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1
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Mar 5, 2011 1:40 PM
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If the psychiatrist says the patient is depressed, is the patient then prohibited
from suicide assistance? What is the patient's escape route if he/she changes heart?
Could 3 physicians, rather than 1, be necessary to approve the suicide, in addition
to 2 physicians needed to confirm prognosis? (This 3-physician request would absolve
the one physician from blame for encouraging suicide out of personal prejudice or
other personal reasons.
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2
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Mar 5, 2011 4:38 PM
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Prescription provided by department of health for A, after B, C, D and E are completed.
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3
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Mar 6, 2011 6:06 AM
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This decision should not be legislated, ever! It is between the patient and one's
physician, with considerations of family members and spiritual practice.
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4
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Mar 6, 2011 7:50 AM
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The aforementioned restrictions are too strict!
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5
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Mar 7, 2011 8:29 AM
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Physician protected from ramifications/lawsuits by family members.
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6
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Mar 7, 2011 11:25 AM
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competency/capacity to make decision to die - but only assent to rescind related
- perhaps durability - a length of time desiring to die despite palliative care
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7
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Mar 7, 2011 12:15 PM
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Physicians participating should lose their license and be prosecuted to the full
extent of the law
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8
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Mar 7, 2011 12:23 PM
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If Hospice and palliatuive care is involved, why will they need a Rx to end their
life. I am still concerned about the possibility of economic coersion
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9
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Mar 7, 2011 12:43 PM
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what method or techniques would be suggested for the actual pharmacologic agents
used for this purpose? The above criteria will likely lead toa tiny eligible population
- so i see this as an poor use of time and resources - better to ensure everyone
has a true PCP who really knows their patients and can orchestrate aggressive pain
and symptom control with hospice support. Patients who really want to kill themselves
can find a way to do so without involving MD.
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10
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Mar 7, 2011 1:48 PM
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If someone else would benefit financially from the suicide, is there a way to make
sure that they are not influencing the decision? I would also hope that there should
be a requiement that the proximate cause of death on the death certificate should
be suicide.
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11
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Mar 7, 2011 1:56 PM
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The perscription for the lethat medication should be written by an agent of the
state, the Director of Health, not the primary care physician.
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12
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Mar 7, 2011 2:25 PM
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protection from litigation
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13
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Mar 7, 2011 2:27 PM
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there are no safeguards that would made it ok
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14
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Mar 7, 2011 3:06 PM
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the requests should be made over the course of two or more weeks.
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15
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Mar 7, 2011 3:16 PM
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minimum period of treatment for depression; qualifications for physicians to participate
in the program (ie trained in palliative care)
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16
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Mar 7, 2011 5:07 PM
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I am concerned that too many professionals are required to be involved in the process,
which could be prohibitive.
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17
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Mar 7, 2011 7:06 PM
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Would still need verification of protection from litigation from family members
protesting the decision
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18
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Mar 7, 2011 7:38 PM
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Insurance companies have provided "services" such as "care managers"
and "counselors" to patients who seek reimbursement for medical services.
The goals of these "services" are to reduce the patient's utilization
of medical care. They typically end the telephone interview each month with a question:
"When do you think you will be able to ----(stop taking the medicine), (go
back to work), (reduce your visits to the doctor). The clear implication is that
the patient needs to do something quickly that may not be the best course for the
patient medically. I worry that if insurance companies are not strictly forbidden
from calling patients who are desperately ill, they will initiate programs similar
to the ones I have encountered. The danger is that they will subtly encourage patients
to take a course of action that saves money, rather than one which meets the patient's
personal needs.
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19
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Mar 8, 2011 7:41 AM
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Mandatory palliative care consultation
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20
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Mar 8, 2011 8:30 AM
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Don't think doctors should do this. Have the state certify some other "type"
to do this.
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21
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Mar 8, 2011 11:57 AM
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Option C is by far the most important
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22
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Mar 8, 2011 4:00 PM
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The patient should meet with the palliative care specialist in the company of their
closest social support. I don't think the support needs to agree with the patient,
but documentation of the discussion is important.
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23
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Mar 8, 2011 4:10 PM
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1. At least one physician should have seen the individual at least 2 times, with
a total history of patient contact of at least a month. 2. There should be an interval
of at least a week between each of the individual's 3 requests
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24
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Mar 8, 2011 6:38 PM
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Protection from prosecution or law suits for the providing physician when all criteria
for physician assisted suicide are met.
