Executive Director, Life Tree. org.
The NC legislature has before it two bills on assisted suicide, one to authorize it and one purporting to criminalize it. It is important to understand that the right-to-die movement contains two distinct groups, each of which supports one of the bills. This fact is important in explaining why BOTH of the bills that have been introduced in the NC General Assembly this spring are BAD bills which should be opposed.
One group known as the Third Path maintains a low profile but you can trace it back to Choice in Dying, later known as Partnership for Caring/Last Acts Partnership. After a well-publicized announcement that the group would disband in 2004 its members simply immersed themselves into several major national healthcare organizations.
A new collaborative designed to measure and promote grassroots sentiments for the Third Path, similar to Last Acts, was formed a few years ago. It is known as the Coalition to Transform Advance Care or C-TAC. You will be shocked to see the diverse membership of C-TAC representing an extensive range of healthcare organizations.
The Third Path Movement relies on two bookend pieces of legislation -- 1) it argues for legislation that will encourage patients to specify their goals of care and 2) it supports legislation that will relieve doctors and nurses of any exposure to criminal prosecution for hastening death.
In NC, the POLST form is known as the MOST form and it became law in 2007. It is a series of boxes for the patient to check that will indicate the level of medical treatment desired in four areas: A) CARDIOPULMONARY RESUSCITATION (CPR), B) MEDICAL INTERVENTIONS, C) ANTIBIOTICS, and D) MEDICALLY ADMINISTERED FLUIDS AND NUTRITION. The MOST form stipulates medical orders and overrides a health care power of attorney.
The other group is very high profile. Most of you are familiar with its main strategy to pass state legislation that legalizes assisted suicide. Their first success was in Oregon which passed a Death With Dignity Act in 1994. Vermont and Washington state have followed.
During Easter week House Bill H611 titled Enact Death With Dignity Act was introduced for the first time in North Carolina . Just the week before on March 30 Senate Bill S646 was introduced in North Carolina titled Unlawful to Assist Another to Commit Suicide.
There is some cause for relief for now as neither of these bills was acted upon before Crossover Day which was April 30. Neither bill should be viable going forward in the 2015/16 session. However, you can be sure that they will both continue to be introduced in future sessions of our legislature.
One might be tempted to support S646 by saying, "NC is one of a few states that has not passed such a ban! It's high time NC passes legislation to criminalize assisted suicide!" But be not so quick! It is more complicated than what meets the eye. Yes, there are two bills -- one which is obviously very evil and one which claims to outlaw that same evil. Unfortunately, as it is currently written, the second bill (S646) will legalize many, many cases of euthanasia.
First of all, it is worthwhile to note that there is already a basis here in NC to prosecute assisting in suicide without passing a statute. Assisting a suicide was specifically recognized in 1961 as a common law crime in North Carolina . See the NC Supreme Court opinion in Willis v State.
Second of all, the devil is in the details of S646. The bill contains exceptions which would give immunity to those who engage in death hastening by withholding or withdrawing medical treatment or by aggressive pain management or use of other medications that hasten death.
A little history about a similar bill to ban assisted suicide over a decade ago in NC might be helpful. LifeTree spent many hours at the NC General Assembly during the winter and spring months of 2003.
The exception language in Section 2 part (d) of S145 introduced in 2003 was complicated language that in essence legalized certain forms of euthanasia. Conveniently, so that history would not record the squabbles in North Carolina , the many other changed editions of S145 never appeared on the internet. But some history of the "give and take" is recorded in LifeTree's articles written during the debate which can be found by searching our website for "S145."
At the time, LifeTree argued against each of the bill's many revisions which still contained the two exceptions for withholding/withdrawing and the description of pain management. Then a revealing moment happened and the bill finally died in June.
The Carolinas Center for Hospice and End of Life Care objected to a version which had removed the exception for pain management. They killed the version of the bill which duplicated legislation designed by a special committee which had been passed in Michigan to stop Dr. Kevorkian. Death with Dignity's 2003 summer newsletter gave The Carolinas Center for Hospice and End of Life Care credit for stopping the bill.
