Legislature Legalizes Involuntary Euthanasia

Doctor Can Override Patient Wishes

The Virginia General Assembly has passed the Health Care Decisions Act, the most dangerous euthanasia legislation in the nation. This bill allows a doctor, based on his own ethical view about a patient's quality of life, to deny a patient's clearly stated choice to live.

"Life in this Commonwealth is jeopardized at both the beginning and the end," stated VSHL spokeswoman Fiona Givens. "Just as the 'hard cases' have been used to justify abortion on demand, so 'hard cases' have opened the door to euthanasia."

Virginia law already allows a person to request that treatment, including food and water, be withheld (voluntary euthanasia), and that a surrogate make such a decision for a person who is unable to give, and has not already given, a written or verbal directive (non-voluntary euthanasia).

This bill goes a step further and allows a physician to make the final decision, even when the patient and/or his family have clearly requested life-saving treatment. This would constitute involuntary euthanasia.

Specifically, the bill permits a patient to write an "advance directive to authorize the providing, withholding or withdrawing of life-prolonging procedures." If the patient has not previously made an advance directive and is unable to do so, the bill provides for certain others to make it for the patient, e.g., a guardian, spouse, adult child, parent, etc. The bill provides that a physician who refuses to comply with the advance directive shall make a "reasonable effort to transfer the patient to another physician." However, a subsequent section (§54.1-2990) of the bill overrules everything else in the bill by stating:

"Nothing in this article shall be construed to require a physician to prescribe or render medical treatment to a patient that the physician determined, in the exercise of reasonable medical judgment, would neither promote nor improve the health of the patient nor alleviate the patient's suffering."

The bill does not, however, permit active euthanasia. The same section states that nothing in this article shall be construed "to condone, authorize or approve mercy killing or euthanasia, or to permit any affirmative or deliberate act or omission to end life other than to permit the natural process of dying."

Delegate Bob Marshall proposed an amendment on the House floor to at least define what is meant by "euthanasia," saying it means "a willful action or an omission which of itself causes death, in order that all suffering may in this way be eliminated." If accepted, such an action or omission would not be condoned by this bill. However, the amendment was defeated 34-59 with 7 not voting. Delegate Cohen, the bill's patron, said that this definition would turn the bill on its head!

Delegate McDonnell proposed an amendment that would require the physician to not withdraw nutrition and hydration during transfer of the patient to another physician. Even this amendment was defeated, on a vote of 44-51 with 5 not voting.

Another problem with the bill deals with the determination of when it applies. Under the bill, a "qualified patient" is one who has made an advance directive and either has been diagnosed as incapable of making an informed decision about treatment, or has been diagnosed to have a terminal condition. A terminal condition is defined in the bill as one "from which, to a reasonable degree of medical probability, a patient cannot recover and (i) the patient's death is imminent or (ii) the patient is in a persistent vegetative state."

But is a "persistent vegetative state" really terminal? A few examples may be helpful. Over 2 1/2 years ago, an elderly woman named Carrie Coons unexpectedly woke up and began speaking just a few days after a judge had issued a court order allowing her family to have her feeding tube removed so she could die. She had been unconscious for 5 1/2 months and diagnosed as being in an irreversible "persistent vegetative state." More recently, on December 17, Barbara Brashers of Missouri unexpectedly woke up from a "vegetative" state that began in October 1989 after surgery to correct a brain aneurysm. When she first became unconscious, a CT scan indicated she had 70% brain damage. Reportedly she can now speak in full sentences, recognize and converse with friends and family, and even recall events that took place while she was supposedly unconscious (Kansas City Star, 12/20/91). Closer to home, in Fairfax, Virginia, 17-year old Nathan Rasmussen fell into a "vegetative state" after receiving head injuries in an auto accident in May. He made what his doctor calls a "remarkable recovery" in December and was able to return home for Christmas. Reportedly he can "walk, run, ride a bicycle and carry on a normal conversation" and will soon be able to continue his education (Washington Post, 12/26/91).

What can happen if this bill is signed into law? Even if a patient in a persistent vegetative state, or someone on his behalf, has written an advance directive specifying that life-prolonging procedures should be provided, the voting on the House floor makes clear that a doctor, if he is so inclined, could legally withhold food and water even if the patient were to be later transferred to another doctor!

The final vote in the House was 69-29 with 2 not voting. The bill now goes to Governor Wilder for signature.

Published in VSHL Lifesaver, March, 1992