Week Seven 2/25/15 – 3/4/15 Medicare, Medicaid, and the Affordable Care Act as Examples of Public Policy Implementation

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Medicare, Medicaid, and the Affordable Care Act as examples of Public Policy Implementation

Welcome back to Dignity Discussion. This week let’s talk about Medicare, Medicaid, and the Affordable Care Act (ACA) as examples of public policy implementation. In past weeks we acknowledged that Medicare, Medicaid, and the ACA were programs established to provide needed services to United States (US) citizens. Let’s recap:

  • The Medicare and Medicaid Act (1965) provided health care to citizens over 65 years of age (advanced age); and poor families (Social Security, n.d.).
  • In 2010, President Barack Obama signed the Affordable Care Act (2010) that included expansion of the Medicaid program with the goal of improving programs; and making healthcare affordable for low-income families (Medicaid.gov., n.d.).
  • The ACA was responsible for expanding healthcare coverage for millions of Americans; and also lowered healthcare costs; ended preexisting exclusions for children; and provided preventive care at no cost (US Department of Health and Human Services, 2015).

This all sounds like pretty good stuff? Let’s take look how this all relates to Death with Dignity laws…

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Medicare, Medicaid, the ACA…and Death with Dignity?

The ACA’s goals are to to provide quality healthcare to all Americans, regardless of social, economic, or environmental factors. There is only one section in the ACA that states no healthcare professional shall be discriminated against if he or she chooses not to supply items or care in the physician-assisted suicide process (e.g., ACA Section 1553) (Patients Rights Council, 2013).

Last week, it was mentioned that states with aid in dying laws received no federal money for these types of services; therefore, if Medicaid is the insurer only state funds can be utilized (Oregon Public Health Division, 2014). Currently, Medicare and Medicaid pays for hospice services (e.g., Medicare Part A); and under the ACA, patients under the age of 21 can seek curative treatments while still under a hospice program without jeopardizing being discharged or paying out-of-pocket for hospice services (Medicaid.gov, n.d.).

A provision of the ACA was the enactment of the Independent Payment Advisory Board (IPAB). This 15 member (non-political) board, chosen by President Barack Obama (and approved by members of the Senate and House of Representatives), is designed to cut Medicare healthcare costs (American Medical Association, 2015). This is the “death panel” I spoke about last week. Opposition to the IPAB suggests that cutting Medicare pay rates leads to limiting access to care. In simpler terms, if a person with a terminal illness wants to pursue aggressive treatments then it will not be paid for under the ACA.

Let’s look at a video from Fox News on The IPAB:

ACA “Death Panels”

In states like Oregon, where aid in dying exists, people have reported wanted treatment for terminal illnesses and getting coverage denied, but received letters that lethal prescriptions will be paid for.

Oregon Debate

Final Thoughts on ACA policy and Death with Dignity

Death and dying is a hard topic to discuss. I believe if health care decisions are broached early on it may make one’s decision about treatment options easier for themselves and their loved ones. Although, is it fair to deny a person aggressive treatment options for a life threatening disease, especially is that person is of advanced age?

One thing is for sure, opponents to aid in dying in the state of Arizona will have more ammunition with the death panel case when it comes to passing future bills.

Let’s take a poll. What do you think?



American Medical Association (2015). Independent payment advisory board. Retrieved from http://www.ama-assn.org/ama/pub/advocacy/topics/independent-payment-advisory-board.page?

