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A
C
A
C
A
I
just
wanted
to
make
sure
I
know
that
the
computer
ghost
might
be
out
and
about
so.
I
just
want
to
make
sure
we're
all
present.
It
looks
like
everyone
is
present,
except
for
assembly
member
benitez
thompson,
and
so,
if
we
can
just
mark
her
present
when
she
arrives,
I
know
that
there
are
people
presenting
in
other
committees
right
now.
So
there
is
that.
So
with
this
we
will
begin.
First
on
the
agenda.
A
We
have
a
work
session
and
one
bill
hearing.
So
at
this
time
I
will
start
with
the
work
session.
If
we
can
go
first
to
assembly
bill,
I'm
going
to
take
them
a
little
bit
out
of
order,
because
I
know
people
have
to
get
back
to
their
other
committees.
So
if
we
can
start
with
assembly
bill
348.,
mr
ashton,
can
you
please
summarize
the
bill
in
any
amendment.
C
C
C
Excuse
me:
amendment
2,
restore
the
existing
duties
of
the
patient
protection
commission
that
are
deleted
by
the
introduced
version
of
the
bill.
Amendment
3
revise
the
membership
composition
of
the
commission
to
provide
that
one
member
who
is
a
provider
of
healthcare
must
be
experienced
in
running
a
healthcare
for
profit,
business
and
b,
one
member
with
expertise
in
healthcare,
information
technology
and
patient
access
to
medical
records,
who
must
be
either
an
employee
or
consultant
from
dhhs
members.
C
C
I'll
continue
with
amendment
4
authorized
the
commission
to
establish
any
sub-committees
or
working
groups
as
necessary.
Amendment
five
required
a
commission
to
adopt
bylaws
governing
its
own
operation.
Amendment
six
provide
that
the
commission
members
surf
at
the
blush
of
the
governor,
thereby
allowing
the
governor
to
remove
members
at
will.
Madam
chair.
A
Thank
you,
mr
ashton.
I
would
note
that
one
of
the
significant
amendments
I
think
that
came
out
of
at
the
conclusion
of
the
hearing-
and
I
know
we
have
assemblywoman
carlton
here-
is
she
did
take
the
suggestion
of
assemblywoman
titus
and
including
a
membership
for
a
for-profit
provider.
I
don't
know
if
assemblywoman
titus
saw
that,
but
I
just
wanted
to
point
that
out.
She
is
available
for
questions
so
at
this
time,
do
any
of
the
members
of
the
committee
have
any
questions.
E
Oh,
I
absolutely
appreciate
assemblywoman
carlton's
edition
of
a
for-profit
person
on
the
board.
I
think
that
is
very
helpful,
with
getting
a
pro
appropriate
data
and
appropriate
input
on
this
commission
and
I
and
I
absolutely
want
to
acknowledge
assembly
carlton's.
Listening
to
my
suggestion
on
the
amendment,
I
wish
that
that
was
the
only
issue
that
I
had
with
this
bill
and
I'm
still
having
some
of
my
health
care.
A
Thank
you
and
I
would
note
for
the
record
that
assemblywoman,
denis
thompson
is
now
present
she
logged
on
right
as
we
began
the
work
session.
Do
I
have
any
other
questions
from
the
committee
seeing
none,
I
didn't
entertain
a
motion
at
this
time
on
assembly
bill
348
so
moved.
A
Do
I
have
a
motion
to
or
a
second
on
that
amend
and
do
pass
motion
and
the
second
from
assemblywoman
being
is
thompson.
I
will
be
doing
a
roll
call
vote
because
I
believe
that
we
have
some
division,
so
I
want
to
make
sure
the
record
is
clear.
Madam
secretary,
can
you
please
take
a
roll
call
vote.
C
A
A
And
with
that
the
motion
passes,
and
at
this
time
I
will
assign
that
floor
statement
to
assemblywoman
carlton
next.
If
we
can
move
to
assembly
bill
287
again,
I'm
taking
these
slightly
out
of
order.
I
know
people
have
to
get
back
to
their
committees
and
I
see
assemblywoman
danielle
monroe
moreno
in
our
zoom
call,
so
I
want
to
make
sure
I
call
her
bill
next.
C
Accumulative
chair
for
the
record
patrick
ashton,
committee
policy,
analyst
we
heard
assembly
bill
287
on
march
31st
and
the
bill
provides
for
the
licensure
or
free
standing
birthing
centers.
The
bill
makes
various
other
changes
related
to
freestanding
birthing
centers
to
ensure
that
they
perform
certain
screenings
and
report.
Certain
information
required
to
be
performed
or
reported
by
other
licensed
facilities
that
provide
health
related
and
pregnancy
related
services,
assembly,
woman,
danielle,
monroe
mourinho,
proposes
to
amend
the
bill
as
follows.
C
Amendment
2
had
a
certified
personal
midwife
and
a
certified
nurse
midwife
as
providers
of
health
care
throughout
the
bill.
Wherever
midwife
is
mentioned
and
authorized
the
legal
division
of
lcb
to
make
conforming
changes.
Conforming
changes
toward
nrs
as
necessary
in
section
12
amendment
3,
revise
subsection
1a
to
require
any
regulations
adopted
for
the
licensure
or
freestanding
birthing
centers
to
be
aligned
with
standards
established
by
the
american
association
of
birth,
centers
and
the
accrediting
body
of
the
commission
for
accrediting
birth,
centers
or
any
other
approved
national
accreditation
body.
C
A
Thank
you,
I'm
going
to
put
this
in
view.
Are
there
any
questions
from
committee
members.
A
Do
you
have
a
question
or
do
you
have
a
comment
on
the
move?
There's
a
comment:
can
I
just
make
it
until
it's
in
the
comment
section?
I
will
have
an
opportunity
to
do
so.
A
A
I
have
a
motion
from
chair
p
by
share
peters.
Do
I
have
a
second
second,
some
woman
assembly,
woman,
gorlo
and
now
at
this
time
I
will
take
any
comments
on
the
motion.
Assemblywoman
titus
go
ahead.
Thank.
E
You,
madam
chair,
I
absolutely
am
supportive
of
freestanding
birthing
centers.
I
do
appreciate
the
comment
during
the
hearing
from
assembling
women
peter's,
that
a
woman
should
have
the
right
to
choose
where
they
birth,
a
child,
and
I
also
believe
where
they
send
their
kids
to
school.
But
that's
another
issue,
but
my
biggest
heartburn
with
this
bill
is
the
fact
that
they
can
be
30
miles
away
from
obstetrical
center
having
delivered
children
and
have
seen
many
an
emergency.
E
Even
in
as
a
family
practitioner,
I
only
delivered
low
risk
mothers
and
so
having
seen
disasters
that
can
happen
in
that
group.
Knowing
the
importance
of
having
an
assistance
close
by,
I
unfortunately
will
have
to
be
a
no
on
this
bill.
Thank
you,
madam
chair.
F
C
A
G
A
Yes,
the
motion
passes
and
I
will
sign
that
floor
statement
to
assemblywoman
monroe
moreno
with
that
I
will
move
on
to
our
next
work
session
bill
and
again,
I'm
going
out
of
order,
I'm
going
to
assembly
bill
256..
Mr
ashton,
can
you
please
summarize
the
bill
and
any
amendments
for
the
committee.
C
Thank
you,
madam
chair,
for
the
record
patrick
ashton,
comedy
policy.
Analyst.
We
heard
assembly
bill
256
on
march
24..
C
The
director
of
the
department
shall
include
in
the
state
plan
of
medicaid
a
requirement
that
the
state
pays
certain
costs
for
doula
services
provided
to
medicaid
recipients
to
the
extent
authorized
by
federal
law.
The
department
shall
apply
for
a
waiver
or
federal
medicaid
requirements,
or
request
to
amend
the
state
plan
to
receive
federal
funding
to
provide
coverage
of
doula
services.
C
A
A
A
C
A
Yes,
the
motion
passes
at
this
time.
I
will
assign
that
floor
statement
to
assemblywoman
summers,
armstrong
one.
Second,
while
I
catch
up
here
next
up,
we
can
go
to
assembly
bill
374..
Mr
ashton,
can
you
please
summarize
the
bill
and
any
amendments.
C
Amendment
1
create
the
nevada,
statewide
substance
use
response
working
group
within
the
office
of
the
attorney
general
amendment
2
require
the
attorney
general
senate
maturity
and
minority
leaders,
speaker
of
the
assembly
and
the
assembly
minority
leader
to
appoint
members
to
this
working
group.
Amendment
3
prescribe
the
duties
of
the
nevada,
statewide
substance,
use
response
working
who,
which
must
include
certain
requirements
as
outlined
on
the
bill
page
and
the
conceptual
amendment.
Madam
chair.
A
Sorry,
are
there
any
comments
at
this
time
or
questions
about
the
bill?
I
know
that
assemblywoman
tolls
is
on
this
call
and
I
believe
there
was
a
further
amendment
that
didn't
make
its
way
into
the
work
session
document.
So
I
will
her
allow
her
at
this
time
to
make
that
orally
assembly
woman
told.
Can
you
unmute
yourself
and
make
those
representations.
B
Yes,
madam
chair,
thank
you
so
much
and
thank
you
again
to
this
whole
committee
for
hearing
this
bill
and
and
for
the
support.
I
just
wanted
to
recognize
that
there
were
some
individuals
who
wanted
to
add
on
as
co-sponsors
and
I
apologize
that
that
didn't
get
through
into
the
work
session
documents,
so
senator
ratty
and
and
assemblywoman
thomas
peters
yourself,
madam
chairwin
assemblyman,
hafen
and
orrin
licker
all
wanted
to
add
on
as
co-sponsors
and,
of
course,
if
anyone
else
would
like
to
join
I'd.
Welcome
anyone
as
well.
A
A
Well,
second,
assemblywoman
gorlo!
Thank
you,
assemblywoman
gorlo.
Are
there
any
comments
from
committee
members
before
we
move
on
bed
and
chair?
Go
ahead,
assemblywoman.
A
Sure
we
could
amend
you
on
during
the
amendment
process
when
we're
moving
through
here.
I'm
sure
assemblywoman
tools
would
accept
you
as
a
co-sponsor
as
well
and.
B
A
C
F
A
You
know
what
how
about
we
do
this
assembly
vice
chair,
peters.
I
think
you
made
the
emotion.
Do
you
have
any
problems,
including
that
motion
her
in
that
motion
to
amend
and
do
pass.
B
A
Okay,
and
do
we
have
a
second
assembly.
B
Sorry,
woman
gorlo
just
asked
if
she
could
join
as
well,
so
if
we
could
just
not
have
to
do
this
twice,
if
that's
okay,
if
we
could
add
both
summers,
armstrong
and
garlow
in
the
same
motion.
A
Why
don't
we
just
go
ahead
and
do
that
right
now,
while
we
do
it,
if
there
are
other
people
I'll
ask
you
to
add
it
as
a
personal
amendment
on
the
floor
to
add
those
names,
so
obsession
are
you
okay,
with
that?
Let's
redo
you,
okay,
mending
with
those
two
individuals
as
well
and
assemblywoman
gorlo.
Would
you
second
that
with
that
as
well?
Yes,
I
will
thank
you
and
since
I
know
we
have
unanimous
support
here,
all
those
in
favor,
please
say
aye.
G
G
A
Nay,
seeing
none
that
next
motion
passes
unanimously
again,
I
would
assign
that
floor
statement
to
assemblywoman
tools
if
there
are
other
individuals
that
do
want
to
be
added.
I'd,
ask
you
to
contact
assemblywoman
tools
and
she
could
do
a
personal
amendment
on
the
floor
to
add
those
names
in
and
with
that
I
will
end
our
work
session
and
we
will
move
into
our
one
bill
presentation
at
this
time.
I
will
open
the
hearing
on
assembly
bill
351.
A
A
I
I
Thank
you,
madam
chair.
Madame
vice
chair
and
esteemed
colleagues
of
the
committee,
I
am
assemblyman
editor
flores
for
the
record
representing
us
from
the
district
28,
and
I
am
here
today
to
engage
in
what
I
hope
to
be
a
very
thoughtful
dialogue
and,
at
the
same
time,
what
I
recognize
to
be
a
difficult
dialogue
and
presenting
assembly
bill.
351.
I
I'd
like
to
first
give
some
context
of
how
I
I
landed
in
in
what
I
believe
is
a
responsibility
to
move
forward
and
push
for
this
legislation
and
then
afterwards
I'll
walk
you
through
the
bill.
I'd
like
to
note
that
you'll
see
that
there
are
two
amendments
posted
on
nellis.
There
is
a
mock-up
and
then
there
is
a
second
amendment
by
washoe
county.
I
I
will
reference
page
numbers
to
that
and
then,
after
when
I
hand
over
the
presentation
to
our
co-presenters,
I
will
let
them
quickly
go
through
the
amendments
to
explain
where
they
why
we
have
them
and
what
their
objective
is.
I
Just
so,
you
know,
as
co-presenters
I'm
going
to
be
having
kim
kalanin
the
ceo
of
compassion
and
choices,
action
network
along
with
peg
sandeen,
the
executive
director
of
death
and
dignity
national
center,
and
then
we'll
also
have
two
doctors
who
will
be
on
the
line
available
to
ask
any
additional
questions,
as
I
get
into
the
genesis
of
why
I
am
here
today
and
feel
I
have
this
responsibility.
I
I
I
do
share
that.
I
am
incredibly
grateful
for
the
work
of
david
parks,
who,
on
three
separate
occasions,
has
come
forth
on
behalf
of
many
nevadans
to
be
a
voice
for
them
in
presenting
similar
like
measures
in
the
past,
and
I
am
grateful
for
that
work
and
I
am
hoping
to
be
able
to
continue
the
work
that
he
has
laid
down
for
nevadans
and
that
we
can
deliver
this
for
nevadans,
and
I
do
it
in
in
respect
and
honor
to
to
his
work.
I
If
I
can
be
honest,
if
I
don't
think
I
would
have
engaged
in
this
conversation
years
back-
and
maybe
it's
because
I
grew
up
in
a
traditional
latino
catholic
household,
where
I
think
we
we
talk
about
death,
but
death
was
always
within
the
confines
of
very
specific
parameters
that
we
were
allowed
to
have
the
conversation
or
maybe
it's
just
because
my
age
had
not
allowed
for
me
to
experience
enough
of
what
death
means
in
my
family,
how
it
impacts
those
around
us
and,
as
I
get
older,
I
am
more
and
more
constantly
reminded
of
my
own
mortality
but,
more
importantly,
reminded
of
how
limited
the
time
is
with
those
around
me.
