 49%, in November.

“We may have lost this time in Massachusetts, but we won in the region,” says Barbara Coombs Lee, president of Compassion and Choices, a non-profit group dedicated to protecting the rights of the terminally ill. “I think the movements in the other states are evidence of that. Vermont is close to passing. In subsequent efforts, Massachusetts will have a leg up.”

Proponents of the Massachusetts measure were outspent 5 to 1 by religious, medical and disability groups, including the Roman Catholic Church, says Coombs Lee. Cardinal Sean O’Malley of Boston said in a statement after the vote that “we can do better than offering them the means to end their life.”

Walters says the Vermont mind-set is different: “Vermonters have a strong belief for respecting each other’s beliefs.”

When his time comes, Walters says, he doesn’t know whether he’d choose to end his life, but his father asked him for help “and it wasn’t legal to do it. It was really hard on me to not be able to help him. I’ve been bothered a long time by his suffering.”

He says a group of Vermont friends, including many retired physicians, got the idea to organize after Oregon passed the first referendum allowing physician-assisted dying in 1997. Oregon’s law went into effect in 1998, and a similar law went into effect in in Washington in 2009.

The Oregon law requires a patient to get two physicians to say he or she is terminally ill (expected to die within six months), to be mentally competent, an adult 18 or older and a resident of the state. The patient has to be physically able to swallow the medication; someone else can’t administer it. The written request for the medication must have two witnesses, one of whom cannot be an heir, and the patient must also make two oral requests.

“There are two waiting periods,” says Peg Sandeen, executive director of Death With Dignity, an advocacy group that helped write the laws. “The person is certain about what he wants.”

Sandeen says when the U.S. Supreme Court ruled 6-3 in favor of Oregon voters in 2006 the ruling paved the way for other states to create their own laws.

But fights continue: In Montana, a bill is pending that calls for imprisoning and fining a person “who aided or solicited a suicide.” The Montana Supreme Court ruled in 2008 that a state law protects doctors from prosecution for helping terminally ill patients die.

Physician Diana Barnard, a hospice and palliative care doctor in Weybridge, Vt., says “citizens are telling us they want this bill to pass. My professional responsibility is to supply the medication.”

Diana Barnard, a physician, says, “Recognizing that the end of your life is coming is important for so many reasons.”(Photo: Handout)

She says most patients want to know when they’re dying, but most doctors don’t know how to have that conversation.

“Recognizing that the end of your life is coming is important for so many reasons,” she says. “You get a chance to say goodbye to people, have closure on big issues. I always ask patients: ‘If time were short, what would be important to you?’ It’s criminal to not let people do this.”

Another part of the Oregon law requires the Health Department to track the number of people who request the medication, those who take it, and the doctors involved. In 2012, 115 requested it, a record number. Among that group, 77 took it and died. Sixty-one doctors filled orders for medications, one fewer than in 2011.

Dick Walters isn’t surprised more patients didn’t take the medication they requested.

“Just having the choice and knowing the medication is available can make a huge difference,” he says. “I think this thing will change how people talk about death and improve end-of-life care.”

Even in hospice care, when patients have stopped taking medical measures to prolong life, someone else administers the medication that helps control pain and eventually aids in ending life.

“That can leave an enormous amount of guilt on the family member,” Coombs Lee says.

“Laws like the one in Oregon relieve the family of the responsibility. It empowers the patient to be in control — to let the family be there, and say ‘Hold me while I do this.’ “

HEARING SET ON DOCTOR IMPRISONMENT ACT OF 2013 – MARCH 26

by Compassion & Choices staff
March 20, 2013

MT BannerClick on the banner to hear our radio ad running in Montana.

HELENA – Legislation that would treat aid in dying as homicide will be heard in the Senate Judiciary Committee on Tuesday, March 26, at 8 a.m. House Bill 505, sponsored by Rep. Krayton Kerns (R-Laurel), seeks to put physicians in prison for up to 10 years for providing aid in dying to terminal patients who request it. It would change the legal landscape established in a 2009 state Supreme Court decision, which found that a physician could not be prosecuted for prescribing medication that a terminally ill person could take to bring about a peaceful death.

The bill could create a government-imposed gag order on physicians and could land doctors in prison for answering their patients’ questions about end-of-life medical care. Physicians worry that they will be second-guessed by prosecutors and legislators when treating dying patients for pain or even patients with symptoms such as sleeplessness or anxiety.