KVAL.com (2008, July 31). Health plan covers assisted suicide but not new cancer treatment. Retrieved from http://www.kval.com/news/26140519.html?tab=video&c=y

Media Matters for America (2014, December 4). Fox resurrects ACA “Death Panels” myth. Retrieved from http://mediamatters.org/video/2014/12/04/fox-resurrects-aca-death-panels-myth/201773

Medicaid.gov (n.d.). Hospice benefits. Retrieved from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/hospice-benefits.html

Medicaid.gov (n.d.). Provisions. Retrieved from http://www.medicaid.gov/affordablecareact/provisions/provisions.html

Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf

Patients Rights Council (2013). Health care reform. Retrieved from http://www.patientsrightscouncil.org/site/health-care-reform/

Social Security (n.d.). Chapter 4: The fourth round 1957 – 1965. Retrieved from http://www.ssa.gov/history/corningchap4.html

Social Security (n.d.). History of SSA and the Johnson administration 1963 – 1968. Retrieved from http://www.ssa.gov/history/ssa/lbjmedicare1.html


Week Six 2/18/16 – 2/25/15 Public Sector Influence on Healthcare Policy : Efforts to Aid the Uninsured, Underinsured, Disabled, and Decrease Health Disparities

Recent Public Sector Influences

Hello and welcome to the discussion about public sector’s influence on healthcare policy. Last week, we discussed the Affordable Care Act (ACA) 2010. The ACA was responsible for expanding healthcare coverage for millions of Americans; and accomplished the following

  • Lowered healthcare costs
  • Ended pre-existing exclusions for children
  • Kept young adults (under the age of 26) insured under their parent’s healthcare plan
  • Provided preventive care at no cost, and allows people to seek emergency services outside their plan (US Department of Health and Human Services, 2015).

The goal behind the ACA is to provide quality healthcare to all Americans, regardless of social, economic, or environmental factors.

Public Sector Influences on Death With Dignity

Since no aid in dying law exists in Arizona, let’s look at how the public sector influences the Death With Dignity law and efforts to protect the uninsured, underinsured, disabled, and those with any other health disparities.

A great place to start was a guidebook for medical professionals written by an Oregon task force to improve the care for terminally-ill patients. In the guidebook it covered many areas including patient’s rights and responsibilities, mental health consultations, and financial issues.

Here are some statements I found important for this topic:

  • Patients have the right to their medical condition and prognosis to order to make informed decisions regarding treatment options
  • Patients have the right to know if their healthcare provider, healthcare plan, or system participates in the Death With Dignity Act
  • If a patient should change physicians in order to obtain a prescription from a participating physician, human and skilled care must continue until the transfer is complete.
  • Patients only deemed mentally-competent can participate in the law.
  • A Depression screening is recommended for all patients wanting a lethal prescription. If the screening is positive, a referral to a psychiatrist or psychologist is warranted.
  • If perceived patients are choosing lethal prescriptions due to financial burdens should be explored
  • Physicians, hospitals, or others involved in care who are perceived to have a direct or indirect financial interest should be disclosed during discussions about treatment options (Oregon Health and Science University, 2008).

I found the financial points interesting. It never states who exactly pays for lethal prescriptions, but through some more investigation I discovered that the Death With Dignity Act does not specify who pays for the services, but it is decided upon individual insurers (and under the Act it is not deemed suicide so insurers cannot view as such upon determination). Also, no federal funding can be utilized for services, so if Medicaid is the insurer only state funds can be utilized (Oregon Public Health Division, 2014).

Recent articles report how President Obama would like Medicare to reimburse providers for end-of-life counseling. Obama wanted to include this in the ACA, but opposition quickly followed. Remember Sarah Palin’s death panel discussions? Since 2010, Medicare did mandate coverage for advance care planning during wellness visits; and private insurance companies, like Blue Cross/Blue Shield of Michigan, are reimbursing  $35 for end-of-life discussions (Compassion & Choices of Washington, 2014).

Since aid in dying state’s decision, it will be up to the state government to influence healthcare policy; and protect the under served in it’s decision making process.

Below is a video about the ACA…do you agree with these stances? Are seniors and those with disabilities be targeted for these ‘death panels?’

See you in Week Seven!