I
Those
who
I
love
and
care
about.
If
I
can
share
a
personal
story,
I
think
in
in
coming
forth,
with
with
this
particular
bill,
I
think
what
really
sent
it
home
for
me
was
with
a
a
particular
family
member
who
I
I
remember
when
he
was
diagnosed
with
his
terminal
illness.
It
was
a
obviously,
very
devastating
and
incredibly
difficult,
but,
more
importantly,
he
fought
every
second
and.
I
I
I
I
That
I
I
needed
to
really
go
on
the
other
side
of
that
conversation
and
and
that's
where
that's
where
it
hit
me
that
it's
not
about
me.
It's
not
about
you.
It's
not
about
the
family
member,
it's
not
about
how
everybody
in
that
room
feels,
but
rather
that
individual
who
suffered
every
second
and
and
that
we
selfishly
sit
there
and
applaud
because
we
saw
it
as
an
act
of
valor
to
say
you're
doing
that
for
us.
But
what
about
your
pain?
I
And-
and
so
I
am
here,
you
know,
I
think
the
the
pandemic
also
put
into
perspective
so
much
for
me,
and
you
know,
I
realized
that
we
just
have
a
responsibility
to
engage
in
very
difficult
combos
and
you
know
in
respect
and
honor
of
them.
I
said
all
right:
let's
do
it,
and
so
I
I
present
this
now
now.
I
I
I
I'd
like
to
just
speak
broadly
as
to
the
actual
language
and
what
we're
doing
I've
had
an
opportunity
to
speak
to
numerous
nevadans
in
every
corner
of
nevada
and-
and
I
am
so
eternally
grateful
to
those
wonderful
combos.
I
I've
had
with
so
many
folk
reaching
out
in
such
painful
stages
of
their
life
that
they
may
find
themselves
in
or
their
families
to
speak
up
and
say
we
need
to
have
this
very
real
conversation
about
what
it
means
to
have
a
bill
like
this,
and
you
know
some
of
these
folk
are
incredibly
healthy,
nevadans.
I
You
know,
and
they've
in
essence,
have
broken
it
down
to
me
and
just
said:
look
we
just
want
to
know
that
if
we're
ever
diagnosed
with
a
terminal
illness
and
that
after
exploring
every
single
traditional
option
that
they
know,
a
legal,
safe
and
peaceful
option
is
available
to
them
to
take
control
of
the
end
of
their
life
and
that
they
do
it
on
their
own
terms.
I
I
I
don't
want
this
conversation
to
to
be
allowed
that
that
it'd
be
taken
to
a
lane
that
it's
not
hijacked
into
something.
That's
not
real.
This
is
not
a
question
about
choosing
between
living
and
dying.
I
Simply
put.
This
legislation
allows
a
terminally
ill,
mentally,
capable
adult
who
is
a
resident
of
nevada,
with
a
prognosis
of
six
months
or
less
to
live,
to
have
the
option
to
request,
obtain
and
take
medication.
Should
they
choose
to
die
peacefully
under
sleep
if
their
suffering
com
becomes
unbearable,
and
this
isn't
something
new.
I
This
bill
is
modeled
after
the
ordering,
the
oregon
death
with
dignity,
act
and
that's
been
in
practice
for
more
than
20
years,
and
we
haven't
had
a
single
instance
of
abuse
or
coercion
in
that
state,
and,
like
I
mentioned,
it's
been
more
than
20
22
years
since
the
the
bill
was
enacted
in
oregon
and
now
collectively
we
have
more
than
40
years
of
evidence
and
cumulative
data
with
medical
aid
and
dying
in
oregon
and
nine
other
authorized
jurisdictions.
I
One
in
every
five
americans
about
25
22
percent
now
have
access
to
this
compassionate
end
of
life
care
option,
and
the
reason
for
that
is
because
we
have
nine
states
that
have
authorized
something
similar:
california,
colorado,
hawaii,
maine,
montana,
new
jersey,
oregon,
vermont,
washington
and
washington,
this
dc
and
that's
how
we
we
got
the
22
percent.
I
We
cannot
forget
that
only
the
dying
person
can
determine
how
much
pain
and
suffering
is
too
much.
This
law
puts
the
decision
in
the
hand
of
the
dying
person
in
consultation
with
their
doctor
and
their
loved
ones,
or
should,
or
it
should
be
for
such
a
deeply
personal
health
healthcare
decision
right.
This
is
them
deciding
that
they
should
have
the
opportunity
to
talk
with
everybody
and
get
all
the
medical
professionals
involved
and
speak
with
all
the
families
make
their
peace
with
whomever,
but
at
the
very
end
they
should
have
the
choice.
I
If
I
could
walk
you
through
the
bill
and
again,
I
recognize
that
it's
a
very
voluminous
bill
so,
rather
than
walk
you
through
the
entire
bill
line
by
line
which
would
take
up
likely
hours,
what
I'm
going
to
do
is
reference
sections
and
then
walk
you
through
the
page
numbers
that
those
sections
fall
in
and
then
afterwards
I'll
hand
over
the
presentation.
I
So,
first,
on
page
five,
we
have
a
new
chapter
that
a
new
section,
that's
being
created.
That's
chapter
four,
four:
zero
and
you'll
see
in
there
section
one
section
one
talks
about
and
specifies
that
a
coordinator
or
coroner's,
deputy
or
local
health
officer
is
not
required
to
certify
the
cause
of
death
resulting
from
the
self-administration
of
medication
that
is
designed
to
end
the
life
of
a
patient.
I
Pursuant
to
this
bill,
section
two,
which
falls
between
pages
five
and
six
talks,
requires
that
a
death
certificate
to
list
to
list
the
terminal
con
condition
of
the
patient
as
a
cause
of
death
of
the
patient.
It
must
not
mention
that
the
patient
self-administered
such
medication,
section
three
page
six
prohibits
a
corner,
corner's,
deputy
or
local
health
officer
from
investigating
such
a
death
under
certain
circumstances
and
specifies
the
cause
of
death
is
not
required
to
be
certified
section.
Four
through
thirty,
which
falls
on
pages
six
through
18.
I
you'll
see
a
whole
host
of
of
of
different
definitions.
I
will
not
walk
by
each
definition,
but
I
just
want
you
to
know
where
you
can
find
them
specifically
you'll
hear
in
section
six
their
definition
of
attending
physician,
section,
seven
competent
section,
eight,
consulting
physician,
section,
nine
division,
section,
ten
health
and
health
care
facility,
section
eleven,
a
person
professionally
qualified
in
the
field
of
psychiatric
mental
health
and
then
section
12
defines
terminal
condition.
I
I
Section
13
and
page
seven
talks
about
the
requirements
in
order
to
authorize
a
patient
to
request
that
his
or
her
physician
prescribe
such
a
medication.
If
the
patient
number
one
is
at
least
18
years
of
age,
number
two
has
been
diagnosed
with
a
terminal
condition
by
at
least
two
physicians.
I
Number
three
is
a
nevada
resident
number
four
has
made
an
informed
and
voluntary
decision
to
end
his
or
her
own
life.
Number
five
is
competent
and
number
six
is
requesting
the
medication,
the
medication
and
is
not
doing
it
because
of
coercion
or
undue
influence.
I
In
fact,
you'll
hear
our
co-presenters
talk
about
how
many
folk,
while
in
this
situation,
have
decided
to
utilize
this
option
and
you'll
realize
that
it's
not
as
much
as
you
think
next
in
section
14,
which
is
pages
seven
and
eight,
it
requires
that
a
patient
to
fulfill
certain
requirements
to
request
such
a
medication,
including
the
patient,
must
make
two
verbal
requests
and
one
written
request
for
the
medication
and
that
the
written
request
for
the
medication
must
be
signed
by
a
witness
section.
I
15,
which
falls
on
pages
eight
and
nine
prescribes
a
form.
A
patient
must
complete
and
request
such
a
medication,
section
16,
which
falls
on
pages
9
and
10,
imposes
certain
requirements
before
a
physician
is
allowed
to
prescribe
such
a
medication,
including
that
the
physician
one
informed
the
patient
of
his
or
her
right
to
revoke
a
request
for
medication
at
any
time.
To
determine
and
verify
that
the
patient
meets
the
requirements
for
making
such
a
request.
I
Three
discuss
certain
relevant
factors
with
the
patient,
including
the
diagnosis
and
prognosis
of
the
patient
and
alternative
options
for
care,
or
refer
the
patient
to
a
consulting
physician,
who
can
confirm
diagnosis,
prognosis
and
competence
of
the
patient
and
that
the
patient
has
not
been
co
coerced
or
unduly
influenced
and
five
instruct
the
patient
against
self-administering
the
medication
in
public
in
the
in
the
two
exhibits
that
you
see
that
are
friendly
again.
The
one
particularly
named
mock-up
you'll
see
an
amendment
to
section
16.
I
again,
we'll
I'll
hit
that
with
our
co-presenter,
just
to
explain
what
we're
adding
to
it.
We're
not
removing
anything,
simply
adding
something
else
to
that
list
and
we'll
explain
why
section
17,
which
is
on
page
10,
requires
a
physician
to
refer
a
patient
to
a
qualified
mental
health
professional
and
to
receive
confirmation
about
the
patient's
competence.
I
If
the
physician
determined
that
a
patient
who
has
requested
a
prescription
for
such
a
medication
may
not
be
competent,
this
is
important
because
all
this
goes
to
the
heart
of
the
conversation
that
I
have
had
an
opportunity
to
have
with
some
of
you
and
that
I've
heard
a
lot
of
concern
about
which
is
you
know?
How
do
we
ensure
that
an
individual
in
fact
understands
what
they
are
doing,
and
I
agree
with
you
100
wholeheartedly.
I
The
22
plus
years
of
of
of
working
in
this
area
by
many
medical
physicians
will
tell
you
that,
obviously
that's
very
important
to
them,
and
that's
why
we've
built
in
these
safeguards
in
place
to
ensure
that
folk
understand
exactly
what
they're
doing
section
18
through
19,
which
is
on
page
11,
describe,
prescribe
certain
procedures
for
the
issuance
every
prescription
for
such
a
medication
and
provides
that
only
an
attending
physician
or
pharmacist
may
dispense.
Such
a
medication.
I
Section
21
allows
a
patient
to
revoke
a
request
for
such
a
medication
at
any
time.
So
again,
if
you
request
it
and
later
change
your
mind,
that's
perfectly
okay
and
allowable
section
22,
which
falls
on
page
12,
provides
that
only
the
patient
to
whom
such
a
medication
is
prescribed
may
administer
the
medication.
I
You
will
see
on
this
particular
section
again
that
there
is
an
amendment
and
we'll
allow
for
our
co-presenters
to
briefly
touch
upon
that
pages.
12-13
address
section
23,
which
describes
certain
information
that
must
be
reported
to
dbpeh
relating
to
the
patient,
who
has
been
prescribed
or
self-administered.
Such
a
medication
makes
such
information
confidential
with
certain
exceptions
and
requires
division
of
public
behavioral
health
to
complete
an
annual
review
of
a
sample
of
the
reports.
I
Section
24
requires
dpbh
to
compile
an
annual
report
concerning
the
implementation
of
the
bill.
I
I
I
Section
28,
which
falls
on
pages
14
and
15,
clarifies
that
a
physician
is
not
required
to
prescribe
such
a
medication,
but
that
the
physician
must
provide
information
concerning
the
prescription
and
self-administration
of
such
a
medication
or
refer
the
patient
to
another
health
care
provider.
Provide
that
a
pharmacist
is
not
required
to
fill
a
prescription
for
for
or
dispense.
I
I
Section
30
is
also
particularly
important
because
there
has
been
a
wide
concern
nationwide
as
to
how
accurate
the
information
that's
being
disseminated
in
some
of
these
facilities
is,
and
it's
imperative
that
we
recognize
that
we
are
giving
clear
and
accurate
information
and
that's
what
this
section
seeks
to
address.
I
Section
31
addresses
nrs453.256
specifically
to
prescriptions,
you'll
find
that
on
page
18
and
it
makes
conforming
changes
by
including
the
dispensing
of
a
medication
that
is
designed
to
end
the
life
of
a
patient
in
the
definition
of
medical
treatment.
I
Section
33
pages
20-23
addresses
nrs454.213,
which
is
the
authority
to
possess
and
administer
dangerous
drug,
and
it
makes
conforming
changes
by
excluding
a
patient
requesting
such
a
medication
from
the
list
of
persons
who
may
possess
an
administrative,
dangerous
drug
section
34,
which
falls
on
page
23
addresses
nrs
454.215
and
it's
the
authority
to
dispense.
I
Section
37,
which
is
pages
24-27,
address
nrs239.010
and
addresses
confidential
information
in
public
books
and
records.
It
makes
conforming
changes
to
ensure
certain
information
is
confidential.
I
I
Section
38
makes
it
a
deceptive
trade
practice
for
a
health
care
provider
or
an
owner
officer.
Employer
independent
contractor
with
healthcare
facility
to
knowingly
engage
in
any
false,
misleading
or
deceptive
conduct
concerning
the
willingness
of
the
provider
of
healthcare
facility
to
make
certain
action
relating
to
the
prescription
and
self-administration
of
such
a
medication.
I
Section
39,
which
is
pages
28
through
29,
addresses
nrs,
639.1375,
advanced
practice,
registered
nurses,
and
it
clarifies
that
an
advanced
practice
registered
nurse
is
not
authorized
to
prescribe
a
medication
that
is
designed
to
end
the
life
of
a
patient,
section
40,
which
falls
on
pages.
29-30
addresses
nrs639.2351
the
advanced
practice
of
the
registered
nurses,
and
it
makes
conforming
changes
to
clarify
that
an
advanced
practice
registered
nurse
is
not
authorized
to
prescribe
a
medication
that
is
designed
to
end
the
life
of
a
patient.
I
Section
42
pages,
31-32
addresses
chapter
688
and
chapter
6a.
Excuse
me
6aa
and
688b.
