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Euthanasia’s Busy Year: Rationing, Involuntary Denial of Treatment, and Direct Killing

by | Jan 29, 2014


By Jennifer Popik, JD & Burke Balch, JD, Robert Powell Center for Medical Ethics

Editor’s note. This column appeared in the January issue of National Right to Life News which can be read in its entirety online Be sure to pass this along to all your pro-life family and friends.

Burke Balch, JD & Jennifer Popik, JD Robert Powell Center for Medical Ethics

Burke Balch, JD & Jennifer Popik, JD
Robert Powell Center for Medical Ethics

2013 was an active year for pro-lifers across the spectrum of issues, particularly in the area of euthanasia. Threats to life addressed by Federal and State governments have run the gamut, from the early signs of rationing under the Obama healthcare law to a variety of issues surrounding protective treatment legislation in the states. An overview of last year follows.


A year-end article from The Hill, which covers DC politics, might have said it best — “The healthcare law faced a very tough year in 2013, but that could pale in comparison to what happens in 2014.”

In her piece, “Top 5 O-Care stories to watch”, Elise Viebeck went on to write, “Between new exchange plans taking effect in January, the first enrollment period concluding in March and the midterm elections in November, the administration will have its hands full managing the rollout and mitigating negative stories for vulnerable Democrats.”

2013, by all accounts, has been a tough year for Obamacare. When one of the law’s major components, the health care “exchanges,” came online October 1, the problems were immediate and major.

Not only were the exchanges difficult or impossible to enroll in, thanks to problems with the Federal website, but the replacement policies that people are finding in the state and federal exchanges typically severe restrict the doctors and health care facilities in their plan’s networks.

Moreover, hundreds of thousands lost their coverage in what Politifact dubbed as the 2013 “Lie of the Year” – Obama’s now debunked promise that if you liked your plan you would be allowed to keep it.

Amid this controversy, public support for the law has dropped to a record low. According to a recent CNN/ORC national poll, support for Obamacare has declined over the past few months to only 35%, with 62% now opposing the law.

The polling is confirming a new and ominous reality–American’s current insurance plans are gradually disappearing, while the new Obamacare exchange plans are going to be more restrictive, with less access to doctors and healthcare centers with specialized expertise and high reputations for providing effective life-saving medical treatment. More on this can be found at

While the president attempts to appease certain groups by offering temporary delays or the short-term ability to hang on to old insurance plans, the larger problems of eroding coverage for most Americans looms on the horizon.

Dr. Marc Siegel, a professor of medicine and medical director of Doctor Radio at New York University’s Langone Medical Center, offered a sobering perspective from the medical community in his piece, “The Death of the Bedside Manner Obamacare is speeding the decline in the quality of medical practice” published on December 26, 2013 in the Wall Street Journal. He wrote:

“Unfortunately, the kind of insurance that is growing under ObamaCare’s fertilizer is the exact kind that was jeopardizing the quality of health care in the first place: the kind that pays for seeing a doctor when you are well, but where guidelines and regulations predominate and choice is restricted when you are seriously ill.”

While many are quick to blame insurers, the real culprit is the Obamacare provision under which exchange bureaucrats are excluding insurers who offer policies deemed to allow “excessive or unjustified” health care spending by their policyholders.

Under the Federal health law, state insurance commissioners are to recommend to their state exchanges the exclusion of “particular health insurance issuers … based on a pattern or practice of excessive or unjustified premium increases.” The exchanges not only exclude policies in an exchange when government authorities do not agree with their premiums, but the exchanges must even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by paying what those government authorities consider an “excessive or unjustified” amount. (See documentation at

This evidently is creating a “chilling effect,” deterring insurers who hope to be able to compete within the exchanges from offering any adequately funded plans that do not drastically limit access to care.

When the government limits what can be charged for health insurance, it restricts what people are allowed to pay for medical treatment. While everyone would prefer to pay less–or nothing–for health care (or anything else), government price controls prevent access to lifesaving medical treatment that costs more to supply than the prices set by the government.