Compassion & Choices of Washington (2014). Coverage for end-of-life talks. Retrieved from http://compassionwa.org/news/coverage-end-life-talks-gaining-ground/

Oregon Health and Science University (2008). The Oregon Death with Dignity Act: A guidebook for healthcare professionals. Retrieved from http://www.ohsu.edu/xd/education/continuing-education/center-for-ethics/ethics-outreach/upload/Oregon-Death-with-Dignity-Act-Guidebook.pdf

Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf

The Big Picture (2014, May 22). Sarah Palin was right: There are death panels in America. Retrieved from https://www.youtube.com/watch?v=6mD7iYFovdk

United States Department of Health and Human Services (2015). About the law. Retrieved from http://www.hhs.gov/healthcare/rights/

Week Five 2/11/15 – 2/18/15 Healthcare Policymaking Including Statutory and Regulatory Mechanisms

Welcome to Week 5! Let us begin this week by reviewing some definitions. What exactly are statutes and regulations?; and how do they link in with the policymaking process, especially regarding Death with Dignity?

Statues and Regulations

Statutes are written laws made by legislators on a federal or state level (Georgetown Law, 2014).

Regulations are the force of the law that governs; and an explanation on how a governing agency intends to carry out laws (Kraft and Furlong, 2014; USA.gov, 2015).

How Does This Relate to Policymaking?

Let’s simplify this some more by giving a recent example. For instance, the Affordable Care Act (ACA) was passed by Congress; and signed into law (a statute) by President Barack Obama in 2010. With the passing of the ACA how does Congress have the time to enforce the new law? Truth is, after a law is passed there are agencies, boards, or commissions assigned to help with the rulemaking process. During this process, rules are created and with the help of public feedback, the rules are either changed, added, or kept; and then final rules are registered with the Federal Register (USA.gov, 2015). One regulatory agency for the ACA was the Center for Consumer Information and Insurance Oversight (CCIIO), which assisted with implementing many of the provisions of the ACA that dealt with private health insurance (Centers for Medicare and Medicaid Services, n.d.).

How Does This Apply to Our Death with Dignity Discussion?

As mentioned in previous posts, Arizona currently does not have any aid in dying laws on the horizon; and the federal government has told states to make their own statutes regarding aid in dying. So who helps with regulation process once an aid in dying law passes?

Let’s look at the state of Oregon, the Death with Dignity statue was initiated in 1997. Within the Death with Dignity Act (1997), it required the Oregon Health Authority (OHA) to be involved in the regulation process. For instance, the OHA collects all patient and physician information; mandates certain reporting practices, and publishes yearly statistical reports (Oregon Health Authority, (n.d.).

Here is the link to the most recent Death with Dignity Statute in Oregon; and Death with Dignity Rules:


Final Thoughts

This week we talked about statutes and regulations. The policymaking and implementation process does appear to have its good points. I especially like the fact that during the regulatory process the public can voice opinions. But what do you think?

Please join me next week when we discuss how the public sector influences healthcare policy (especially in regards to aid in dying).


Centers for Medicare and Medicaid Services (n.d.). Consumer information and insurance oversight: Ensuring the Affordable Care Act serves the American people. Retrieved from http://www.cms.gov/cciio/

Georgetown Law (n.d.). Overview of administrative law. Retrieved from https://www.law.georgetown.edu/library/research/tutorials/admin/upload/1_overview_text.pdf

Kraft, M. E., & Furlong, S.R. (2015). Public policy: Politics, analysis, and alternatives (4th edition). Los Angeles, CA: Sage Publications, Ltd.

Oregon Health Authority (n.d.). Public health’s role. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ohdrole.aspx

Oregon Health Authority (n.d.). Rules and regulations. Retrieved from https://public.health.oregon.gov/RulesRegulations/Pages/index.aspx

USA.gov (2015). Laws and regulations. Retrieved from http://www.usa.gov/Topics/Reference-Shelf/Laws.shtml

Week Four 2/4/15 – 2/11/15 The Historical and Contemporary Role of Institutions and Actors (Including Consumers) in Developing Healthcare Policies

Historical and Contemporary  Role of Institutions and Actors (Including Consumers) in Developing Healthcare        Policies

Welcome back to Week Four’s discussion. This week let’s delve a little further into healthcare policies by focusing on the historical and contemporary aspects involving the role of institutions and actors (including consumers) in the policymaking process.

