End-of-Life Choice, Palliative Care and Counseling

Posts TaggedGeorgia

Bishops’ Actions at Odds With Call for Religious Freedom

U.S. Conference Imposes Catholic Doctrine on Non-Catholics

Atlanta, GA – Compassion & Choices  today called on Catholic
Bishops to acknowledge that their own actions limit religious freedom. The United States
Conference of Catholic Bishops (USCCB) meets this week in Atlanta. The meeting,
according to USCCB press materials, “will include a two-hour floor discussion on domestic
and international religious freedom.”

“It’s ironic the bishops are convening in Georgia to discuss religious freedom,” said Perry
Mitchell, incoming president of Compassion & Choices’ Georgia chapter. “Just weeks ago
the Catholic Conference lobbied the Georgia legislature to outlaw as ‘assisted suicide’
accepted end-of-life medical practices and support for terminally ill patients making
rational, informed decisions. In lobbying government to restrict end-of-life choices, the
bishops are imposing Catholic doctrine on patients and physicians – Catholic and non-
Catholic alike.”

With HB1114, the Georgia legislature originally aimed to outlaw suicide assistance. Yet the
bulk of the bill focuses not on people who aid and abet mentally ill, suicidal individuals, but
on doctors delivering end-of-life care. It repeatedly specifies that any withholding,
withdrawing, prescribing, administering or dispensing of medical services must be solely
intended and calculated to relieve symptoms. Patients are never allowed to make a rational
decision to advance the time of death. The new law gags patients who might express a wish
to die. It makes doctors more vulnerable to accusations of “assisted suicide” merely for
providing treatments that relieve end-of-life suffering. During legislative debate, the
Georgia House speaker even thanked the Catholic Conference for helping to write the bill.

The bishops are working to impose their religious teaching not just in Georgia, but also
across the nation.

The Massachusetts Catholic Conference has announced its opposition to the Death with
Dignity ballot measure before that state’s voters this November, and it plans to mount a
vigorous — and likely expensive — campaign against it.

Through its vast national network of Catholic healthcare facilities, the bishops enforce
Ethical and Religious Directives for Catholic Healthcare (ERDs). The bishops instruct
doctors to ignore advance directives that conflict with Catholic moral teaching (ERD #24),
obligate them — with few exceptions — to provide indefinite tube feeding to patients in
permanent vegetative states (ERD #58), disallow as “euthanasia” a patient’s refusal of
treatment such as kidney dialysis if they intend to advance the time of death (ERD’s #59
and 60), limit dying patients’ knowledge of treatment options to those the bishops consider
“morally legitimate” (ERD #55) and urge employees to offer religious teaching on the
redemptive power of suffering when standard comfort care fails (ERD #61).

With regard to Oregon and Washington’s Death with Dignity Acts, the bishops use the
machinery of Catholic healthcare to violate informed consent principles and withhold
information about aid in dying, a legal end-of-life choice. Catholic hospitals, hospices and
healthcare systems in those states instruct their employees to deprive patients in their care of
comprehensive knowledge of end-of-life choices.

“Over and over we see the bishops confuse the right to exercise their religion with a right to
impose their religion on Americans who don’t share it,” said Barbara Coombs Lee,
president of Compassion & Choices. “This is not a subtle difference.”

The Religious Right’s Assault on Palliative Care

Anti-choice forces are taking aim at end-of-life care. They’re after people at the end of a long decline who exercise their right to stop life-prolonging technology or treatment. Their tactic is to tie the hands of doctors attending those patients, when palliative treatment might ease the patient’s chosen death. They seek to undermine the widespread agreement among doctors: Treatments can be stopped, and should be stopped as humanely as possible, when patients’ wishes are clear.

But the medical establishment’s support for patient choice exists within a particular, and peculiar, bioethical framework. Doctors usually invoke the Catholic doctrine of double effect to explain how they can perform an act, such as administering sedatives and disconnecting a ventilator, knowing the two acts will cause the patient’s death. The doctrine holds that a person is not responsible for what they know will ensue as the product of their actions, so much as what they intend. In essence, “my intention was not to cause death, my intention was to ease suffering.”

A problem arises for palliative care physicians when people question their intention. Since it is impossible to prove a thought, doctors will always be vulnerable to accusations about intentions. This vulnerability is exploited when anti-choice advocates promote legislation that 1) raise the bar on what will pass for lawful practice and thought, 2) magnify penalties for those found guilty of forbidden thoughts and intentions and 3) encourage scrutiny and whistleblowing by onlookers and medical colleagues. And the medical lobby has done little to oppose these bills.

Recent events illustrate the danger.

Georgia HB 1114, passed last month to prohibit assisted suicide. Shaped by Georgia Right to Life and the Georgia Catholic Conference (thanked from the floor of the House) and with no visible objection from the physician community HB 1114 purports to outlaw suicide assistance. Here I would like to affirm my strong support for clear laws and harsh penalties for those who incite and abet suicide.

But a mere 19 of this bill’s 57 lines address actual criminal behavior.  The bill’s drafters wasted few words on perpetrators of violence, guns, nooses and other atrocities by which online predators and other malicious enablers encourage self-destructive impulses of the mentally ill. The heinous crime of inciting a despondent or disturbed person to kill themselves seems almost an afterthought in this bill.