I
These
are
both
new
sections
and
and
what
they
do
is
they
prohibit
insurers
from
number
one
refusing
to
sell,
provide
or
issue
a
policy
of
life,
insurance
or
group
life,
insurance
or
annuity
contract
or
changing
or
charging
a
higher
rate,
because
a
person
makes
or
revokes
a
request
for
a
medication
that
is
designed
to
end
the
life
of
the
person
or
self-administer
such
a
medication
or
two
conditioning
life,
insurance
benefits,
group,
life,
insurance
benefits
or
the
payment
of
claims
on
whether
the
issue
the
insured
makes,
makes
fails
to
make
or
revokes
a
request
for
a
medication
that
is
designed
to
end
the
life
of
the
insured
or
self-administered
such
as
such
as
medication.
I
Provisions
required
in
a
group
contract
makes
confirming
changes
reflecting
the
prohibitions
in
sections
42
and
43
on
the
policy
of
the
group
life
insurance
section
45
on
page
33
requires
dpdh
dhh
dhhs
to
make
the
prescribing
forms
in
the
bill
available
not
later
than
45
days
after
the
effective
date
of
the
bill.
And
lastly,
section
46
page
33
specifies
that
this
bill
becomes
effective
upon
passage
and
approval
members.
I
apologize
for
having
to
go
so
deeply
into
the
sections.
That's
the
fastest
way
I
could
think
of
going
through
the
bill.
I
I
I
I
appreciate
you
indulging
me
through
my
slight
moment
of
vulnerability
there.
I
did
not
intend
for
that
to
occur,
and
I
apologize
for
that.
I
will
now
hand
over
with
the
committee's
respect
the
presentation
over
to
tim
kalanin,
who
is
the
ceo
of
compassion
and
choices
action
network.
Thank
you,
madam
chair.
D
My
name
is
kim
kalanin
and
I
am
the
president
and
ceo
of
the
compassion
and
choices
action
network.
Thank
you
so
much
for
having
me
here
today
and
thank
you
to
assemblyman
flores
for
sponsoring
this
bill
and
for
his
very
authentic
and
courageous
remarks
and
good
afternoon,
madam
chair
and
members
of
the
health
and
human
services
committee.
D
What
I
thought
I
would
do
was
first
start
off
and
just
re-um
re-encapsulate,
some
of
the
key
components
of
the
bill
since
assemblyman
florist
did
go
through
33
pages
and
there
really
is
a
tremendous
amount
in
this
bill.
D
This
bill
includes
the
same
strict
eligibility
criteria
and
core
safeguards
that
are
in
all
of
the
other
bills
that
have
been
proven
to
find
that
balance
between
ensuring
that
vulnerable
populations
are
protected,
but
also
making
sure
that
this
compassionate
option
is
available
to
those
who
want
it.
D
As
assemblyman
flores
noted.
This
is
for
a
really
small
group
of
people.
A
person
has
to
be
an
adult,
mentally,
capable
terminally
ill,
have
a
prognosis
of
six
months
or
less
to
live,
and
that's
very
important.
It's
tied
to
the
prognosis
in
hospice
so
that
people
aren't
choosing
between
death
and
care.
They
do
have
hospice
care
available
to
them.
D
One
of
the
amendments
that
assembly
member
flores
mentioned
is
an
amendment
that
will
strengthen
the
language.
That's
being
used
around
self-administration
to
make
it
very
clear
that
only
the
qualified
patient
is
able
to
self-administer
the
medication
and
that
it
can
only
be
you
go
through
ingestible
means.
So
that
is
one
of
the
amendments
and
it
will
allow
your
bill
to
align
more
directly
with
the
other
authorized
states
and
is
a
very
important
safety
feature.
D
The
law
also
has
more
than
two
dozen
additional
regulatory
requirements.
So
when
you
look
at
that
33-page
bill,
there
are
a
lot
of
steps
that
a
patient
has
to
go
through.
Two
doctors
have
to
certify
that
the
person
meets
the
requirements.
The
person
makes
three
separate
requests,
two
oral
and
one
written.
There
are
two
witnesses
that
have
to
confirm
that
the
person
is
making
this
cred
request
voluntarily,
there's
a
15-day
waiting
period
and
there's
mandatory
reporting
by
doctors.
D
All
of
the
provisions
in
this
bill
are
also,
on
top
of
all
of
the
other
regulations
that
practice
the
govern
that
govern
the
practice
of
medicine.
D
The
other
thing
that
it
includes
is
a
requirement
for
a
lot
of
education
of
the
patients
of
the
patient
before
they
afford
themselves
of
this
option.
The
attending
physician
must
discuss
with
the
patient
the
importance
of
having
another
person
present
when
the
patient
self
administers
the
medication,
and
they
must
review
the
benefits
of
notifying
the
patient's
next
of
kin
of
his
or
her
decision
to
request
a
prescription
for
medication
that
is
designed
to
end
the
patient's
life.
D
One
of
the
additional
proposed
amendments
that
is
there
for
your
consideration,
which
we
are
in
support
of,
is
that
the
doctor
should
also
counsel
the
patients
about
the
benefits
of
discussing
their
decision
to
request
the
medication
with
their
religious
faith,
spiritual
or
support
leader.
So
that's
another
provision
that
is
being
recommended,
and
this
would
be
the
only
bill
in
the
nation
that
includes
that
provision.
But
it
is,
I
think,
a
good
addition
to
the
legislation.
D
As
I
mentioned,
on
top
of
all
of
the
provisions
of
this
bill,
you
also
have
the
practice
of
medicine
that
governs
on
this
and
the
standard
of
care.
That's
been
developed,
and
it's
worth
me
noting
that
your
own
assembly,
member
david
ornlicker,
dr
david
orton
licker,
I
could
say,
is
one
of
actually
the
lead
author
for
a
peer-reviewed
journal
of
medicine
article
that
was
published
in
2016,
which
outlines
the
clinical
criteria
around
medical
aid
and
dying
assembly.
D
Member
flores
spoke
about
how
you'll
be
surprised
that
very
few
people
choose
to
use
the
law,
and
this
is
really
important
across
all
of
the
authorized
jurisdictions
across
all
50
60
years
or
50
years
of
data.
There
have
only
been
about
4
300
people
who
have
chosen
to
use
the
law.
It's
a
really
really
small
number.
So
the
concern
that
large
numbers
of
people
are
going
to
use
this
law
are
just
that's
not
the
reality.
In
practice,
it
hasn't
been
in
any
of
the
authorized
states.
It's
far
fewer
than
one
percent
of
people.
D
So
then,
of
course,
the
question
becomes.
If
so
few
people
are
choosing
to
use
the
law,
then
why
spend
all
of
this
time
authorizing
this
as
an
option?
And
it's
because
it's
not
just
about
the
small
number
of
people
that
choose
to
use
the
law.
It's
about
all
the
people
who
get
the
peace
of
mind
of
knowing
that
should
their
suffering
become
too
great
that
they
have
an
option.
D
In
addition
to
that,
what
we
know
is
that
when
the
law
gets
implemented,
what
the
evidence
and
the
data
shows
is-
and
there
was
a
journal
of
medical
ethics
report
that
showed
this
is
that-
is
that
there's
no
there's
no
concern
about
abuse
or
coercion
or
misuse.
What
the
journal
of
medical
ethics
report
concluded
was
that
assisted
dying
did
not
pose
any
heightened
risk
for
any
population,
including
vulnerable
populations
such
as
the
elderly,
the
uninsured
and
those
who
are
physically
disabled.
D
D
Research
from
a
journal
of
palliative
medicine,
article
demonstrated
that
medical
aid
and
dying
also
improves
end-of-life
care
generally
by
contributing
to
more
candid
conversations
between
doctors
and
patients,
higher
hospice
usage
rates
and
improved
palliative
care
training
for
physicians,
because
we
now
have
so
much
evidence
and
data.
We
also
are
seeing
this
movement
grow
across
the
country.
D
Polling
data,
which
was
just
completed
in
your
state
last
month,
shows
that
nevada
voters
want
this
compassionate
option.
Three
out
of
four
residents:
support
passage
of
medical
aid
and
dying,
including
widespread
support
across
all
demographic
groups,
and
we've
seen
that
over
the
past
six
years,
30,
national
and
state
medical
professional
associations
have
endorsed
or
dropped
their
opposition
to
medical
aid
and
dying
in
support
to
the
growing
to
the
growing
reality
that
this
is
something
that
the
american
public
wants
within
the
state
of
nevada
state.
D
We
no
longer
have
to
hypothesize
about.
What's
going
to
happen
when
this
law
gets
implemented,
the
evidence
is
very
clear.
Medical
aid
and
dying
protects
vulnerable
populations.
It
affords
dying
people
the
autonomy
and
compassion
during
the
most
difficult
time.
It
improves
end-of-life
care
generally
by
resulting
in
more
conversations
about
hospice
care
and
improved
palliative
care
training,
and
it
costs
almost
nothing
to
implement.
D
The
cost
of
inaction,
however,
is
truly
immense
without
the
option
of
medical
aid
and
dying
terminally.
Ill
individuals
may
not
try
that
one
last
miracle
treatment,
because
often
it
is
the
treatment
itself
that
causes
the
most
amount
of
suffering
and
they're
afraid
to
try
that
one
last
treatment
without
knowing
that
they
have
this
option
available.
D
They
may
also
choose
violent
means
to
end
their
suffering
and
they
could
experience
needless
agony
when
they
die,
while
families
and
doctors
remain
powerless
with
no
legal
way
to
respond
to
their
pleas
for
help
terminally
ill
residents
do
not
have
the
luxury
of
endless
deliberations,
they
need
the
relief
that
this
law
affords
them
right.
Now,
not
a
single
additional
person
will
die
if
you
authorize
medical
aid
and
dying,
but
far
fewer
will
suffer
on
behalf
of
our
thousands
of
supporters
across
the
state
supporters
like
hannah
olivas,
who
need
this
option
right
now.
D
I
Thank
you
assembly,
medical
referrals
for
the
record,
madam
chair.
If
I,
if
I
may
ask
that
we
allow
our
executive
director
from
deaf
and
dignity
national
center,
miss
sandeen
to
to
do
a
brief
presentation
now.
J
Peg
sanding
death
with
dignity,
national
center
in
portland,
oregon
and
chairwin,
and
assemblymember
flores
and
all
committee
members.
Thank
you
for
agreeing
to
listen
to
my
presentation
today.
I'm
a
social
worker
I
live
in
portland
oregon
and
I
have
been
working
on
death
with
dignity
for
16
years
and
I'm
really
pleased
to
be
able
to
share
my
experience
with
you
and
as
a
social
worker
who
has
built
a
career
caring
for
and
working
with,
people
who
are
dying.
J
I
just
want
to
reflect
on
the
the
vulnerability
and
the
honesty
with
which
assembly
member
flores
shared
the
story
with
us
today.
I
hear
stories
like
this
every
day
about
people
who
are
dying,
people
who
would
qualify
for
oregon's
death
with
dignity,
act
or
people
who
don't,
and
I
think
that
one
of
the
things
that
it's
important
to
remember
is
we
all
get
one
death
and
we
all
deserve
an
option
like
death
with
dignity,
one
of
the
most
difficult
things
for
a
terminally
ill.
Individual
is
the
silence
right.
J
The
silence
surrounding
the
dying
experience
and
this
silence
arises
out
of
society's
unwillingness
to
face
death
directly,
and
I
know
that
at
least
one
family
in
the
state
of
nevada
tonight
will
have
a
difficult
conversation
about
dying
and
last
wishes
and
advance
directives
because
they
were
somehow
engaged
with
or
heard
about
this
hearing
today,
and
that
is
meaningful
and,
what's
also
meaningful,
is
the
care
with
which
this
bill.
Before
you
has
been
constructed.
J
It
provides
strong
time-proven
safeguards
which
have
been
well
covered
by
assemblymember
flores.
These
these
safeguards
protect
vulnerable
individuals
from
coercion
and,
at
the
same
time,
these
safeguards
do
not
act
as
barriers
to
access
for
those
who
need
it,
and
this
bill
strikes
a
tension
between
protection
and
access,
and
this
tension
is
difficult
to
strike
and
our
team
in
nevada
has
worked
with
all
the
necessary
stakeholders
to
get
this
bill
just
right.
J
J
J
Nevada
has
considered
similar
legislation
in
the
past
and
those
of
you
who
have
engaged
in
this
debate
in
prior
sessions.
You
know
that
you're
going
to
hear
a
lot
of
negative
accusations
about
this
bill
for
more
than
two
decades.
Now
we
have
heard
these
same
slippery
slope
arguments
statement
that
this
law
will
target
individuals
who
are
poor
or
living
with
disabilities.
J
The
elderly
statements
suggesting
that
those
without
medical
care
or
access
to
health
care
resources
will
be
forced
to
end
their
lives
using
medical
aid
and
dying
because
it
is
cheaper
than
treating
cancer.
These
slippery
slope
arguments
are
just
not
true.
Independent
researchers
have
concluded
that
that
the
results
are
quite
the
opposite.
J
One
group
of
researchers
explored
data
out
of
oregon
to
determine
if
there
was
a
disproportionate
impact
on
10
groups
of
potentially
vulnerable
patients
and
the
data
led
the
researchers.
To
conclude-
and
I
quote,
there's
no
current
factual
support
for
so-called
slippery
slope
concerns
about
the
risks
of
legalization
of
assisted
dying.
These
patients
are
not
at
risk.
J
I
have
already
read
letters
to
the
editor
in
nevada
published,
suggesting
that
death
with
dignity
will
undermine
hospice
and
palliative
care
services,
and
the
researchers
are
clear
on
this
point.
Also
in
a
study
published
in
the
journal
of
palliative
medicine,
research
concluded
and
again
I
have
another
quote.
Another
concern
regarding
the
legalization
of
physician
aid
and
dying.
Is
that
physician
dying
would
become
a
substitute
for
quality
end
of
life
care?
J
This
study
adds
to
the
evidence
that
the
choice
to
pursue
physician
aid
and
dying
does
not
appear
to
be
due
to
or
a
reflection
of,
poor
end-of-life
care.
What
we
do
know
is
that
for
the
states
that
have
enacted
death
with
dignity,
laws,
the
the
question
is
or
the
the
point
is
that
people
have
access
to
death
with
dignity
and
hospice
care.