Last week, I mentioned the basics about policies and why they exist. To reiterate, policies ensure people’s basic needs and rights are met (e.g., health, education, and safety). Also mentioned was the Medicare and Medicaid Act in 1965 that was an amendment to the original Social Security Act of 1935 signed by President Franklin Delano Roosevelt (Centers for Medicare and Medicaid Services (CMS), 2013). The Medicare and Medicaid Act (1965) provided health care to citizens over 65 years of age (advanced age); and poor families (Social Security, n.d.).

In recent times, there have more amendments and provisions to the Medicare and Medicaid Act:

  • In 2003, President George W. Bush signed the Medicare Modernization Act (MMA) that included an outpatient prescription drug benefit; and other provisions (CMS, 2013).
  • In 2010, President Barack Obama signed the Affordable Care Act (2010) that included expansion of the Medicaid program with the goal of improving programs; and making healthcare affordable for low-income families (Medicaid.gov., n.d.).

So now that we covered some historical and contemporary healthcare policies what does it mean when asked how does the role of institutions and actors (including consumers) play in development of healthcare policies? Longest (2008) discusses the role people, organizations, and interest groups have on healthcare policies; and prefaces the discussion by noting two related areas of interest between the groups:

  1. All have an analytical interest, meaning how will these policies affect me and the ones I love? And demand to know prior to prepare.
  2. All want to have influence on the policies proposed since the consequences will be affecting them and their loved ones.

So far this makes sense…and to add one more thing… when one can effectively analyze and influence policy, one is deemed having policy competence (Longest, 2008).

Who are these people, organizations and interest groups that affect policymaking? Longest (2008) goes on to clarify:

  • People – Would include citizens of the United States (US). The government mandates healthcare policies to aid its citizens for their pursuit of health.
  • Organizations – Would include hospitals, state or county health departments, health maintenance organizations (HMOs), nursing homes, or hospices. Many of these organizations developed as a result of healthcare policymaking.
  • Interest Groups – Would include groups like the American Hospital Association, the American Medical Association (AMA), the American Nurses Association (ANA), the Association of American Medical Colleges (AAMC); or the American Association of Retired Persons (AARP). it should be stated that these interest groups could be primary service providers (like the AHA); individual health practitioners (like the ANA); secondary service providers (like the AAMC); or individual (consumer) member constituencies (AARP). The interest groups are motivated to be involved in policymaking over the economic or health concerns of its members; or maybe both.

This brings up a good point that Sam Arora, the Maryland state legislator, mentioned last week during my interview which was having limited funds to pay staff to help develop and draft policies. You need staff to help in the policymaking process; hence why special interest groups are successful in developing policies because they have the money and staff to do these necessary tasks.

How Does This Relate to Death With Dignity?

A Death with Dignity law does not currently exist in the State of Arizona, but who could get involved (e.g, institutions or actors) to help develop this policy? To start, it helps to start with special interest groups because they have money. Organizations like Death with Dignity and Compassion & Choices have been essential to passing the aid in dying law in states like Oregon; and currently, they are helping states like California draft bills.

With stories like Brittany Maynard in the national spotlight, it gets individuals (actors) involved in their state policymaking for bills like aid in dying. Media attention equals exposure. Just this week I spotted Brittany Maynard’s widower on the cover of People magazine. This will only help in getting individuals to sign petitions and demand action from their elected officials. This is power!

