NH assisted suicide bill, round 1

For hours yesterday, people spoke up against assisted suicide in New Hampshire, essentially saying “hell, no.” The count was impressive. The only decisive count will come from legislators, though, and the outcome is very much in doubt. Here’s this morning’s Facebook post by a committee member, referring not only to HB 1325 but to a second bill, HB 1226, to set up a committee to study end-of-life decisions

“NH Voters: If you are concerned with end of life decisions and you are against Assisted Suicide, please send e-mails to the House Judiciary Committee, flood our in boxes. We had two public hearings yesterday on the subject and some committee members are actually planning on voting for this to pass. NO ONE spoke in favor of these two horrific bills, but plenty of people spoke out against it. Unfortunately, some of the speakers were from out of town and most e-mails have come from out of town. Their thinking is that since no one is speaking out in NH, it must not be something people are concerned about, so let’s pass it…… The link is HouseJudiciaryCommittee@leg.state.nh.us. Thank you!”

The setting for the hearing

Too much was going on at once yesterday. Two hearings, only a few yards apart in Concord’s Legislative Office Building, and I had to choose. I went with door #2. Over an hour later, first round of business done, I hurried to where the House Judiciary Committee was having its hearing on HB 1325.  I hoped I wasn’t too late.

I could barely get in the door.

There was the committee, seated around its big U-shaped table taking up two-thirds of the room, with no one aside from House staff permitted to stand along the walls. This is the standard set-up for New Hampshire House committees. In the remaining third of the room, the two rows of seats were full, with more people standing in clusters at each end of the rows. When I managed to squeeze into the room, I became the de facto doorkeeper as people entered and left.

I was so wedged in that I couldn’t reach my phone or use my tablet, so the world had to get along without my livetweeting (and at last report the world was getting along fine without it). Just as well, since I’d been using the hashtag #hb1325, which someone later pointed out to me was the same hashtag used for a bill in Colorado on a different subject. In the future I’ll use #noPASnh (with PAS standing for physician-assisted suicide).

Some of the testimony

I had earlier provided the committee clerk with the testimony I had prepared on behalf of the New Hampshire nonprofit organization for which I work. The committee members will see this, even though I didn’t testify in person. The core of the testimony is here:

Nothing is more certain to inhibit support for palliative- and supportive-care strategies than to make physician-prescribed death a treatment option. Pain management, respite care, and adaptive technology can require complex, time-consuming effort. Taking a handful of pills is cheap. The negative message to vulnerable, depressed individuals would be unmistakable.

I recognized friendly faces in the crowd, including legislators who have worked for years to resist assisted-suicide legislation. I also saw many people I didn’t know, and I could only hope they were there to protest the bill. I later heard from a committee member that they were indeed opponents – and articulate ones, too. Two of them posted their testimony online via links on PRWeb. They’re worth quoting, but I heartily recommend you go to the PRWeb link to read the statements in full.

From John Kelly, on behalf of Not Dead Yet and Massachusetts Second Thoughts:

We were the progressive voice in Massachusetts that defeated the assisted suicide ballot question.  Our opposition is based in universal principles of social justice that apply to everyone, whether disabled or not….We chose our name Second Thoughts because we find that many people, once they delve below the surface appeal of assisted suicide, have “second thoughts” and oppose it.  In Massachusetts a month before the election, 68% of Massachusetts voters supported the ballot question.  But upon closer look at the real-world threats the legislation posed, voters had serious “second thoughts.”  …

There is nothing in this or any other assisted suicide bill that can protect people who are being abused.  Every year in New Hampshire, it is estimated that there are over 26,000 reported and unreported cases of elder abuse.  No independent, disinterested witness is required when the lethal dosage is taken, which means that the stipulation that someone “must” self-administer the drug is merely a recommendation.  These bills take no notice of how self-interest can motivate family members and caregivers.  Because of the typical provision in these laws that death certificates list the cause of death as the underlying illness, investigations are foreclosed….

HB 1325 uses a definition of “terminal condition” that directly threatens the lives of me and many of my disabled friends.  Section 13 reads:“Terminal condition” means an incurable and irreversible condition, for the end stage for which there is no known treatment which will alter its course to death, and which, in the opinion of the attending physician and consulting physician competent in that disease category, will result in premature death.

