A few weeks ago, I wrote of Canada’s decision to delay until 2027, implementation of Physician Assisted Suicide (“PAS”) for people whose primary diagnosis is a mental illness.
Reasons given included: Canada’s healthcare system was not ready to handle the increase in requests for PAS from patients with mental health issues; the expansion of PAS could undermine efforts to prevent suicide; politicians casting blame on the opposing party; and the risk of medical practitioners recommending assisted suicide as a cost-cutting measure to alleviate strain on Canada’s health care system.
And so reasonable, hopefully rational studies will be funded addressing the issue of PAS for patients with mental health issues.
Brava Canada!
In opposition to this reasoned, rational, logical approach, we have ‘Murica … specifically the State of Colorado.
In 2006, the movie, “Idiocracy” had a limited release in the U.S. It was directed by Mike Judge and co-written by Mr. Judge and Etan Cohen. Mr. Judge was the creator (or co-creator) of Beavis and Butthead, King of the Hill and Office Space.
The plot of Idiocracy follows U.S. Army librarian Joe Bauers, (played by Luke Wilson) who wakes up five hundred years in the future after a botched government hibernation experiment. He finds himself in a dystopian society run by corporations, where evolution has made humanity stupid because the benefits of technology made it unnecessary for people to be intelligent and physically fit to survive. Idiocracy serves as social satire that touches on issues including anti-intellectualism, commercialism, consumerism, dysgenics and overpopulation.
Colorado already has in place an overly liberal (or accommodating depending on your viewpoint) law on PAS. But then, certain Colorado politicians embraced some of the over the top aspects of the Idiocracy movie and are seeking to expand Colorado’s PAS law.
This is the proposed bill:
The Colorado bill could have been drafted by Mike Judge as a script for an Idiocracy sequel entitled, “Idiocracy: How to Die in Colorado Without Really Trying.” And yet, to date, there is no registered opposition to the bill in Colorado’s lobbying database.
So, let’s review some of the key provisions of this Idiocracy bill.
First, we know how busy Colorado medical doctors are. Overworked. Underpai.. well, overworked. So, let’s take some of the burden off them by allowing “Advanced Practice Registered Nurses” to make the determination that a patient qualifies for PAS. We also want to take even more burden off physicians so let’s allow Advanced Practice Registered Nurses to also serve as “consulting providers.”
Of course, this “consulting provider” must be qualified by specialty or experience to make a professional diagnosis and prognosis regarding a terminally ill individual’s illness. [emphasis added] Qualified by experience? That certainly gives an entirely new meaning to the phrase, “Expert by Experience.”
Naturally, with Colorado being an enlightened, beneficent land of opportunity, they surely cannot restrict their expanded PAS to residents of Colorado alone. When the bill is passed, ANY ADULT is eligible to apply for PAS. Even those who reside outside the State of Colorado. The bill does not restrict its implementation and activities to the State of Colorado. Which brings up a number of intriguing and troubling issues.
With the expansion and proliferation of the Interstate Medical Licensure Compact Act and the use of tele-health, the bill does not address whether a provider can make his/her diagnosis via telehealth and whether the opinion of the consulting provider may be provided via telehealth. If the attending provider has the requisite DEA certificate and complies with any applicable administrative rules, that provider can send the poison cocktail medications directly to the patient.
Then there is the current mandatory waiting period for PAS in Colorado which is 15 days. Presumably, that is far too long to consider and contemplate the end of one’s existence. So, let’s shorten that puppy up to 48 hours! After all, one can squeeze a lot of living in 48 hours … champagne, five-star dining, complaining about the latest Taylor Swift conspiracy. What more does one need? However, if the attending provider believes that death will come within that 48-hour window, even that waiting period can be waived.
But, what to do about those pesky life insurance companies which have exclusions in their policies for insureds who commit suicide? The Colorado bill thought of that too. The bill provides that a life insurance company doing business in Colorado cannot deny nor alter benefits otherwise available to its insured who chooses to undergo the Colorado PAS process.
At this point, we should also ask if this is merely a tempest in a teapot. How prevalent is PAS in Colorado?
Since 2017, [when Colorado’s medical-aid-in-dying law went into effect] and 2022, according to data gathered by state health officials more than 1,090 patients were prescribed life-ending medication. Of those, 838 picked up the medication. [This information can be read by clicking on the link underlined in the prior sentence.] It’s unknown how many people used the medication to end their lives.
Over that six-year period, aid-in-dying prescriptions were provided by 219 Colorado doctors.
Interestingly, a survey was published in January 2022 of 583 physicians in Colorado carrying for potential medical-aid-in-dying patients. This survey can be found here:
https://link.springer.com/article/10.1007/s11606-021-07300-8
This survey provides some fascinating insight into those providers who are involved in medical-aid-in-dying for their patients.
The survey’s general conclusions were, “Many physicians in our sample are both willing and prepared to discuss MAiD with patients and to provide MAiD referrals. Fewer are prepared and willing to serve as an attending or consultant and fewer have provided these services. MAID consultants and attendings largely report the experience to be emotionally fulfilling and professionally rewarding, but all respondents reported multiple barriers to participation.”
The survey was transparent about the ethical concerns which included: “Ethical concerns include, but are not limited to, issues of equity and justice, patient autonomy, the nature of human suffering, slippery slope arguments, the proper roles of physicians, and the potential for devaluing human life. Religious beliefs have led some religiously affiliated hospitals to prohibit employed physicians from providing MAiD.”
For diseases like cancer, the availability and applicability of MAiD is much more compelling. Medical knowledge has shown the human body constantly produces new cells. Normal cells follow a typical cycle: They grow, divide and die. Cancer cells, on the other hand, don’t follow this cycle. Instead of dying, they multiply out of control and continue to reproduce other abnormal cells. These cells invade body parts, such as the breast, liver, lungs and pancreas. They may also flow through the blood and lymphatic system and spread to other parts of the body. Within a reasonable medical likelihood, death can be estimated.
But PAS for mental illnesses? For Anorexia Nervosa? Without having any objective medical criteria to determine a person’s capacity to make a life-or-death decision? Not even requiring a licensed psychiatrist or physician to be involved? Our wisdom and knowledge have not expanded to address mental health issues and PAS. To believe otherwise is clearly Idiocracy material.
One day, will our understanding of the human body, the brain, the complexities of our psyche reach a level which turns Physician Assisted Suicide into Medical-Aid-in-Dying for mental health issues? Perhaps so. But that day is certainly not today. Today, we are subjected to Idiocracy bills like Colorado’s law, short on wisdom and long on pedantic naivete.
Without the need of a physician to oversee the process, opening the process to everyone, and shortening the mandatory wait period to 48 hours, Colorado could become a mecca for PAS tourism.
Imagine Colorado’s new state slogan:
A DAD'S JOURNEY WITH EATING DISORDERS 