It's
not
one
or
the
other.
The
data
demonstrate
that
they
come
together
in
all
of
the
jurisdictions
that
have
enacted
death
of
a
dignity
legislation.
J
A
lot
of
people
want
to
speak
against
the
oregon
experience
and
you'll
probably
hear
that
today,
but
in
almost
every
legislative
hearing
I've
attended
these
people
are
not
from
oregon
and
the
thing
is
I've
worked
in
in
this
state.
I
am
an
oregonian
and
I've
worked
with
people
who
have
used
this
law
for
almost
20
years.
J
J
A
B
Thank
you
chairwin
and
thank
you
assemblyman
flores,
for
the
presentation.
I
know
that
it's
been
noted
that
this
bill
is
is
modeled
after
oregon's.
That's
what
dignity
act,
and
I
know
also
that
the
stated
intent
of
this
bill
is
to
provide
options
for
those
who
are
are
suffering
and
those
who
are
experiencing
unbearable
pain.
B
D
So
kim
kalanin
with
the
compassion
and
choices
action
network.
So,
first
of
all,
it's
really
important
to
remember
that
that
organ
data
is
coming
from
a
doctor,
filling
out
a
form
about
their
perception
of
why
a
patient
is
choosing
to
use
the
option.
It's
not
the
patient's
self-reported
reason
for
choosing
the
option,
so
that
first
is
really
important.
D
Secondly,
when
you're
talking
to
a
patient,
that's
at
the
end
of
life,
it's
not
just
about
pain,
but
it's
about
all
the
pain
and
suffering
that
they
are
experiencing,
and
assembly
flores,
I
think,
spoke
to
it
so
beautifully
in
the
beginning,
when
he
talked
about
his
own
personal
experience,
watching
his
loved
one
who
was
going
through
this
a
person
who's
at
the
end
of
their
life
they're,
going
through
a
whole
host
of
things.
D
It's
the
totality
of
that
experience
that
determines
whether
or
not
suffering
they're
suffering
too
much
and
really
only
the
dying
person
can
decide
how
much
suffering
is
too
much.
So
I
don't
see
the
oregon
data
as
a
problem.
It's
a
very
small
number
of
people
who
choose
the
option
but
they're
getting
peace
of
mind
and
knowing
that
they
don't
have
to
suffer
from
whatever
their
definition
of
suffering
is
and
again
they're
terminally
ill
they're
already
going
to
die.
The
question
is
simply
how
they
die,
not
if
they're
going
to
die.
K
Assembly
member
flores
for
bringing
this
really
compassionate
bill
forward
ab351.
My
question
actually
has
to
do
with
our
black
brown
and
people
of
color.
B
Who,
at
times
have
had
a
disparaging
experience
with
healthcare.
E
Personnel
and
the
the
crooks
of
my.
E
With
dignity,
when
they've
decided.
B
When
it
comes
to
accepting
this
as
a
final
episode
in
their
life's
journey.
D
D
Unfortunately,
black
and
brown
americans
do
not
have
you
know
the
same
level
of
they
do
are
more
likely
to
have
less
likely
to
enroll
in
hospice
care
and
get
adequate
pain
management
and
all
of
those
things
that
you're
referencing,
and
so
that
is
a
huge
commitment
and
priority
for
the
organization
in
terms
of
this
particular
bill.
D
D
The
person
has
to
make
the
request
they're
in
charge
of
the
process
from
start
to
finish
so
they're
really,
with
this
particular
end
of
life,
option,
there's
not
a
chance
that
a
person
is
going
to
be
coerced
into
using
the
option
because
it
is
entirely
self-directed.
D
But
what
we
do
see
and
it's
an
issue
that
we
will
address
across
the
entire
end
of
life
care
spectrum-
is
that
a
lot
of
public
education
is
needed
in
order
to
ensure
that
african
americans
latinos
other
minority
populations
are
aware
of
in
taking
advantage
of
all
end-of-life
care
options
that
are
available
to
them,
so
they're
able
to
make
the
best
decisions
that
that
they
can
for
themselves.
That's
our
values
and
priorities.
D
The
bill
actually
has
the
potential
to
help
ignite
that,
because,
as
peg
referenced
in
her
opening
remarks,
what
we
see
happen
is
this
legislation
opens
the
door
up
to
people
finally
having
a
conversation
that
they
otherwise
avoid,
and
it
might
open
up
because
there's
a
bill
hearing
it
might
open
up
because
they
see
a
media
article.
It
might
open
up
because
now
they
ask
their
doctor
and
that's
why
you
see
increased
enrollment
into
hospice
care
after
the
legislation
gets
implemented
into
a
state.
D
A
patient
goes
in
and
they
say
I
want
to
be
in
control
of
my
end.
It
opens
up
the
door
for
that
conversation,
and
then
you
have
doctors
and
patients.
Finally,
having
a
conversation
about
what
kind
of
end-of-life
care
options
you
have
and
it
does
improving
end-of-life
care
across
the
board,
so
we
are,
as
an
organization
very
committed
to
addressing
the
inequities
that
exist
across
all
of
end-of-life
care.
This
bill.
E
Answer.
Thank
you.
E
Thank
you,
madam
chair.
I
appreciate
the
opportunity
to
ask
some
questions
if
I
might
and
someone
flores
thank
you
for
bringing
this
bill
and
thank
you
for
sharing
your
personal
story
and
you
should
never
apologize
for
being
human
and
and
have
an
emotion
and
I'm
honored
to
have
to
actually
hear
your
story
today.
So
thank
you
for
that.
I
have
some
questions
actually
about
the
bill.
E
These
are
emotional
issues
as
a
physician,
literally
involved,
literally
with
hundreds
of
patients
at
the
time
of
their
death,
understanding
their
fears
and
concerns
and
had
patients.
Ask
me
please
doc,
you
know.
Don't
let
me
suffer,
I'm
worried
about
pain,
et
cetera,
and
that's
always
my
question
to
him.
What
are
you
afraid
of,
and
I
was
there
for
them-
I'm
actively
involved
in
making
sure
we
have
palliative
care
making
sure
we
have
hospice
care
so
that
concern
about
the
number
one
death
of
dignity
and
not
making
sure
they
don't
suffer.
E
Usdi
can
absolutely
solve
that
for
them
and
so
making
sure
that
doesn't
happen
so,
but
never
actively
engaged
in
ending
their
life.
But
I'd
have
questions
about
the
bill
itself.
So
if
I
might
do
that
assignment,
flores
and
focus
on
the
bill,
the
rest
is
all
about.
I
know
a
lot
of
emotional
folks
on
both
sides
of
the
story,
but
I
have
some
concerns,
which
is
why
one
of
several
reasons
in
the
past
that
still
has
has
not
made
it
past
is
because
of
some
of
these
true
concerns
that
I
see.
E
First
and
foremost,
the
testimony
happened
early
that
there
was
no
abuse
of
this
that
in
oregon.
However,
my
concerns
with
this
on
the
bill
in
section
one,
it
is
forbidden
for
a
coroner
to
investigate
the
case.
So,
however,
would
we
know
if
the
case
was
abused
or
not
when
somebody
who
has
the
prescription
has
it's,
they
forbid
the
coroner
to
investigate
to
get
the
case.
So
how?
How
do
we
know
this?
There
isn't
abuse
when
you
can't
investigate
it.
D
So
the
intention
of
the
language
in
section
one
is
that
if
the
person-
oh
sorry,
kim
kalani
and
compassionate
choices,
action
network,
the
intention
of
the
language
in
section
one-
is
that
if
the
person
you
know
has
chosen
this
as
an
option
that
there's
nothing
to
investigate,
because
you
know
that
they're
going
to
take
the
prescription
medication.
If
there
is
some
reason
or
suspicion
of
foul
play.
Of
course,
the
coroner
would
be
able
to
investigate
it's,
not
stopping
an
investigation
if
there's
foul
play.
D
E
So
again,
I
would.
I
would
disagree
with
that,
because
that,
just
because
they've
gotten
the
prescription
doesn't
mean
that
they're
ever
going
to
use
it,
and
you
yourself
have
testified
that
many
people
apply
for
this
and
then
don't
use
that.
So
how
does
that
then?
Just
the
very
fact
that
they've
applied
for
their
prescription
now
negate
any
other
studies
or
any
other
investigation,
at
least
a
walkthrough?
So
I'll
I'll
have
to
disagree
with
you
on
your
your
comment
on
that
one.
E
Then
next
on
section
3
on
section
3
and
25,
I,
as
a
doctor
have
signed.
Oh
after
a
doctor
of
36
years,
signed
many
many
death
certificates
in
that
death
certificate.
There
are
immediate
cause
of
death
and
then
associated
cause
of
death
and
there's
up
to
five
lines
per
se
on
underlying
causes
of
death.
In
your
bill,
it
mandates
that
we
have
to
sign
that
it
is
from
the
cause
of
death
which
allowed
them
or
the
diagnosis
that
allowed
them
to
obtain
this
mess
medication.
The
six-month
diagnosis.
E
Now
we
all
know-
and
you
have
to
know
that,
just
because
a
doctor
says
they're
going
to
die
in
six
months.
I've
had
patients
die
in
a
week
and
I've
had
patients
die
many
many
years
later,
so
the
diagnosis
of
six
months
doesn't
mean
that's
inevitable.
I
believe
there's
a
power
greater
than
me
and
I
and
just
to
say
you're,
going
to
be
dead
in
six
months
frequently
that
doesn't
happen.
E
So
my
concern
with
that
is
that
by
not
being
able
to
sign
that,
yes,
indeed,
they
did
take
an
assisted
suicide
drug
and
say
they
took
it
with
a
day
of
getting
that
suicide
drug,
their
diagnosis
of
pancreatic
cancer,
which
the
average
lifespan
of
somebody
with
pancreatic
cancer
frankly
is
six
months.
But
now
this
person
has
died
in
two
weeks,
not
from
pancreatic
cancer,
but
from
taking
this
medication
that
skews
the
data
on.
E
When
I
have
a
discussion,
what
the
average
lifespan
is
on
a
person
with
x
disease
and
so
because
we're
looking
at
terminal
diseases
here
so
not
being
allowed
to
say.
Yes,
it
was
you
know
they
took
this
medication,
but
with
the
caveat
with
the
terminal
disease,
by
saying
they
died
from
pancreatic
cancer,
which
is
absolutely
not
true.
They
died
from
the
medication
because
I
would
write
down
immediate
cause
of
death
respiratory
distress,
heart
attack.
Why
is
that
any
different?
Their
underlying
case
cause
would
still
be
pancreatic.
E
D
So
I
know
that
dr
grub
is
on
the
line
and
I
figured
it
would
be
nice
for
dr
group
to
respond
to
this
one.
A
L
Thank
you
very
much.
My
name
is
david
grube,
I'm
a
retired
family
physician
here
in
oregon,
who
did
respond
to
patient
requests
regarding
aid
in
dying
man.
I
really
appreciate
your
question
because
I
I've
heard
this
many
times
and
we've
had
had
many
conversations
with
other
other
physicians
about
this.
From
my
perspective-
and
I
think
maybe
the
perspective
of
the
bill
is
that
there
are
two
reasons
for
the
death
certificate.
One
is
to
establish
the
legal
parameters
of
the
estate
and
the
other
is
the
epidemiology
of
the
disease
that
you
kind
of
talked
about.
L
The
latter
will
be
covered
by
the
reporting
requirements
that
you'll
have
in
nevada
that
we
have
in
oregon,
and
so
all
that
data
will
be
will
coming
to
the
state
for
epidemiological
concerns
it.
The
death
certificate,
however,
is
a
public
document
and
as
a
public
document
discoverable
by
anybody
and
when
the
death
of
dignity
or
medical
aid
and
dying
or
the
name
of
the
bill
is
on
the
death
certificate
that
has
implications
publicly
for
the
family
for
intimacy,
for
hipaa
violations,
etc.
L
E
E
On
section
28
I
mandated
to
refer
to
another
physician:
is
there
a
timeline
in
the
bill
that
says
how
much
time
do
I
have
to
to
to
refer
that,
and
is
there
going
to
be
a
list
published
somewhere
so
that
I,
as
a
provider,
have
a
list
of
the
providers
other
providers
that
are
willing
to
do
this?
How
does
that
work.
D
Kimberly
kalanine
with
the
compassion
and
choices
action
network
there
isn't
a
time
frame.
That's
in
the
bill.
It's
expected
that
in
the
same
way,
you
would
refer
somebody
in
a
timely
manner
to
any
other
provider
that
you
would
do
the
same
with
medical
aid
and
dying.
So
it's
just
asking
you
to
follow
the
normal
practice
of
medicine
and
to
refer
the
patient
out.
There's
also
the
option
of
referring
the
person
for
information,
so
it
doesn't
mandate
that
it
has
to
be
to
another
provider
that
will
practice
medical
aid
and
dying.
D
It
can
also
just
be
to
a
general
information
source
so
that
the
person
is
able
to
obtain
information.
E
Somewhere
somewhere
there's
a
list
somewhere
of
other
providers,
so
the
next
question
request,
if
I,
if
who
pays
for
the
medication
they're
mandated
you
you
get
this
prescription,
they
go
to
the
pharmacist
section,
29
mandates
that
the
pharmacist
fills
it.
What's
the
average
cost
and
what,
if
they
can't
pay,
does
the
the
pharmacy
have
to
dispense
the
medication.
D
Kim
kaladin,
with
the
compassion
and
choices
action
network,
the
medication
can
be
most
of
the
time
a
person
is
paying
for
the
medication
themselves,
or
some
of
the
states
that
have
priced
medical
aid
and
dying
have
allowed
for
the
medication
to
be
paid
for
through
their
state
medicaid
program
depending
on
the
state
and
then
private
insurance
does.
Some
does
often
cover
the
medication.
It
runs
about
550
to
600
dollars.
L
Yeah
dr
david
grube
in
oregon
again
there's
no
stories
of
supplies
at
the
present
time.
The
the
prescription
is
a
compounded
prescription
of
currently
available
medications.
E
Last
question
madam
chair
section:
4243
mandates
insurance
companies
give
the
fill
the
cannot
deny
somebody
insurance
coverage,
even
though
they
have
noted
that
they're
going
to
take
this
medication.
