Patient Choice at End of Life Act
— On April 4, 2016, The Nebraska Legislature indefinitely postponed consideration of LB 1056, the Patient Choice at End of Life Act that had been introduced by Rep. Ernie Chambers.
Under the proposed legislation, an adult with the capacity to make medical decisions who has been determined to have a terminal illness would have been able to receive a prescription for aid-in-dying medication if the individual had voluntarily requested such a prescription and had the physical and mental ability to self-administer the aid-in-dying medication. Procedural safeguards are included in the bill to assure that the patient has appropriate capacity and that the decision is voluntary and free from coercion.
At the hearing held by the Judiciary Committee on February 24, 2016, a number of individuals testified in support of Bill, many with anecdotes concerning very difficult end-of-life episodes endured by loved ones that could have been ameliorated had LB 1056 been in effect.
The Bill attracted opposition of the Nebraska Family Alliance, the Nebraska chapter of National Right to Life (which described the bill as legalizing “doctor prescribed suicide”) and an organization that calls itself “Not Dead Yet,” self described as “a national, grassroots group that opposes legalization of assisted suicide and euthanasia as deadly forms of discrimination.”
Dr. Helen S. Chapple, an Associate Professor at Creighton University, also weighed in with the admonition that bill did nothing to resolve existing confusion and disarray in matters related to advance directives, DNRs and POLST orders. Dr. Chapple suggested that real choice in end of life care would result from improved communication between healthcare providers and patients and provision of realistic access to palliative care and hospice.
Indeed, for the first time, Medicare has begun paying for physicians to discuss preferences for care with patients and their families at any time in the disease course. This change, which took effect on January 1, 2016. There was little controversy for the new Medicare position, unlike the so-called “death panels” opposed by anti-ACA politicos, in part due to the release of the Institute of Medicine’s 2014 report “Dying In America,” which elevated the issue of patient autonomy and choice. Among the conclusions of the report was that advance planning and medical orders are needed to ensure that end-of-life preferences of people, most of whom choose care focused on alleviating pain and suffering rather than extension of life, are honored. This patient preference contrasts starkly with the default mode of hospital treatment, which is acute care without regard to likely outcome even for terminal patients.
In April 2016, the Journal of Internal Medicine ran an article discussing physician-assisted death which approaches the subject from the point of view of the medical profession. An excerpt:
“By the end of 2016, more than 80 million people in the United States and Canada will live in a jurisdiction allowing physician-assisted death. As such, this practice can no longer be considered a quirky experiment in a few states. The North American experience with physician-assisted death began in 1994, when voters in Oregon approved a ballot measure, the Death With Dignity Act, allowing a physician to prescribe a lethal dose of a medication that a patient voluntarily self-administers. Oregon stood alone for 14 years until Washington (2008), Vermont (2013), and now California (2015) approved similar laws. As of January 2016, the effective date of the California law, known as the End of Life Option Act, is uncertain. These laws are in general very similar, with safeguards that include requirements for a waiting period and that eligible patients be mentally competent, not mentally ill, and have a life expectancy of less than 6 months. In 2009, the Montana Supreme Court removed prohibitions against physician-assisted death for competent patients. There are no reporting requirements in Montana, so little is known about the actual practice of physician-assisted death in that state. In 2015, the Canadian Supreme Court unanimously reversed a federal law that prohibited physician-assisted death and gave the government until June 2016 to establish mechanisms for access to such assistance.”