Bill offers end of life options

Terminally ill patients could access aid-in-dying medications under a bill considered by the Judiciary Committee Feb. 24.

Under LB1056, introduced by Omaha Sen. Ernie Chambers, an adult diagnosed with a terminal illness—with less than six months to live—and capable of making his or her own medical decisions, could request a prescription for aid-in-dying medication. The medication must be self-administered by the patient.

A person would not be eligible for medication based solely on age or disability.

Chambers said he understands the emotional nature of the issues addressed by the bill, but that they should be discussed in a public forum.

“When it comes to the most significant and portentous decision in a dying person’s life, no third party—including the government—has the right to interfere with, impede or countermand the wishes of the person,” he said. “For the government to withhold from such a person the right and means to carry out his or her final decision is totally unjustified, inexcusable and unacceptable.”

To receive a prescription under LB1056, a qualifying patient would:
• have a diagnosis of terminal illness from an attending physician;
• express a wish to receive the prescription voluntarily and without coercion; and
• demonstrate the physical and mental ability to self-administer the medication.

A request for aid-in-dying medication would be made orally and in writing to an attending physician. The written request must be signed and dated by the patient in the presence of two witnesses who can attest to his or her capacity to make medical decisions and that the decision was made voluntarily and without coercion.

The bill requires that one of the witnesses not be related to the patient by blood, marriage or adoption, entitled to any portion of the patient’s estate upon death or the owner or employee of a health care facility where the patient is receiving medical treatment.

An attending physician would determine if the patient requesting aid-in-dying medication has a terminal illness, has made the request voluntarily and is qualified to receive the medication. Upon reaching a qualifying determination, the attending physician would refer the patient to both a consulting physician for confirmation of diagnosis and a mental health professional for confirmation of mental capacity capable of making medical decisions.

Charmaine Manansala, representing the end-of-life advocacy group Compassion and Choices, testified in support of the bill. She said five states have passed similar legislation and their residents no longer have to worry about future physical pain just knowing the option is available to them.

“All Nebraskans should have the option, together with their families and doctors, to make end-of-life decisions right for them in the face of terminal illness,” she said. “Medical aid in dying is not suicide. It involves individuals who would love to live but can’t. They request assistance not in the spirit of depression, but to help them pass peacefully.”

Tom Meyer of Lincoln also supported the bill. His wife Dianna suffered from late-stage terminal breast cancer but was unable to receive the relief she sought.

“In the five weeks before her death, she became weaker and experienced a great deal of nausea. She asked for help from hospital staff to end her ordeal but all they could promise her was that they’d keep her as comfortable as possible,” Meyer said. “She was aware of her terminal diagnosis and was ready to die and move on.”

Opposing the measure, family physician Dr. Steve Higgins said he worries aid-in-dying medication may be proactively offered by medical professionals in the future.

“I’ve attended to about 300 people at the end of their life. Of those, not one has ever asked me to end their life,” Higgins said. “I have a real concern that [LB1056] may mean [doctors] would be required in the future to give this as an option as opposed to offering hospice care.”

Wayne Cockfield, of Florence, South Carolina, also opposed the bill, which he said could be used to target people with mental and physical disabilities.

“There is a huge difference between refusing medical service and institutionalizing suicide,” he said. “This is not compassion, it is medical abandonment.”

The certificate of death would report the terminal illness as the cause of death, not suicide, for any patient who dies as a result of aid-in-dying medication.

Health care providers, who may choose whether to provide aid-in-dying medication, would not be held criminally or civilly liable for practicing in good faith under the bill. However, any person who knowingly forges, alters or intentionally destroys a written request for medication would be guilty of a Class III felony.

Similarly, any person who coerces or exerts undue influence on a person to request medication also would be guilty of a Class III felony. A Class III felony could result in one to 20 years’ imprisonment, a $25,000 fine or both.

The committee took no immediate action on the bill.

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