The bulk of the bill — 37 lines — frets over patient decision-making and medical treatment in minute detail. It focuses on doctors more than the voyeurs and predators that endanger society. The new law repeatedly specifies that any withholding, withdrawing, prescribing, administering or dispensing must be solely intended and calculated to relieve symptoms and never to cause death. Some tried to allow treatment that “eases the dying process,” but the lawmakers deemed that language too permissive and generous.

Georgia lawmakers not only paste targets on healthcare professionals, they also armed those taking aim at forbidden intentions with the state’s RICO (Racketeer Influenced and Corrupt Organization) law. The heavy artillery of RICO magnifies the state’s policing authority, extends penalties, adds civil liability and enables prosecution of individuals only tangentially involved in the patient’s care.

A recent study showed onlookers and watchful colleagues already threaten palliative care physicians with accusations of murder and euthanasia. Over half of palliative physicians report they have endured such accusations at least once, some as often as 6 times, over the past 5 years. And in the bills they promote, anti-choice advocates enable these watchdogs.

Patients need more legislative vigilance on their behalf. Dying patients need a voice in our nation’s statehouses. Without one, the creation of thought crimes, threats of exorbitant punishment and hyper-vigilant whistle-blowers could stunt the future of palliative care.

Threat to End-of-Life Choice Heads to Georgia Governor

Bill Will Force Unnecessary Suffering at Life’s End

Portland, OR – Compassion & Choices, the nation’s oldest and largest nonprofit organization working to improve care and expand choice at the end of life, today expressed disappointment with a bill that undermines end-of-life choice in Georgia. The bill, sent today to Governor Nathan Deal’s desk, was initially aimed at preventing suicide coercion but will force unnecessary suffering on people near the end of their natural lives.

“Responsible medical practice at the end of life has no relationship to the crime of assisting a suicide,” said Barbara Coombs Lee, president of Compassion & Choices. “Treating the suffering of a terminally ill cancer patient is not similar to goading vulnerable young people to play Russian roulette.”

In drafting HB1114, the Georgia legislature tried to prevent assistance for people with mental illness to kill themselves, while also permitting rational end-of-life decisions and supportive medical care. They achieved the first goal, but fell far short in the second. Now doctors and patients are more vulnerable to accusations of murder and assisting a suicide for decisions and treatments to relieve end-of-life suffering.

HB1114 threatens compassionate implementation of advance directives, medical orders and responsible pain and symptom management. Doctors are at risk for criminal prosecution and civil litigation unless they can prove their decisions and actions were strictly “intended” and carefully “calculated” to treat pain.

The bill could have been even worse, said Coombs Lee. “Compassion & Choices fought to preserve the liberty and dignity of dying patients, and to protect the doctors, nurses and family members who care for them. Earlier versions gutted constitutionally protected rights and contained a dangerous provision that would have applied organized crime statutes to medical practice. This could have pulled dedicated doctors and nurses, families, loved ones, caregivers and even educators into unknowingly committing a crime.”

HB1114 creates uncertainty among medical providers and caregivers as to whether it is a crime when a licensed physician aids a mentally competent, terminally ill person in dying by:

• Providing palliative support to a patient who decides against dialysis, pacemakers, antibiotics or other medication, or who elects to stop eating and drinking;
• Administering palliative sedation upon the request of the patient;
• Prescribing medication to offer the comfort of knowing that a peaceful death is possible.

“We hope Governor Deal will veto HB1114,” said Coombs Lee, “and insist on a bill that protects private medical decisions between patients and doctors.”

Accusations of murder against those who provide palliative care are a growing national problem. Patients suffer when doctors are afraid to treat their pain. Patients who hope to end prolonged agony and advance the time of death are denied protection under the bill.

Confusion and disagreement about the reach of state assisted-suicide laws cause physicians to reject their patients’ end-of-life wishes and drive dying patients to endure prolonged, agonized deaths against their will, turn to violent means to end their suffering, or persuade loving family members to risk criminal prosecution.

“A law against assisted suicide,” said Coombs Lee, “should protect Georgians with disordered thinking from anyone who would facilitate attempts to harm themselves. But it should not interfere with options for comfort and support of terminally ill patients.”

Don’t Confuse FEN Death and Investigation with Aid in Dying

The media has recently reported the arrest of individuals associated with a group known as Final Exit Network (FEN) on charges of assisting a suicide in Arizona, and attempting to engage in similar activity in Georgia. The cases reported in the media this week involving FEN ought not be confused with the choice of aid in dying.

Media accounts of the facts suggest that the Arizona decedent was not terminally ill and may have suffered from impaired judgment and/or mental illness.

It is important to recognize the difference between the choice of a mentally competent, terminally ill patient for a peaceful death via self-administering medications prescribed for this purpose, and the act of a distraught individual who is not dying, who may be suffering from impaired judgment or mental illness, to precipitate death.

Read the press release here

Keeping Aid in Dying Illegal Results in Covert, Violent Deaths

Compassion & Choices, the nation’s largest advocate for end-of-life care and choices, today responded to the arrests in Arizona and Georgia.

“Covert, clandestine aid in dying occurs every day in the U.S.,” said Barbara Coombs Lee, president of Compassion & Choices. “It is a symptom of a national crisis—the unbearable suffering and covert, frightful options that many dying patients face at the end of life. Today’s developments illustrate the desperation patients feel, and the need for rational public policy on end-of-life choices. Only Oregon, Washington and Montana currently have rational policies. Terminally ill patients need laws that provide legal aid in dying now. The time has come to close the door on illegal aid in dying and underground, desperate actions by suffering patients.”

Read the press release here