Las Vegas Sun

November 18, 2017

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Death with dignity: Nevada lawmakers consider enabling doctors to prescribe end-life medications

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Alison Noon / AP

Stephanie Packer, a chronically ill patient, tells reporters she opposes physician-assisted suicide on Wednesday, April 12, 2017, at the Nevada Legislature in Carson City. She joined doctors and other activists against Senate Bill 261 at a news conference after Democratic lawmakers canceled a hearing on the proposal that would allow Nevada physicians to prescribe life-ending drugs to patients with prognoses of six months or less to live.

Long before state Sen. David Parks, D-Las Vegas, drafted his death-with-dignity legislation, a longtime friend who died of bladder cancer in 2006 had suggested the concept of the bill in her final days.

“(Her cancer) was both excruciatingly painful and humiliating,” he said. “Morphine only provided limited relief for Cathy. Shortly before dying, she asked me to try to get an Oregon-style death-with-dignity law passed in Nevada.”

More than halfway through the 79th session, Parks is working to keep that promise, with Senate Bill 261. If passed, the legislation would enable a physician to prescribe medications designed to end the life of a patient.

“This is one of my higher-priority bills,” he said.

The legislation requires that patients be 18 or older, a Nevada resident for at least 30 days, capable of making and communicating health care decisions. Two physicians must agree on a diagnosis of terminal illness that will lead to death within six months.

Patients seeking a prescription must submit an oral request to a physician, followed by a 15-day waiting period, and then a second oral request to the physician. Then they must submit a written request. There is then a 48-hour waiting period before the patient can acquire prescribed medications.

Five states have passed similar legislation, starting with Oregon in the mid-1990s. Washington followed suit in 2008, then Vermont in 2013 and California in 2016. Colorado passed its act in November. The District of Columbia also passed legislation in 2016.

Charmaine Manansala, the national director for political advocacy at the nonprofit organization Compassion & Choices, which advocates for end-of-life care options, said in recent years states have been more prone to consider this type of legislation.

Click to enlarge photo

This undated photo shows Brittany Maynard. The terminally ill California woman moved to Portland, Ore., to take advantage of Oregon's Death with Dignity Act, which was established in the 1990s. Maynard wants to pass a similar law in California and has turned to advocacy in her final days.

“Ever since Brittany Maynard, legislation has skyrocketed,” she said, referring to the woman whose story went viral in 2014. Maynard, who was diagnosed with terminal brain cancer at 29, moved from California to Oregon to obtain end-of-life options.

“Because of her story, more and more people are talking about this,” Manansala added. “In 2016 alone, 25 states looked into passing legislation.”

This year, there are 23 states, including Nevada, wrestling with this subject.

For those who have dealt with or watched someone at the end of their life, this is an inevitable conversation.

“Almost everyone whom I’ve talked to has a devastating story to share regarding a friend or relative who died under unbearable circumstances where this legislation would have provided an alternative to enduring excruciating agony,” Parks said.

Before his friend died, Parks talked to her multiple times about end-of-life care. He knew he would fight for his promise to bring legislation to Nevada, but he just didn’t know when.

It was after Washington passed its bill that he began to really look into the possibility of bringing it to Nevada.

“It was on my mind for the 2011 session,” he said.

But he didn’t introduce the legislation until 2013.

“I ended up withdrawing the draft of that bill at the start of the 2013 session based upon the fact that the session was well underway, and it would have left no time to educate and lobby for the successful passage of the bill,” he said.

But he vowed to bring it back.

The next session, he introduced the bill but it didn’t get a hearing. This session is the first time the legislation was heard. The Senate Health and Human Services Committee took up Parks’ bill in a hearing May 10.

“Sometimes, it takes multiple sessions to get a major bill passed,” Parks said.

Parks’ bill is sponsored by 10 senators and cosponsored by seven Assembly members. It even has some bipartisan support, such as state Sen. Ben Kieckhefer, R-Reno, a co-sponsor who did not respond to requests for comment.

While this has been a tough battle among politicians, it also has been a point of disagreement for medical professionals.

Dr. T. Brian Callister, of Reno, board-certified in internal medicine and hospitalist medicine, said it would be a bad step.

“It’s giving a doctor permission to kill,” he said.

Callister says there are many factors why he and other colleagues are against the legislation, including that doctors are “notoriously bad” at predicting life expectancy.

He also says it’s an unnecessary option people take prematurely. Callister said two of his patients needed to transfer to other states because the procedures that could have helped their conditions were not available in Nevada. He said neither procedure would have been covered by their insurance, yet another option was on the table.

“They talked about considering assisted suicide,” he said. “Proponents of this bill want to point at Oregon or Washington to show how well it’s going. That couldn’t be further from the truth.”

He said the majority of people requesting life-ending prescriptions have done so not because of pain but because they felt as though they were a burden on a family member.

Another point of contention is how death certificates are written for patients.

“They say the primary illness was the cause of death and not assisted suicide,” he said. “That’s a lie. We would be lying on an official medical form.”

On the flip side, Dr. Mitchell Forman, a board-certified rheumatologist in Henderson, views this legislation as a positive step.

“We talk about ‘do no harm,’ ” Forman said. “If you look at end-of-life care, everything we do can be more painful, disruptive or disturbing. Maybe they live longer, but they don’t have a quality of life.”

Dr. Jerry Cade, the director of viral specialty treatment services at UMC, agreed with Forman and added that patients should be in control of their own health care decisions.

“There are four pillars of medical ethics,” he said. “One of the most important ones is a patient’s autonomy. They have the right to make their own choices.”

Working with patients with HIV/AIDS during the height of that epidemic, he saw patients at their worst.

And although treatment for HIV has improved, Cade says he still sees patients (with or without the virus) who go through painful deaths.

“We shouldn’t deny them their dignity,” he said. “This (bill) is the right thing to do.”

Callister, though, said patients need not have issues of pain or discomfort.

“We have great hospice care, and we are in a day and age where there is no reason someone should be in pain when they die,” he said. “I hear the horror stories of people suffering at the end, and frankly my response is, ‘Sorry you didn’t have a different doctor.’ ”

He also said there is fear that the proposed legislation could open the door to abuse, whereby a person would benefit financially from a patient’s death.

Manansala said there hadn’t been any documented cases of death-with-dignity laws resulting in coercion.

Forman said there were safeguards in place to prevent such situations.

“I’ve seen elderly patients who were kept alive just because (their families) had a check coming,” Cade added.

While on opposing sides, all were committed to speaking about this legislation.

Catherine O’Mara, the executive director of the Nevada State Medical Association, said most physicians the organization had talked to were conflicted between two tenets: do no harm versus patient autonomy.

During the 2015 session, the association was opposed to death-with-dignity legislation, but that has changed.

“The association doesn’t have a majority consensus among its members (on this legislation),” she said. “That’s why we’ve taken a neutral stance.”

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