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25
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Mar 9, 2011 5:33 AM
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As a physician, I oppose this legislation completely. Suicide should not be encouraged,
but rather good medicine and pain control.
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26
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Mar 9, 2011 6:27 AM
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N/A, since I don't think this legislation should be enacted no matter what safeguards
are in place
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27
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Mar 9, 2011 6:57 AM
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I would suggest that a position like 'Medical Examiner' take on this responsibility,
and decouple from primary care
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28
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Mar 9, 2011 7:18 AM
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Keeping track of the situations in which it arises and the outcomes, both pathological
and social, mental
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29
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Mar 9, 2011 7:42 AM
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there are no "protections" that justify suicide.
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30
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Mar 9, 2011 8:59 AM
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Physicians should do no harm and offer relief of pain. A physician needs to have
the freedom to listen and act on the patients need for relief.
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31
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Mar 9, 2011 10:29 AM
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(1) Patients must be advised of the uncertainty of making predictions about being
in the last 6 months of life. (2) We don't have nearly the capacity needed for palliative
and hospice care in VT--would need some assurance that this will be developed and
THE SERVICES PAID FOR (not out of the patient's pocket)!
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32
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Mar 9, 2011 12:53 PM
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It would be most helpful if family members, although not able to control the patient's
decision, can be made aware of the patient's desire/intention.
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33
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Mar 9, 2011 1:03 PM
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The idea that once this legislation is enacted, that it will not be expanded and
protections diminished is very naive. As Calvin Coolidge aptly noted...better to
not enact any legislation than to enact bad legislation.
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34
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Mar 9, 2011 6:53 PM
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Not sure but this is scary. The external pressures on a dying family member could
be extreme. Please don't let this happen.
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35
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Mar 10, 2011 7:27 AM
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I really like the idea of the Hospicw/Palliative Care consult.
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36
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Mar 10, 2011 9:21 AM
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There can be no financial gain for the patient or family from physician assisted
suicide
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37
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Mar 10, 2011 9:57 AM
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External ethics panel to review individual cases, which are likely to be relativey
infrequent.
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38
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Mar 10, 2011 2:28 PM
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who will do the depression "screening" and what exactly does it entail?
i am a psychiatrist. what liability does the prescriber have?
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39
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Mar 10, 2011 6:22 PM
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I'm not sure just consulting palliative care or hospice is strong enough. I think
they should be fully engaged with those services.
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40
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Mar 10, 2011 7:27 PM
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The two physicians should not be in the same practice.
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41
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Mar 11, 2011 6:54 AM
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If the above medicine is prescribed we are free of ANY liability, form anyone related
to the patient.
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42
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Mar 11, 2011 6:06 PM
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Bill is not necessary in my opinion. Just providing good terminal care (comfort
measures only) you can have death with dignity without the taint of euthanasia
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43
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Mar 11, 2011 6:58 PM
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perhaps all patients should be reviewed to make sure no patterns of abuse/inappropriate/over
zealous use occur on part of providers. No liability for provider.
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44
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Mar 12, 2011 2:00 PM
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It might be of great importance to consider the training of the psychiatrist or
psychologist, and in addition, to have some provision that if said professionals
are not available, then this requirement of the law should not be waived. We have
a shortage of psychiatrists in Vermont as it is. The qualifications & training
of the psychiatrist or psychologist should be considered. The professional should
perhaps be required to have some formal advanced training in the psychiatric evaluation
of the medically ill and/or geriatric patient, and should have training and/or experience
in the administration of psychopharmacologic treatments to depressed patients.
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45
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Mar 13, 2011 11:51 AM
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specifically other suffering, eg pain, which the referrals in theory might not cover
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46
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Mar 13, 2011 2:44 PM
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Unethical practice is unethical practice! Why try to sanitize suicide with physician
participation. Read the bill, section 2312 states this is a homicide if not preformed
as prescribed.
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47
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Mar 14, 2011 10:12 AM
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yes. Protection against anyone other than the patient making end of life decisions.
