End-of-life bill: Sanctioned 'suicide' or patient choice?

Saturday May 4, 2013

BRATTLEBORO -- It's called "an act relating to patient choice and control at end of life."

But the controversial bill that follows -- allowing doctors to prescribe lethal doses of medication to terminally ill patients -- has split local representatives who argued passionately for and against it even after an affirmative vote Wednesday in the state House.

A key question is whether the state is promoting suicide, and, if so, what younger people who are not terminally ill may make of that.

"I'm dreadfully fearful of the message that we're giving to adolescents," said state Rep. Mike Hebert, R-Vernon. "We as a state are saying, ‘Suicide is a solution.'"

But Rep. Mike Mrowicki, D-Putney, supported the bill and contends it "isn't that simple or black and white."

"As someone who has worked with youth for decades and raised my own kids, I know that when kids have good connections with adults, they can understand life is complex with complex issues," Mrowicki said. "This is how we help them become productive adults who can tell the difference between a teen impetuously entertaining suicidal ideation as much different than an elder with a terminal disease who seeks a dignified end to their suffering."

When initially proposed in the state Senate, the bill had been modeled on Oregon's "Death With Dignity Act" and had included provisions designed as safeguards. For example, patients had to be deemed mentally competent and had to request lethal doses of medication three times, including once in writing.

But by the time the Senate approved the legislation in February, the bill was stripped of most of that language and took a "hands-off" approach that simply said doctors who write such prescriptions could not be held liable.

Rep. Dick Marek, D-Newfane, believes that approach "would have been largely ineffective." The version of the bill approved Wednesday by the House is "essentially similar to the original Senate version" and restores many safeguards, Marek said Friday.

"This creates a process that, I think, protects against possible abuses" while also preserving patient choice, Marek said.

The House vote was 81-64 to approve the bill. Windham County's representatives voted 10-2 in favor of the legislation, with Hebert and Rep. John Moran, D-Wardsboro, casting votes against it.

"The House was divided. It had nothing to do with partisanship," Hebert said. "It's a very personal thing based on what you have seen in your own life."

Hebert cites his faith as one reason he opposed the bill. He also recalls his own mother, whom he said lived 13 years "of very high-quality life" after she had been diagnosed as terminally ill.

There are similarly personal stories on the other side of the issue, however.

"Passage of this bill in the House this week was helped greatly by the compelling testimony of Brattleboro's Ben Underhill. His long fight with multiple myeloma continues as he fights to both survive and thrive," Mrowicki said.

"His courage in the face of his battle with multiple myeloma is admirable and puts a face on those who continue their fight with life-threatening disease and, at the same time, want the option of patient choice should the time come that it would be appropriate," Mrowicki added.

Rep. Mollie Burke, a Brattleboro Progressive Democrat, compared the end-of-life debate to the equally emotional debate over abortion rights.

"I really felt that it's a choice, just like a woman's right to choose whether to terminate a pregnancy," Burke said. "And I felt that I shouldn't get in the way of that choice."

Rep. Matt Trieber, D-Rockingham, said he was most concerned that the bill ensured that terminally ill patients "are aware of what all of their treatment options are."

He added that similar laws in Oregon and Washington have not encouraged large numbers of patients to seek life-ending medication.

"A lot of the fears that people have just haven't taken place," Trieber said.

It remains unclear, though, what shape Vermont's law may take. The House-approved version now goes back to the Senate, and lawmakers will try to reconcile two very different bills.

Sen. Peter Galbraith, a Windham County Democrat who had advocated successfully for the Senate's stripped-down version, said he hopes that language ultimately will prevail.

"I'd prefer that this stay within the doctor-patient relationship," Galbraith said. "I think we over-legislate. These are essentially private issues."

In other legislative news related to Windham County and its lawmakers:

-- Another divisive issue was expansion of pre-kindergarten programs. The House approved that measure 95-43 on Wednesday, with Windham County's delegation voting 8-4 in favor of the bill.

The legislation calls for expanded access to "high-quality, publicly funded" pre-kindergarten programs and provides for at least 10 hours per week, 35 weeks per year of instruction for any child ages 3, 4 or 5 (if not yet enrolled in kindergarten).

"The research just shows overwhelmingly that we cut down on our overall educational costs" by investing in pre-kindergarten, Trieber said.

Windham County representatives voting against the bill were Hebert and Moran along with Tim Goodwin, a Weston independent who represents part of Windham County, and Ann Manwaring, D-Wilmington.