So
for
me
the
person
can
get
a
terminal
illness
say
well,
I'm
going
to
go
immediately,
get
this
medication
and
then
apply
for
life
insurance.
It
seems
from
a
business
standpoint
you're
putting
the
insurance
companies
a
huge
burden
there
that
they
could
sign
up,
there's
no
limit
that
they
could
sign
up
for
this
life
insurance.
E
It
seems
to
me
how
does
that
work
in
oregon?
They
can
still
issue
the
life
insurance
policy.
I
know
I
have
a
terminal
illness.
L
David
grube
in
oregon,
these
people
are
all
about
to
die.
There's,
no,
not
one
single
one
of
them
would
be
available
life
insurance.
Could
they
ever
be
covered?
As
you
know,
in
oregon,
95
percent
of
them
are
already
enrolled
in
hospice
and
so
they're
covered
in
that
way,
but
there's
not
any
possibility
that
this
group
of
people
would
be
eligible
for
life
insurance.
E
L
Yep,
I
do
not
believe
that
this
is
david
grube
again
in
oregon.
I
do
not
believe
we
have
that
as
part
of
our
death
within
80
act
in
oregon,
so
I
defer
to
those
people
yeah.
E
D
Kim
calan
with
the
compassionate
choices
action
network,
so
that
was
not
the
intention
of
it.
It
could
have
been
that
in
bill
drafting
something
got
got
rewarded,
so
that
is
certainly
something
that
I
am
sure
that
we
can
look
talk
to
with
look
at
with
assemblymen
burp
flores.
And
if
your
conclusion
is
correct,
we
would
be
supportive
of
an
amendment
if
he
was.
E
A
A
E
B
Thank
you
chairwin
first
I'd
like
to
say
thank
you
to
assemblyman
edgar
flores
for
his
presentation
and
sharing
his
personal
story
with
us.
My
question
is
for
kim
miss
miss
callanan.
B
I
read
several
articles
on
the
topic
and
I'm
glad
that
she
talked
about
vulnerable
populations
and
and
protecting
vulnerable
populations,
because
in
some
of
the
articles
I
was
reading
about
the
limitations
on
the
safeguards
for
vulnerable
populations
and-
and
I'm
just
wondering-
is
there
anywhere
in
the
bill
where
there
are
safeguards
to
prevent
an
insurance
company
from
delaying
or
denying
expensive
treatments
for,
say
cancer,
and
thus
just
sort
of
causing
the
person
to
suffer
and
sort
of
almost
pushing
or
encouraging
someone
to
choose
end
of
life.
B
Prescriptions,
and-
and
this
is
something
I
saw
in
the
the
national
council
on
disability
that
just
says.
Basically,
when
assisted
suicide
is
legalized,
it
immediately
becomes
the
cheapest
treatment.
Direct
coercion
is
not
necessary
if
insurers
deny
or
even
simply
delay
approval
of
expensive
life-sustaining
treatment,
patients
can
be
steered
toward
hastening
their
death.
I
I
if
you
could
please
comment
on
that.
Thank
you.
D
Thank
you,
assemblyman
crass
and
our
kim
kalanian
with
the
compassion
and
choices
action
network,
so
the
decisions
that
an
insurance
company
makes
about
whether
or
not
to
provide
care
have
nothing
to
do
with
the
medical
aid
and
dying
laws
being
in
a
state
or
not.
Insurance
companies
have
their
own.
D
You
know
they
look
to
see
whether
or
not
a
treatment
meets
their
criteria
and
that's
what
determines
whether
or
not
they
do
that
the
bill
does
not
allow
for
an
insurance
company
to
deny
treatment
and
then
offer
medical
aid
and
dying
as
an
option,
and
if
that
was
really
happening.
If
that
was
you
know
the
way
it
worked
across
the
state,
you
wouldn't
have
4
500
people
utilizing
the
law
across
the
combined
50
years
of
experience.
A
L
Yes,
thank
you
so
much
david
grube
in
oregon.
That's
that
is
his
concern
that
I've
heard
brought
up
before.
But
it's
not
a
reality.
It's
not
something.
The
experience
of
oregon
doesn't
show
that
has
ever
happened.
L
D
I
missed
was
that
just
an
organ
or
is
that
a
total
number?
It's
43
000
people
across
all
of
the
authorized
states
that
collect
data,
which
I
think
is
about
nine
states
in
the
combined
number
of
years
about
50
years.
B
Over
50
years,
okay
and
then
in
section
22,
it
says
that
the
patient
must
be
able
to
ingest
the
medication
themselves.
So
is
this
a
pill
form
or
is
this
a
liquid
just
curious.
L
Yeah
this
is
david
gruben
oregon,
dr
grube.
The
current
protocol
is
a
a
liquid
of
about
four
ounces
or
half
a
glass
of
water
that
is
drunk
an
individual
will
fall
asleep
in
about
10
minutes
and
die
very
peacefully
in
about
well
less
than
an
hour.
It
can
sometimes
come
as
a
powder
that
the
family
would
mix
with
the
liquid,
so
it
could
be
powder
or
it
could
be
a
liquid
form.
It's
not
pills,
though,.
B
Thank
you
so
much
and
then
my
last
question
goes
to
section
28,
which
states
that
a
pharmacy
does
not
have
to
dispense.
Such
medication
has
that
been
a
barrier
in
other
states.
L
This
is
david
gruber
again
in
oregon,
and
I
would
like
to
address
that
personally,
because
I
actually
had
a
a
woman
who
was
who
went
four
miles
on
her
in
her
electric
wheelchair.
She
was
dying
of
breast
cancer.
L
She
couldn't
walk
anymore
to
get
a
prescription
and
I
live
in
a
small
town
and
the
pharmacist
that
day
did
not
believe
in
death
with
dignity
and
would
not
dispense
the
medication
that
was
sitting
on
the
shelf,
and
so
she
had
to
get
wrapped
back
in
her
moby
and
go
all
the
way
back
to
her
residence
and
and
return
another
day.
So
this
is
a
thing
that
can
happen.
D
Thank
you,
hopefully,
I'm
sorry
with
the
compassion
and
choices
action
network,
if
I
can
just
add
david's,
absolutely
right
that
this
is
something
that
can
happen.
The
good
news
is
that
we
do
have
more
pharmacies
that
are
participating
and
with
the
ability
to
mail.
D
I
A
No
no
go
ahead,
and
I
know
that
carly
o'krent
with
lcb
legal
can
also
assist.
I
know
that
she
looked
up
some
of
the
concerns
too,
but
I
will
turn
it
over
to
you
to
answer
any
of
the
questions.
I
Thank
you
assemblywoman
again,
just
for
the
for
a
point
of
clarification.
Somebody
editor
for
us
for
the
record,
assemblywoman
titus.
Thank
you
for
your
question
and
we
had
a
folk.
We
were
messaging
back
and
forth
just
for
a
point
of
clarification
and
grateful
to
legal
and
the
folk
who
helped
draft
this
bill,
particularly
to
section
42,
page
31
lines
42
to
45..
I
You
posed
a
question
as
to
if
we
were
somehow
tying
the
hands
of
an
insurance
provider
now
by
including
that
section,
we
just
wanted
to
clarify
that
the
insurance
company
now
can
still
refuse
based
on
somebody
having
a
terminal
disease
or
illness.
They
can
still
do
that.
What
this
section
is
clarifying
is
that
they
cannot
solely
say
we're
not
going
to
based
on
the
the
fact
that
the
medication's
been
requested,
but
we
we
just
wanted.
I
We
wanted
to
very
specifically
delineate
that
so
that
we're
not
sending
mixed
messaging,
but
the
insurance
company,
as
they
do
now,
would
be
allowed
to
refuse
based
on
the
fact
that
they're,
you
know
somebody
has
a
terminal
illness
that
doesn't
change.
This
is
just
specifically
denying
on
the
basis
of
the
actual
request
of
the
medication.
E
Well,
thank
you
so
if
I
might
thank
you,
assemblyman
flores
for
that
clarification
and
again
I'll
I'll
follow
up
offline
with,
because
I
still
have
some
concerns
about
that
provision
on
being
in
there
and
maybe
the
only
thing
they
know
about
the
patient
so
anyway,
thank
you
for
that
clarity.
E
A
You
I
I
would
encourage
the
assemblywoman
titus
to
reach
out
to
ms
o'krent.
I
know
that
she
provided
a
similar
answer
and
she
said,
assemble
him
in
flores
kind
of
stated
what
she
would
have
said.
But
if
you
have
further
clarifying
questions,
I
would
ask
you
to
reach
out
to
her
and
next
I
will
go
to
assemblyman
haven.
M
M
My
question
to
the
experts
is
that
in
some
of
the
the
research,
not
necessarily
in
the
bible,
but
in
the
other
states
that
have
had
the
assisted
suicide
path,
we've
seen
a
direct
correlation
with
increased
suicides,
and
my
concern
is:
is
that
with
the
recent
pandemic
and
lockdown
we've
seen
a
dramatic
increase
in
suicide
attempts,
and
I
was
just
wondering
if
there
was
an
explanation
of
why
we're
seeing
a
direct
correlation
with
the
states
that
have
passed
the
assisted
suicide
specifically
to
oregon
and
the
increase
in
suicide.
L
This
is
david
in
oregon,
and
I
I
might
respond
to
that.
The
very
important
question
there.
I
actually
will
we'll
we'll
send
you
an
article
that
really
recognizes
there
is
no
correlation
between
increased
suicides
in
oregon
and
our
death
with
dignity
act
is
probably
more
based
on
the
fact
that
our
population
has
increased
and
other
situations
and
stressors
in
life.
L
Suicide
in
america
is
a
huge
problem
that
we
in
medicine
and
in
all
parts
of
our
society,
need
to
address
genuinely,
and
that's
a
very
important
thing
that
we
do.
However,
it
is
not
true
that
there
is
a
direct
correlation
between
the
passage
of
death
with
dignity,
act
in
oregon
and
suicides
in
our
state,
so
I'll
send
that
data
in
a
study
that
has
been
done
to
show
that
there
is
no
correlation.
J
Yeah
peg
sanding
for
deathwith
dignity
national
center,
and
I
would
echo
just
what
dr
group
said
very
much.
There
is
not
a
direct
correlation
and
there's
statistical
evidence
that
there's
not
a
direct
correlation
between
suicide
and
the
enactment
of
the
organ
death
with
dignity,
act
and
suicide
patterns
are
just
different
across
the
united
states.
Sometimes
some
states
have
higher
levels.
Some
states
have
lower
levels,
but
it's
not
related
to
the
existence
of
any
of
the
death
with
dignity,
acts.
M
Well,
I
have
a
follow-up,
thank
you
and
I
would
appreciate
to
look
at
that
data
because
the
data
that
I've
looked
at
is
is
showing
that
oregon's
suicide
rate
is
41
higher
than
the
national
average.
M
And,
if
I
understand
the
problem
is
not
the
assisted
suicide
but
the
increase
in
population
I'm
just
confused.
Why
an
increase
in
population
would
be
the
rationale
for
a
percentage
increase.
I
could
see
the
the
number
increase,
but
not
a
percentage
increase
over
the
national
average
being
caused
by
population.
L
That
for
me,
thank
you.
Yes,
thank
you
very
much.
This
is
david
grube
and
reagan.
Thank
you
very
much
to
clarify
that
I
didn't
mean
to
that.
It
was
an
increase
in
the
percentage.
That's
a
part
of
the
argument,
the
argument
that
shows
there's
no
correlation,
and
I
will
send
you
that
study
and
you
so
that
you
could
read
that
but
you're
correct.
A
I
I
actually
have
a
follow-up
question
to
that
when
you're
looking
at
like
some
of
these
studies,
because
I'm
sure,
like
myself,
many
of
our
committee
members
have
been
inundated
with
emails
and
support
and
opposition
of
assembly
bill
351
and
that
reference
to
like
high
suicide
rates
in
oregon
over
the
past.
I
don't
know
since
1999,
I
think,
is
what
most
of
the
emails
and
like
other
like
types
of
correspondent,
I
have
received
kind
of
indicate.
Do
we
have
any
indication
of
what
the
suicide
rates
were
in
oregon
prior
to
this?
D
Kim
kallinan,
with
the
compassion
and
choices
action
network,
so
the
when
you
look
at
the
studies
that
are
looking
at
suicide
rates.
There
really
just
is
no
correlation,
there's
so
many
different
factors,
as
you
noted
of
things
that
could
lead
to
suicide.
The
thing
that
actually
shows
there
is
that
the
western
states
that
have
lacks
or
gun
laws
are
the
ones
that
have
higher
suicide
rates.
That's
where
the
correlation
exists.
D
A
At
this
time,
I'm
looking
around
to
see
if
there
are
any
other
people
here
with
questions
assembly,
woman
titus.
Would
you
like
me
to
go
back
to
you
first
questions
before
we
go
to
the
word.
E
Testimony,
thank
you.
I
appreciate
it
and
I
I
do
appreciate
the
opportunity
question
on
nevada.
President
nevada
is
famous
in
history
that
we
became
a
lot
of
people
came
to
nevada
residents
because
of
our
divorce
laws
many
years
ago,
as
other
states
had
long
time
to
get
that
divorce.
E
We
have
numerous
places
in
both
southern
nevada,
northern
and
southern
nevada
that
were
established
because
of
they
could
get
a
divorce
here.
So
how
does
this
affect
when
we
say
nevada
resident?
There's,
no
limitation
that
you
have
to
be
here
six
months?
You
know
you
know.
What's
the
definition,
I
guess
our
legal
have
to
answer
this.
What's
the
definition
of
nevada
resident
going
to
be
here
just
a
week
and
they're
considered
a
nevada
resident.
D
I'm
calling
in
with
the
compassion
and
choices
action
network,
yeah,
there's
no
time
frame
for
how
long
someone
has
to
be
within
a
state.
It's
really
about
whether
you
have
an
id,
a
government
id
voter
registration,
all
the
normal
ways
that
you
would
establish
residency,
but
the
reality
is.
I
mean,
there's
two
really
important
things
to
keep
in
mind.
The
first
is
that
you're
bordering
states
of
oregon
and
california
already
have
this
as
an
option,
and
we
now
have
one
in
five
americans.
