Daily on Healthcare: Medically assisted suicide faces roadblocks after legalization

MEDICALLY ASSISTED SUICIDE FACES ROADBLOCKS AFTER LEGALIZATION: Even as advocates for medically-assisted suicide press more states to allow doctors to prescribe life-ending drugs to terminally ill people, patients face logistical hurdles to such treatment in states where it’s already allowed.

New Jersey is the most recent state to join California, Colorado, Hawaii, Oregon, Vermont, Washington state, and the District of Columbia to enact statutes allowing the practice, which advocates refer to as “aid in dying” or “death with dignity.” It’s being considered elsewhere this year, including in New York and Maine.

Advocates have helped to standardize the laws in states by requiring that two healthcare providers confirm patients have no more than six months to live and that they are able to make their own decisions. The laws also require patients ingest the medications themselves.

But one aspect that isn’t written into statute is what medication doctors are to prescribe to help patients end their lives. The drugs come from compound pharmacies, which aren’t heavily regulated by the Food and Drug Administration and therefore could become a target for opponents.

State data in Oregon, where the practice has been legal since 1997, show that no patients in 2018 were prescribed a drug called pentobarbital, which was commonly used in the past but has been restricted by its manufacturers who fear that it will be used by states to carry out the death penalty. About half instead used a drug known as secobarbital, which operates similarly to pentobarbital but is significantly more expensive, and just under 40% were prescribed a drug cocktail of diazepam, digoxin, morphine sulfate, and propranolol.

The shortage has caused doctors to try different formulas, and certain mixes have resulted in a liquid that burned patients throats’ or delayed death for hours, undercutting the message that medically assisted suicide leads to a fast, painless death.

The option to receive a prescription for life-ending medication isn’t open everyone with a terminal illness. People who have degenerative illnesses, such as Alzheimer’s disease, are not permitted to participate. Data from Oregon show that most patients who participate have cancer, while others have diseases such as amyotrophic lateral sclerosis, or Lou Gehrig’s disease, a painful illness that breaks down a person’s muscles.

Opponents worry about patients with a terminal illness being pressured to end their lives so they are not a financial burden to their families. They contend poor people and those with disabilities will become targets.

“They are already at a disadvantage when they try to gain equal access to healthcare, and this law will only increase the challenges they face,” Matt Valliere, executive director of the Patients Rights Action Fund, said in a statement.

They also are concerned that doctors would be compelled to prescribe the medication or be forced to refer patients to someone who will. Doctors aren’t required to participate, and in some states patients have had difficulty finding doctors who will. Catholic-affiliated hospitals, which are a growing part of the industry, opt out because the practice violates their faith.

Those who advance the policies often argue that patients would otherwise face a slow and painful death or turn to killing themselves with firearms. They believe patients should have the choice to decide when and how they die. Organizations like Compassion and Choices have worked to bring attention to patients’ inability to access lethal medications when they receive care from a Catholic facility.

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VERMA BASHES MEDICARE FOR ALL: Centers for Medicare and Medicaid Services Administrator Seema Verma said during a Fox and Friends interview Wednesday that policymakers should be focused on addressing the issues leading to high healthcare costs rather than trying to overhaul the U.S. healthcare system as proposed by Sen. Bernie Sanders, I-Vt.

“I’ve been saying that Medicare for All is the biggest threat to the American healthcare system,” she said of the Sanders plan, which would enroll everyone residing in the U.S. into a government program.

She warned the system would result in a “bureaucracy making decisions about everyone’s healthcare” that would result in long wait lines and stymie innovation.

“We are having problems today paying for the Medicare program … so just adding more people to the program is just going to exacerbate it,” she said.

FDA ORDERS IMMEDIATE STOP TO SALES OF MESH USED FOR TRANSVAGINAL REPAIR: The Food and Drug Administration on Tuesday took the unusual step of ordering manufacturers to immediately stop selling surgical mesh used for transvaginal repair because it has caused infection, bleeding, and pain during sex.

Boston Scientific and Coloplast, the companies that sell the mesh, have 10 days to tell the FDA how they plan to take their product off the market.

SCOTUS RESCHEDULES CONFERENCE ON ABORTION BILL: The Supreme Court is considering whether to take up a challenge to a law in Alabama that bans a common type of abortion procedure used in the second trimester, known as dilation and evacuation.

The justices had been scheduled to discuss the challenge in an April 12 conference but then delayed it to April 18 before delaying it a second time. The challenge is in addition to another it is considering in Indiana, which bans abortion on the basis of race, sex, or disability. The Alabama law, which has been struck down by lower courts, prohibits the use of surgical tools and suction — a practice opponents call “dismemberment abortion” — effectively outlawing aboriton during the second trimester.

ALABAMA CONSIDERS BILL CRIMINALIZING ABORTION: A state House committee will consider a bill Wednesday that would make performing an abortion a felony, punishable between 10 and 99 years in prison. The bill has an exemption for a pregnant woman’s health, but not in cases of rape or incest.

LARGEST INSURER SLAMS MEDICARE FOR ALL: UnitedHealthGroup CEO David Wichmann in an earnings call Tuesday told shareholders that the company believed the healthcare system could be improved by expanding on the current public programs and with private health insurance, and not by moving to a government-financed system as sought by liberal Democrats.

“The wholesale disruption of American health care being discussed in some of these proposals would surely jeopardize the relationship people have with their doctors, destabilize the nation’s health system, and limit the ability of clinicians to practice medicine at their best,” Wichmann said. “And the inherent cost burden would surely have a severe impact on the economy and jobs — all without fundamentally increasing access to care.”

