As Karen Banks wrote her testimony, there was a moment of déjà vu.
This was Banks’s third time testifying against the same bill in the short span of two years. Known as HB 7015 in its current incarnation, the bill is making its third appearance in the Connecticut legislature in the past two years. In its past two iterations, the bill was defeated.
The bill currently being discussed in committee would permit a patient that has been diagnosed as terminally ill, with fewer than six months to live, to submit a written request to his or her physician to receive lethal medication.
Two written requests would have to be submitted, 15 days apart. Each would have to be signed by two witnesses testifying that the patient was not coerced into requesting the medication. Physicians would have to find the patient to be competent and not mentally ill.
While its support and opposition continue to come from the same sources as in the past, a public hearing last Wednesday drew more people to testify than ever before.
This year’s bill is similar to past versions, with a change in the requirements for witnesses. In past proposals, one of the witnesses was allowed to be from the patient’s family, but the current bill mandates that neither witness be related to the patient.
“MY LIFE. MY DEATH. MY CHOICE.”
Last Wednesday’s hearing before the judiciary committee drew a visibly mixed crowd. Throughout the audience, supporters of the bill wore green stickers that read “My Life. My Death. My Choice.” while opponents sported blue ones.
More than 200 people testified at the public hearing, sharing their experiences as patients, caregivers, medical professionals and religious and spiritual leaders.
Much of the testimony was motivated by personal encounters with illness and death. However, similar experiences also informed opposing opinions on the issue.
State Rep. Kelly Luxenberg testified in support of the bill, as she recounted her father’s painful battle against early onset Parkinson’s Disease while she was a child. Parkinson’s took away his ability to have a dignified death, she said. He ultimately drowned himself in a local reservoir.
However, Julianna Bennett’s experience caring for her grandmother in her final years convinced her that assisted suicide would be “misguided compassion.” She recalled various moments when her grandmother felt discouraged by her helplessness, and noted that in these moments, the elderly are particularly vulnerable to legislation that may allow them to take their own lives.
Compassion and Choices, one of the groups involved in the national movement pushing for assisted suicide bills, has been working locally in Connecticut to pass HB 7051.
The American Civil Liberties Union of Connecticut has also expressed its support for the legislation as a means of defending people’s personal choices, said Patrick Gallahue, communications director for the ACLU of Connecticut. The bill was incorporated into their annual lobby day on Tuesday. Other groups that advocate for personal choices have also vocalized their support for the bill.
“This is a choice that should be available to all mentally competent adult citizens in any open, enlightened and democratic society,” said Patrick McCann, president of Harford Area Humanists.
However, Maggie Karner, a patient with glioblastoma brain cancer, dismissed the claim that assisted suicide laws actually increase patients’ choices. She added that these laws weaken the promise of care and support at the end of life for terminally ill patients.
OPPOSITION FROM THE MEDICAL ESTABLISHMENT
The issue of choice and control over treatment has also been met with resistance from medical professionals who have spoken out against assisted suicide.
Robert Russo, president of the Connecticut State Medical Society, testified against the bill on behalf of the CSMS. He cited his concern that assisted suicide goes against the Hippocratic Oath because it allows physicians to give a “deadly drug.” National medical organizations, including the American Medical Association, have also spoken out against assisted suicide laws for the same reason.
Andre Sofair SPH ’97, a professor of medicine and epidemiology at Yale and a general internist at Yale-New Haven Hospital, said the legislation is fraught with problems, from the definition of competency, which varies between doctors, to the safeguards listed in the bill.
For example, one safeguard requires doctors to refer patients to a consulting physician to confirm the diagnosis of a terminal illness. However, doctors will tend to refer patients to doctors similar to themselves, who will likely deliver the same diagnosis because they have similar perspectives, Sofair said.
Representatives from various hospice and palliative care centers also testified in opposition to the bill, which they claim is an undesirable alternative to the personalized care that hospice offers.
“Providing dignity to individuals at the end of life comes as a result of caring for them through their illness and natural dying process,” said Laura Borrelli, hospice director at Franciscan Home Care and Hospice Care.
Banks, a former nurse, thinks that assisted suicide should not be discussed until issues in palliative care and hospice are addressed first.
The Palliative Care Advisory Council was formed out of past debate on end-of-life issues, with the goal of generating reports of its findings by Jan. 1, 2015. However, these reports have not yet been released, making it difficult to evaluate the role of palliative care at the end of life, Banks said.
“It’s premature to bring forward a bill on assisted suicide,” Banks said. “There’s a lot of work to be done, and we need to get more information on the status of palliative care.”