D
So
the
idea
that
nevada
will
become
like
a
suicide
mecca
for
this
is
highly
unlikely,
both
because
you're,
seeing
so
many
other
states
adopt
this
as
an
option.
But
in
addition
to
that
people
of
their
life
they
are,
they
don't
have
the
wherewithal
the
means,
the
physical
ability
to
pick
up
and
move.
So
people
choose
this
option
because
they
want
to
be
able
to
die
at
home,
surrounded
by
their
loved
ones,
and
very
very
few
people
have
the
wherewithal
and
are
able
to
just
pick
up
at
the
end
of
their
lives.
D
After
getting
a
terminal,
diagnosis,
be
able
to
re-establish
residency,
someplace
and
then
be
able
to
go
through
the
13-step
process
in
order
to
access
the
law,
so
in
the
history
of
it
being
authorized
across
all
of
the
states.
There
are
a
couple
of
examples
where
people
have
successfully
moved
to
a
state
in
order
to
access
the
option,
but
it's
few
and
far
between.
E
D
Kim
calan,
with
the
compassion
and
choices
action
network
when
you
look
across
at
this
data
across
all
of
the
authorized
states,
generally
speaking,
you're,
seeing
it
be
older
people
that
are
accessing
the
option,
you
know
the
average
age
I'd
have
to
pull
it
up
and
see.
If
I
can
quickly
find
the
average
age-
and
I
don't
know
peggy,
do
you
remember
the
average
age
off
hand.
L
L
That
is
almost
that
the
only
diagnosis
of
for
younger
younger
people,
but
the
average
age
is
over
70
each
year.
A
Thanks
no
problem
and
before
I
start
testimony
and
support,
I'm
taking
a
look
around
here
to
see.
If
I
have
any
other
questions
from
committee
members
and
seeing
none
I'm
going
to
start
with
testimony
in
support,
I
believe
we
have
at
least
one
person
I
see
on
here
to
testify
in
support
again
I'd
remind
people
testifying
and
support.
A
Please
clearly
state
your
name
before
the
record
and
limit
your
testimony
to
two
minutes,
although
I
have
given
people
that
are
on
the
zoom
link
some
additional
leeway
in
their
testimony,
but
keep
in
mind
that
it
will
take
away
from
the
testimony
that
we
go
to
on
the
phone
lines.
So
at
this
time
I
see
senator
parks,
you
can
go
ahead
and
then
mute
yourself
and
introduce
yourself
to
assembly
health
and
human
services
and
welcome
back
and
go
ahead
with
your
testimony
and
support
when
you're
ready.
G
Thank
you,
chairwinn,
and
vice
chair
peters
and
health
and
human
services
committee
members
for
the
record.
I'm
david
parks
and
I
support
the
passage
of
senate
bill
351
sponsored
by
assemblyman
edgar
flores
for
the
last
three
legislative
sessions.
I
requested
legislation
on
the
issue
of
medical
aid
and
dying.
G
G
Some
were
cancer
patients
who
wanted
to
have
the
peace
of
mind
knowing
they
can
control
their
final
days.
Others
wanted
the
assurance
that,
after
exploring
all
traditional
options,
a
legal,
safe
and
peaceful
option
would
be
available
to
them
to
control
the
end
of
their
life
on
their
own
terms.
Please
support
assembly
bill
351.
A
Thank
you
senator
parks,
and
it
is
a
pleasure
to
see
you
back
here
in
the
virtual
legislative
building
and
with
that.
I
think
that
is
the
only
caller
and
support
that
we
have
on
the
zoom
link.
So
at
this
time,
if
I
can
turn
this
over
to
broadcast
services
to
go
to
the
callers
on
the
line
in
support
of
assembly
bill
351
again,
I
would
remind
callers
to
please
clearly
state
your
name
for
the
record,
sell
it
if
necessary
as
well
and
limit
your
testimony
to
two
minutes
again.
A
A
I
know
that
one
of
our
own
assembly
members,
assemblyman
assemblywoman
black,
has
reached
out
and
had
a
lot
of
constituent
outreach
regarding
assembly
bill
351,
and
so
I
would
encourage
those
people
that
have
participated
with
her
outreach
to
also
directly
reach
out
to
the
legislative
website
to
submit
that
documentation
and
with
that,
if
we
can
go
to
broadcast
services
to
begin
testimony
and
support.
A
A
B
Thank
you
caller,
with
the
last
three
digits:
zero.
Eight
zero.
Please
start
your
testimony
over
again
and
slowly
state.
You
spell
your
name
for
the
record.
You
have
two
minutes.
It
may.
B
B
H
You,
madam
chair
and
members
of
the
committee
for
the
record,
my
name
is
susan
fisher
s-u-s-a-n-f-I-s-a-t-r
with
mcdonald
carano.
I
represent
death
with
dignity
organization,
but
I'm
speaking
today
on
behalf
of
a
friend
and
I
thank
assemblyman
flores
for
picking
up
the
torch
on
this
important
issue
and
for
introducing
ab351
during
the
2015
session,
I
was
working
on
senate
bill
336,
which
was
a
bill
similar
to
what
you
have
before
you
today.
In
the
course
of
the
session,
I
met
a
woman
who
lives
right
here
in
carson
city
who's
been
suffering
with
cancer.
H
H
Debbie
couldn't
join
us
today,
because
she's
spinning
what
will
probably
be
her
last
visit
with
her
three
sisters
who
all
live
in
different
states.
Debbie
asked
that
I
relay
her
story
and
urge
you
to
support
ab351
for
her
she's,
not
in
a
hurry
to
die.
She
was
first
diagnosed
with
breast
cancer
29
years
ago,
when
her
son
was
just
six
months
old.
H
This
past
august
she
had
a
craniotomy
to
get
to
a
new
mass
in
her
head.
It
was
a
metastatic
brain
tumor.
They
were
not
able
to
remove
it.
She
couldn't
have
visitors
due
to
coven,
so
she
sent
me
photos
of
the
huge
swath
of
bare
scalp
covered
with
metal
staples
and
the
dent
in
her
skull
where
the
bone
had
been
removed.
It
was
estimated
in
early
september
that
she
had
10
to
12
months
to
live.
H
Do
the
math
she
asked
me,
then,
if
we
could
hurry
up
and
get
this
bill
passed
within
that
time,
so
that
she
could
control
the
end
game.
I
told
her.
I
didn't
think
we
could
get
it
done
that
fast,
but
we'd
try
her
son
and
granddaughter
living
here
in
carson
city.
She
doesn't
want
to
leave
them,
but
she
will
leave
this
world
anyway,
one
way
or
the
other.
It's
considered.
H
She
has
considered
setting
up
residency
at
a
friend's
home
in
california,
where
death
with
dignity
act
has
been
in
place
since
2016
and
she's
asked
me
to
be
there
with
her
to
help
make
her
laugh
right
up
to
the
end.
She
told
me
just
last
week
that
her
doctors
think
there's
a
new
mass
in
her
brain.
We
don't
know
what
it
is
yet,
but
they
think
it
may
be.
Necrosis
dead,
brain
tissue,
debbie
black,
doesn't
know
if
she
would
actually
use
this
act
in
the
medication
to
end
her
life.
H
B
H
Thank
you
chair
and
members
of
the
committee
for
the
record.
My
name
is
tess
opferman
spelled
o-p-f-e-r-m-a-n
speaking
on
behalf
of
the
nevada
women's
lobby.
We
appreciate
the
emotional
testimony
that
has
been
presented
today.
End-Of-Life
care
decisions
are
difficult
for
everyone
involved.
Family
children,
parents
and
these
decisions
are
even
more
difficult
when
someone
is
dealing
with
unbearable
pain
and
suffering.
Ab351
gives
the
option
for
compassionate
end
of
life,
allowing
someone
with
six
or
fewer
months
to
live,
to
live
the
opportunity
to
make
informed
decisions
with
their
family
and
friends
to
escape
pain
and
suffering.
H
N
N
We
recently
lost
my
aunt
to
pancreatic
cancer
and
it
was
one
of
the
most
brutal
and
violent
and
aggressive
things.
I've
ever
had
the
misfortune
of
witnessing
the
fact
that
she
lived
in
a
state
where
she
had
access
to
this
type
of
and
life-ending
medication
brought
comfort
to
her
to
my
grandmother,
my
family,
that
she
would
not
otherwise
have
had
in
that
and
at
that
point
towards
the
end
of
her
life
there
she
did
not
choose
to
use
the
medicine,
but
the
option
made
all
the
difference.
N
The
right
of
individual
autonomy
protects
people's
constitutional
right
to
control
their
bodies
to
make
end
of
life
decisions.
There
is
value
in
having
aid
and
dying
that
is
legal
and
transparent
states.
With
bands
have
tolerated
gray
markets
where
people
with
resources
can
find
sympathetic.
Doctors
to
give
them
medication,
but
those
with
limited
resources,
often
use
self-induced
means
that
fail.
When
the
process
is
open
and
transparent,
it
can
be
regulated
and
we
keep
people
safe
in
and
keep
track
of
the
process.
N
End
of
life
choices
are
already
recognized
and
accepted
legal
practice,
competent
adults,
unqualified
legal
right
to
decline.
Medical
care
is
accepted
with
clear
and
convincing
evidence
exists
that
the
patient
wishes
to
end
life
support
and
through
advanced
directives.
Finally,
aiden
dying
laws,
open
communications
between
the
doctors
and
their
patients
to
promote
the
right
of
the
person
to
choose
to
keep
living.
N
The
statistics
from
disability
to
aids
projects
show
that
one
in
25
patients
who
ask
a
physician
about
aid
and
dying
actually
request
the
medication,
because
the
patients
and
the
physicians
can
speak
openly
about
end-of-life
options
without
fear
of
criminal
liability.
Those
patients
are
free
to
discuss
their
fears
more
openly
and
seek
alternative
options.
For
these
reasons,
we
strongly
support
this
bill.
We
encourage
you
to
vote
yes
and
again.
We
thank
you
for
bringing
this
bill
on
behalf
of
anyone
who
has
watched
someone
struggle
through
the
end
of
life.
Thank
you.
B
F
F
Committee
members.
We
really
appreciate
your
consideration
of
this
bill
today
and
the
thoughtful
questions
you
asked
thus
far.
While
you
continue
to
evaluate
this
bill,
I
wanted
to
point
your
attention
to
a
poll
conducted
just
a
few
days
ago
that
resulted
in
72
percent
of
nevadans
supporting
this
legislation.
F
F
G
B
F
Several
of
this
committee's
members
are
either
lawyers
medical
doctors,
work
in
the
helping
professions
or
have
science
training
in
their
backgrounds.
They
are
oriented
toward
problem
solving.
Unfortunately,
an
incurable
disease
does
not
have
a
solution
worth
noting.
Most
of
this
committee's
members
are
of
a
younger
age
where
they
probably
have
not
personally
experienced
the
horrific
illnesses.
F
B
H
Hello
and
thank
you,
madam
chair,
my
name
is
kathleen.
Bohol
b
is
in
baby
o-h-a-l-l.
H
I
am
in
support
as
a
symbol
of
assembly
bill
351,
the
nevada
end
of
life
options
act
is
not
murder,
nor
is
it
suicide.
It's
a
plan
for
the
eventuality
of
death,
which
we
all
face.
We
don't
wait
until
the
moment
of
birth,
of
a
child
to
plan
for
it
we
spend
nine
months
sometimes
years
preparing.
For
that
event,
I'm
not
afraid
of
death,
but
I
am
afraid
of
the
dying
process.
H
H
She
chose
to
utilize,
the
california
end
of
life
options
act,
the
relief
and
joy
she
experienced
when
she
was
authorized
to
use.
This
option
was
remarkable.
I
shared
that
relief,
all
the
while
dreading
her
death.
I
moved
to
nevada
in
1962
almost
60
years
ago.
Nevada
is
my
home
and
I
want
to
die
in
nevada,
but
I
plan
to
move
to
a
state
which
allows
end-of-life
options
if
and
when
I
am
diagnosed
with
a
terminal
illness.
H
I
urge
all
lawmakers
to
research
the
process
of
a
death
from
congestive
heart
failure
before
you
deny
this
alternative.
Every
mentally,
capable
adult
with
six
months
or
less
to
live,
should
have
the
choice
to
request
from
their
doctor
a
prescription
they
can
take
to
avoid
unbearable
suffering
and
die
peacefully.
B
H
E
I
live
in
assembly
district
41..
I
appreciate
being
allowed
to
come
before
you
to
speak
in
favor
of
ab351.
Today
I
have
been
a
physician
assistant
for
38
years
with
the
last
27
being
here
in
southern
nevada.
Before
that
I
was
a
registered
nurse
and
commissioned
officer
in
the
public
health,
united
states,
public
health
service.
H
I
have
attended
bedside
with
patients
and
their
families
at
the
end
of
life,
and
it
has
all
too
often
been
fraught
with
pain,
suffering
and
intense
anxiety
for
the
patient
and
their
families.
Medical
aid
in
dying
is
not
assisted
suicide.
It
is
not
out
of
depression
that
a
terminally
ill
patient
may
want
to
end
their
life.
They
simply
want
the
option
to
die
peacefully.
H
H
Their
death-
it
is
simply
humane
and
compassionate
when
self
suffering
is
refractory.
When
hospice
care
has
done
all
it
can
do
for
a
person
suffering
from
an
irreversible
terminal
illness
that
the
patient
be
allowed
to
ingest
a
lethal
medication
to
end
their
suffering.
If
that
is
what
they
choose,
I
urge
you
to
vote
in
favor
of
ab351,
and
I
appreciate
this
opportunity
to
speak
with
you.
Thank
you.
B
H
H
K-I-M-M-A-Z-E-R-E-S
from
reno
nevada-
I
am
speaking
today
in
support
of
ab351.
My
husband
was
cognizant
until
his
very
last
hours.
He
knew
he
wanted
the
option
to
decide
for
himself
when
enough
was
enough,
steve
passed
away
in
june
of
last
year
after
suffering
chronic
rejection
due
to
a
lung
transplant.
H
Steve
was
diagnosed
with
copd
when
he
was
in
his
50s
after
an
exacerbation
and
a
failed
surgery,
doing
nothing
or
having
a
transplant
were
his
only
options.
Steve
brought
up
the
idea
of
moving
to
oregon
so
that
he
could
utilize
their
medical
aid
and
dying
law.