Hebert said he is worried that the legislation restricts parental choice, and he has funding concerns.

Manwaring also was thinking of the bill's financial implications, pointing out that the House last week approved a bill that seeks to "constrain spending on education (and) thus also contain increases in property taxes."

"Yet this bill we've just passed ... mandates increased spending by our schools, which will exert upward pressure on property taxes despite its promise of long-term value," Manwaring said in comments recorded by the official House journal.

"That we can pass two bills in quick succession, one of which cancels (the) impacts of the other, is the best argument yet for the need to reassess the construct of our education-finance system," Manwaring said.

-- Four Windham County representatives also cast votes against granting unionization rights to workers who provide in-home personal care to the elderly or disabled.

When the House voted 94-41 in favor of the bill on Thursday, Goodwin, Hebert, Manwaring and Trieber voted against it.

Trieber said he consistently has supported the right to unionize. And he noted that those whom the bill labeled "independent direct-support providers" earn, on average, $10.50 per hour "for work that's really difficult and really important."

But Trieber was concerned that, with both the workers and those they serve receiving money from the same state fund, a lack of available resources could cause strife.

"With only one pool of money for the whole program, my fear was that we were pitting the workers against the people who receive the benefits," Trieber said. "The state can solve this problem at any point by appropriating more money for the program."

Moran has been among those advocating for the bill, reportedly saying it will allow independent, in-home workers to negotiate directly with the state for better pay and benefits.

And Marek said the legislation "simply allows a group of workers who serve our state and some of its most-vulnerable citizens the right to consider forming a union."

"The arguments against it rest entirely on speculation about what might happen if they do -- not fact, but sheer speculation," Marek said in House journal comments. "That was no reason to deny them the same right other Vermont workers enjoy -- simply to bargain for their pay and working conditions."

-- The Senate approved a revenue plan that includes new taxes including a 3 percent minimum levy for those earning more than $125,000, Galbraith said.

The bill also applies the state's 6 percent sales tax to bottled water and imposes a 3 percent tax on satellite-television service.

Galbraith said he opposed the satellite-tax provision, arguing that residents in rural Windham County often must rely on such service because they have no access to cable.

But he has no issue with the bottled-water tax, and Galbraith says the 3 percent tax on higher-income residents "moves toward fairness."

However, Galbraith also pointed to reports that the state's recent revenue collections are better than expected. If that remains the case, additional taxes may not be necessary, he said.

"If we don't need the revenue, we shouldn't be raising it," Galbraith said.

-- State officials are sure, however, that they need additional revenue to cover an expected shortfall in transportation funding.

That's why Gov. Peter Shumlin on Monday signed a transportation budget that includes a new, 2 percent sales tax on the price of gasoline.

The levy, which took effect two days later, increased gas prices by 5.9 cents per gallon. It was accompanied by a decrease of just under a penny in the state's per-gallon gas tax.

A similarly formulated increase is scheduled to bump up prices again next year. The idea, officials say, is to raise more revenue for roads and bridges even as drivers use less gasoline.

"It's going to fill this funding gap for a few years," said Burke, a House Transportation Committee member.

But she believes the gas tax is only a temporary solution because the number of electric-powered cars will grow rapidly in the coming years.

"It's a really interesting time. How do we make the transition?" Burke said.

She added that lawmakers eventually may have to revisit the idea of taxing drivers based on the miles they drive rather than the fuel they use.

-- With this year's session winding down, Mrowicki said most legislative work occurs on the House floor. But some bills still are working through committees.

"One of them recently got the attention of corporate interests as we look to ban the TRIS chemicals from being used as flame retardants because of their carcinogenic properties," said Mrowicki, a member of the House Human Services Committee.

"With our work to ban these chemicals, our committee room was ‘full of black suits from Boston' representing various corporate interests who are trying to stop our efforts to ban this known carcinogen," Mrowicki said.

He added that such chemicals commonly are used in baby products and couches in spite of the fact that they are "not effective at protecting us from fire."

"Safer alternatives do exist, so we are working to require companies to switch to these safer alternatives," Mrowicki said.

-- The 2013 legislation session had been scheduled to end after one more week of work. But several local lawmakers said they believe the session could extend beyond that deadline -- possibly to May 17 or 18 -- due to the work that remains.

"There are a lot of really serious issues yet to be decided," Hebert said.

Mike Faher is the political beat writer at the Brattleboro Reformer. He can be reached at mfaher@reformer.com or 802-254-2311, ext. 275.


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