With the passing of new legislation, Canada has become one of the few nations to legalize physician-assisted suicide. The new law imposes strict requirements, however, by limiting the option to the incurably ill and requiring medical approval, a 15-day waiting period and two independent witnesses. Moreover, to obtain a request for physician-assisted suicide, a patient must: (1) be eligible for government-funded health care; (2) be a mentally competent adult over the age of 18; (3) have a serious and incurable disease, illness or disability; and (4) be in an “advanced state of irreversible decline” with enduring and intolerable suffering.
The legislation is more restrictive than some of the lawmakers had wanted. Some argued that it should be broadened to include degenerative disease, whereby patients who are suffering from incurable degenerative diseases but are not necessarily close to death would also qualify for physician-assisted suicide. Yet, others believed that such a broad criteria would push the law too far. As Justice Minister Jody Wilson explained, the requirements in the final legislation “strike the right balance between personal autonomy for those seeking access to medically assisted dying and protecting the vulnerable.”
On June 27, 2016, the Supreme Court invalidated a Texas law that limited women’s access to abortion. The law required physicians performing pre-viability abortions to have hospital admitting privileges. It also required women’s health centers that offered abortion services to abide by certain surgical center requirements, causing many centers to close.
Proponents of the law claimed that it was an effort to maintain safety standards for women. However in a 5-3 vote, the Supreme Court concluded that the legislation imposed an undue burden on women attempting to obtain an abortion. Justice Breyer explained in his opinion that with the majority of clinics that offered abortions forced to close, the law would require women to travel long distances to the only “crammed-to-capacity” compliant facility. He further stated that nothing in the legislation provided any benefit to women’s health. Justice Ginsburg echoed this conclusion in her concurring opinion by explaining that complications from pre-viability abortions are rare and not life-threatening.
Justice Samuel Alito, Jr. wrote the dissenting opinion, which did not directly speak to the constitutionality of the law. Instead, he focused on the doctrine of res judicata, which prevents recurring litigation on a matter that has already been resolved. Justice Thomas affirmed this argument in a concurring dissent, claiming that the majority has repeatedly “distorted” the law and given preference to pro-choice arguments.
This is the first case the Supreme Court has decided regarding abortion rights in nine years, and while it was by no means a unanimous decision, it affirmed that the undue burden test established in Planned Parenthood v. Casey in 1992 continues to control the constitutionality of abortion laws.
In June 2016, California joined three other states – Washington, Vermont, and Oregon – in enacting legislation that legalizes physician-assisted suicide for terminally ill patients. Conversation surrounding such end-of-life decision-making sparked in 2014, when Brittany Maynard, a California schoolteacher diagnosed with brain cancer, decided to move to Oregon to die on her own terms.
The new California legislation allows a physician to prescribe lethal doses of medication only when requested by a terminally ill patient who is likely to have less than 6 months left to live. However, unlike other states that have similar laws, California is allowing physicians to demand that requests be made in writing. Moreover, physicians are not required to prescribe the medication, nor are they required to refer the patients to another physician willing to do so. Catholic hospitals and other religious health groups have already expressed their unwillingness to participate, stating that “[w]e are crossing a line — from being a society that cares for those who are aging and sick to a society that kills those whose suffering we can no longer tolerate.” Some physicians say that they will require patients to go through rigorous psychological evaluations before prescribing the medication. Yet, the majority of patients with incurable diseases support the legislation, explaining that it will allow them not to be a burden to their families as their diseases progress.
While the enactment of the legislation has certainly not ended the debate over end-of-life decision-making in California, health care systems in the state are drafting new policies to help physicians and patients adjust to the new option for end-of-life care.
The trend of “population mixing” in nursing homes is on the rise as more young people with brain injuries and mental illnesses are being placed in facilities intended to serve an elderly population. Unfortunately, for young patients in need of long-term skilled nursing care who rely on Medicaid and other government funding for health care, placement in a nursing home is often the only available option. This is because there are few remaining facilities specifically designed for patients with mental illnesses or brain injuries.
Although “population mixing” in nursing homes has been occurring for some time, the recent increase is linked to a spike in resident-to-resident altercations (“RRAs”). RRAs are most common in nursing homes with shared rooms and pose a significant risk to elderly patients who are involved in an altercation with younger, more physically able patients. In order to decrease the incidence of RRAs between young, able-bodied patients and physically vulnerable elderly patients, experts opine that it is necessary to increase government funding for mental health facilities so as to provide better treatment options for young patients. Nursing home could then be dedicated to care for the elderly populations they were designed to serve.