While Obamacare continues to roll out in 2014, it is important to continue to educate friends and neighbors about the dangers the law poses in restricting what Americans can spend to save their own lives and the lives of their families. More can be found here:


In the wake of the 2005 Terri Schiavo case many authorities urged Americans to complete advance directives. Every state authorizes these legal documents, which allow a person to specify whether and under what circumstances she or he wants life-preserving medical treatment, food or fluids when no longer able to make health care decisions.

However, the laws of all but twelve states may allow doctors and hospitals to disregard advance directives when they call for treatment, food, or fluids. Increasingly, health care providers who consider a patient’s “quality of life” too low are denying life-preserving measures against the will of patients and families – and the laws of most states provide no effective protection against this involuntary denial.

Most states with laws protecting against involuntary denial of treatment essentially require health care providers unwilling to allow their patients to life to provide directed life-saving treatment pending transfer to a willing health care provider. Last spring, Oklahoma became the first state to enact a new approach derived from anti-discrimination language in federal law when Governor Mary Fallin signed the Oklahoma Nondiscrimination in Treatment Act after it passed the legislature with huge margins.

Click here to read the January issue of National Right to Life News,
the “pro-life newspaper of record.”

Under the new law, if a patient or the patient’s legal representative chooses life-preserving medical treatment, food or fluids, the law will prevent health care providers from denying that treatment “on the basis of a view that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.”

The protection against forcing people to die against their will based on their age, disability or illness provoked vociferous opposition. An April 24 article on the bill in the Tulsa World stimulated many online attacks on the legislation.

Okierat wrote, “When you are old and sick you are a parasite and should not have a choice in your life.” Iamarock said, “If doctors agree that life will not be qualitatively improved with aggressive treatment then it can and ethically should be withheld.” More can be found at

“Quality of life” bioethicists began promoting living wills and other advance directives in the 1970′s using the argument that medical paternalists were forcing people to stay alive against their will. Now many of them strongly argue that medical paternalism is justified when people doctors deem to have a poor quality of life dare to consider their own lives worth living and seek life-saving medical treatment, food, and fluids.

As documented in the Powell Center report, “Will Your Advance Directive Be Followed?” since the 1990′s hospital ethics committees have increasingly been applying “futility protocols” under which patients desiring life-preserving treatment are regularly denied it and forced to die against their will.


During 2013, Vermont became the first state to legalize assisting suicide by legislative action (Oregon and Washington State had previously done so by referendum), and early this year a lower state court held New Mexico’s protective law to violate the state constitution.

After a decade-long and hard-fought battle, the Vermont legislature passed the nation’s most dangerous doctor-prescribed suicide measure. Governor Peter Shumlin had been a long-time advocate of such a measure and worked to ensure its passage. The measure passed the Vermont Senate narrowly, only gaining passage with two votes. Vermont will become the first state in the nation to decriminalize assisted suicide through a legislative vote- as opposed to ballot iniative or court mandate.

For the first three years, the Vermont law grants doctors immunity from prosecution for providing a lethal dose of medication if they follow a loose list of rules, including making sure the patient is terminally ill and making a voluntary, informed decision. In 2016, that list of rules expires, with the hope that doctors will have established their own personal guidelines. The hospitals in the state, fearing liability, have directed their physician employees to not participate for now. Also, there is effort to possibly revisit this dangerous law again in the legislature.

Just last week, Judge Nan G. Nash of the Second District Court in Albuquerque struck the decades-old New Mexico law which protected the state’s citizens from assisted suicide. Nash asserted that prescribing lethal drugs to a patient, or as she defines it, “aid in dying,” is merely another type of medical treatment. Although she acknowledged that the US Supreme Court has ruled that killing someone with that person’s consent is not a constitutional right, she held it to be a fundamental right under the New Mexico Constitution, at least for those who are “terminally ill.” The state attorney general’s office has said it is still in the process of deciding whether to appeal Nash’s ruling to the State Supreme Court. More on this can be found at

Although advocates of these laws claim to merely be providing another option to a person with a tough diagnosis, the laws are riddled with legal problems, and their so-called safeguards ultimately do not protect vulnerable groups including those suffering from mental illness, the elderly, and persons with disabilities. (More on how so-called safeguards do not work can be found at

2013 was a critical year in the battle over euthanasia – a struggle that, if anything, is likely to intensify in 2014.

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Categories: ObamaCare Rationing