Death with Dignity is not considered a money maker in the healthcare world (nor should it be). Meaning if it were to make some company or institution millions, it may have more institutions or actors behind the bill. Although when we look back in history, the Medicare and Medicaid Act in 1965 was supported heavily by such groups as the American Hospital Association (AHA), the American Federation of Labor and Congress of Industrial Organizations (AFI CIO) and the ANA. The AHA got involved heavily with the bill because private hospitals were losing money due to elderly patients being unable to pay their bills (Social Security Online, n.d.).

Let’s end this post with a poll. I am interested in your opinion…


Centers for Medicare and Medicaid Services (2013). History. Retrieved from http://www.cms.gov/About-CMS/Agency-Information/History/index.html?redirect=/history/

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Medicaid.gov (n.d.). Provisions. Retrieved from http://www.medicaid.gov/affordablecareact/provisions/provisions.html

Social Security (n.d.). Chapter 4: The fourth round 1957 – 1965. Retrieved from http://www.ssa.gov/history/corningchap4.html

Social Security (n.d.). History of SSA and the Johnson administration 1963 – 1968. Retrieved from http://www.ssa.gov/history/ssa/lbjmedicare1.html


Week Three 1/28/15-2/4/15 The Basics: Definitions and Premise of Policy-Making.


Policymaking is a term most Americans heard of; and all Americans have directly been effected by on a daily basis.  In a nutshell, policymaking occurs at a federal, state, or local level; and involves decision making to establish laws as solutions to problems with the goal of improving quality-of-life for all its citizens.

Premise of Policymaking

There are steps in the policy making process that include: (1) identification of a problem; (2) setting of an agenda; (3) formulation of a policy; (4) adoption of the policy; (5) implementation of the policy; and (6) evaluation of the policy (USHistory.Org, 2014).  This process is familiar to healthcare professionals, especially nurses, when speaking about the nursing process. Does anyone in nursing remember the acronym ADPIE (e.g., assess, diagnose, plan, implement, and evaluate) that was implanted into our novice brains?

Back to policymaking…when it comes to health care policy, they are formulated with the goal of the pursuit of health; and led to such reforms as Medicare and Medicaid in 1965; and now  the emergence of the Affordable Care Act (ACA) in 2010 (Longest, 2010).  Policies like these were made at the federal level, but with Death With Dignity laws, the federal government has placed the decision in the states’ hands.

Here is a recent map depicting the current states either with aid in dying laws passed (e.g., green states) or in the campaigning stage (e.g., orange states):

(Compassion and Choices, 2015)

As one can deduce, the blue states are not in the campaigning stage; and will have to wait until a bill for aid in dying is either introduced or re-introduced (as in the case of Arizona where the bill came up for debate in the house multiple times).

There was an interesting article in the New York Times (2013) pertaining to how getting laws passed on the national level is challenging due to political polarization.  In layman’s terms, this means Democrats and Republicans cannot reach an agreement in Congress to pass bills, hence the legislative process stalls. Such national issues like gay rights and aid in dying are now pushed to state governments to make decisions; and state officials have the power to challenge national policy by passing laws (New York Times, 2014).

This week I had the honor to interview former member of Maryland’s House of Delegates, Sam Arora.  Since this week’s blog featured policymaking, I thought it would be a perfect opportunity to get answers from a person who was actually part of a state policy making process. Some interesting points Mr. Arora had to share were the following:


  • A good bill usually doesn’t pass the first time it is introduced.
  • A bill that is continually vetoed still has the potential to pass.
  • Policymakers are not always “politicians”; and the majority of bills are drafted by lobbyist groups (although he didn’t operate that way).
  • The biggest challenge of policymaking was time, staffing, and resources (he only had a budget of $39,000).
  • A good policymaker has to reach across the aisle; and campaign for his bill to pass.
  • Healthcare professionals, like advanced practice registered nurses (APRNs), have an important voice in policymaking; and can be extremely credible attesters for proposed bills.

Please click on the audio below for this intriguing view into policymaking on a state level.

WORKING ON GETTING LINK TO YOU!…Email douglesgrube@gmail.com and I will email you directly.  Promise it is worth it!