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48
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Mar 14, 2011 5:20 PM
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"In the last 6 months of life" is too long. How many people live much
longer than the expected 6 months? Too many. We as physicians are not clairvoyant
with regard to the end of life. "With and incurable condition" is also
not specific to an incurable LETHAL condition. Diabetes, Rheumatoid arthritis, and
many, many other diseases are incurable ones that shorten the lifespan of the people
who have them. "Must be seen by a psychiatrist or psychologist" doesn't
mean that the patient will be treated for the depression before the request for
suicide is acted upon.
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49
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Mar 14, 2011 6:54 PM
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with regard to depression, then what? If the patient is depressed, is she not a
candidate?
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50
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Mar 16, 2011 1:18 PM
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Any barriers (social, physical, family beliefs or understandings) to effective palliative
care must be addressed.
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51
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Mar 16, 2011 3:02 PM
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clarification that the choice to use or not use the drugs is the patients alone
and is not considered suicide.
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52
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Mar 17, 2011 6:16 AM
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The physician should believe/certify that the patient has decision making capacity.
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53
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Mar 17, 2011 10:35 AM
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Assurance that this decision is not influenced by medications.
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54
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Mar 17, 2011 10:37 AM
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I'm not against death with dignity, I just do not see where this service would require
a physician.
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55
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Mar 17, 2011 10:40 AM
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these protections might prevent patients from pursuing this option.
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56
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Mar 17, 2011 10:45 AM
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I think that in addition to the patient being within the last 6 months of life with
an incurable condition, they should also have a significant deterioration in Quality
of Life parameters, such as intractable pain. I think that if a patient is in intractable
pain, and is not mentally able to request physician assisted suicide/ death with
dignity, their health care proxy could ask/ intervene on their behalf if the patient
has stated in a health care document prior to incapacitation that they would wish
for this. I think there should be some consideration in terms of the time interval
that would be acceptable for the 3 requests, ie, if a patient requested x 3 on the
same day, that shouldn't qualify.
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57
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Mar 17, 2011 11:02 AM
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If patients have adequate access to palliative services they would not suffer and
would not be so fearful of suffering at the end of their lives (current services
are inqdequate).
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58
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Mar 17, 2011 11:06 AM
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Protectio from third party right to life groups. Harrassment of these physicians
needs to be criminalized.
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59
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Mar 17, 2011 11:11 AM
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There should be a panel of physicians that are involved in this.
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60
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Mar 17, 2011 11:39 AM
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Depression is not the only psychiatric condition which will require screening, and
non-psychiatric conditions affecting cognitive capacity for decisin making are also
likely to be pertinent and will need to be folded into the legislation. While the
frequency of the requsts are likely to be low, there is already a shortage of psychitrists
in vermont, and the availbility of consultatin in atimely fashiopn may be a rate
limiting process.
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61
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Mar 17, 2011 11:42 AM
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Participation of patient's lawyer re: will provisions
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62
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Mar 17, 2011 12:09 PM
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I am very opposed to this legislation. It speaks to the public lack of understanding
about advances in pain management and the role of hospice care.
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63
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Mar 17, 2011 12:23 PM
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at least one of the physicians certifying that the patient is incurable should be
aware that the patient is requesting MD assisted suicide at the time they certify
uncurability
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64
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Mar 17, 2011 12:39 PM
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What about minors? What about patients who are now incapacitated (from some type
of brain injury) who have competed a Living Will or Advanced Directive explicitly
requesting physician-assisted suicide?
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65
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Mar 17, 2011 12:42 PM
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The moral implications of this legislation are issues that I haven't grappled with,
so I am unprepared to weigh in on the topic.
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66
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Mar 17, 2011 12:55 PM
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Physicians should not be in the business of hastening death. They should only provide
comfort (both psychological and pharmacological), and recognize that noone (physician
or non-physician) should start down this slope.
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67
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Mar 17, 2011 1:56 PM
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I just don't think we should legislate how a physician eases a patient's pain.
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68
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Mar 17, 2011 2:22 PM
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I'm against it.
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69
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Mar 17, 2011 2:39 PM
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physicians should not assist in suiside under any circumstances
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70
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Mar 17, 2011 2:56 PM
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there should be some legal protection for the MD being asked to provide the prescription,
so after the event occurs, the family of the deceased or whoever can not come after
the MD prescriber
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71
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Mar 17, 2011 5:09 PM
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A Measurement of suffering
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72
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Mar 17, 2011 6:48 PM
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Life insurance carriers should NOT be expected to pay death benefits.
