Ed Sitter

Executive Director, Greater Toledo Right to Life

Opponent Testimony on Senate Bill 165

May 4, 2016

Mr. Chairman and members of the Senate Civil Justice Committee:

Greater Toledo Right to Life advocates for ethical laws and effective policies, which protect and defend the right to life from the moment of fertilization to natural death. Greater Toledo Right to Life is a trusted advocate for life-affirming measures throughout Fulton, Lucas, Ottawa and Wood Counties.

I would like to address three areas of opposition to S.B. 165:

  1. It fails to bring clarity in addressing end of life care.
  2. It creates a host of unintended consequences and conflicts with existing statute.
  3. That the proposed MOLST form is pro-life neutral, it is not.

Senate Bill 165, Medical Orders for Life Sustaining Treatment (MOLST) presents more concerns than solutions for end of life care choices. It reduces such choices to a simple checklist that sacrifices person-specific needs and wishes to bureaucratic attempts at efficiency.

Significant protections for patients and even certain healthcare providers are absent from S.B. 165, which should not be enacted, but at the very least call for further analysis and clarification.

S.B. 165 subtly manipulates focus away from preserving life to hastening patient death. Life sustaining treatment is defined as any medical procedure, treatment, intervention or other measure intended to principally "prolong the process of dying," not to help a patient live (2133.30 O). [italics added]

S.B. 165 allows for MOLST to include withdrawal of comfort care measures (2133.30 P), which includes by definition nutrition and hydration, which is basic, ordinary patient care (2133.30 E 1 & 2).

The bill establishes in law that a MOLST form can be issued for any patient, regardless of age or condition. Once issued, a MOLST form "is valid and its instructions govern how the patient is to be treated with respect to hospitalization, administration or withdrawal of life saving treatment and comfort care...." [italics added]

MOLST is to replace Ohio's current Do Not Resuscitate (DNR) protocol due to repeated 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 the MOLST form omits.

S.B. 165 negates any duty of a health care provider to obtain informed consent before implementing 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."

Amendments to S.B. 165 offered and accepted in an earlier hearing even removed without explanation this minimal informative statement from the proposed MOLST form: "You will still receive medical treatment regardless of whether this form is signed."

Doctors really cannot know when a person will die, but S.B. 165 assumes that if a person is terminal 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?

The only remote definition of terminal in the bill is the highly subjective standard for whom MOLST is recommended, that is, a patient "for whom a health care professional would not be surprised if the individual died within one year (Section 2133.31 G)." [italics added]

Finally, of concern to many in the healthcare industry—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 unborn child instead.

These are only some of the glaring problems with S.B. 165 and proposed MOLST protocol. Let me be very clear this bill in any form does not enhance or advance the right to life. The MOLST form by its very nature focuses on withdrawal of care and treatment to hasten death.

The bill is not necessary, current law effectively deals with end of life directives. Regrettable S.B. 165 is a solution in search of a problem. Please oppose S.B. 165, Ohio’s MOLST.

Thank you.

Ed Sitter

Executive Director, Greater Toledo Right to Life

5726 Southwyck Blvd. Suite 120

Toledo, OH 43614

(419) 535-5800