JOB UPDATE: IMPAQ International announced Monday that it has hired Tim Hill, who was at CMS for nearly three decades and most recently was acting deputy administrator and director at the Center for Medicaid & CHIP Services. Hill will be senior vice president for the public policy research and analytics firm.

OKLAHOMA LAWMAKERS SEND ABORTION ‘REVERSAL’ BILL TO GOVERNOR: The Oklahoma state House voted 74-24 on a bill requiring abortion providers to tell women who are taking medication to terminate their pregnancies that the process can be reversed after they take the first of two pills. Doctors who do not inform women about abortion reversal could face felony charges. The bill now heads to the state’s new Republican Gov. Kevin Stitt, who previously has said he’d sign any anti-abortion bill sent to his desk. Seven states have enacted such a law, starting with Arkansas in 2015.

NEW FDA HEAD VOWS TO CARRY OUT CRACKDOWN ON TEEN E-CIGARETTE USE: Acting Food and Drug Administration commissioner Ned Sharpless said Tuesday that the administration would press on with efforts launched by his predecessor Scott Gottlieb to curb youth tobacco use. Sharpless said the FDA will carry out “vital research to ensure we have the data necessary to make informed regulatory decisions on electronic cigarette products, so that we can reverse the growing epidemic of youth ENDS use.”

UPTON PLEDGES NO CUTS TO MEDICARE AND MEDICAID: Rep. Fred Upton, R-Mich., vowed Wednesday that Medicare and Medicaid would not be cut, and said that any changes to the programs proposed in the President Trump’s proposed budget are “not going to happen on our watch.” He said he wanted to assure to all seniors that they do not have to fear these cuts.

ANTI-ABORTION REP. DAN LIPINSKI FACES PRIMARY CHALLENGE FROM LEFT: Attorney Marie Newman, who narrowly lost to Lipinski in 2018, announced Tuesday she’ll challenge anti-abortion Rep. Dan Lipinski, D-Ill., for a second time. In a tweetstorm Tuesday, Newman, a progressive Democrat, accused Lipinski of “selling out” Illinois families to corporations and that constituents deserve “a real Democrat.”

O’ROURKE UNDERPAID TAXES DUE TO MEDICAL EXPENSES: Presidential hopeful Beto O’Rourke and his wife appear to have underpaid 2013 and 2014 taxes, having mistakenly reported medical expenses. They took deductions for medical costs without considering the limit that only allows that tax break for medical and dental expenses above 10 percent of income for people their age. The 2013 tax year was the first that had different income limits for the medical expense deduction based on the taxpayer’s age.

PALLONE INTRODUCES REVERSING THE YOUTH TOBACCO EPIDEMIC ACT: Alongside public health officials in New Jersey, Rep. Frank Pallone, D-N.J., unveiled a bill to raise the age for purchasing tobacco to 21, to prohibit non face-to-face sales of all tobacco products — which includes e-cigarettes, and makes it illegal to market or promote tobacco products to people under 21 years of age. The act has received praise from the American Lung Association, Campaign for Tobacco-Free Kids, American Heart Association, American Associations, and more.

VENEZUELA ACCEPTS FIRST RED CROSS AID SHIPMENT: The first shipment of humanitarian assistance from the Red Cross made its way into Venezuela Tuesday. The Maduro regime struck a deal with the organization to begin the protected flow of aid into the South American country. signals a change in attitude for the regime, which has done everything in its power to block humanitarian assistance from U.S.-aligned countries and organizations entering through Colombia and Brazil. The aid is intended to be distributed among hospitals and clinics across the country.

MARK YOUR CALENDARS: The Washington Examiner is hosting its next “Examining Healthcare” event on Wednesday May 1 at 8 a.m. The event will feature interviews by Kimberly with Sens. Bill Cassidy, R-La., and Doug Jones, D-Ala. Breakfast is provided. Register here.

The Rundown

The Globe and Mail Health Canada no longer requiring ultrasounds before prescribing abortion pill

Atlanta Journal Constitution Tom Price talks U.S. GOP health plan gap with Cobb conservatives

Politico Republicans reject Democratic attempts to tighten vaccine laws

San Francisco Chronicle VA schedules health care town hall in southern Illinois

WJCT News Sen. Amy Klobuchar talks healthcare and Venezuelan crisis at stops in Miami

The New York Times Opioid users call kratom a godsend. The F.D.A. says it’s a menace

Calendar

WEDNESDAY | April 17

House and Senate in recess.

Noon. Dirksen G-50. Alliance for Health Policy event on “Right Care, Right Patient, Right Time: The Role of Comparative Effectiveness Research.” Details.

Noon. SD-G11 Dirksen. Council for Affordable Health Coverage event on “The ABCs of Medicare Part B: Affordability Challenges for Physician-Administered Drugs & Proposals for Reform.” Email [email protected] to RSVP.

THURSDAY | April 18

Noon. 215 Massachusetts Ave. NE. Heritage Foundation event on “Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence.” Details.

MONDAY | April 22

April 22-25. Atlanta. Rx Drug Abuse and Heroin Summit. Agenda.

10 a.m. 1330 G St. NW. Kaiser Family Foundation event on “The Trump Administration’s HIV Initiative: What It Will Take to End the US Epidemic.” Details.

5 p.m. 1775 Massachusetts Ave. NW. Brookings conversation with author Dr. William A. Haseltine on “World Class: A Story of Adversity, Transformation, and Success at NYU Langone Health.” Details.