Coalition* Opposes “End of Life” Legislation
FOR IMMEDIATE RELEASE, May 4, 2016 (Columbus, OH) – Despite contact from many citizens across the state, the Senate Civil Justice Committee this morning voted to approve the end-of-life measure, Senate Bill 165, Medical Orders for Life Sustaining Treatment (MOLST) and release it for vote by the full Senate, likely this afternoon.
Pro-life leaders* from around the state have coalesced in opposition to S.B. 165 due to glaring lack of clarity regarding implementation and patient protections. Efforts are redoubled to continue opposition if this bill advances in the legislative process.
The bill, sponsored by Senator Peggy Lehner (R-Dayton) would establish “medical orders for life sustaining treatment” or “MOLST” form for Ohio. S.B.165, MOLST would also sunset Ohio’s already existing do not resuscitate (DNR) protocols, which are working effectively in Ohio.
“Because citizens’ end of life concerns are already addressed in Ohio law, MOLST is unnecessary, even dangerous,” stated Paula Westwood, Executive Director of Right to Life of Greater Cincinnati on behalf of the coalition opposing Ohio MOLST. “Pro-euthanasia groups developed and promote these types of forms, which should discredit Senate Bill 165 immediately from consideration.”
The coalition identified the following problematic issues in the bill for all Senators, which have yet to be answered:
1. The bill allows more than attending physician to issue and certify MOLST form, including: certified nurse practitioner, clinical nurse specialist, or physician assistant (2133.23, 2133.30). Shouldn’t the primary care physician be the only one to work with patients to make such a significant decision regarding their own health care?
2. Preparation of the form with the patient is not limited to the attending physician, but also includes “the individual who completes the form pursuant to the practitioner’s delegation…(2133.30(K))” which can include any personnel, from social worker to chaplain.
The proposed form to be established in statute implies the effect of excusing the issuing practitioner from liability by stating “My signature in this section indicates, to the best of my knowledge, that these orders are consistent with the patient’s current medical condition and preferences…” Again, shouldn’t the primary care physician be the only one to work with patients to make such a significant decision regarding their own health care?
3. SB 165 allows for the MOLST to include withdrawal of comfort care measures (2133.30 P), which includes by definition (2133.30 E 1 & 2) nutrition and hydration. This is a major reason why the Terri Schiavo Life and Hope Network opposes SB 165.
4. Life sustaining treatment is defined in the bill as any medical procedure, treatment, intervention or other measure that is intended to serve principally to “prolong the process of dying” (2133.30 O). This indicates a tacit change from the goal of preserving life to a goal of hastening death with this bill.
5. Amendments that were offered and accepted in an earlier hearing removed language from the proposed MOLST form that stated the following: “You will still receive medical treatment regardless of whether this form is signed.” Why was this removed?
6. Amendment language adopted in the bill creates a previously-unrecognized standard for when this protocol is recommended to a patient. The language states that the protocol is for a “(patient) for whom a health care professional would not be surprised if they died within one year”.
This is a very subjective standard for issuing a standing medical order, given other existing law standards under DNR’s that require such judgment by a physician be “to a reasonable degree of medical certainty and in accordance with reasonable medical standards.”
7. Contrary to the sponsor and proponent testimonies, the bill establishes in law that a MOLST form can be issued for any patient (2133.33), given the issuing practitioner’s belief that the practitioner “wouldn’t be surprised if the patient died within one year”. Once issued, a MOLST form “is valid and the instructions in it become operative and govern how the patient who is the subject of the form is to be treated with respect to hospitalization, administration or withdrawal of life saving treatment and comfort care…”
8. The bill includes incomplete conscience clauses to protect facilities or practitioners who cannot follow a MOLST treatment order due to the institution’s or person’s moral, ethical, or medical concerns; the bill’s required referral to those who will implement a MOLST order still keeps the facility or practitioner complicit in the morally objectionable act (Sections 2133.24 (B), 2133.45 (B)). This is similar to forcing those who do not want to perform abortion to refer a patient to an abortionist who will kill the child instead.
9. MOLST is to replace Ohio’s current Do Not Resuscitate (DNR) protocol due to claims that existing DNR is too complicated. But Ohio’s DNR is a simple one-page form (odh.ohio.gov/pdf/forms/dnrfrm.pdf). Significantly, the Ohio DNR form defines what DNR comfort care will and will not include-clarity MOLST forms omit.
10. S.B. 165 negates any duty of the health care provider to obtain informed consent before implementing the MOLST. Obtaining informed consent to treatment (including refusing treatment) or a care plan requires disclosure of diagnosis, prognosis, treatment alternatives and their benefits and burdens so that the patient’s (or surrogate’s) decision is “informed.” A form preparer, who may not be medically-trained to address the above, has authority to fill out the form with the patient. The only requirement for the practitioner is their signature on the form.
11. Doctors really don’t know when a person will die, yet S.B. 165 assumes that if a person is terminal than that indicates a clear time of death. Yet “terminal” is not defined in the bill. A terminal diagnosis can assume life expectancy with normal medical care, or without care. S.B 165 also does not take person-specific needs into account regarding a terminal diagnosis, for example, if a person is insulin-dependent, is life expectancy based on receiving insulin or not?
*Coalition Opposing Ohio S.B. 165, MOLST as of May 4, 2016 (alphabetical order):
Advocates for the Family
Citizens for Community Values
Clermont County Right to Life
Cleveland Lawyers for Life
Cleveland Lutherans for Life
Cleveland Prays for Life
Cleveland Right to Life
Euthanasia Prevention Coalition, U.S.A.
Fostoria/Bascom Area Pro-Life
Fostoria Teens for Life
Geauga County Right to Life
Geauga County Tea Party
Greater Toledo Right to Life
H.E.L.P. Pro-Life Apostolate
Hancock County Right to Life
Henry County Right to Life
Hospice Patients Alliance Institute for Principled Policy
International Right to Life Federation
Lake County Right to Life
Lima & Allen County Right to Life
National Black ProLife Coalition
National Lawyers Association
Northeast Ohio Values Voters
Ohio Christian Alliance
Ohio Pro-Life Action
Putnam County Right to Life
Right to Life of Greater Cincinnati
Right to Life of Northeast Ohio
Terri Schiavo Life & Hope Foundation
Tiffin Right to Life
Warren County Right to Life
What’s Right/What’s Left Ministries