From True Dignity Vermont
http://www.truedignityvt.org/from-the-netherlands-to-vermont-patients-under-pressure-to-die/Around one in five patients who choose euthanasia in the Netherlands acts under pressure from family members, according to a leading expert on the ethics of assisted dying, as reported last week in Dutch News: http://www.dutchnews.nl/news/archives/2015/07/pressure-on-patients-is-cause-for-concern-euthanasia-expert/
According to the report, Professor Theo Boer, who teaches ethics at Groningen’s Protestant Theological University and has for nine years served as a member of one of five review committees that assess every euthanasia case, said, “Sometimes it’s the family who go to the doctor. Other times it’s the patient saying they don’t want their family to suffer. And you hear anecdotally of families saying: ‘Mum, there’s always euthanasia.’”
Here in Vermont, where physician-assisted suicide has been legal for just two
years, cases of pressure are already starting to emerge, and it isn’t always
family members providing the pressure. True Dignity has spoken with the family
of a 90-year-old Medicaid patient who felt pressured by caregivers in the
facility where she was admitted for recovery from a fall. The patient did not
have a terminal diagnosis.
According to Beth Neill, clinicians at the Berlin Health and Rehab Center
informed her mother at regular intervals during her 4-month stay there that she
had a “right” to use Act 39, and that, “She didn’t even have to discuss it with
her family.” It was the act of repeatedly bringing up Act 39 as a health care
“option” that caused her mother to feel pressure, and not overt efforts by
clinicians to convince her to request the lethal prescription, Neill said.
However, she said her mother made it clear she wanted nothing to do with Act 39
and was disturbed that staff re-introduced the topic repeatedly.
Neill notes that her mother was, and is, in otherwise surprisingly good
health for her age, and would not have qualified for Act 39, as the extended
stay in Berlin Health and Rehab was strictly for help recovering from her
fall.
Neill was not made aware of the situation at Berlin Health and Rehab until
after her mother had already been moved to assisted living at a Northfield
facility, where she currently resides. When she did hear of it, “It blew my
eyebrows off,” she said.
According to Neill, the staff at the Northfield facility informed her that
her mother had reacted strongly when they began to discuss care options. “Mom
thought they were going to start talking about Act 39, the way they did at
Berlin (Health and Rehab), and she blew up at them. She said, ‘I don’t want
anyone talking to me about killing myself.’”
That’s when it came out that the staff at Berlin Health and Rehab had talked
to her more than once about her “right” to request a lethal prescription. “I
recalled then that my mother had been very eager to get out of there, and I had
noticed that she seemed frustrated and unhappy, but I didn’t know why,” Neill
explained.
Her mother told her that the staff at the Berlin facility specifically stated
that Act 39 “is the law,” and in her words, “They said she could ‘off’ herself
any time she wanted to.” She told her physician, who adamantly opposes Act 39,
“They want me to take a bunch of pills and kill myself.”
Clearly, confusion abounds regarding the duties of medical caregivers with
respect to Act 39. Vermont’s “affirmative duty to inform” under the Patient
Rights Act requires that health care providers let patients know of all
available treatment options, but it is not clear how this is understood to apply
to Act 39 . Beth Neill’s mother did not have a terminal diagnosis and would not
have been eligible for a lethal prescription under Vermont’s law. Asked why she
was informed of this “treatment option” by health care workers at his facility,
John O’Donnell, Executive Director of Berlin Health and Rehab, declined to
reply.
True Dignity also was unable to get answers from Berlin Health and Rehab to
explain where staff received training around the implementation of Act 39 and
what the facility’s official policy is on assisted suicide.
We can only speculate about where some information may be coming from. In a
letter to members, the well-funded pro-assisted-suicide group Patient Choices
Vermont, an arm of the national organization Compassion and Choices, says that
the group Compassion and Choices Vermont has been doing “extensive work
educating patients, medical providers and institutions, as well as assisting
individuals” to find the “resources they need.” The letter also states, “While
details are still being determined, PCV will have an important role to play as
health department regulations are developed (and) insurance coverage issues are
dealt with.”
We do not know whether or not this group had a hand in helping “educate”
staff at the nursing home where Beth Neill’s mother felt pressured to use Act
39. At present, there is no oversight mandated by Act 39 to prevent abuse, and
the only other organization we are aware of with resources and staff to educate
health care providers about Act 39 is the Vermont Ethics Network, which also
receives funding from Compassion and Choices.
States are prohibited from using Medicaid dollars to cover costs associated
with physician assisted suicide, but it is unclear whether there are provisions
in the State-sponsored Green Mountain Care Medicaid to pay for drugs and doctor
visits for patients requesting Act 39.
Because Act 39 contains few safeguards and almost no reporting requirements,
it seems that questions will be more abundant than answers for the foreseeable
future.
Thanks to a strong family support system and a personal physician who is
opposed to assisted suicide, Beth Neill’s mother was able to resist pressure to
consider using Act 39. What is unknown is how many other vulnerable individuals
are feeling pressure today from family or caregivers, and may eventually
succumb, as physician assisted suicide becomes entrenched in Vermont and
aggressively promoted by those who may operate from motives at odds with the
best interests of the patient.