CommunityMy FDL

The Religious Right’s Assault on Palliative Care

Anti-choice forces are taking aim at end-of-life care. They’re after people at the end of a long decline who exercise their right to stop life-prolonging technology or treatment. Their tactic is to tie the hands of doctors attending those patients, when palliative treatment might ease the patient’s chosen death. They seek to undermine the widespread agreement among doctors: Treatments can be stopped, and should be stopped as humanely as possible, when patients’ wishes are clear.

But the medical establishment’s support for patient choice exists within a particular, and peculiar, bioethical framework. Doctors usually invoke the Catholic doctrine of double effect to explain how they can perform an act, such as administering sedatives and disconnecting a ventilator, knowing the two acts will cause the patient’s death. The doctrine holds that a person is not responsible for what they know will ensue as the product of their actions, so much as what they intend. In essence, “my intention was not to cause death, my intention was to ease suffering.”

A problem arises for palliative care physicians when people question their intention. Since it is impossible to prove a thought, doctors will always be vulnerable to accusations about intentions. This vulnerability is exploited when anti-choice advocates promote legislation that 1) raise the bar on what will pass for lawful practice and thought, 2) magnify penalties for those found guilty of forbidden thoughts and intentions and 3) encourage scrutiny and whistleblowing by onlookers and medical colleagues. And the medical lobby has done little to oppose these bills.

Recent events illustrate the danger.

Georgia HB 1114, passed last month to prohibit assisted suicide. Shaped by Georgia Right to Life and the Georgia Catholic Conference (thanked from the floor of the House) and with no visible objection from the physician community HB 1114 purports to outlaw suicide assistance. Here I would like to affirm my strong support for clear laws and harsh penalties for those who incite and abet suicide.

But a mere 19 of this bill’s 57 lines address actual criminal behavior. The bill’s drafters wasted few words on perpetrators of violence, guns, nooses and other atrocities by which online predators and other malicious enablers encourage self-destructive impulses of the mentally ill. The heinous crime of inciting a despondent or disturbed person to kill themselves seems almost an afterthought in this bill.

The bulk of the bill — 37 lines — frets over patient decision-making and medical treatment in minute detail. It focuses on doctors more than the voyeurs and predators that endanger society. The new law repeatedly specifies that any withholding, withdrawing, prescribing, administering or dispensing must be solely intended and calculated to relieve symptoms and never to cause death. Some tried to allow treatment that “eases the dying process,” but the lawmakers deemed that language too permissive and generous.

Georgia lawmakers not only paste targets on healthcare professionals, they also armed those taking aim at forbidden intentions with the state’s RICO (Racketeer Influenced and Corrupt Organization) law. The heavy artillery of RICO magnifies the state’s policing authority, extends penalties, adds civil liability and enables prosecution of individuals only tangentially involved in the patient’s care.

A recent study showed onlookers and watchful colleagues already threaten palliative care physicians with accusations of murder and euthanasia. Over half of palliative physicians report they have endured such accusations at least once, some as often as 6 times, over the past 5 years. And in the bills they promote, anti-choice advocates enable these watchdogs.

Patients need more legislative vigilance on their behalf. Dying patients need a voice in our nation’s statehouses. Without one, the creation of thought crimes, threats of exorbitant punishment and hyper-vigilant whistle-blowers could stunt the future of palliative care.

Previous post

Spain's Serious Banking Troubles Presage Eurozone Crackup

Next post

Penn Jillette Calls BS on Obama's "States' Rights"

BarbaraCoombsLee

BarbaraCoombsLee

Barbara Coombs Lee is President of Compassion & Choices, a non-profit organization dedicated to expanding and protecting the rights of the terminally ill. She practiced as a nurse and physician assistant for 25 years before beginning a career in law and health
policy.

Since then she has devoted her professional life to individual choice and empowerment in health care. As a private attorney, as counsel to the Oregon State Senate, as a managed care executive and finally as Chief Petitioner for Oregon’s Death with Dignity Act, she has championed initiatives that enable individuals to consider a full range of choices and be full participants in their health care decisions.

Ms. Lee took her undergraduate education at Vassar College and Cornell University and obtained advanced degrees in law and medicine from the University of Washington and Lewis & Clark College. She holds an adjunct position at the University of Washington School of Public Health and Preventative Medicine and is a member of the Oregon State Bar.

She has been interviewed by NBC News, CNN Crossfire, 60 Minutes, McNeil Lehrer News Hour, NPR, The Today Show, and Bill Moyers’ “On Death and Dying” among others. She has also testified before the US Congress on end-of-life issues.

She has been recognized with a national health Policy Fellowship, Boeringer Ingeheim Foundation, an American Jurisprudence Award for outstanding performance in the study of medical law and a National Health Lawyers Association scholarship for outstanding student achievement.

Ms. Coombs Lee has been a presenter at programs sponsored by American Bar Association, Older Women’s League, American Pain Society, Oregon State Bar, Americans for Better Care of The Dying, American Associations for the Advancement of Science, End of Life Concerns, and the American Pain Society. She spoke at the World Federation Right to Die conference in Zurich, Boston and Brussels.
Her audiences have included the Oregon Gerontological Association: the California Nurse Assembly & Education Conference. Her debate “Doctor Assisted Suicide: Compassionate Alternative or Murder” with James Bopp, Jr., was produced by “Justice Talking” a project of the University of Pennsylvania’s Annenberg Public Policy Center
for Public Radio.

Since Gonzales v. Oregon, the lawsuit defending the Oregon assisted-dying law, Ms. Coombs Lee has been interviewed by many of the nation’s newspapers. She has been quoted in the New York Times, The Washington Post, The Chicago Tribune, and on NPR’s All Things Considered. Recently, The Harvey M. Meyerhoff Lectures on Ethics at the End of Life hosted her presentation “Local Medical Practice and the Federal Threat” at Johns Hopkins University.

5 Comments