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73
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Mar 17, 2011 7:14 PM
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protection from lawsuit for physicians who participate
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74
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Mar 17, 2011 8:28 PM
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(1) I am still worried that even if a person themselves is asking for the prescription,
that they will do so because they feel pressured by a desire not to burden their
family with financial, emotional, and time necessary to care for a dying individual.
I have no idea how you would protect against this natural desire of the dying to
shield those supporting them. (2) I am also worried that I have seen doctors be
wrong about diagnosis and prognosis far too many times, but I don't know how you
could legislate a protection in which doctors would have perfect predictive powers
about the prognosis.
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75
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Mar 17, 2011 9:09 PM
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there should be a short but specific waiting period between each request (?days
?a week) to asure this is not a fleeting wish
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76
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Mar 18, 2011 4:53 AM
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Above protections seem overly cumbersome as it is.
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77
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Mar 18, 2011 5:55 AM
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Depression should be allowed as coincident with the desire to end your life. Perhaps
suicidal ideation should be excluded.
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78
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Mar 18, 2011 8:03 AM
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Strongly support hospice/palliative care
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79
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Mar 18, 2011 9:38 AM
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Patient should be deemed competent to make such a decision
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80
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Mar 18, 2011 12:27 PM
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As an ICU physician, I am frequently involved in withdrawing care at the end of
life, but I think there is an important distinction between withdrawing of care
and terminating life.
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81
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Mar 18, 2011 12:39 PM
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? should require two specialty opinions that condition is incurable and death anticipated
within 6 months.
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82
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Mar 18, 2011 7:15 PM
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There needs to be a contingency for the patient who is unable to write. All three
requests need to be documented in the patient record, so all three will re written.
Perhaps you want one request to be witnessed by two people who are not family members
and signed by the patient if the patient unless the patient is physically unable
to sign.
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83
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Mar 19, 2011 8:18 AM
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If anything, asking 3 times seems onerous....
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84
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Mar 19, 2011 11:04 AM
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Absolute disconnection between the government, which makes laws and regulations,
and the payment for services. If the Government makes both payments and regulation/law,
there is a significant potential for abuse of the legislative power in order to
meet fiscal needs.
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85
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Mar 19, 2011 3:16 PM
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process for changing mind would like some continuity of care - it is difficult to
imagine this in context where the medical practitioners are not known to the patient
for some length of time.
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86
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Mar 19, 2011 5:00 PM
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I would not limit to 6 months. Anybody with incurable disease whom life is impair
significantly should be allow to this choice.
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87
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Mar 20, 2011 5:02 AM
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Immunity from civil or criminal lawsuits, arrest and discrimination.
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88
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Mar 20, 2011 8:23 AM
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Evidence that they are declining from the condition. Sometimes people are told they
don't have long to live, but infact a misdiagnosis or inaccurate prognosis has occurred
and they do much better than expected.
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89
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Mar 20, 2011 6:37 PM
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Patient must be able to withdraw their claim
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90
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Mar 21, 2011 6:46 AM
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Noted Multiorgan failure
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91
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Mar 21, 2011 9:19 AM
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There should be legislation to keep third party groups from either legally or physically
(eg protesting) disrupting the process once it is in progress. You can't have someone
ready to let go and then call a legal timeout to ice them. No one's last minutes
needs to be with hatred being screamed from the street.
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92
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Mar 21, 2011 2:40 PM
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we simply need to do a better job of comfort at the end of life, to prompt death
is against our professional code of conduct
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93
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Mar 22, 2011 10:47 PM
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the consulations and screenings must be done one on one, without the presence of
friends or relatives.
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94
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Mar 23, 2011 3:02 AM
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Special protection for mentally ill-chronic, dementia dx, and mentally retarded.
Also restrictions to only home living people with family or alone but not for patients
in nursing homes.
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95
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Mar 23, 2011 10:03 AM
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Patient is home bound
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96
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Mar 24, 2011 9:05 AM
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an exploration of the financial aspects of the decision
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97
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Mar 27, 2011 5:33 AM
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physician committee makes the final decision, not a single physician
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98
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Mar 31, 2011 9:43 AM
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Psychiatric evaluation should be mandatory.
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