Euthanasia in Nevada

Despite opposition to euthanasia and assisted suicide by various medical and citizens groups, the Nevada Medical School provides a professor to teach the methods for starving and dehydrating the patient.
  • Senate Bill 234 was an attempt to "prevent the movement toward the unwanted assisted suicide of elderly persons...." 
  • One submission said said the need for the bill was in order to pre-empt the "death angel movement."
  • When doctors are unaware of what effective pain medications were available they would be likely to suggest that people should be able to commit suicide.
  • If assisted suicide is legalised,a person could make a decision to die, based on bad advice from doctors.
  • A physician who directs the killing of the patient can then conceal the cause of death in the death certificate.
On March 22, 1995, the Chairman of the Senate Committee on Judiciary, Senator Mark A. James Carson, stated he had been approached by a member of the medical profession and asked to request a bill draft regarding "privilege of peer review documents" relating to Senate Bill (S.B.) 234 which would prohibit the act of assisting suicide.

Opposition to physician-assisted suicide came from the Medical Director of the Hospice of Northern Nevada, members of the Nevada State Medical Association and the American Medical Association. Letters were also received from several doctors.

Dr Dieringer, M.D., Treasurer, Nevada State Medical Association in response to a question regarding the definition of assisted-suicide, expressed his concern regarding the language of the bill, which seemed to "blur" previous legislation, the Uniform Rights of the Terminally Ill, which set out the parameters for dying declarations and directives to physicians.

The question of "quality of life" was raised, with a member of the public saying that if a doctor felt an individual had "no quality of life" and if that doctor "dared to help him end his life," he would not want that doctor to be a criminal.

The purpose of the bill
While most people would support the right of individuals to refuse treatment or ask for the removal of artificial means of life support, S.B. 234 was, it was pointed out, attempting to "prevent  the crossing to an affirmative act that prematurely causes the death of a person who would not have otherwise died of natural causes at that time."

It was to "prevent the movement toward the unwanted assisted suicide of elderly persons...." where "someone in government" could decide a person's care is too costly...or that their quality of life ...doesn't meet the standards of a non-handicapped person."

It was pointed out in one submission that  the legislation as it was "too vague," and would leave too many doctors and health care providers at risk. It was felt that the definition of "suicide" and the difference between "refusing treatment" and "actively seeking assistance in ending your life" was too loose

 Senator Washington established that Ms. Medeiros was involved in "medical ethics," and asked how "medical ethics" would define suicide. Ms. Medeiros responded, "Termination of life." Senator James reviewed the statute which states: "Death resulting from the withholding or withdrawal of life sustaining treatment...does not constitute for any purpose suicide or homicide." He said pursuant to this language, withholding treatment or honoring a patient directive would not be considered suicide.

Quality of life
One member of the Nevada Concerned Citizens stated: "Nevada Concerned Citizens believes the individual has the right to decide if, when and how he is to be medically treated." He said they support the sanctity of all life, and believe that no one else has the right to determine someone's quality of life, or "to put anyone else out of their misery."

He further stated that the intent of the bill was not to criminalise current medical care for the terminally ill, and added he felt doctors are not asking for the right to make judgments over who should die and when. He said the need for the bill was in order to pre-empt the "death angel movement."

While it was generally agreed that a person's decision to "live on" or not should not be in the hands of the government, Tahnya Ballard, an attorney-at-law asked the question, "Who's to know that the person who helps [with the assisted suicide] isn't just sick and tired of dealing with [him or her]?"

Consumer fraud
Dr Robin Bernhoft, M.D., F.A.C.S., of the International Anti-Euthanasia Task Force, from Everett, Washington, said the question of "Why should the government become involved?" raised a particularly good point. He said he viewed the matter as a type of "consumer fraud issue."

Dr. Bernhoft indicated that four higher court cases in the across the country and in Canada had resulted in rulings which state: "There is no right to have assisted suicide." He said the reasoning has been that "...whatever individual right may exist is outweighed by the government's responsibility to protect people from abuse and from fraud."

