Nevada committee hears AB346 to allow medical aid in dying; debate focuses on safeguards and disability concerns

CARSON CITY — The Assembly Select Committee on End of Life Care spent more than two hours Thursday hearing testimony on Assembly Bill 346, the End of Life Options Act, a measure that would permit mentally capable adults diagnosed with a terminal condition to request and self-administer medication intended to end their life.

Assemblymember Joe Dahlia, the bill sponsor, introduced the bill and framed it around his father’s death, saying the proposal would give terminally ill patients “the freedom to write their own dignified ending.” Dahlia said he took up the legislation to continue work begun by former lawmakers and that the bill is aimed at people who are “suffering … largely doing so in silence.”

The bill’s lead explainers, policy advocate Elliot Malan and oncologist Charles Blanke, outlined provisions adopted from other U.S. jurisdictions that legalize medical aid in dying (MAID). Malan summarized requirements in the bill: patients must be 18 or older, have a terminal diagnosis confirmed by two practitioners, make two verbal requests and one signed written request, and be confirmed as mentally capable and free from coercion. He told the committee that “15 days is the most common waiting period” used in other states. Dr. Charles Blanke, who described his experience with MAID in Oregon, said MAID can provide relief even to patients who ultimately do not take the medication: “MAID offers benefits to many who don't even take the medication,” he said, citing Oregon data.

Why it matters: Proponents said AB346 would add an option for people experiencing unrelieved suffering at the end of life and built in reporting, documentation and conscience protections for practitioners and facilities. Opponents, including disability-rights advocates, religious groups and some physicians, warned of risks to vulnerable people, disputed the reliability of six‑month prognoses and urged the state to invest in hospice and palliative care instead.

Key provisions described to the committee included: mandatory verification by two clinicians of a terminal prognosis; two verbal requests and a signed written request witnessed as conditions to prescribe; a statutory form; confidentiality and an annual report to the Division of Public and Behavioral Health; a prohibition on conditioning care or benefits on whether a person requests or revokes a request; conscience protections for practitioners, pharmacists and facilities; and rules on disposition or destruction of unused medication. Malan said the bill would add a checkbox on the death certificate to record use of medical aid in dying while listing the underlying terminal condition as the cause of death.

Committee members asked practical questions about timing and logistics. Assemblymember Gonzalez asked how long it would take from a patient’s first request until they could obtain medication; Malan and Blanke explained the law’s waiting periods, the need for a second opinion and pharmacy filling times. On recordkeeping, Malan and Blanke said the attending physician would keep the written request and that the state typically requires submission of paperwork describing the attending and consulting clinicians’ findings.

Public testimony was divided. Supporters included the Nevada State Medical Association, which was represented by Dr. Sandra Koch and said its members “recognize that end of life choices … should be made with dignity, autonomy, and respect” and that polling showed majority support. Other supporters included Compassion & Choices, the Nevada Governor’s Council on Developmental Disabilities, hospice and palliative clinicians, end‑of‑life doulas and the ACLU of Nevada. Testifiers described personal experiences with loved ones in severe pain or prolonged decline and urged the committee to adopt the bill’s safeguards.

Opposition testimony came from disability‑rights groups (including Not Dead Yet), faith groups, several physicians and national and local Right‑to‑Life organizations. Opponents raised several recurring concerns: prognoses can be inaccurate, creating the risk that people with more time could choose to end their lives; economic incentives could pressure vulnerable patients; institutional and family coercion might occur; and laws in other countries have, in opponents’ view, later broadened access beyond the original eligibility criteria. Several disability‑rights speakers argued the bill could disproportionately harm people with disabilities and said the state should prioritize stronger hospice and community supports.

Procedure and next steps: Committee Chair David Ortlicker opened the hearing and set a 30‑minute block for each testimony category (support, opposition and neutral). No committee vote was taken at the hearing; the committee concluded its consideration of AB346 and accepted additional written comments for its record.

What the bill does not do: Under the bill as explained by presenters, a practitioner would not be required to prescribe the medication; a pharmacist or health‑care facility may opt not to participate; and only the patient to whom a medication is prescribed may self‑administer it, according to the provisions outlined during the hearing.

Stakeholder responses and concerns: Opponents repeatedly asked for stronger safeguards or withdrawal of the bill to allow more attention to palliative care and hospice funding. Supporters pointed to data from other U.S. jurisdictions and to statutory safeguards in AB346 intended to limit coercion and to preserve providers’ conscience rights. Several speakers urged the committee to consider amendments discussed during the presentation, including clarifying the death certificate and CPT‑code billing guidance for clinicians.

The committee will accept written testimony and exhibits for the record; no action was taken at the close of the hearing.