PAPA Passes Without Dissent

Rectifies Involuntary Euthanasia Provision

The Patient Autonomy Protection Act (PAPA), a major VSHL legislative goal for this year, passed both houses of the Virginia General Assembly without a single negative vote.

That seemingly simple result was anything but simple to accomplish.

Two identical bills were submitted: HB 1367, patroned by Delegate Morgan Griffith (R-Salem), and SB 677, patroned by Senator Randy Forbes (R-Chesapeake), but were given the simpler title of Health Care Decisions. The legislation corrects the provision in the current law that allows withdrawal of life-saving medical treatment against the will of a patient or his/her family if a doctor considers it "medically or ethically inappropriate." The bills would require the physician in such a case to notify the patient "or his authorized decision-maker" and then continue "any life-sustaining care" for "a reasonable time of not less than fourteen days" in order to allow the patient or family time to find another physician who is willing to abide by the choice for life. The bills define "life-sustaining care" as "any ongoing medical treatment that utilizes mechanical or other artificial means to sustain, restore or supplant a spontaneous vital function, including hydration, nutrition, maintenance medication, and cardiopulmonary resuscitation."

The original Health Care Decision Act passed in 1992 was relatively long and complex. Although it was the first in the nation that actually authorized involuntary euthanasia (i.e., withdrawing life-saving treatment due to a doctor's decision that was not authorized or agreed by the patient or his family), most Virginians were unaware of this "technicality" buried in the bill's wording. Even a great many legislators were unaware of it. So the first step was to meet with legislators to explain the problem and the proposed solution. VSHL State Legislation Chairman Fiona Givens spent the past year doing exactly that, and continued to do so during the legislative session. All told, she visited 110 General Assembly members explaining the necessity of passing what became known as PAPA. She also met with other Virginia organizations expected to have an interest in it.

Dr. John A. Jane, Sr., Chairman of the Department of Neurological Surgery at the University of Virginia Health System, wrote a letter to committee members urging support of the bill. He said in part:

"There is great disagreement among physicians and the general public about what 'quality of life' is worth preserving. Many older people and people with disabilities are at risk if the decision about whether their lives are worth preserving is to be taken out of their hands. . . .

"The Virginia Patient Autonomy Protection Act . . . imposes a minimal obligation on a physician or facility unwilling to respect their patients' choice for life. It merely requires that they continue life-sustaining care for two weeks so the patients or their representatives can seek a more congenial health care provider. Surely this is not too much to ask when the patient's very life is at stake."

In spite of all the preparatory effort, the bill garnered some significant opponents. The Medical Society of Virginia, the Virginia Health Care Association, the Virginia Hospital Association, and the Virginia Bar Association all opposed the bills.

Governor James Gilmore, III, however, was a strong supporter and, along with Secretary of Health and Human Resources Claude Allen, took a leading role in initiating negotiation meetings with dissenting groups. The outstanding leadership skills of the patrons of the bills, Senator Randy Forbes and Delegate Morgan Griffith, were also critical in this process. The result was a compromise that addressed a number of specific concerns raised by health care providers while retaining the essential requirements of patient or family notification and continuation of life-saving treatment while another physician is found.

The resulting bills with identical wording were reported unanimously out of their committees and passed in floor action by votes of 39-0 in the Senate and 99-0 in the House.

Burke Balch, Director of the Medical Ethics Department at the National Right to Life Committee, commented, "Tragically, too many doctors today, pushed both by ideological commitments to the quality of life ethic and pressures from managed care providers to ration medical treatment, are denying life-saving treatment against the wishes of patients and their families. Virginia's new Patient Autonomy Protection Act provides vital protection against this very scary trend."

Passage of this legislation is a major pro-life victory, not only in Virginia, but in the United States as well. Virginia is the first state to pass a freestanding bill of this kind, which could be an important precedent for other states to follow.

Published in VSHL Lifesaver, April 2000