'Death with dignity' bill sparks emotional Iowa Senate debate

An emotional debate over the right to die has returned to the Iowa Capitol, with passionate arguments Wednesday over individual freedom to end personal suffering versus protection of the sanctity of life.

Sen. Joe Bolkcom, D-Iowa City, is the lead author of a bill titled the “Iowa Death with Dignity Act,” which is modeled after an Oregon law enacted in 1997 that advocates say is working effectively. Last year, 218 people in Oregon received prescriptions for lethal medications, state records show.

A three-person Iowa Senate subcommittee chaired by Bolkcom adjourned Wednesday without taking action on Senate File 2051, which would establish a medical process for a terminally ill patient to take his or her life. But Bolkcom said he hopes to hold another meeting next week, before a Feb. 19 deadline for bills to advance during the 2016 session.

“I know that this is a controversial topic, and I know that there are deeply held views about this,” Bolkcom said.

The debate Wednesday came just four days after the death of prominent Des Moines businessman and philanthropist David Hurd, who fell from the 22nd floor of a downtown condominium complex where he lived. His death is being investigated as a suicide. Hurd had suffered from a type of dementia with Parkinson’s-disease-like symptoms.

Wendy Smith of Ottumwa urged Iowa lawmakers Wednesday to enact the legislation. She formerly worked as a director of home health and hospice in Washington state, which has allowed terminally ill patients to take lethal doses of medication since 2009.

“As a hospice nurse, I have been at the bedside of patients who exercised their options for 'end of life' care and those who were denied those options,” Smith said. “I have witnessed patients cry out for the relief of death, and watched husbands, wives and children pleading with their physicians who were limited to manage the pain of suffering.”

Sen. Rich Taylor, D-Mount Pleasant, a co-sponsor of the bill, told how his sister died about a year ago after a long battle with cancer as her family watched and tried to comfort her. “She died a terrible death” and was kept alive with feeding tubes and breathing devices, he said.

“My sister didn’t have to die a painful death. She didn’t have to die slowly,” Taylor said.

Religious groups and right-to-life organizations lined up against the legislation. Opponents said it was wrong for Bolkcom to contend the bill is not assisted suicide.

Danny Carroll, a lobbyist for The Family Leader, a Christian conservative group, cautioned that the consequences of passing the legislation would be severe and far-reaching.

“If we pass this bill, we are telling Iowans, especially teens, that suicide is an acceptable alternative to hardship and adversity that comes with this life,” Carroll said.

Tom Chapman, a lobbyist for the Iowa Catholic Conference, noted that the suicide rate has soared in Oregon. A Centers for Disease Control and Prevention report shows suicides among men and women age 35 to 64 increased 49 percent in Oregon from 1999-2010, compared to 28 percent nationally. Oregon was ranked 10th-highest among the 50 states for suicides in 2013, federal records show.

Chapman said suicides can prompt copycat attempts, and he suggested Iowa lawmakers would be sending a mixed message by supporting suicide prevention efforts while approving doctor-prescribed suicides.

Sen. David Johnson, R-Ocheyedan, a cancer survivor, told how he met a woman who has lived 10 years with an aggressive and deadly type of breast cancer after her doctor told her she was not expected to survive five years.

“Who is going to prove abuse?” Johnson asked. “How will you not know that there has been pressure and that something has been done” to pressure people to take their lives?

Bolkcom defended the legislation, insisting the proposal would not constitute “state-sanctioned suicide.”

“I appreciate people’s religious objections. But not everyone has religious objections,” Bolkcom said.

"Death with dignity" laws have been approved in Oregon, Washington, Vermont and California, although the California law has not yet taken effect. In addition, the Montana Supreme Court has ruled that nothing in the state law prevents a physician from honoring a terminally ill, mentally competent patient’s request to prescribe medication to hasten the patient’s death.

Legislation to consider assisted suicide has been proposed at the Iowa Capitol since at least 1992, when then-state Sen. Al Sturgeon, a Sioux City Democrat, spearheaded discussion after an Iowa man stricken with AIDS was killed by his housemate, who then killed himself. Sturgeon suggested  such a law might have eased anxieties over the prospect of a slow, painful death, prolonging the life of the AIDS patient and saving the other man’s life.

Some prominent Iowans who have taken their own lives have contributed to the debate. In 2002, at age 94, Des Moines philanthropist and social activist Louise Noun publicized her struggle to obtain the means to end her life, which she eventually accomplished by a drug overdose.

The same month, 80-year-old Ruth Nash of Dubuque, who like Noun was an Iowa Women's Hall of Fame member, drowned herself after two previous attempts ended in unwanted rescues and in one case confinement in a mental health facility. Both women faced declining health.

The process proposed in the Iowa legislation would include an initial oral request for lethal medication, followed by a second oral request at least 15 days later, and finally a written request. At least 48 hours would need to elapse between filing the written request and issuing a prescription for a life-ending drug.

The bill says a person planning to take his or her life would need to be an Iowa resident and be terminally ill, competent and voluntarily request to die. The patient would also need to be at least 18 years old.

In addition, the signing of the written request for life-ending medication would need to be witnessed by two people. This would include at least one person who is not a relative or entitled to a portion of the patient’s estate, a nursing home employee or owner, or attending physician.

The legislation also says the patient would be counseled about the importance of having another person present when taking the life-ending medication and to not take the medication in a public place.

A qualified patient’s act of self-administering medication to end his or her life would not have an effect on any life, health or accident insurance or annuity policy.

If a doctor would be unable or unwilling to carry out the patient’s request for life-ending medication, the health care provider would be required to transfer the patient’s relevant medical records to a new physician, the legislation says.

Besides Bolkcom and Taylor, the “death with dignity” legislation is sponsored by two other Iowa Senate Democrats, Matt McCoy and Dick Dearden, both of Des Moines