A bill introduced in the Oregon Senate would drastically alter current advance directive laws, diminishing the effects of powers of attorney and allowing incapacitated patients to be refused ordinary food and water. It would also mandate the formation of an unelected state committee to create a new advance directive form.
According to reports, the bill is in response to a case in southern Oregon, where a court ruled that a husband was not allowed to deny his wife spoon-feeding by staffers at her care home after she became incapable of caring for herself due to Alzheimer’s disease. The woman is conscious and able to move, but needs prompting to eat. As reported in the Medford Mail Tribune,
In June 2009, Nora was diagnosed with early onset Alzheimer’s disease. She was 56.
[…]
In 2013, Bill [Nora’s husband] made the difficult decision to place his wife in Fern Gardens, a Medford memory care facility specifically designed for patients with Alzheimer’s and dementia. A sunny garden courtyard is encircled by a hall, allowing patients to wander safely when they leave their rooms.
Although he wanted to retire, Bill, who is now 74, continues to work in information technology to pay for his wife’s care, which costs thousands of dollars each month. Like many family caregivers for Alzheimer’s patients, he fears he may die before his spouse.
In 2014 and again in 2015, Nora’s weight dropped dramatically and she was placed in hospice care. Her family believed the end was near each time.
Then Bill learned a volunteer ombudsman had directed Fern Gardens staff members to spoon-feed Nora after seeing her with a sandwich while other patients were eating a hot, prepared meal. At that time, she was able to eat with her hands, but not utensils.
Nora, 63, now cannot eat without prompting and someone feeding her, according to her husband.
SB494 would remove “current safeguards which prohibit surrogates from withholding ordinary food and water from conscious patients with conditions that don’t allow them to make decisions about their own care. Currently, patients … are given help with eating and drinking when they cannot do it themselves. This is not tube feeding or an IV—this is basic, non-medical care for conscious patients.”
Most advance directive forms, intended to lay out a person’s wishes for care should they contract a debilitating disease or condition, specify whether or not they wish to receive forced feeding such as feeding tubes or intravenous nutrients. They do not cover ordinary food and water.
Senate Bill 494 would make the following changes, according to the bill summary:
Establishes Advance Directive Rules Adoption Committee for purpose of adopting form of advance directive to be used in this state. Specifies that form may not take effect unless form is submitted and presented to certain committees of Legislative Assembly. Repeals statute setting forth current form of advance directive used in this state. Sets forth alternative form of advance directive that may be used in this state. Sunsets alternative form on January 1, 2020. Modifies means by which advance directive is executed. Modifies law by which individual is selected to make health care decisions for another individual who becomes incapable of making health care decisions. Makes certain other changes to provisions governing individuals who become incapable of making health care decisions.
Advocates for patients’ rights and opponents of euthanasia are sounding the alarm on the consequences—some unintended—of this bill. They note, in particular, that the creation of the Advance Directive Rules Adoption Committee would lead to less legislative oversight of an unelected group of bureaucrats. Given the sensitive nature of advance directives, one can easily envision how future versions could further erode patient rights if, for instance, bureaucrats are more concerned about cutting costs than patient rights in a state-run medical system.
After all, that’s exactly what is being done right now in Great Britain’s National Health System with their Quality Adjusted Life Years (QALY) calculation. QALY is a cold statistical analysis designed to treat only those who will live long enough to generate enough tax revenue to justify their existence. The calculations, according to SR Larson, are designed to:
1. Discourage physicians from sending patients to specialists, as specialists cost more money than General Practitioners (a.k.a., Gatekeeper Practitioners);
2. Demand the use of QALY, an instrument for evaluating the economic worthiness of a person’s life; and
3. Encourage hospitals to put patients on medical death row when treatment is considered fiscally futile.
All these payment instruments are put in place by the British government to cap the costs of operating the National Health Service. Cost containment has infiltrated the practice of medicine to such a degree where the final word on a person’s health, even life, is fiscal, not medical.
The language of SB494 is also vague—deliberately so, charge some of its opponents. So vague, in fact, that it completely removes the definitions of tube feeding, life support, and dementia. Perhaps the most troubling alteration to the advance directive law, however, would be the removal any reference to a power of attorney in the statute. This means that patients would no longer need someone holding a power of attorney to act on what they interpret as the patient’s last wishes when they have a terminal, debilitating disease. Potentially any guardian, spouse, other family members, or an attending physician could pull the plug. Removing the definition of life-sustaining care from the statute could mean that a doctor gets to decide if a patient starves to death simply because the individual can’t move his or her extremities and can’t give informed consent.
From here, it is only a small step to cold math being used to determine whether you deserve to be starved to death by your medical facility.
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