Newspaper column: Assisted suicide bill creates perverse incentives

by Thomas Mitchell

Sometimes good intentions can create more problems than they solve. Take Senate Bill 165 for example.

Nevada lawmakers held hearings recently on this bill that would legalize and tightly regulate physician-assisted suicide for the terminally ill. The bill would allow competent adults diagnosed to be within six months of death, as diagnosed by two physicians, to be prescribed medication that the patient could self-administer to “peacefully end his or her life.”

The problem is that the 28-page bill goes far beyond that simple, seemingly liberating and decriminalizing notion by opening up the potential for widespread abuses and unintended consequences.

Dr. Brian Callister testifies

First of all, the bill requires doctors to falsify official records. “The medical certificate of death of a patient who dies after self-administering a controlled substance that is designed to end the life of the patient … must be signed by the attending physician who shall specify the terminal condition with which the patient was diagnosed as the cause of death of the patient,” SB165 reads.

Further, the bill turns suicide into an acceptable medical treatment on par with protracted and expensive treatment intended to prolong life. This provides health insurers with a perverse incentive to cover the cost of suicide but not the medical care that prolongs life.

Dr. Brian Callister, an associate professor at the University of Nevada, Reno School of Medicine, testified at a recent hearing on the bill that he once called two health insurance companies on behalf of two patients seeking lifesaving treatment in California and Oregon, both of which have assisted suicide laws. He said he was told procedures or transfers would not be covered, but he was asked if he had talked to the patients about assisted suicide, which was covered. He also told lawmakers that 50 to 70 percent of death prognoses are in error.

Others testified about family members who lived comfortably for years after being told they had six months to live.

Dr. Callister told a newspaper in 2017, “We have the physicians, the medicines, and the skills to keep people comfortable in palliative care and hospice. Assisted suicide changes the way we care for patients. It creates a dangerous segue to perverse incentives for insurance companies and there’s no going back from that.”

A group called the Patients Rights Council claims, “In California, after finding that her insurance company would not cover the chemotherapy her doctor had prescribed, a woman asked if assisted suicide was covered under her plan. She was told, ‘Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication.’”

Opponents of the bill also note that there is no requirement to have trained medical personnel present at the time the lethal drugs are being self-administered. They also note the request for the lethal drugs must be signed by two witnesses other than the doctor and one of them could be an heir, which creates a financial incentive to encourage a hastened death. There also is no requirement for psychiatric counseling.

Though the law makes it a felony to coerce someone into taking his or her own life, when does candid and honest discussion of the options cross the line into coercion? This raises a free speech issue.

Some of the drug cocktails prescribed can cause unintended pain and prolonged suffering. This is why the death penalty has been effectively put on hold in many states, including Nevada. It’s OK for the innocent but ill.

Opponents of the bill also note that a recent report on Oregon’s assisted suicide law states that avoiding pain and suffering is not the primary incentive for suicide. Fully 55 percentof those who used the state’s assisted suicide law cited a fear of being a burden to others.

The bill further restricts life insurance companies from writing fiduciarily sound contracts. Currently under Nevada law life insurance benefits can be denied only if someone commits suicide during the first two years of the insurance contract. SB165 dictates that a life insurer shall not deny a claim, cancel a policy or charge more solely because the insured has chosen assisted suicide. Nor may the company refuse to sell a policy to someone who has requested a prescription for life-ending drugs.

That, of course, means the rest of us will pay higher premiums.

This bill creates more problems than it solves.

A version of this column appeared this week in many of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel and the Lincoln County Record — and the Elko Daily Free Press.