End-of-Life Choice, Palliative Care and Counseling

New Legislation

Legal Debate Over Aid-in-Dying Legislation

Tuesday, March 5, 2013

The Diane Rehm Show on WAMU 88.5 | NPR

Montana’s House of Representatives passed a bill that could imprison doctors for assisting in suicide. Legislation is pending in other states to make it legal. A panel joins Diane to discuss the legal and political debate over end-of-life issues.


Barbara Coombs Lee
president, Compassion & Choices, and chief petitioner of the 1997 Oregon Death with Dignity Act. She was a nurse and physician assistant before becoming a private attorney.

Thaddeus Pope
director of the Health Law Institute and associate law professor at Hamline University School of Law.

Joanne Lynn
geriatrician, hospice physician and director of the Altarum Institute Center on Elder Care and Advanced Illness.

Krayton Kerns
doctor of veterinary medicine and Republican member of the Montana Legislature.


Listen Here: http://thedianerehmshow.org/audio-player?nid=17396



Bill to Imprison Doctors for Aid in Dying Advances in Montana, Despite Voter Opposition

by Compassion & Choices staff
February 28, 2013

(Washington, D.C. – Feb. 28, 2013) The nation’s leading end-of-life choice advocacy organization urged the Montana Senate and Governor Steve Bullock to reject a bill passed Thursday in the Montana House of Representatives by a 51-46 vote that would imprison doctors for up to 10 years if they provide aid in dying.

“Threatening doctors with 10 years in jail for honoring a terminally ill patient’s request for aid in dying violates the sacred doctor-patient relationship and the views of most Montana voters,” said Compassion & Choices President Barbara Coombs Lee, a nurse and physician assistant for 25 years before becoming a private attorney, counsel to the Oregon Senate and a Chief Petitioner of the first-in-the nation 1997 Oregon Death with Dignity Act. “Taking away the option of aid in dying would exacerbate the suffering of dying patients.”

A 2010 Binder Research poll showed an overwhelming majority of Democratic, Republican and Independent voters in Montana “support allowing dying patients in severe distress to make their own end-of-life choice to receive a prescription for life-ending medication.” If the bill, HB505, authored by House Judiciary Committee Chairman Krayton Kerns (R-Laurel), is enacted into law, it would gut a 2009 Montana Supreme Court ruling in Baxter v. Montana, a case brought by Compassion & Choices, confirming that it is not against public policy in Montana for a physician to provide aid in dying to a mentally competent, terminally ill person.

“The Senate and Governor Bullock must honor the views of their constituents by rejecting this draconian bill to take away the right of mentally competent people to make their own medical decisions,” said Coombs Lee. “Other state legislatures are moving to protect this legal right, not deny it.”

In contrast to Montana, legislative efforts promoting patient choice at the end of life are underway in numerous other states, including New Jersey, Connecticut, Hawaii, Kansas, Massachusetts, Vermont and New Hampshire. Two weeks ago, the Vermont Senate gave final approval to a “Death with Dignity” bill that would protect doctors from criminal or civil liability when treating terminally ill patients who choose to end their lives. National polls consistently show the vast majority of Americans want to maintain their right to choose their medical treatment at the end of their life.

Unwanted Medical Treatment at Life’s End Causes Needless Costly Suffering

February 20, 2013

Testimony of Mickey MacIntyre
Chief Program Officer, Compassion & Choices

Before the Institute of Medicine’s Committee on Transforming End-of-Life Care

Good afternoon. I am Mickey MacIntyre, Chief Program Officer for Compassion & Choices, a national nonprofit consumer organization dedicated to improving care and expanding choice at the end of life. I appreciate the opportunity to address the committee today.

Compassion & Choices’ central tenet is that Americans are free to choose how they live – so it follows that when the time comes, we are free to choose how we die. This private, personal decision belongs to all Americans – free from government interference. U.S. courts around the country, including the United States Supreme Court, have upheld this right.

Today, I want to address one specific problem: unwanted medical treatment. Patients have the right and the responsibility to guide their own health care throughout their lives, with their trusted health care professionals. Many Americans give thoughtful consideration to medical decisions that may need to be made if they are injured or debilitated, and they articulate their decisions in advance directives.

Congress passed the Patient Self-Determination Act (PSDA) in 1990 to reinforce an individual’s right to determine the course of his health care. This Act amended Medicare and Medicaid law to require providers to follow policies and establish procedures with regard to advance directives. The PSDA established that if these policies are not followed, the Secretary of Health and Human Services (HHS) may decide that the provider is ineligible for payment through Medicare and Medicaid.

President Obama reasserted the importance of respecting patients’ rights in a 2010 memorandum to HHS asking the agency to, “ensure that all hospitals participating in Medicare and Medicaid are in full compliance with [these regulations]…[t]hat all patients’ advance directives…are respected, and that patients’ representatives otherwise have the right to make informed decisions regarding patients’ care.”

Nevertheless, many patients’ decisions are overridden or ignored in the weeks and months before their deaths. This happens for a variety of reasons and can lead to invasive and fruitless testing, needless suffering, unrelenting pain and a prolonging of the period before death. Patients are tethered to monitors and machines despite their determination to reject unwanted treatment and desire to die at home in the embrace of loved ones.

A new study published in JAMA found that between 2000 and 2009, treatment in intensive care units in the last month of life increased from 24% to 29%. The accompanying editorial 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.” Compassion & Choices could not agree more.

