‘How much suffering is too much?’ Senate committee debates end-of-life options for terminally ill

Democratic lawmakers are once again attempting to legalize the use of life-ending medication for terminally ill patients in Nevada.

Under their proposal, such medications would be limited to mentally competent adults who have been diagnosed with a terminal condition by two medical practitioners and are expected to live just six months or less. The medications would be self administered in pill form.

Senate Bill 239, which was heard in the Senate Health and Human Services Committee on Tuesday, establishes safeguards against rash decision making. For example, patients would have to make two verbal requests 15 days apart and then submit a written request, which would have to be signed by a witness who is unrelated and does not stand to benefit from their death.

“How much suffering is too much?” asked state Sen. Edgar Flores in his opening remarks at the hearing. “And when we talk about suffering, who is deciding that? Is it we, the family, forcing a human being to suffer up until the very last breath to serve our own egotistical desire to keep that individual for that additional second regardless of how painful that moment may be?”

Flores is leading the effort on the legislation but eight other Democrats across both chambers have signed on as sponsors, and an additional 10 are signed as cosponsors.

He urged the committee to see the issue not as a decision between life and death.

“When you have terminal illness and you are suffering every single second, you’re not choosing between life and death,” said Flores. “You’re simply choosing how it is you want to die.”

Ten states have authorized it, more considering it

Some form of legislation allowing life-ending medications for terminally ill patients has been introduced in every Nevada legislative session since 2015. The furthest a proposal advanced was in 2017, when a bill sponsored by then-state Sen. David Parks narrowly passed the Senate 11-10, with two Democrats and all Republicans opposing. That bill was not granted an Assembly committee hearing.

Over the years, such legislation has been called different things — “death with dignity,” “right to die” and, more recently, “medical aid in dying” or “end-of-life options.”

The practice itself is sometimes referred to as medically assisted (or physician-assisted) suicide, though advocates have pushed back against the terminology because of the negative connotations associated with the word suicide.

According to the Compassion & Choices Action Network, 10 states and Washington DC have authorized the practice and more than a dozen others have pending legislation on the issue.

Samantha Trad, the group’s national director of advocacy, said data from those states shows that more than a third (37%) of terminally ill patients who go through the process of being approved for life-ending medication do not use it.

But “they have peace of mind from simply knowing that if their suffering became too great, they would have the option,” she argued.

Available data also suggests that 90% of people who have chosen a medically assisted death self administer at home.

Most people, Trad added, prefer to die at home, surrounded by their family and friends, on their own terms.

Compassion & Choices, which is working on the bill with Flores, presented results from a 2021 Public Policy Polling survey that found giving terminally ill adults the option to ask their doctor for a medication to voluntarily end their life is supported by two-thirds of Nevadans. The survey further found that support is still in the majority when broken down by gender, age, race, religion and political ideology.

The results do, however, show stronger support among Democrats and Libertarians — 80% and 82%, respectively — than Republicans (65%).

Discussion at Tuesday’s hearing was limited by Democratic state Sen. Fabian Doñate, the committee’s chair, who directed members to ask just one primary question and one follow-up question. He also limited public testimony to 15 minutes for support and 15 for opposition.

State Sen. Jeff Stone, a Republican pharmacist who served in the California State Legislature when it approved similar legislation in 2015, said the issue warrants lengthier debate. (Stone voted against California’s bill and, according to one media report, spoke in opposition of the bill for more than 20 minutes.)

State Sen. Rochelle Nguyen, a Democrat, countered that the issue has been discussed within the Nevada State Legislature multiple times in previous sessions.

State Sen. Robin Titus, a medical doctor who practices in rural Nevada, took issue with a provision in the bill that requires practitioners to list the terminal condition as the patient’s cause of death rather than acknowledging the use of the self-administered life-ending medication.

Compassion & Choices Advocacy Manager Sara Manns said the death certificate provisions protect medical practitioners from attempts at criminal action, as well as to ensure that insurance companies don’t refuse to pay out life insurance policies because of suicide clauses. Manns likened medical aid in dying to the practice of refusing life-extending care even if you know it means imminent death, a practice which is legal and widely accepted.

“If someone discontinued dialysis, you wouldn’t say that their cause of death was discontinued dialysis,” she said. “You would say they had renal failure.”

Titus also pointed out the bill as introduced expands what types of medical practitioners are allowed to sign death certificates, something Manns said was a “drafting error” that will be amended out should the bill move forward.

The bill may also be amended to address concerns from Clark and Washoe counties. Those concerns, the respective lobbyists told the committee, are technical in nature and unrelated to the policy of medically assisted death. Both counties are officially neutral on the policy.

‘We have done all we can do’

SB 239 garnered passionate testimony both in opposition and support.

Support came from medical professionals who argued that medically assisted death is a part of a compassionate health care system that respects patient wishes, as well as people with personal experience watching someone in their death throes.

R.J. Erickson, son of longtime Reno obgyn Dr. John Marshall Erickson, fought back tears as he recalled his father’s final five days of life.

“I was personally responsible for mixing his methadone and morphine,” he said. “I was slowly killing my father.”

Erickson said he watched his father decline into episodes of hysteria and delusions. The “breaking point,” he added, was watching the accomplished doctor during a delusional state ask the hospice nurse whether someone had found a cure for his stage-4 lung cancer.

“It was not what I was expecting to happen,” said Erickson. “He wanted a peaceful and painless passing.  And for loved ones, watching their other loved ones go through this is not something anything should have to endure.”

Lynda Brooks-Bracey, a 57-year-old Las Vegan, said she “would prefer not to die at this particular time, but unfortunately … my diagnosis says differently.”

Brooks-Bracey has metastatic pancreatic cancer. She is currently in palliative care.

“We have done all we can do,” she said. “I have been through numerous rounds of chemo, surgery, everything that is left to be done, and I am terminal.”

She said she worries about her family seeing her suffer. Nevadans like her deserve every option available to them, she said.

“This bill may not become law in time for me but I believe it should become law for those in need.”

On the other end, the bill received sharp rebuke from some disability advocacy groups, which stated in submitted letters that they fear the practice will be pushed on the disabled or other marginalized groups. No provisions can safeguard against potential abuse of the option, they argued.

Dr. Kirk Bronander, a Reno physician, opposed the bill on the grounds that physicians’ prognoses of how long terminally ill patients have left to live is subjective.

“A misdiagnosis coupled with a poor prognostication results in a patient getting a lethal prescription when they could have years of good quality life left to live,” he said.

The committee took no action on the bill Tuesday. It has until April 14 to advance out of committee.