Soon, Congress will hear testimony concerning the Helping Families in Mental Health Crisis Act. Republican representative, Tim Murphy, from Pennsylvania, sponsored the bill, and, though many agree that the mental health care system requires revamping, some provisions in the bill have sparked controversy. Among the more controversial provisions is one that supports the increased use of involuntary outpatient treatment—via court-ordered therapy for “certain mentally ill people with a history of legal or other problems.” Detractors of this provision claim that it will erode trust in doctor-patient relationships, and that it presents a civil rights issue. However, 45 states have compelled treatment programs already, one of which is New York.
New York’s compelled treatment program, Kendra’s Law, was passed in 1999. Since the implementation of Kendra’s Law, studies show that the percentage of patients returning to the hospital or getting arrested has greatly decreased. The statistic is significant, as “about 350,000 Americans with a diagnosis of severe mental illness…are in state jails and prisons” and the availability of psychiatric beds meets only 10 percent of that need.
Anti-fetal homicide laws were enacted originally to protect mothers of unborn children against violent acts. Yet, in reality, “they’ve led to disproportionate prosecution against African American women who suffer miscarriages.” An ongoing case in Mississippi could set a dangerous precedent with regard to the criminalization of pregnant women for their purportedly reckless acts. Rennie Gibbs was charged with the murder of her unborn child after it was stillborn when she was 16 years old. Gibbs is being prosecuted for “depraved heart murder” because the autopsy showed that Gibbs had used cocaine during her pregnancy—but the cause of death was originally attributed to the umbilical cord being wrapped around the infant’s neck. That cause of death was never ruled out.
In 1990, Congress approved the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The CARE Act funds support and medical treatment for individuals with HIV. However, under the Act every state had to certify that it had criminal laws that would prosecute individuals with HIV who knowingly exposed others to the disease, even if those exposed did not contract HIV. Individuals who are successfully prosecuted under these laws are listed as sex offenders. In one case in Iowa, a woman was prosecuted successfully even though she claimed that she informed the man that she was HIV positive. He claimed she did not tell him; however, two weeks prior to filing his complaint against her, he was convicted of domestic abuse for hitting her. She is now listed as a sex offender.
Currently, the federal government and advocates consider these HIV-specific laws to be draconian in light of modern scientific knowledge regarding HIV, which is “no longer the death sentence it once was.” Many of these HIV-specific laws do not require exposure in the form of sexual contact, and some even include exposure in the form of something as innocuous as spitting. HIV cannot be transmitted through saliva. Some states, including Iowa, are reconsidering and changing their HIV-specific laws in response to this change in public opinion.
The Center for Medicaid and Medicare Services (CMS) administrator, Marilyn Tavenner, stated in a letter to Congress that Medicare Part D is working well, and a proposed rule change, which would have “substantially reduced patient choice,” is unnecessary. The Senate Finance Committee stated that, at present, the cost of the program is 45% below the projections of the Congressional Budget Office. In addition, Part D enjoys a 90% satisfaction rate by its beneficiaries. Under the Affordable Care Act the cost of Medicare Part D premiums has remained low, but the quality of care has improved. However, Ms. Tavenner wrote also that opportunities exist to improve the program, and CMS will continue to review Part D policies periodically.
A bitter court battle is raging over whether an elderly Brooklyn woman should continue to be kept alive. Sylvia Sodden, 78, is still on life support, even though her original health care proxy agreed to its removal. In 2011, Sodden appointed her godson, Joe Arrigo, as her health care proxy. Arrigo is Catholic, and states that Sodden converted from Orthodox Judaism to Catholicism when she was 20 years old. He states also that Sodden did not want to be on life support, and that “she didn’t want to end up like this.” He consulted with two priests prior to making the decision to remove life support.
However, on March 18, 2014 a Brooklyn Supreme Court Judge determined that Esther Feigenbaum, Sodden’s sister, would replace Arrigo as Sodden’s health care proxy. Feigenbaum claims that Sodden never converted, and that shutting down life support is “anathema to Orthodox Jewish belief.” The Court indicated that part of its decision to divest Arrigo of his role as health care proxy rested on the fact that Arrigo was absent from Court on the day of the proceedings. Arrigo maintains that he did not know he was supposed to appear.
Mayor Vincent Gray of Washington D.C. announced that D.C. will now require insurance companies to provide full coverage to transgender residents, which includes gender reassignment surgery. The D.C. Department of Insurance, Securities and Banking stated its official position that treatment and gender reassignment surgery for gender dysphoria are covered benefits. The Mayor stated that transgender people should not be required to pay extensive out-of-pocket fees for treatment.