We learned the definition(s) and premise of policymaking, especially pertaining to healthcare.  Please join me for Week Four for more thoughts on the issue of aid in dying.


Compassion & Choices AZ (2005). In your state. Retrieved from https://www.compassionandchoices.org/what-you-can-do/in-your-state/

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

New York Times (2014). States get things done, affecting national policy. Retrieved from http://www.nytimes.com/roomfordebate/2013/07/16/state-politics-vs-the-federal-government/states-get-things-done-affecting-national-policy

USHistory.Org (2014). Policymaking: Political interactions. Retrieved from http://www.ushistory.org/gov/11.asp


Week Two 1/21-1/28 Healthcare Policy and the Role of Ethics

Healthcare Policy

Admittedly, as RN “in the field” I never paid attention to health care policy.  My thinking was those in administrative roles would engage in these types of issues.  It wasn’t until pursuing the DNP degree did the realization register that everyone, including patients, families, and healthcare workers, have a voice; and with a substantial amount of voices, changes can occur.

For this week I am beginning at ground zero; and asking the question, “What exactly is a healthcare policy?” To clarify for those who are wondering the same, the World Health Organization (WHO) describes healthcare policy as actions, decisions, and plans initiated to enact specific health care goals within a society (WHO, 2015).  Let’s take this concept and apply it the topic, Death with Dignity, and think about how healthcare policy (or the lack thereof) relates to this topic.  Clearly, as related in Week One’s post, the state of Oregon was a trailblazer with the landmark ruling to legalize physician-assisted suicide in 1994.  Since then, other states have succeeded, but many have failed in their attempts to establish aid in dying policies.  Arizona (AZ) is one such state where the Aid in Dying bill, sponsored by former State Representative, Linda Lopez (Democrat), has consistently been rejected in the House of Representatives.  For those of you who need a quick civics review of how a bill turns into a law, I included a picture because who doesn’t like visuals?

I also included a link to a news clip on how Death with Dignity remains dead in the water (no pun intended).  (For effective view please right click and open as new link).

Death with dignity’ legal in only 5 states, Arizona is not one of them | KVOA.com | Tucson, Arizona.

For those terminally ill patients (living in AZ) seeking to make their own choice in when and how they want to die, this is an extremely frustrating situation.  The only choice for these patients may be a hospice program, where at least end-of-life symptom management is offered.  For others, desperate times call for desperate measures, like violent suicide (e.g, guns); and looking for organizations that may assist in finding measures to hasten one’s death.  For instance, the case of a 58 year old Phoenix woman, Jana Van Voorhis, who inquired the help from Final Exit members to help with her suicide.  Final Exit is an organization that counsels and supports mentally competent people with intolerable diseases end their lives (Final Exit, 2011).  The problem was Jana told members, one being a retired anesthesiologist, that she had terminal conditions that were never verified by her physicians.  In fact, Ms. Van Voorhis had been recently diagnosed as having psychosis; and had persistent disturbing hallucinations.  These members were tried in an AZ court for manslaughter.  The physician was acquitted; and the three other members pleaded to lesser charges (AZ Central, 2012).  This led to a bill, recently signed by former Governor Jan Brewer in 2014, to prosecute any individuals with manslaughter who assist in suicides.  The term assist means providing physical means to end one’s life (Arizona Capitol Times, 2014).

Watch Dr. Sanjay Supta, my favorite CNN consultant, investigate the Jana Van Voorhis case.  Think about what side of the fence you are on in this debate; and if heath care policy could have prevented tragedies like this case.

There are still those in the community keeping the Death with Dignity debate alive.  Arizona State University (ASU) hosted an event, that I attended, in September 2014 titled “Should Arizonans Have the Right to Die with Dignity?”  This event had a panel discussion with two highly informed professors on the topic: Dr. Courtney Campbell, from Oregon State University; and Dr. Helene Sparks, from the University of Washington.  Both taught courses in ethics; and have numerous articles published on topics like physician-assisted suicide.