Dustin Hankinson, a disability rights activist and dedicated advocate of end-of-life choice who suffers from muscular dystrophy, testified at the House Judiciary hearing on Feb. 20 against this threat to the right he helped secure in Montana, “By going through all this work – all this work to stay alive – because I want to make a difference in this world, what have I earned? I’ve earned the ability to have them starve me to death and dehydrate, or to drown in my own body fluid. Those are my only options. There should be another option. Palliative care by itself is not adequate. We’re not pro-death. We’re pro-choice. We want people to make decisions that allow them to take responsibility for their own lives.”

A 2010 Binder Research poll showed that an overwhelming majority of Democratic, Independent and Republican voters in Montana “support allowing dying patients in severe distress to make their own end-of-life choice to receive prescription for life-ending medication.”

Before the Supreme Court’s ruling in Baxter v. Montana, it was unclear whether physicians could help terminally ill patients who wished to end their suffering. On December 31, 2009, the Baxter decision made Montana the third U.S. state where aid in dying is a safe and legal medical choice. The ruling strengthened the 1991 Rights of the Terminally Ill Act, which allows mentally competent adults to make a declaration – Montana’s term for a living will. In 2009 the court ruled that the Rights of the Terminally Ill Act specifically defers to a patient’s own decisions and affords patients the right to control their own bodies at the end of life. HB505 would take that right away and weaken the Rights of the Terminally Ill Act.

“Most Montanans agree that it is not the government’s role to interfere in private medical decisions. Politicians are the last people needed at the bedside of a dying person,” said Rep. David “Doc” Moore (R-Missoula). “House Bill 505 would allow the government to undermine the sacred relationship between doctor and patient.”

Many doctors are also speaking out against HB505. Family medicine and palliative care physician Eric Kress appears in a Compassion & Choices Montana radio ad campaign airing on stations throughout Montana this week.

“Sometimes I’m called upon to provide care and compassion to suffering, terminally ill patients at the end of their lives,” Kress said. “But legislators want to put doctors like me who help dying patients in extreme pain in prison. This would ignore the Montana Supreme Court and get big, invasive government into our private medical decisions.”

Kress, Moore and Hankinson will be available at the hearing on March 26 to speak with media representatives.

Aging in America Conference Features Panel on Rise of Unwanted Patient Care

What:  

Aging in America Conference panel sponsored by the Compassion and Choices: “What is Patient- and Family-Centered Care and What Happens When We Fail to Prevent It?” Patient-centered care should not include unwanted medical treatment and unnecessary suffering. Yet millions of Americans with advanced illnesses or who are terminally ill:

  • Suffer needlessly from undertreated pain and other agonizing symptoms;
  • Undergo pointless and costly invasive tests and treatments, often in their last days and hours; and
  • Have their treatment preferences or advance directives ignored or overridden by healthcare professionals and others.

Why:   

A new study published in Feb. in the Journal of the American Medical Association examining Medicare claims data found that between the years 2000 and 2009 treatment in acute care hospitals decreased while the usage of intensive care units (ICU) and healthcare transitions the last month of life increased. An accompanying Journal of American Medical Association editorial, “Changes in End-of-Life Care Over the Past Decade More Not Better,” concluded: “The focus appears to be on providing curative care in the acute hospital regardless of likelihood of benefit or preferences of patients. If programs aimed at reducing unnecessary care are to be successful, patients’ goals of care must be elicited and treatment options such as palliative and hospice care offered earlier in the process than is the current norm.”

Who:  

Mickey MacIntyre, Chief Program Officer, Compassion & Choices (read his testimony about how unwanted medical treatment at life’s end causes needless costly suffering before the Institute of Medicine’s Committee on Transforming End-of-Life Cares);
Lynn Feinberg, MSW, Sr. Strategic Policy Advisor, AARP Public Policy Institute;
Brian Lindberg, MMHS, Exec. Dir., Consumer Coalition for Quality Health Care;
Andrew MacPherson, Director of Government Affairs at Jennings Policy Strategies Inc.

Where:

Crystal C (West Tower/Green Level), Hyatt Regency Chicago, 151 E. Wacker Dr.

When:  

Friday, March 15, 1pm-2pm CT. If you cannot attend panel but want an interview Tuesday (March 12) Wednesday (March 13), Thursday (March 14) or Friday (March 15) with Compassion & Choices Chief Program Officer Mickey MacIntyre, please contact Sean Crowley: 202-550-6524, seancrowley57@gmail.com.

How:   

If you want to attend panel, but have not registered yet for the Aging in America Conference, please contact Jutka Mándoki: jutkam@asaging.org, 312-239-4834.