Senate passes end-of-life planning bill

The Connecticut Senate passed a bill on Thursday that, with House approval, would create a system for terminally ill people to declare their wishes for end-of-life care.

The Medical Orders for Life-sustaining Treatment (MOLST) bill, which passed the Senate with a unanimous vote, would create a two year pilot program in two different locations in the state for people with terminal illnesses to discuss with healthcare providers how much treatment they want, from limited care to life-support treatment. Resulting signed documents would be sent in a medical order to care providers, a move supporters said would clarify treatment plans for patients and doctors.

The bill is one of two pieces of legislation dealing with end-of-life care this year, the other being a controversial Aid-in-Dying bill that would allow terminally ill patients to get prescriptions for life-ending medication. The bill, called “assisted suicide” by opponents, did not get through the public health committee for the second year in a row.

Representative Phil Miller, who is the vice-chair of the Public Health Committee and has supported aid-in-dying legislation in the past, expressed his support for the MOLST bill. The bill has also received public support from Governor Dannel Malloy.

“There’s a lot of people who are open to this course of action,” Miller said. “But there’s also a lot of people who are against it, and they’re very vehement. There’s concern that the right-to-die may sometime become an obligation to die.”

A bill similar to the MOLST bill failed in committee last year after push-back from disabilities and anti-assisted suicide advocacy groups like Second Thoughts Connecticut, which argued that there were not enough protections to make sure doctors were not trying to influence patients to choose less costly care.

But this year, members from Second Thoughts CT were included in the bill’s drafting process, resulting in what Miller called “good safeguards.”

“This year there are some very important fixes,” said Cathy Ludlum, a member of Second Thoughts CT who had input into the bill. “There are a number of protections and the whole structure is set up to support autonomy and individualized choice. That’s why we are supporting it this year.”

Safeguards in the bill include requiring the patient’s signature on the medical order, providing information to patients in a language they understand, and requiring training for medical practitioners in talking about end-of-life care, said Ludlum.

Ludlum said she will still be watching for data from independent studies if the bill is passed to see whether the safeguards prove effective.

“It’s only a pilot,” she said. “We have to see how it works.”

Connecticut already has systems in place for terminally ill patients, according to Jay Patel MED ’16, a medical school student who founded a student-run group advocating for end of life care and aid-in-dying legislation.

Patel, who supports the bill that passed the Senate, said Connecticut’s hospice care system includes forms for living wills and “Do Not Resuscitate” (DNR) orders.

However, patients’ requests can be vague and are not currently “medical orders,” meaning family members can request that they be disregarded. He said that when patients have not officially declared end-of-life wishes, hospitals run into large problems.

He cited a legal dispute over prolonged life support in Florida, the case of a terminally ill patient Terri Schiavo, who was kept on life support for nearly fifteen years despite her husband advocating that she be removed from support.

“[The bill] is a great way to encourage decisions to have a written record while discouraging the kind of thing that happened in the Terri Schiavo case where people were going back and forth,” Patel said. “But is it something that’s groundbreaking? No not really.”

Patel said the bill’s passage in the Senate was a step in the right direction toward passing the Aid-in-Dying bill that was tabled this year, and would allow doctors to give patients medication to end their lives.

Tim Appleton, the director of Compassion and Choices in Connecticut, which has advocated for the Aid-in-Dying bill, agreed. He said the “advance directives” required in the current bill would complement future aid-in-dying legislation, which he expects to pass in the future.

“Connecticut voters want that bill to be passed, and we will be back next year to do just that,” Appleton said, adding that passing an aid-in-dying bill was inevitable.

A study by Quinnipiac University last month showed that 61 percent of voters supported the Aid-in-Dying bill.

But despite aid-in-dying advocates’ claims that the MOLST bill will create momentum to pass aid-in-dying legislation, Ludlum disagreed.

“We feel that if [the MOLST bill] goes through it will actually reduce some of the clamor for assisted suicide,” Ludlum said. “If the issue at hand is that people need more choice, this will give people a lot more choice.”

Oregon was the first state to create an end-of-life medical orders system, in 1991.

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