The day this bill goes into effect, thousands of people will be instantly made eligible.  For example, my quadriplegia constitutes “an incurable and irreversible condition.”  It has “no known treatment,” and likely “will result in premature death.”  This bill would authorize a New Hampshire doctor, whom I saw “regularly,” to validate temporary feelings of being a burden as being worse than death.  Legalizing assisted suicide sends the wrong message to anyone who depends on caregivers, the message that feeling like a burden is not only an acceptable reason for suicide, but a justification for our health care system to provide the lethal means to end your life.  We are not better off dead.

From Stephen Mendelsohn of Second Thoughts Connecticut:

This bill, with its expansive eligibility targeting a wide range of people with long-term disabilities who are nowhere near death, morphs New Hampshire’s honored state motto, “Live Free or Die” into an ableist obscenity: “Live Nondisabled or Die.”… 

Let us remember that people in Oregon and Washington [where assisted suicide is legal] are killing themselves not because of pain, but because of fear of disability, because they view needing assistance with eating or toileting as a “loss of autonomy,” a “loss of dignity,” and a “burden” on others [according to Oregon’s 2012 report on the Death with Dignity Act]….

As Oregon’s experience shows, death is always the cheapest “treatment.”  Barbara Wagner and Randy Stroup found that out when Oregon Medicaid refused to pay for chemotherapy, but offered to pay for lethal drugs so they could commit suicide under that state’s “Death With Dignity Act.”…

And what message does this legislation send toward those contemplating suicide?  We constantly hear the six-word slogan from proponents, “My Life. My Death. My Choice.”  If “my death” is “my choice,” what message are we sending to an autistic or LGBT teenager who is being mercilessly bullied?  After all, victims of bullying also experience “severe, unrelenting suffering.”  Why even have suicide prevention? … Let us reject HB 1325 and instead work to build a world where no one feels they ought to die merely because they cannot do everything for themselves and instead receive blessing from others, whether they may have days, months, or many years of life ahead.

When I arrived at the hearing, Margaret Dore was speaking, trying vainly to compress extensive testimony into just a few minutes. It’s a fact of life that even when a committee chair goes out of her way to be accommodating, as did Judiciary chair Marjorie Smith (D-Durham) yesterday, all those who testify late in a hearing bear the burden of everyone’s impatience. Dore is an elder-law attorney from Washington state, and she has come to New Hampshire before to fight other assisted suicide bills. Her experience with her own clients has thoroughly schooled her in the risks of abuse inherent in any law that makes physician-prescribed death just another medical option.

The hallway conversations – and what must be done next

Before the hearing began, I spoke with a veteran legislator from the Judiciary committee. He was not optimistic. “Lobby the Senate. Now.” I raised an eyebrow (perhaps two) and asked for his count of the votes on the committee. He declined to elaborate.

Another committee member caught up with me after the hearing and filled me in on what I had missed. She said the turnout by anti-1325 forces had been great. Then this morning, she wrote the warning with which I opened this post. As if the truth changes at the state line … but I appreciate her candor.

Yesterday, a lot of people did a good day’s work. I wish it were enough. Instead, it’s only round one. If this gets through House and Senate – and I concede nothing at this point – it may come down to a veto by Governor Maggie Hassan. Hassan has not addressed this bill directly, but she did veto a bill last year for an end-of-life study committee, introduced by an assisted-suicide supporter. At that time, she said our focus should be “on helping all of those in our society to fully live their lives with the dignity that they deserve.” That sounds promising.



NH has an assisted suicide bill (again); time to say no (again)

[An earlier version of this post had an incorrect time for the hearing.]

What better way to kick off February than with a life-issues extravaganza? That was apparently the thought somewhere in the State House when the the legislative calendar for the coming week was devised. And just to make things more interesting, the Powers that Be scheduled the House hearing for an assisted suicide bill the same time as a hearing on the fetal homicide bill: 1:30 p.m. this Tuesday, February 4 in the Legislative Office Building. I’ll be there. Sprinting between rooms 204 and 208 is not that hard.

The sponsors for assisted suicide legislation come and go, but the goal never changes: death on demand, as as a corollary, put to rest the silly notion that medicine is a healing art. This year’s bill is HB 1325. Text is here, complete with list of sponsors, led by Joel Winters of Concord.