Here is the video discussion for those interested in this debate.  Think about the question, “Do Arizonans have the right to die with dignity?”


 Role of Ethics

The ASU discussion on Death with Dignity leads us to the topic of ethics.  How does the role of ethics affect the decision-making policy regarding aid in dying for terminally ill patients?  As it stands, the American Nurses Association (ANA) has this position statement regarding assisted-suicide that “prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses with Interpretive Statements, the ethical traditions and goals of the profession, and its covenant with society (ANA, 2013, p. 1).  This code also applies to advanced practice registered nurses (APRNs).  With the ANA against assisted-suicide, only strengthens the debate for those opposed to an Aid in Dying bill in AZ.  As a hospice RN in AZ, I believe those diagnosed with a terminal illness; and who are mentally deemed competent should be able to end their own life.  If for any reason to stop drastic, desperate measures by those seeking a safe, painless, monitored way to die.

Let’s talk further about this topic in Week Three when I will delve more into the actual policy-making process!


American Nurses Association (2013). Position statements: Euthanasia, assisted suicide, and aid in dying. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

Arizona Capitol Times (2012). Brewer signs bill targeting assisted suicide. Retrieved from http://azcapitoltimes.com/news/2014/04/30/brewer-signs-bill-targeting-assisted-suicide/

Arizona State University (2014). Should Arizonans have the right to die with dignity? Retrieved from https://www.lincolncenter.asu.edu/events/should-arizonans-have-right-die-dignity

AZ Central (2012). Jury acquits Phoenix doctor in assisted-suicide case. Retrieved from http://archive.azcentral.com/community/ahwatukee/articles/2011/04/21/20110421phoenix-doctor-assisted-suicide-verdict.html

Final Exit Network (2011). Our guiding principles. Retrieved from http://www.finalexitnetwork.org/

Mullins, Jean (2015, November 4). Sanjay Gupta, MD: Assisted suicide or manslaughter? Retrieved from https://www.youtube.com/watch?v=_of5pFqLB-k

News 4 Tucson (2014, November 3). Death with dignity legal in only 5 states, and Arizona is not one of them. Retrieved from http://www.kvoa.com/news/death-with-dignity-legal-in-only-5-states-arizona-is-not-one-of-them/#.VL7aKRev61M.wordpress

World Health Organization (2015). Health policy. Retrieved from http://www.who.int/topics/health_policy/en/

Week One 1/14-1/21: Introduction to the Health Policy Topic

Health Policy Topic

Legalizing Death with Dignity  in the state of Arizona

Background and Significance of the Death with Dignity Act

The Death with Dignity movement made national headlines in 2014 when Brittany Maynard, a young woman with terminal brain cancer, chose to end her life with the assistance of a physician (through prescribed medications) on November 1, 2014. Brittany moved and established residency in the state of Oregon, which was the first state to pass the Death with Dignity Act in 1997.  To date, their are four other states where patient-directed dying (PDD), also known as physician-assisted dying, is occurring either by mandated state laws (e.g., Vermont and Washington) or court rulings (e.g., Montana; and one county in New Mexico) (CNN.com, 2014); sparking the national debate of should terminally ill patients, deemed mentally competent, be allowed the choice to end their own life?  Proponents for PDD, like the Death with Dignity National Center, want to proliferate the movement for people facing terminal illnesses to have control and options when facing end-of-life decisions, including PDD (Death with Dignity National Center, 2015).  Some interesting statistics since the inception of these mandated laws or court rulings include:

  • In Oregon, there have been 1,173 physician prescriptions written; and 752 deaths since 1997 (Oregon Health Authority, 2014).
  • In Washington, there have been 549 prescriptions written; and 529 deaths since 2009 (Washington State Department of Health, 2014).
  • In Vermont, there has been no deaths reported since the passing of the doctor-prescribed suicide bill in 2013 (CNN, 2014)

