Bill to Correct Involuntary Euthanasia in Virginia
Your Help Needed Before January
With the passage of the Health Care Decisions Act of 1992 (54.1-2990), Virginia became the first state in the country to explicitly legalize involuntary euthanasia. This law now authorizes denial of life-saving medical treatment against the will of the patient or family whenever a doctor considers such treatment "medically or ethically inappropriate."Unfortunately, many doctors now argue that they should have a veto over a patient's request to be allowed to live if the doctor, in disagreement with the patient or patient's family, thinks the patient's "quality of life" is so poor that her or his life is not worth living. The consider "medically or ethically inappropriate" not just treatment that would not save a patient's life, but also treatment that would save life if the life's quality is deemed poor.
While 54.1-2990 now provides for transfer of the patient to another physician in such a circumstance, it does not require that treatment necessary to prevent the death of the patient be provided pending transfer.
VSHL is supporting a new bill to be introduced in the Virginia General Assembly in January to correct this situation. The Patient Autonomy Protection Act (PAPA) is being sponsored by Sen. J. Randy Forbes (R-Virginia Beach) in the Senate and by Del. H. Morgan Griffith (R-Salem) in the House. Unless this bill is passed, vulnerable Virginians -- the aged, the terminally ill and those with disabilities -- remain in very grave danger.
Please arrange to meet with your State Senator and your Delegate and urge them to support this vital piece of legislation. A good time to do so would be in the weeks following the election but prior to the beginning of the legislative session in January. If you do not know who your elected legislators are, contact the VSHL office at 804-358-VSHL or your local library. Following is further information that will be useful in your discussions.
What PAPA does, and doesn't do
With this type of legislation, it is as important to understand what the bill is not as what it is. For example, PAPA would not mandate physiologically futile treatment; it requires only treatment whose denial "would in reasonable medical judgment be likely to result in the death of the patient." Nor would it require an unwilling physician to preserve the patient's life indefinitely, but only for two weeks or such additional time as a judge determines would allow for "a reasonable prospect that a physician willing to accept transfer and to comply with the directive or treatment decision can be found."PAPA would also not require treatment for which the demand is greater than the supply (such as organ transplants), when providing treatment to one patient would mean denying the same treatment to another patient.
Why is PAPA needed?
Tragically, medical journals are full of articles documenting and advocating denial of life-saving medical treatment against the will of the patient and patient's family. For example, a nursing home study in the March 1991 New England Journal of Medicine found that 25% of the time advance directives were not followed by the nursing home and medical staff. In 18% of these cases, patients were denied treatment they had requested, compared with only 7% of cases in which treatment they had rejected was provided. In the last issue of the Lifesaver (August, 1999, page 4) are examples of hospitals today with policies of allowing patients to die against their wishes or their family's wishes.
How would it work?
The proposed bill simply says this: If denial of treatment against the will of a patient or the patient's surrogate would cause the patient's death, the physician would merely have to provide treatment to preserve the status quo -- the patient's life -- until the transfer is completed.Because PAPA requires only treatment whose denial "would in reasonable medical judgment be likely to result in the death of the patient," it leaves to physicians the discretion to determine whether treatment is likely to prevent the patient's death and what treatment is likely to do so. The only limit it places on physician discretion is in deciding, against the will of the patient or the patient's representative, that a patient whose life can be preserved must instead die.
Published in VSHL Lifesaver, October 1999
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