On my desk, I have an inch-thick binder full of my notes and copies of old New Hampshire legislation on assisted suicide. The oldest bill I have is HB 339 from 1995. Do you know how much difference there is between the statement of purpose in the 1995 bill and the one in 2014? None. How about the difference in what the two bills define as “terminal condition”? Again, none.

Stephen Drake of the Not Dead Yet, a disability-rights group, wrote recently about this year’s New Hampshire bill in New Hampshire Assisted Suicide Bill Redefines “Terminal Condition” Broadly Enough to Make Anyone With a Significant Disability or Chronic Condition Eligible.

“[In the bill] ‘Terminal condition’ means an incurable and irreversible condition, for the end stage of which there is no known treatment which will alter its course to death, and which, in the opinion of the attending physician and consulting physician competent in that disease category, will result in premature death.

Read that definition carefully, terminality is defined as having a condition that is irreversible and will result in a premature death. My partner would fit that definition. Many people I work with also fit the definition.

None of them are dying.

Keep in mind that this definition is to be used only in terms of eligibility for assisted suicide. It doesn’t, for example, apply to hospice services which are limited by federal rules to those who are deemed as having six months or less to live.

So, no guarantee of palliative care for people with significant disabilities or conditions, unless they’re thought to be close to death. That would be expensive.

OTOH, this bill would offer help with easy and successful suicide for anyone with a serious, significant, potentially life-shortening condition/disability at any time at all.

So, no guarantee of medical support to make life easier, but a ‘hand out’ to those who want to die, even if they’re not dying.”

I’ve been involved in right-to-life work for too long to believe any longer that medicine is a healing art. The fact that assisted suicide hearings are not overrun by angry health care professionals – everyone from medical technicians to M.D.’s – speaks volumes.

I firmly believe that legalizing medical murder will be a huge disincentive to the development of effective palliative care strategies. The cheaper strategy will prevail, particularly in a government-run health care environment. Alleviating pain can be a complex, multispecialty endeavor. Compare that to the cost of a lethal-dose prescription.

I’ve been with a loved one who was dying in pain. In 2009, my mother died three excruciating weeks after taking a fall on an icy driveway and then being alone and helpless for an estimated 30 to 60 minutes. She was in poor health to begin with. The injury set off the failure of one organ after another, and she hung on as long as she did only because she didn’t want to leave her husband, my stepdad. It took three weeks for her body to get the better of her iron will. Those three weeks gave me plenty of time to consider how it feels to watch a loved one in pain. It also gave me plenty of time to consider how much less care she’d have gotten if prevailing medical wisdom had been about killing instead of caring.

She died in a hospice bed, where she belonged. Somewhere on a balance sheet, the transfer from hospital to hospice is counted as an expense. I shudder to think whether that expense would be considered worth it in a medical setting where assisted suicide is legal. Politics being downstream of culture, I wonder how long Medicare would cover such things as transfers to hospice if physician-prescribed death is accepted.

Someone is reading this and thinking But she didn’t ask for assisted suicide, and her case is irrelevant to the New Hampshire bill. Not so. Once it’s legal for a physician to prescribe a drug for the purpose of ending a patient’s life, it’s only a matter of time before other health care professionals are given the same authority. (Ask any nurse practitioner about “scope of practice.”) It will only be a matter of time before it’s clear how sloppy the law’s definition of “terminally ill” really is. And the minute an assisted suicide bill becomes law, and medically-administered death becomes just another therapeutic option, palliative care will be treated by the bean counters as a luxury.

Not that I have anything against bean counters, but medicine is no longer a matter between doctor and patient. It’s a matter between provider and patient and whoever is footing the insurance bill.

Aside from the substantive moral bankruptcy of assisted suicide, I’m offended by the violence that such legislation does to language. From HB 1325: “Nothing in this chapter shall be construed to authorize a physician or any other person to end a patient’s life by lethal injection, mercy killing, or active euthanasia. Actions taken in accordance with this chapter shall not, for any purpose, constitute suicide, assisted suicide, mercy killing, or homicide, under the law.” Really? A physician can prescribe a drug for the sole purpose of ending a patient’s life, and that’s not homicide on the physician’s part or suicide on the patient’s part?

“‘When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean – neither more nor less.’ — Lewis Carroll. Humpty Dumpty would have been right at home with HB 1325. We’ll soon know how many New Hampshire legislators want to be perched up on that shaky wall with him.