Sofair also noted that many of the reasons that motivate terminally ill patients to end their lives stem from underlying issues that can be dealt with without death.
This bill would make patients see doctors as people with the ability to end patients’ lives rather than extend them, he added.
“If this law is passed in Connecticut, it will change the relationship between the physician and the patient in a dangerous way,” Sofair said.
NOT JUST A CATHOLIC ISSUE
Last week’s public hearing included testimony, mostly in opposition, from more than 10 religious representatives. According to Michael Culhane, executive director of the Connecticut Catholic Public Affairs Conference, assisted suicide bills are an affront to the Catholic Church’s moral teachings on the sanctity of life.
Many other pieces of testimony were grounded in religious beliefs.
However, Culhane does not want people to look at the issue as one unique to Catholicism. He noted that there are dozens of groups nationwide that are institutionally opposed to assisted suicide bills.
“The proponents of this measure would have the legislators believe that this is solely a ‘Catholic’ issue,” Culhane said. “That’s just wrong.”
Stephen Mendelsohn, a member of Second Thoughts Connecticut, a group that advocates against assisted suicide, added that he is “disheartened” when the issue is portrayed as a Catholic one because he thinks that attitude disregards other groups who have their own reasons to oppose the bill.
The bill has also raised opposition from the disability community.
Aid-in-dying policies are discriminatory, said Cathy Ludlum, a member of Second Thoughts Connecticut. She noted that suicide prevention is in place for the general population while the terminally ill are provided suicide assistance.
“Choice does not extend to asking others to commit acts that would be considered criminal in different circumstances,” said Lisa Blumberg, a member of Second Thoughts Connecticut.
Mendelsohn noted that there are numerous problems with assisted suicide bills, including insufficient protection of the elderly. Requiring two witnesses who are unrelated to the patient does not prevent a family member from bringing two friends to witness the request, she noted.
Additionally, provisions in the bill that refer to “self-administering” the lethal medication or demonstrating “competency” are not clearly defined as applied to the disabled and those who are unable to communicate or move freely, Mendelsohn added.
In its testimony, Compassion and Choices noted that there have been no documented cases of elderly abuse in Oregon, where an assisted suicide law was passed in 1994.
But reporting does not necessarily mean regulating, said Katrina Hedberg ’80, state health officer at the Oregon Public Health Division. By the reporting system currently in place in Oregon, the Department of Public Health only has the power to collect data and audit incorrectly completed forms. They only collect data that they feel has medical and health relevance, Hedberg said.
The data that they have collected so far paints a nuanced picture of terminally ill populations. Only two-thirds of the patients who are prescribed lethal medication use it to end their lives. Most of the patients have cancer and are in hospice, but are not depressed or suicidal.
Hedberg added that assisted suicide measures have not been isolated among minorities and people with low education; rather, data show that most patients are white and college-educated. The most common reason for using lethal medication was “loss of autonomy,” but almost forty percent of patients also considered themselves a burden on their families.
ORGANIZING THE MOVEMENT
The assisted suicide bill was first proposed in Connecticut in 2013, but was defeated in the Public Health Committee. In 2014, former state Rep. Betsy Ritter and state Sen. Edward Meyer sponsored the bill again, but it was defeated once more.
This year, the bill is taking a different path through the legislature. Ritter was not re-elected to her position, so, under new sponsors, the bill has been referred to the Judiciary Committee, rather than the Public Health Committee.
Mendelsohn believes that the change in committee is an attempt by the bill’s proponents to present the bill to a new group of legislators, instead of having to present the same arguments to the same committee for a third time. He added that some members of the Judiciary Committee have been on the Public Health Committee in the past, and may continue to look upon the bill unfavorably.
Sofair attributed the increase in testimony to concern that the bill might pass this year.
Both sides are preparing for a legislative battle. On Tuesday, more than 100 people spoke with legislators at the state capitol as part of the ACLU of Connecticut’s Lobby Day. Compassion and Choices is also reaching out to various organizations to spread awareness of the bill, said Tim Appleton, Connecticut campaign manager at Compassion and Choices. He added that the group currently has one to two dozen supporters in every House district.
Second Thoughts Connecticut, on the other hand, lacks the resources that Compassion and Choices has, Blumberg said. Mendelsohn agreed, adding that their challenge is explaining the bill’s risks to those who may not have thought about specific implications.
“When assisted suicide is reduced to six word slogans like ‘My Life. My Death. My Choice,’ many people support it,” Mendelsohn said.
Assisted suicide is legal in Oregon, Vermont and Washington.