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Will Nevada Join The Other States That Allow Physician-Assisted Death?

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Heidi de Marco/Kaiser Health New/Heidi de Marco/Kaiser Health News

A palliative care doctor reassures a patient that she will do all she can to ease is pain and improve his comfort.

The right-to-die, or physician-assisted death, is an idea now legal in six states and the District of Columbia. 

 

Nevada might be next. 

 

State Senator David Parks has tried twice before to pass right-to-die bills in Nevada. Both attempts failed. He is trying again this session to get the legislation passed.

“Death with dignity is an end of life option that allows certain terminally ill people to voluntarily and legally request and receive a prescription from their physician that would hasten their death in a peaceful, humane and dignified manner," Parks said.

Currently, patients are allowed to refuse medication treatment, but Parks said that is really not enough for people who aren't getting a medical treatment but instead are just taking something to minimize the pain. Those patients might be refusing food and water, which is an extremely painful way to die.

Support comes from

Parks started his efforts to pass right-to-die legislation after a friend of his became seriously ill. She told Parks several times that if she had been well enough she would've moved to Oregon where physician-assisted death has been legal for 20 years.

"She went through a horrible experience at end of life," he said, "And she asked that I try to get such legislation passed here in Nevada."

But not everyone agrees that allowing someone to choose physician-assisted death is the humane decision.

 

Dr. T. Brian Callister is a professor at the University of Nevada, Reno School of Medicine. He's opposed to the bill. Dr. Callister said while his heart goes out to the people who have a bad experience with the death of a loved one it doesn't mean a bill allowing physician-assisted death is the right thing to do.

"We have to be careful that some individual cases personal bad experiences with the dying process doesn't result in a reaction that forms a bad public policy," he said.

Callister said that right-to-die laws are ripe for abuse and decrease access to care.

He also pushed back on the idea that people are dying in pain and the bill gives them an option to relieve the pain.

He said surveys of people in Oregon who were choosing to end their lives show that only 21 percent say it was because of pain. The top reasons are concerns about being a burden to family, loss of enjoyment of life and loss of autonomy. And while Callister admits those are serious issues, he doesn't believe they are enough to end a life.

In addition, Callister said that palliative care has become much better over the years and so has pain control. He said inadequate pain treatment does not need to be a problem. 

Callister believes allowing people to decide when to end their lives is a slippery slope and he wonders when and where the line is drawn about how much "good time" a person has left?

“At one point have we crossed that line and said we’re prophylactically killing people so that we don’t have to face our fears of what the future may hold,” he said.

For Don Strait, the support of the bill was easy.

"This is what my wife wanted," he said.

Strait's wife had a rare and extremely aggressive form of cancer. She had wanted to move to Washington state, where physician-assisted suicide is allowed, when her health became too bad but the cancer progressed faster than expected and she was too sick to move.

Strait agreed with Dr. Callister that medications can control pain but he pointed out there is a cost to taking them.

"Dr. Callister is correct. They are able to stop the pain," he said, "But unfortunately, the amount of medication it takes to stop the pain also pretty much stops living."

He said, in the end, his wife was just slowly wasting away. She died after 12 days of being unable to eat or drink anything.

"The death itself was not the frightening part," he said, "The frightening part is the loss of control and basically the loss of living. When all you can do is lay there unconscious, and breath shallow and slowly lose weight until the heart finally gives out. It just felt to her like legalized torture."

Kristen Hanson with the Patients Rights Action Fund understands what it is like to lose a loved one to cancer. Her husband died of brain cancer but she disagrees with right-to-die laws.

She said laws like the one being looked at in Nevada have fatal flaws. She said protections against depressed people using the law aren't strong enough and doctor's make mistakes, which is what happened with her husband.

He was diagnosed and told he had only a few months to live. Instead, they choose to go through treatment and he lived three years beyond what was first expected.

Hanson said in his darkest days of treatment he might have taken pills to end his life but he survived those days and even fathered their second child while in remission.

She and Callister say there is a perverse incentive for insurance companies in states with right-to-die laws. 

"It will lead to some patients who want to live, who have curable cancers or other diseases that will be denied life-saving treatment and will lose their lives when they didn't want to," she said.

Hanson gave the example of two patients in Oregon, Barbara Wagner and Randy Stroup, who were denied chemotherapy by insurance companies but the companies sent them letters telling them that physician-assisted suicide was legal in the state. 

She said insurance companies don't give out those letters anymore but she is certain that information is still conveyed behind closed doors. 

However, Death with Dignity, an advocacy group for right-to-die laws disputes the characterization of those cases.

For his part, Parks said of all the years that right-to-die legislation has been around there hasn't been a single case of abuse or coercion. In fact, he said that palliative care improves in states with right-to-die laws.

Dr. David Orentlicher is a professor at UNLV Boyd School of Law. He is both a medical doctor and he holds a law degree. 

He has been studying the trend of states adopting right-to-die laws. He said it wasn't until the 70s that patients were allowed to refuse treatments.

Now that they are allowed to refuse life-saving treatments, he doesn't see a big difference between allowing patients to stop life-saving treatments and allowing terminally ill patients from taking a handful of pills.

"If we really think it's important for people who are seriously ill and suffering from irreversable illness not to have to continue living then it really doesn't matter whether it's taking the pills or turning off a ventilator," he said.

Guests

Bill sponsor Sen. David Parks, D-Las Vegas; Dr. T. Brian Callister, professor, University of Nevada, Reno School of Medicine; Dr. David Orentlicher, professor, UNLV Boyd School of Law; Kristen Hanson, Patients Rights Action Fund; Don Strait, supports bill/wife died of terminal illness

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