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Briefing from Oregon: House Bill 2232

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House Bill 2232 would expand the remit of Oregon's Death with Dignity Act

What does the Bill do?

-Prohibits anyone other than patient from administering medication to end patient’s life in humane and dignified manner

-Defines “self-administer.”

-Expands definition of “terminal disease.”

-Permits patient to request medication to end patient’s life in humane and dignified manner no earlier than 90 days after receiving terminal diagnosis. Creates exception to 90-day waiting period for patient with less than six months to live.

Issues:

i) Self-administration

The Bill, inserts a definition of self-administer which does not feature in the original DWDA. Bill 2232 defines “Self-administer” as follows:

Self-administer” means a qualified patient’s physical act of ingesting or delivering by another method medication to end his or her life in a humane and dignified manner.”

Bill 2232 replaces the term “taking” which is featured in the DWDA throughout and replaces it with ‘self-administer.’

ii) Terminal Disease

In the DWDA, terminal disease is defined as in incurable and irreversible disease which, “within reasonable medical judgment” will produce death within six months.

Bill 2232 defines terminal disease as follows: “A disease that will, within reasonable medical judgment, produce or substantially contribute to a patient’s death.”

iii) Responsibilities of the attending physician

Bill 2232 adds the following responsibilities:

-The attending physician shall “medically confirm the patient has a terminal disease”

iv) Waiting Periods

The DWDA states that “no less than 15 days shall elapse” between the patient’s first oral request for PAS and the writing of a lethal prescription. It also states that at least 48 hours must elapse between the patient’s written request and the writing of a lethal prescription.

Bill 2232 amends this detail by stating there should be a cooling off period of at least 90 days between receiving a terminal diagnosis and the patient orally requesting lethal medication.

However, it stipulates that if the patient has less than six months to live according to “reasonable medical judgment” the patient can make the request for oral medication straight away.

Bill 2232 retains the criterion that there must be at least 15 days between the patient’s oral request and the writing of a prescription and at least 48 hours should pass from when a patient submits a written request to when a prescription is written.

ANALYSIS:

Bill 2232 would change Oregon’s DWD law in a number of significant ways.

First of all, the redefinition of terminal illness is significant. It no longer stipulates a prognosis of less than six months to live but says instead, that it must be a disease which would “produce” or “substantially contribute” to a patient’s death. By scrapping the criterion of less than six months to live, Bill 2232 would significantly widen the remit of Oregon’s PAS law to people who may have years ahead of them but who have received a diagnosis of dementia or who are in the very early stages of another degenerative illness, like motor neurone disease.

Second, on the surface, extending the cooling off period between terminal diagnosis to 90 days seems like a tightening up of the DWDA. But in the light of the redefinition of terminal illness, this is not the case and would apply only to people who have been diagnosed with a serious or degenerative disease but who potentially have years ahead of them.

For those with a prognosis of less than six months to live, (namely those who would qualify currently under the DWDA) Bill 2232 allows them to make an oral request for medication straight away, when they are still highly vulnerable because they’re processing earth shattering news. This is a significant loosening of Oregon’s current safeguards, especially when we consider that prognosis is by no means an exact science.

Finally, the substitution of the word ‘take’ with ‘self-administration’ which is defined as ingestion or ‘another method’ is vague and requires clarification. If a patient cannot ingest the medication this begs the question; how much assistance they will need to commit suicide by other means and whether, in reality, Bill 2232 would actually teeter on doctor administered euthanasia.

 

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