Policy makers can and should provide both the carrot and the stick to ensure that patients’ wishes are honored: financial incentives for honoring advance directives and financial DISincentives for disregarding patients’ expressed wishes.

The Centers for Medicare and Medicaid Services (CMS) should deny payment to providers where there is clear evidence that specific treatments were unwanted — similar to policies where unnecessary treatment is provided.
The Justice Department is investigating and taking legal action against hospitals and doctors groups when instances of unnecessary treatment are exposed. The same due diligence should be trained on unwanted medical treatment. It is always unnecessary and should be considered a never event.

The explosion of the aging population coupled with the nation’s financial and moral commitment to providing health care to an ever-increasing number of Americans reveals that the scourge of unwanted treatment should be an urgent priority for this committee. Among the next steps Compassion & Choices recommends are:

Initiate and improve the quality of conversations among health care professionals, patients and families about end-of-life decisions, including:
1. reimbursing medical providers for participation in advanced care planning with patients and their families well in advance of illness or before facing end of life;
2. providing financial incentives and training to encourage medical providers to offer all the information and counseling necessary for decision making when securing informed consent;
3. ensuring that the full range of medical care and treatment decisions, including curative care, palliative care and medical assistance in dying, are freely available to patients without institutional or reimbursement barriers.

Further CMS should:
1. exclude from covered services and reimbursement any treatment that contravenes an adult patient’s informed health care decision;
2. track complaints where patient wishes were ignored and ensure that the survey and certification processes for providers require attention to patient’s advance directives;
3. revise billing forms to have providers indicate that care was rendered in conformance with patient’s advance directive and informed consent.

I thank you for the opportunity to testify today, and I will be happy to answer questions or provide written follow-up information.
Thank you.

Submit Your Story of Unwanted Treatment

Have you had an experience involving unwanted or unnecessary medical treatment. If so, please take a moment and tell us your story in an effort to help ensure that all patients have the right to guide their own health care decisions throughout their lives. Please follow this link to our stories submission page.


Montana Bill Would Obstruct Baxter Decision and Roll Back End-of-Life Choices

by Compassion & Choices staff
February 19, 2013

HELENA – Legislation that would make aid in dying a homicide will be heard in the
House Judiciary Committee on Wednesday, Feb. 20, at 8 a.m. House Bill 505 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. HB505, sponsored by
Rep. Krayton Kerns (R-Laurel), seeks to “clarify the offense of aiding or soliciting
suicide” and would deny Montanans’ the right to choose aid in dying.

Before the Supreme Court’s ruling in Baxter v. Montana it was unclear whether
physicians could face prosecution for helping terminally ill patients who wished to end
their suffering. On December 31, 2009, the Baxter decision made Montana the third U.S.
state in which 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 deferred 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.

“The fact that Senate Bill 220 was tabled and House Bill 505 exists is really
disappointing,” said Dustin Hankinson, a disability rights activist. “This bill is part of a
continuing effort to deny rights established in 1991 by the Rights of the Terminally Ill
Act and reaffirmed by Baxter three years ago.”

HB505 goes beyond just prohibiting aid in dying by putting a physician at risk of
prosecution for answering a patient’s questions about any of a variety of deathhastening
options, such as directing deactivation of a cardiac device, directing
withdrawal of a ventilator or feeding tube, or provision of palliative sedation; and a
spouse, child or friend could be prosecuted for driving the patient to the doctor’s office
for the discussion.

“The complex issues surrounding how we die represent the most critical and sacred
moments of our individual lives,” said Dr. Stephen Speckart, a Missoula cancer
specialist. “For a very small number of patients experiencing intolerable end-of-life
suffering and who have received maximal palliative support and who meet specific
criteria, physician aid in dying should be an option as an appropriate and compassionate
end-of-life decision.”

Compassion & Choices Applauds Vermont Senate’s Important Vote to Advance Death With Dignity Bill

by Compassion & Choices staff
February 12, 2013

(Montpelier, VT) – The Vermont Senate today voted 17-13 to override the Senate Judiciary Committee’s recommendation on S.B. 48, a bill to allow mentally competent, terminally ill Vermonters the option of choosing aid in dying. The following statement can be attributed to Kathryn Tucker, Director of Legal Affairs for Compassion & Choices, the nation’s oldest and largest nonprofit working to improve care and expand choice at the end of life. Tucker testified before the Senate Judiciary Committee in favor of the bill on February 6.

“Today’s vote is an important step for patients, families and doctors who support choice and autonomy. The Vermont Senators’ vote reflects the views of a great majority of Vermonters, who overwhelmingly support aid in dying. Citizens want to control their lives, up to the moment they die, without government interference in their private healthcare choices. Today’s Senate vote supports giving individuals the opportunity to make deeply personal medical decisions based on their own values and beliefs.

“We are pleased that the full Senate will continue debate on the aid-in-dying measure. Beyond Vermont, end-of-life choice is advancing in at least seven other states this year.

“Compassion & Choices is proud to work alongside Patient Choices Vermont and our many supporters throughout the state who, along with Governor Peter Shumlin, were instrumental in this important legislative victory.”

Compassion & Choices provides support, education and advocacy to improve care at the end of life. To request client services or for more information, call 800.247.7421 toll-free or visit www.CompassionAndChoices.org. All services are free of charge, and confidentiality is strictly protected.