I
was
mad
now
that
we
might
have
to
uproot
ourselves
to
establish
residency
in
a
state
where
we
have
no
family
a
place
that
was
not
home
for
either
of
us.
H
Steve
ultimately
opted
for
the
transplant
and
he
did
really
well
for
a
year,
but
something
kicked
off
chronic
lung
rejection.
He
opted
for
treatment
of
the
rejection,
but
it
did
not
work
for
him.
Steve's
last
24
hours
were
horrific.
He
was
in
a
tremendous
amount
of
pain
and
I
scrambled
to
get
him
enrolled
in
hospice
as
it
turned
out.
Assistance
from
hospice
was
perfect.
H
Steve
passed
only
five
hours
after
starting
on
service
with
him,
but
what
would
have
happened
if
it
had
been
a
weekend
with
hospital
with
no
hospice
intake
staff
available
or
I'd
have
been
unable
to
make
that
happen
for
him.
If
we
had
the
option
of
medical
aid
and
dying
in
nevada,
my
husband
could
have
chosen
whether
or
not
he
wanted
to
unveil
himself
of
that
option.
Terminally.
A
H
B
B
M
K
I
F
Okay,
sorry
about
that,
my
name
is
dan
diaz
d-I-a-z
and
I
am
brittany.
Menard's
husband,
brittany
died
on
november
1st
2014..
She
was
only
29
years
old.
Brittany
experienced
a
gentle
dying
process
only
because
of
the
option
of
medical
aid
and
dying.
Yes,
my
wife
utilized
the
very
program
that
we
are
discussing
here
today.
I
am
testifying
in
support
of
ab351.
F
F
This
program
allowed
her
to
truly
live
the
time
that
she
had
left
and
then
experience
a
gentle
death
britney's
case
received
significant
attention
because
at
the
time
we
had
to
move
from
our
home
in
california
so
that
she
could
access
oregon's
law
had
we
stayed
in
california.
The
brain
tumor
would
have
continued
to
torture
her
to
death.
F
People
in
nevada
deserve
better
than
that.
No
one
should
ever
have
to
leave
their
home,
like
we
did
with
72
percent
of
nevadans
agreeing
with
brittany
that
a
terminally
ill
individual
should
have
this
option
at
the
end
of
life.
I
hope
this
hhs
committee
reflects
that
support
from
your
constituents
as
you
vote
in
favor
of
this
bill.
F
I
have
spoken
with
several
of
you
personally
and
please
keep
in
mind
that
britney
simply
took
control
back
from
that
cancer,
so
she
would
not
have
to
suffer.
The
opponent's
campaign
is
based
on
fear.
They
use
inflammatory
words
like
suicide
and
euthanasia
and
their
attempt
to
scare
legislators
and
the
public,
but
to
be
very
clear
on
this,
this
very
protective
option
for
terminally
ill
individuals.
It
does
not
result
in
more
people
dying,
it
simply
results
in
fewer
people
suffering.
A
Thank
you.
I
believe
we
have
maybe
one
more
caller
on
the
line
and
go
ahead
when
you're
ready.
B
H
Hi,
my
name
is
dr
claire
johnson
j-o-h-n-s-o-n.
Thanks
for
letting
me
join
today,
I'm
an
emergency
medicine
physician
living
in
reno.
As
an
er
doctor,
I
see
patients
at
the
peak
of
their
suffering.
Often
in
the
last
six
months
of
life
I
have
seen
patients
lose
the
ability
to
eat
as
stomach
cancer
has
progressed.
H
H
H
H
A
Thank
you,
and
that
was
the
last
caller
that
we
had
on
the
line
in
support
of
assembly
bill
351,
and
I
think
we
are
at
about
22
minutes.
23
minutes,
sorry,
so
close,
and
at
this
time
I
will
begin
testimony
in
opposition
of
assembly
bill
351.
A
I
do
have
two
individuals
that
are
three
individuals,
two
on
one
zoom
that
are
on
the
zoom,
so
I
am
going
to
start
with
them.
I
will
ask
them
to
unmute
and
I
will
call
them
and
by
name
just
so,
we
can
make
sure
that
we
get
them
on
here.
I'm
going
to
start.
First
with
we
have
two
disability
advocates
on
the
line:
brianna
hammond
and
her
mother
dedra
hammond.
They
are
both
on
the
zoom.
A
A
A
H
K
B
K
K
So,
even
though
the
bill
cleverly
does
not
say
the
word
disability
there,
I
am
all
you
need-
is
an
opinionated
doctor
to
make
a
subjective
pronouncement
of
my
imminent
death,
which
many
would
be
very
willing
to
do,
and
I
meet
the
definition
of
terminally
ill.
I'm
amazingly
healthy,
but
I
am
at
risk
here.
K
K
K
K
K
It
is
like
they
have
a
script
in
their
head
about
the
poor
disabled
girl
and
they
assume
they
need
to
make
decisions.
For
me,
I
explained
to
the
doctor
that
I
had
a
significant
gag
reflex
and
would
need
sedation
for
a
procedure,
but
he
kept
ignoring
me
and
assuring
my
mother.
I
was
not
a
behavior
problem.
K
K
Family
members
have
so
much
influence
in
the
medical
field,
and
not
all
of
them
want
what
you
want.
Well,
meaning
doctors
look
at
me
and
think
I
would
be
better
off
dead.
They
will
think
it's
a
favor
to
offer
to
suicide
me
over
and
over
again,
I
will
be
educated
about
my
right
to
die.
Do
you
know
what
it
is
like
to
be
told
you
should
suicide?
K
A
Thank
you
for
your
testimony.
At
this
time
I
will
go
to
dr
brian
callister,
I
think,
is
also
a
muslim.
I
remind
you
again
to
please
state
your
name
for
the
record
and
please
limit
your
testimony
to
four
minutes.
M
M
M
Did
you
talk
about
assisted
suicide?
Did
you
bring
it
up?
I
was
stunned,
I
I
absolutely
couldn't
believe
it
and,
of
course,
when
I
called
them
out
on
that.
Their
response
and
you've
heard
a
little
bit
of
this
earlier.
Their
response
was,
oh,
there's,
no
correlation,
and
you
heard
some
of
that
today,
no
correlation,
they
deny
treatments
all
the
time.
They
approve
treatments
all
the
time
and
they
just
happen
to
deny
a
life-saving
standardized
treatment
and
ask
if
we
offered
this
up.
M
That's
what
got
me
involved
in
this
and
in
fact,
when
you
talk
about
the
potential
for
coercion
and
abuse,
you
have
to
understand
that
as
physicians,
we
are
very
poor
at
predicting
life
expectancy
with
a
terminal
diagnosis.
Today,
I've
been
listening,
it
sounds
all
so
precise.
Oh
I'm
a
doctor,
and
you
have
six
months
to
live.
M
Yes,
we
need
more
effort
in
palliative
care
and
hospice
and
they're
working
well
in
other
states,
but
this
falls
in
the
category
of
kind
of
thrown
out
the
baby
with
the
bath
water
and
to
address
assemblyman
thomas's
concern,
especially
with
communities
that
have
limited
access
to
health
care.
They've
been
marginalized,
disenfranchised
people
of
color
people
in
poor
neighborhoods.
M
How
do
you
know-
and
you
don't-
and
this
is
what
I'm
afraid
of
with
my
two
insurance
cases-
that
people
are
not
being
denied
standard
medical
treatments,
because
this
is
now
called
a
medical
treatment.
Killing
someone
with
a
prescription
is
called
a
medical
treatment
and
it
gives
the
insurance
companies
the
cheapest
option
the
chance
to
offer
that
up
instead
of
a
standardized
treatment-
and
it's
happened
to
me
twice
some
of
the
compassion
and
choices
people
have
said
in
the
past.
Oh
there's!
No
proof
of
that.
Let
me
get
rid
of
that
right.
Now.
M
M
M
No
thank
you
and-
and
I
will
finish
up
right
here-
you
know
the
real
story
here,
especially
how
it
affects
other
communities
is
when
does
your
right
to
die,
become
some
other
person's
duty
to
die.
This
is
not
a
medical
treatment.
This
is
assisted
death.
Let's
make
that
very
clear.
I
thank
you
very
much
all
of
you
for
your
time
and
I'll
be
happy
to
hang
around
and
ask
any
questions
answer
any
questions
as
they
come
up.
A
Thank
you
broadcast
services
that
we
don't
have
any
other
colors
on
the
zoom.
If
we
can
now
go
to
the
phone
lines
and
begin
testimony
in
opposition
of
assembly
bill
351
again,
I
will
remind
callers
that
we
have
a
limited
amount
of
time
to
do
your
statement.
So
I
know
this
is
a
very
emotional
thing,
so
please
state
your
name
clearly
for
the
record
and
also,
what's
it
going
to
say,
limit
your
testimony
to
two
minutes
and
with
that
we
will
begin.
B
Specify
in
opposition
to
assembly
bill
351,
please
press
star
9
now
to
take
your
place
in
the
queue,
and
it
has
come
to
my
attention
that
we
may
have
missed
a
caller
and
support.
If
you
can,
please
submit
your
testimony
and
writing
so
that
the
assembly
can
look
it
over.
That
would
be
very
helpful.
Thank
you.
A
B
H
Madam
chair,
my
name
is
kathleen
rossi,
I'm
a
registered
nurse
who
has
worked
in
nevada
for
over
35
34
years,
and
I
have
much
experience
in
end-of-life
care.
I'm
opposed
to
this
legislation
because
it
is
rift
with
laws
and
it
will
bring
unintended
consequences.
The
phrase
that
hard
cases
make
bad
law
could
never
be
truer
than
here.
It
will
change
the
standard
of
care
when
it
makes
assisted
suicide
quote
medical
treatment.
Suicide
has
never
been
a
medical
treatment
and
one
certainly
does
not
need
a
physician
to
overdose
with
pills
to
act
like
assisted
suicide.
H
Does
not
change
attitudes
to
other
physicians
towards
medical
care
options
is
naive.
I'd
like
to
to
quote
wesley
smith
bioethicist
when
he
says
advocacy
for
legalizing.
Assisted
suicide
is
always
couched
in
terms
that
would
limit
access
to
those
are
terminally
ill,
but
given
the
philosophical
and
ideological
principles
that
underlie
the
assisted
suicide
movement,
that
autonomy
is
paramount
and
ending
life
is
a
valid
answer
to
human
suffering.
Restricting
assisted
suicide
to
the
dying
becomes
utterly
illogical.
H
After
all,
many
people
experience
far
greater
suffering
and
for
a
longer
period
of
time
than
people
who
are
terminally
ill.
Thus,
should
the
two
fundamental
premises
of
assisted
suicide
become
generally
accepted
by
a
broad
swath
of
medical
professions
and
among
the
public
there
is
little
chance
that
this
permitted
suicide
would
remain
limited
to
the
terminally
ill.
H
We
do
see
this
in
the
netherlands
and
in
the
documented
cases
of
suicide
contagion,
and
I
see
that
almost
every
state
that
has
passed,
assisted
suicide
goes
on
to
expand
and
progress
those
laws
in
future
years
as
a
nurse,
I've
also
noticed
that
it
often
isn't
the
patient
that
can
hand
that
can't
handle
the
terminal
suffering.
It
is
the
family
and
often
the
family
that
doesn't
understand
the
dying
process
in
general.
H
B
H
Thank
you,
madam
chair
members
of
the
committee.
My
name
is
mary
fetchner
f,
like
frank
e
c,
h,
n
e
r.
I
represent
myself
and
I
urge
you
to
vote
no
on
assembly
bill.
Three
five
one
physician
assisted
suicide
is
an
extremely
complex
subject.
It
demands
careful
thought
and
consideration
of
the
many
issues
at
stake.
H
These
experts
presented
their
findings
based
on
their
research
and
experience.
They
published
a
165
page
summary
of
their
findings,
rather
than
a
cursory
consideration
of
public
testimony
which
I've
found
there
are
some
inaccuracies
and
some
lack
of
the
basic
general
knowledge
of
how
this
bill
works
in
oregon,
which
is
very
concerning.
H
This
very
complex
issue
and
its
ramifications
before
making
your
decision,
and
rather
than
concentrating
your
efforts
and
our
tax
dollars
on
ending
the
lives
of
our
citizens,
please
direct
them
towards
preserving
life
and
providing
loving
palliative
care
at
its
end,
nevada
citizens
will
thank
you
for
it.
I
just
also
wanted
to
bring
up
that
you.
A
Are
at
two
minutes
now,
if
I
can
get
you
to
wrap
it
up.
If
you
have
additional
comments,
please
submit
those
in
writing
at
the
legislative
website.
H
Okay,
I
just
wanted
to
say
that
miss
callahan
has
been
quoted
in
1919
is
saying:
if
lawmakers
want
to
improve
medical
aid
and
dying
laws,
then
let's
address
the
real
problem.
There
are
too
many
regulatory
roadblocks
broadcast
services.
Can
we
go
okay?
Next,
please.
B
B
B
G
My
name
is
john
kelly.
I
am
the
director
of
second
thoughts.
Massachusetts,
disability
rights
advocates
against
assisted
suicide.
I
agree
with
everything
brianna
hammond
said
bills
like
these
promote
prejudice
against
our
lives,
because
we
depend
on
others
for
our
care.
The
message
is
that
our
lives
are
worthless,
are
endless,
and
this
the
bill
promotes
that
prejudice.
G
Bill
ab-351,
like
all
assisted
suicide
bills,
takes
away
individual
choice
and
gives
it
to
insurers
who
care
more
about
money
than
people
who
care
more
about
money
than
people.
Dr
callister
speaks
the
truth.
We
cannot
trust
insurers
to
do
the
right
thing
rather
than
the
cheapest
thing.
Proponents
say
there
has
never
been
a
case
of
abuse,
but
that
is
absolutely
false.
Please
do
a
search
for
wendy
melcher,
a
very
ill
trans
woman
who
had
not
applied
for
assisted
suicide.
G
G
I
thank
dr
titus
for
bringing
up
the
impossibility
of
accurate
prognosis.
As
she
said,
people
could
live
years
longer
than
six
months,
like
the
12
to
15
percent
of
people
admitted
to
hospice
who
outlived
their
prognosis.
What
about
these
people?