According to Dr. Bernhoft there are several type of people who would be "defrauded" by legal assisted suicide. He gave some examples:
  • A survey of 63 cancer specialists revealed an average of 2 persons per month are referred by other doctors who stated, "It is a shame I can't kill this person, because the pain medicine is not working
  • When a patient is given morphine, they may live months or years of good quality life
  • The medical community has not done its homework on treating pain
  • According to the World Health Organization, approximately 70 percent of doctors in the USA in 1991 did not know morphine pills were on the market.
Dr Bernhoft reasoned that when doctors are unaware of what effective pain medications were available they would be likely to suggest that people should be able to commit suicide. He indicated that there are generally three reasons why persons with a terminal illness wish to die:
  1. pain which is not being treated adequately
  2. depression
  3. abandonment
Bernhoft stated that before legalising physician-assisted suicide, doctors needed to be trained how to provide care, which in his opinion was not being done. He referred to the matter of depression in the terminally ill and said studies are not encouraging, 90 percent of "treatable, curable depression" in the terminally ill is either ignored or not noticed.

Economic pressures
It was felt that a clear line needed to be drawn  because of some of the pressures placed upon physicians and on families. There is an economic pressure to get people out of the health care system as soon as possible. Where people have medical insurance, some insurance companies are doing what is called "economic credentialing."

Dr Bernhoft pointed out that one of the  "economic realities" is that persons are being pushed toward hospice care instead of being treated for their terminal illnesses. He said it was very important to draw a clear line between what is acceptable and what is not.

He said his concern was if it were made legal for doctors to assist suicide, the type of doctors which do not know what pain medication is on the market "...are going to be knocking people off that don't need to die."

Honouring personal decisions
While honouring the personal decision of a person to end their own life because they do not want to "live as a vegetable...or in agonizing pain," sounds reasonable in theory, the question of choice may not be as clear cut as first thought.

A person could make a decision to die, Dr Bernhoft submitted, based on bad advice from doctors who simply did not know how to effectively treat pain or recognise depression. In almost every case where people get good care, they want to live.

Euthanasia taught in Nevada Medical School
Dr John H. DeTar, a physician living in Nevada has detailed how the laws prohibiting euthanasia and assisted-suicide have been circumvented in Nevada. He says that in Nevada euthanasia is now a reality simply because the Nevada Medical School is teaching it and the State Board of Medical Examiners is giving credit for post-graduate education (PGE) in "ethics" to physicians who have taken a one-hour course.

The medical school provides a professor to teach the methods for starving and dehydrating the patient so that he/she will die in approximately six days.

In March 1999 the euthanasia programme was presented to approximately 200 doctors as an hour of "ethics." The ethicist, Dr Paul Jensen, presented a paper called "Stopping Hydration and Nutrition."

According to the paper, if the patient is the one who initiates the request, the method is called "patient refusal of hydration and nutrition" (PRHN). More common is what Dr Jensen calls "surrogate refusal of hydration and nutrition" (SRHN). This is when the doctor accepts the authority of a spouse, son/daughter or relative - enabling that person to authorise the dehydration and starvation of the patient.

The physician who directs the killing of the patient can then conceal the cause of death in the death certificate by using one of the following examples:
  • terminal dehydration
  • patient refusal of hydration and nutrition
  • pancreatic carcinoma, end stage
In June 2003, the Nevada State Board of Medical Examiners revoked Dr. Kenneth D. Mower's right to practice medicine, finding that he had administered a lethal dose of morphine on the 19th July 2002 to a woman who was brought to the emergency room at Desert Springs Hospital Medical Center after attempting to commit suicide by taking a large amount of prescription medications.

The Board rejected Mower's arguments that the patient was terminally ill due to extremely shallow breathing when the morphine was administered, that her living will specified that she did not want life support, and that her husband supported the decision. The hospital filed the complaint with the Board after Mower sued for wrongful termination.