Drug overdose could become a legal choice for some

This year, for the first time, the Ohio Legislature will be considering a bill that would transform the crime of assisted suicide into a “medical treatment.”

The Ohio bill, SB 249, if passed, would permit a doctor to prescribe “aid-in-dying medication” to end the life of a patient if certain conditions are met. Many people assume that the “medication” would be “a pill” the patient could take and then “slip peacefully away.” But this is false.

In states where doctor-prescribed suicide is legal, the vast majority of prescriptions are for 100 times the normal dose used for medicinal purposes. When the prescription is taken, the individual dies of a massive drug overdose.

Those promoting the Ohio “End of Life Option Act” portray it as a necessary, benevolent choice that should be available. While their sincerity is beyond question, their good intentions cannot protect people from the deadly consequences of what they are proposing.

Under the “End of Life Option Act,” here is what could happen:

A person could be diagnosed as having a terminal condition. While still reeling from the news of the diagnosis that individual could ask, “What are my options?”

At that point the doctor is to discuss the “feasible alternatives” that are available. But knowing about those options doesn’t necessarily mean the patient can obtain any of them. Health insurance programs may refuse to pay for treatments that the patient needs and wants.

Take, for example the case of Stephanie Packer, a young California mother who was diagnosed with a terminal form of scleroderma. Her doctor prescribed treatment that would be less toxic than other drugs and her insurance company indicated that it would cover the cost.

But, then, California’s “End of Life Option Act” went into effect and the insurance company notified Packer that its approval had been withdrawn. They would not pay for the treatment she wanted and needed. She then asked if assisted suicide would be covered under her plan.

The response was, “Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication.”

Packer’s experience is not unique. Similar cases have been reported in other states where doctor-prescribed suicide is considered a medical treatment. Referring to payment for assisted suicide, the Oregon Department of Human Services explains, “Individual insurers determine whether the procedure is covered under their policies, just as they do any other medical procedure.”

The reality is that low-income individuals face great difficulties when they attempt to receive necessary health care. Those who are disenfranchised and underprivileged confront barriers that put any and all “feasible options” out of reach.

If the Ohio law passes, will insurance companies do the right thing — or the cheap thing?

Invariably, proponents of doctor-prescribed suicide claim that it is necessary to prevent dying in excruciating pain. Yet official reports from Oregon, where assisted suicide has been legal for many years, indicate that pain or even concern about pain is not the reason the vast majority seek out the prescription for a drug overdose.

Instead, fear of being a burden on their families and losing autonomy are among the five top reasons patients give more often than pain.

The following are among the specific elements of the Ohio measure.

An adult (defined as someone 18 years old or older) who is diagnosed with a terminal condition could request and receive a prescription for what is euphemistically called “aid-in-dying medication.”

So, someone who is not old enough to buy beer could buy the lethal prescription drugs.

And what about the “terminal condition?” That would be something caused by disease, illness or injury that is predicted to cause death within a “relatively short time,” which is an elastic term if there ever was one.

But, we are told, there are “safeguards.” Unfortunately, the safeguards have so many loopholes you could drive a hearse through them.

Here are just a few more examples of what is in the Ohio proposal.

The patient must make two oral requests and one written request, which must be witnessed by two people. However, one witness can be someone who would benefit financially from the person’s death. The other witness could be the heir’s best friend.

Patients can be mentally ill or severely depressed and still not be referred for any mental health assessment. A referral is necessary if, and only if, the attending or consulting physician believes that patient lacks “capacity” which is defined as the ability to make and communicate an informed decision. No counseling of any type is required.

This provision is similar to that contained in Oregon’s law where, in one year, fewer than 3 percent of those receiving the lethal prescription were referred for any mental evaluation.

Unlike the laws and proposals in other states, the Ohio bill would permit someone other than the patient to administer the deadly overdose. According to the bill, no person shall “administer an aid-in-dying medication to an individual without the individual’s knowledge or consent.” Of course, there’s no way to know if the patient knew or consented to taking the drugs, since once the prescription is filled, all safeguards cease.

The bill only addresses activities taking place up until the prescription is filled. There are no provisions to ensure that the patient is competent at the time the drug overdose is taken. Someone could trick or even force the person into taking the overdose and no one would ever know.

But, one might wonder, since the bill requires reporting from physicians, wouldn’t this provide information about what happened?

Actually, it would not.

It’s true that prescribing physicians must file report forms after the patient dies and must answer a number of questions such as when and where the patient consumed the drugs; if there were any complications, etc. But for each question the physician has the option of answering, “Unknown.”

That’s because the physician who prescribed the drugs doesn’t need to be present or even know the circumstances surrounding that patient’s death.

Isn’t it ironic? At a time when there is tremendous concern about the epidemic of drug overdose deaths, there is also a campaign in Ohio to promote drug overdoses for a certain category of people.

(Rita Marker is an attorney and executive director of the Patients Rights Council.)

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