Assisted suicide bans containing similar exceptions have passed in other states starting in the 1990s so you may ask why was LifeTree against such a bill and why wasn't there more controversy in the other states. I cannot answer the second question but I will tell you there are many pro-life organizations that support these bans on assisted suicide with safe harbor exceptions.
The high profile wing of the euthanasia movement insists there is no difference between withholding and withdrawing medical treatment and giving someone access to a lethal dose of barbiturates. The end result is the same...a hastened death. The low profile group argues otherwise.
After over 12 years of researching the Third Path movement we are certain that the exception language in these bills comes from the subtle wing of the euthanasia movement, the wing that says it is against assisted suicide but promotes death hastening tools such as the POLST/MOST form. 
That is why bills to ban assisted suicide usually contain at least two exceptions for withholding and withdrawing medical treatment and for prescribing pain management that hastens death, as long as the intent is not to hasten death. They rely on a misuse of St. Thomas Aquinas' Principle of Double Effect.
Withholding or withdrawing food and water (which is now said to be medical treatment) from patients who are not actively dying and who are in palliative sedation is labeled "natural death" by the Third Path. In reality, these hastened deaths are euthanasia.
For those who wish to dig deeper, LifeTree made public a timeline of raw data which describes the development of the Third Path Movement.
In case you wonder, simple language statutes to ban assisted suicide are possible and we recommend them. For example, read the Missouri law on assisted suicide: "A person commits voluntary manslaughter ... if he knowingly assists another in the commission of self-murder." (Simple language without exceptions).
LifeTree believes S646 can be amended to close the two major loopholes sought by the Third Path and would propose the following changes to the bill as presently written:
- Remove the word remunerative in the definition of assisted suicide. Comment: Assisted suicide can certainly occur without compensation to the assister.
- Add the following definition: " 'proper titration' means the lowest total opioid dose that provides adequate pain control with the fewest side effects."
- Drop the sentence that reads: "This section does not apply to withholding and withdrawing medical treatment." Comment: Given the definition of assisted suicide in the draft bill, this sentence is not applicable and is unnecessary.
- Change the remainder of the section on pain management to read: "Pain Management. - If there are no other medications or procedures available to relieve pain, then medications or procedures may be used even though they cause death, as long as the intention is not to cause death, proper titration of medicines is used, and consciousness is maintained as long as possible." Comment: These changes are necessary to control the misuse of the Principle of Double Effect.
We recognize the temptation is to jump on board to pass a bill that says it will criminalize assisted suicide, but we caution you not to react in haste. The subtle wing of the euthanasia movement was successful in passing the MOST form in NC in 2007 and now they are very serious about passing a companion bill that will relieve physicians and nurses of any anxiety over possible prosecution after carrying out the MOST form.
Because Crossover Day has passed, according to Senate rules this NC bill to ban assisted suicide with dangerous exceptions (S646) should no longer be viable. Now is the time to become better educated about these state bills to legalize withholding and withdrawing medical treatment and aggressive pain management that causes death while hiding behind the Principle of Double Effect.
Prayers to the Holy Spirit and to St. Joseph,
Elizabeth D. Wickham, PhD, lifetree.org, PO Box 17301 , Raleigh, NC, 27619
 See www.thectac.org/about/members/.
 A sample MOST for NC is found at http://www.polst.org/educational_resource/north-carolina-most-form/.
 See Edition 1 of S145 (2003/04 session) at http://www.ncleg.net/gascripts/BillLookUp/BillLookUp.pl?Session=2003&BillID=S145&submitButton=Go
 For a discussion on the development of the MOST legislation in NC written by those who drafted and promoted it go to www.ncmedsoc.org/wp-content/up/eeds/2014/02/final_most_manuscript.pdf . LifeTree was present at a March, 2005 meeting of the task force at the NC Medical Society and voiced opposition. By 2006 no further dissenting opinions were allowed to be expressed.
 See www.lifetree.org/timeline.
 For a better understanding of the legislative strategies of the Third Path see LifeTree's newsletters at www.lifetree.org/newsletter/archive.html and also Ione Whitlock's posts at www.belburyreview.com.