Do
we
care
about
them?
Please
do
a
search
for
jeanette
hall
who's
been
alive.
20
years
after
she
sought
assisted
suicide,
she
was
persuaded
to
try
more
treatment,
and
now
she
is
active
against
these
bill.
G
G
B
H
It's
truly
astounding
to
hear
assemblyman
foreign
advocate
for
ending
human
life
in
such
a
casual
form,
assisted
suicide,
gives
insurance
companies
and
governments
the
ability
to
save
money
by
pushing
lethal
drugs
that
are
less
expensive
than
treatment.
No
trained
medical
personnel
are
required
to
be
present
at
the
time
the
lethal
drugs
are
taken
were
at
the
time
of
death,
creating
the
opportunity
for
an
error
or
abusive
caregiver
to
force
the
patient
to
take
the
deadly
drugs
or
put
them
in
the
patient's
food
without
the
patient's
knowledge
or
consent.
H
There
is
no
requirement
in
the
bill
that
the
patient,
in
order
to
receive
lethal
drugs,
be
facing
a
terminal
disease
that
would
take
their
life
in
six
months.
For
those
in
difficult
circumstances.
The
correct
response
is
our
encouragement
and
assistance,
not
an
argument
in
favor
of
their
death.
People
dealing
with
depression
in
the
face
of
illness,
injury
or
impairment
need
those
around
them
to
affirm
their
value
rather
than
advocating
for
a
quick
end.
People
targeted
for
assisted
suicide
are
often
people
of
color
like
myself,
who
often
lack
the
resources
to
pay
for
medical
care.
H
This
is
this
discriminatory
bill
will
result
in
a
result
in
a
bigger
inequity
gap
between
income
levels
in
the
state
favoring,
the
wealthier,
who
are
able
to
afford
such
treatment
as
people
near
the
end
of
their
lives,
realistic,
humane
treatments
and
compassionate
care
are
essential.
We
can
and
should
support
options
such
as
hospices
and
other
measures
that
help
provide
comfort
to
people
in
their
last
days.
However,
intentionally
killing,
someone
can
never
be
compatible
with
an
ethical
worldview.
Please
vote
no
on
ab351.
A
Thank
you.
I
know
we
have
some
callers
that
have
some
difficulty
like
turning
on
so
it
may
seem
like
we
are
going
a
little
bit
over
on
the
time
in
opposition,
but
I
am
going
to
take
one
last
caller
in
opposition
broadcast
services
that
we
can
go
to
that
lab
caller.
B
G
Dr
peter
fennick,
f,
f
foxtrot
e
n
w
I
c
k,
I'm
a
family
practice
physician
of
over
50
years
at
present
a
professor
at
unr
medical
school,
seeing
patients
and
teaching
students.
I
practice
at
times
in
four
countries,
england,
scotland,
anguilla,
where
I
was
the
only
physician
in
the
usa.
I
oppose
ab
351
for
several
reasons.
I
took
the
hippocratic
oath,
which
categorically
states
I
will
give
no
deadly
medicine
to
anyone.
If
asked
or
suggested.
G
As
a
family
practitioner,
my
patients
have
become
my
family.
I
have
treated
literally
thousands
of
patients
and
hundreds
of
patients
with
terminal
and
determinism
never
needed
to
subject
anyone
to
a
form
of
assisted
suicide.
I
also
have
never
let
anyone
suffer
as
I've
always
been
able
to
treat
any
untoward
symptoms
successfully.
G
M
G
And
reno,
I
saw
several
people
who
were
brought
in
having
taken
overdoses
and
those
that
were
not
from
the
toes
were
suffering
severe
physical
symptoms.
Do
we
really
want
to
subject
people
to
the
kind
of
depth
when
I
can
treat
all
their
symptoms
of
illness
and
experience
a
normal
debt
which
also
helps
the
family
in
the
situation?
G
The
very
fact
that
the
patient
must
administer
the
administ
medication
and
the
decision
must
dated
basically
not
be
there
incurs
that
the
physician
is
not
responsible.
This
is
terrible.
Section
25
states
that
taking
a
prescribed
overdose
is
not
suicide,
so
the
whole
procedure
is
titled
assisted
suicide.
G
If
handing
a
patient
a
handful
of
pills
to
kill
themselves
would
be
okay,
is
it
okay
to
hand
them
a
gun
which
could
cause
instant
death
and
not
necessarily
a
slow
death
sections?
One
two
and
three
state
that
the
position
must
not
state
the
true
cause
of
death.
A
A
G
A
I
A
You
know
what
I'm
sorry
I
gotta
go
to
neutral
testimony.
Okay,
I'm
coming
back
here
broadcast
services.
If
we
can
now
go
to
neutral
testimony,
I
don't
see
anyone
on
the
zoom
if
you
are
on
the
zoom,
and
you
are
here
to
present
neutral
testimony.
If
I
could
ask
you
to
unmute
and
turn
on
your
camera,
I'm
looking
I'm
looking.
I
don't
see
any
oh
wait.
I
see
is
rodriguez.
Are
you
testifying
in
neutral?
I
am
chair.
A
B
B
The
purpose
of
our
amendment
was
to
create
clarity
and
ensure
the
roles
of
the
different
participants
in
the
process,
wanting
to
make
sure
that
who
was
going
to
be
signing
the
death
certificate,
treating
this
much
more
like
hospice,
so
that
these
cases
would
not
come
to
the
corner
or
the
medical
examiner,
I'm
requiring
us
to
do
a
full,
autopsy
and
and
sign
off
on
those
death
certificates.
B
So
that's
really
the
purpose
of
our
amendment
and
just
again
really
want
to
thank
the
bill
sponsor
and
the
proponents
for
working
with
us
understanding
our
concerns
and
accepting
our
amendment.
Thank
you,
chair.
A
Thank
you.
Do
we
have
any
other
people
on
the
zoom
that
are
here
to
testify
in
neutral
on
assembly
bill
351?
If
you
are
I'd,
ask
you
to
please
unmute
and
turn
on
your
camera.
This
time
thing
none
broadcast
services.
Can
we
now
go
to
the
line
in
neutral?
I
will
remind
callers
that
this
is
neutral
testimony.
This
is
not
in
support.
This
is
not
in
opposition.
A
This
is
neutral.
Testimony
of
assembly
bill
351
again,
if
you
did
not
have
the
opportunity
or
you
came
on
late
or
you
didn't
get
to
submit
your
full
comments.
I
would
encourage
you
to
submit
those
comments
in
writing.
Within
48
hours
of
today's
hearing
on
assembly,
bill
351
broadcast
services.
Can
we
begin
testimony
in
neutral.
B
H
A
I
Thank
you
very
much,
madam
chair
assembly,
medicare
for
us
for
the
record,
and
I
don't
know
if
my
co-presenters
may
have
some
additional
comments,
but
I
did
want
to
respond
to
some
of
the
folk
that
called
in
well
and
first
of
all,
I
wanted
to
say
thank
you
to
everybody
who
called
in.
I
don't
believe
anybody
who
called
in
either
in
support
or
opposition
came
from
a
place
of
wanting
to
harm
nevadans,
or
do
anything
like
that.
I
I
think
everybody
just
came
from
a
very
personal,
compassionate
lens,
and
so
I
I
appreciate
them
engaging
in.
In
this
conversation,
I
will
say
that
I
I
don't
take
this
conversation
lightly
and
that
I
didn't,
and
by
no
means
I
think,
it's
easy
engaging
in
this
conversation.
Quite
the
contrary,
it
was
a
very
difficult
conversation
for
me
to
engage
in,
but
through
my
personal
experiences
find
myself
here
presenting
this
bill.
I
I
also
find
it
slightly
disingenuous
that
we
have
so
many
folk
calling
in
opposition
talking
about
this
is
a
bill
to
harm
people
of
color
and
poor
communities.
I
think
we
consistently
tokenize
people
of
color
and
poor
communities
whenever
it's
to
our
advantage,
which
is
why
precisely
I
refused
to
engage
in
that
conversation
period
is
a
a
political
tool
that
is
used
consistently.
I
You
know
all
of
a
sudden
we're
going
to
be
utilizing
this
medication
to
kill
all
people
of
color
and
poor
people
when
we
don't
have
necessarily
the
data
to
suggest
that
even
people
of
color
are
the
ones
that
are
engaging
in
this
option.
To
begin
with,
so
it's
frustrating
to
me
because
it
is
often
a
political
employee
that
is
utilized,
and
I
think
often
they
see
me,
they
see
a
person
of
color
and
just
drop
these
key
phrases
and
hope
that
they
will
trigger
something
not
supported
by
data.
I
So
with
that,
madam
chair,
if
I
may
ask
if
our
co-presenters
have
any
additional
comments,
but
I
will
also
say
thank
you
to
senator
parks
for
his
advocacy
and
work
in
this
area.
As
I
mentioned
previously,
I
am
simply
picking
up
the
work
that
he
has
done
in
the
past
for
us
and
I'm
appreciative
to
him.
D
D
It's
fewer
than
4
300,
4
300
people
across
nine
jurisdictions
in
about
50
years
that
have
ingested
the
medication
somebody
suggested
I
may
have
added
a
zero
to
the
end
of
that.
So,
if
I
did,
I
just
wanted
to
be
sure
that
I
had
got
that
right.
That
brings
such
profound
peace
of
mind
to
those
people
who
choose
the
option.
D
I
also
wanted
to
just
note
that
the
law
specifically
notes
that
people
with
disability
do
not
qualify,
so
someone
cannot
qualify
simply
because
they
are
disabled.
They
must
be
terminally
ill
with
a
prognosis
of
six
months
or
less
to
live.
I
know
how
difficult
it
is.
We
have
so
many
systemic,
so
much
systemic
issues
within
our
health
care
system
targeting
people
with
disabilities.
This
law
actually
provides
a
structure
and
a
framework
to
ensure
that
they
are
protected
and
actually
has
far
more
safeguards
in
place
than
any
other
end-of-life
care
option.
That's
out
there.
D
D
None
of
us
would
want
health
care
to
be
denied
by
this
becoming
an
option,
and
I
will
say
that
if
that
were
to
happen,
that
that
is
the
kind
of
court
case
that
compassion
and
choices
would
take
on
and
litigate,
because
we
want
people
to
be
able
to
have
this
option,
but
we
also
want
them
to
be
able
to
have
good
medical
care,
and
it
is
important
that
both
of
those
things
can
exist
at
the
same
time.
D
I
also
did
want
to
note
that
the
national
academy
of
sciences
two-day
conference
that
was
there-
I
actually
attended
that
and
I
spoke
at
it.
I
walked
away
from
that
conference
hearing
very
clearly
that
the
doctors
that
prescribed
and
were
practicing
medical
aid
and
dying
they
had
a
lot
of
people
that
came
in
from
california.
D
What
they
were
experiencing
was
that
the
law,
as
written
had
too
many
regulatory
roadblocks
in
place,
and
so
what
what
we've
seen
in
the
states
that
have
authorized
is
no
expansion
of
the
law.
It's
not
that
more
different
people
are
now
eligible
for
the
law,
but
you
are
seeing
lawmakers
begin
to
grapple
with
the
fact
that
you
have
about
a
third
of
people
who
died
during
the
15-day
waiting
period,
which
is
something
that
your
bill
does
address.
D
So
that's
what
the
outcome
from
that
conference
is
and
that's
what
the
statement
that
the
person
read
that
I
made
was
that
we
needed
to
find
that
appropriate
balance,
but
there's
been
no
expansion
of
medical
aid
and
dying
laws
to
different
populations.
They're.
All
designed
with
that
same
six-month
prognosis,
that's
tied
to
hospice
care.
I
could
go
on
because
there
were
so
many
different
provisions,
but
I
know
that
you've
been
at
this
for
a
long
time.
D
I
Assimilate
referrals
for
the
record,
madam
chair,
I
don't
believe
that
anybody
else
wishes
to
make
any
closing
remarks.
But
just
again,
thank
you
to
everybody
who
engaged
in
this
dialogue
and
thank
you
to
all
the
folks
who
helped
me
work
on
this.
A
Thank
you
at
this
time
I
will
close
the
bill
hearing
on
assembly
bill
351.
At
this
time
I
will
open
up
a
public
comment.
I
see
that
there
are
quite
a
few
people
on
the
line
for
public
comment.
I
know
that
this
is
a
policy
committee
and
a
lot
of
times.
We
will
disagree
on
policy.
A
I
would
ask
people
to
remain
respectful
and
civil
with
our
rules.
They
are
in
there
for
a
place
to
ensure
fairness
and
the
ability
to
have
as
many
people
on
the
line
that
we
can
hear.
I
will
remind
that
public
comment
is
not
a
place
to
rehash
the
bill
that
we
just
heard
assembly
bill
351
again,
if
you
have
concerns
in
support
opposition
or
neutral
of
assembly
bill
351.
A
I
strongly
encourage
you
not
only
to
reach
out
to
the
bill
sponsor
to
send
emails
to
the
health
and
human
services
committee
members,
as
well
as
your
own
state
assembly
representatives,
but
you
can
also
submit
those
comments
in
writing
and
they
will
become
a
part
of
the
public
record
if
you
do
so
within
48
hours.
With
that
we
will
begin
public
comment
and
at
this
time
again
I
will
remind
callers
to
please
clearly
state
and
spell
your
name
for
the
record
and
limit
your
comments
to
two
minutes.
B
A
Thank
you
again.
I
would
remind
people.
I
know
that
this
was
a
very
emotional
hearing
about
a
very
an
emotional
topic,
and
I
would
encourage
everyone
if
you're
willing
to
share
your
comments
either
in
support
opposition
or
neutral
of
this
bill,
to
do
so
in
writing
at
the
legislative
website
and
with
that.
Are
there
any
other
comments
at
this
time
from
committee
members?
A
With
that
I
will
adjourn
the
meeting
today.
There
isn't
an
agenda
up
for
friday,
but
I
do
anticipate
that
we
will
have
an
agenda
on
friday
at
1,
30
or
possibly
at
the
adjournment
of
floor.
If
there
is
floor
on
friday,
so
please
keep
an
eye
on
your
email,
so
we
can
make
sure
that
we
get
everyone
here
when
we
do
come
to
order
and
with
that
have
a
wonderful
rest
of
your
afternoon.