For those patients diagnosed with terminal illnesses in states with no Death with Dignity laws, it can be a frustrating journey. Most are dealing with painful and debilitating disease processes like cancer or amyotrophic lateral sclerosis (ALS).  This is the case in the state of Arizona (AZ) where an Aid in Dying Bill (HB 2572) was proposed in 2007; and continues to remain in the Health, Judiciary, and Rules Committees (Life Issues Institute, Inc., 2014).  In 2005, an AZ Opinion Poll conducted by the local new channels, KAET-TV/Channel 8 and the Walter Cronkite School of Journalism and Mass Communication at Arizona State University (ASU), telephoned 442 voters inquiring about a physician-assisted suicide law for people with terminal illnesses.  The results revealed 53% of those polled were in support of a law being passed (Compassion & Choices AZ, 2005).

Establishing Death with Dignity laws can potentially do the following:

  • Lower healthcare costs for those with terminal illnesses. Studies show 1 in 4 Medicare dollars,  over 125 billion dollars, are spent on care at end of life (Time, 2014)
  • Mandate safe and effective means over ending a person’s life.  Stopping potential suicide attempts that are horrific and traumatic for all involved.
Please watch the video of Brittany Maynard’s fight with terminal brain cancer; and her decision to die with dignity.

Significance to Me

My name is Leslie Moses-Grubenhoff; and I have been a registered nurse (RN) for the past 10 years.  Currently, I am a Doctor of Nursing Practice (DNP) student at Arizona State University (ASU) concentrating in adult and geriatric primary care.

Working for a non-profit hospice in Phoenix, AZ for the last 9 years, I have encountered patients who have inquired or requested assistance with dying.  Many had lost their abilities to feed, bathe, or toilet themselves; and all had lost their overall quality of life.  They assumed being admitted to a hospice program would hasten the dying process due to the morphine the agency could provide.  Clarification and education on what a hospice does never includes providing medications to end a person’s life.  Comfort medications, like morphine, are only utilized for symptom management for issues such as pain and/or shortness of breath.  This left some patients feeling hopeless because they were ready to die; and wanted control in when this would happen.  One story that I will always remember is an admissions call I received for a man who attempted suicide with a helium tank and a paper bag, but failed.  This man was suffering from terminal cancer; and had unrelieved pain.  He told me he got all his affairs in order; said his goodbyes to his family and friends; and distributed out all his life savings only to receive an empty helium tank for a botched suicide attempt.  He was angry and frustrated that the state of Arizona did not have laws in place to help him die with dignity.

Please watch the video below of an elderly man who shot his wife of more than 40 years as a “mercy killing.”

Man shoots elderly wife in alleged ‘mercy killing’ – FOX 10 News | fox10phoenix.com

Looking forward to the upcoming weeks to discuss this topic further.  See you in Week Two!


CNN (2014). Physician-assisted suicide fast facts. Retrieved from http://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/

Compassion & Choices (2014, October 29). A new video for my friends. Retrieved from http://www.youtube.com/watch?v=1lHXH0Zb2QI

Compassion & Choices AZ (2005). Arizona opinion polls. Retrieved from http://www.choicesarizona.org/azpoll2.htm

Death with Dignity Center (2015). About us. Retrieved from http://www.deathwithdignity.org/aboutus

Fox 10 News (2013, November 13). Man shoots elderly wife in ‘mercy killing.’ Retrieved from man shoots elderly wife in alleged ‘mercy killing’ – FOX 10 News | fox10phoenix.com

Life Issues Institute (2014). Current attempts to legalize assisted suicide in the United States. Retrieved from http://www.lifeissues.org/euthanasia/current_attempts.htm

Time (2014). Cutting the high cost of end-of-life care. Retrieved from http://time.com/money/2793643/cutting-the-high-cost-of-end-of-life-care/