By Robert A. Milch
As proposed legislation regarding medical aid in dying (MAD) moves through the State Legislature, public discourse deserves clarity regarding just what the bill contains and portends. That discussion is not well served by the inaccuracies and distortions that have typified recent discussion.
The New York bill closely follows the templates of Oregon and Washington state, where MAD is legal and where we have years of data on which to draw. Oft-voiced concerns regarding inadequate protection against manipulation of disabled people or the “vulnerable” flies in the face of peer-reviewed experience.
For example, as of 2016, the Office of Disability Rights Oregon still has not received a complaint of exploitation or coercion of an individual with disabilities in the use of Oregon’s Death with Dignity Act.
But rather than continue with a point-by-point refutation of common concerns and allegations of inadequacy, here are some bullet points of what is actually contained in the bill. Requests for MAD pertain only to a terminally ill patient who:
• Has made both an oral and a signed request for medication to end life witnessed by two adults known to the patient attesting to capacity and non-coercion, one a non-beneficiary, one a non-relative, requisite forms attested to and signed.
• Has been assessed by an attending and a consulting physician, who have reviewed records, examined and interviewed the patient and documented their findings.
• Has been determined to have decision-making capacity.
• Has been determined to be participating voluntarily and has requested a prescription for medication with the purpose of dying from its ingestion by self-administration.
• Has been fully informed of diagnosis, prognosis and likely outcome of ingesting the requested medication as prescribed and self-administered.
• Has been informed of the alternatives for care, including palliative care and hospice, and the opportunity to rescind decisions or the request at any time.
Clearly, participation in this process – voluntary for both patient and physicians – leaves the patient “in charge” of decision-making and process, thus leaving one to wonder if any amount of oversight reassurance would satisfy those in opposition on pragmatic grounds. That said, claims that MAD benefits “only” a small number of upper-class, insured patients is a demagoguery of fact and is offensive on its face.
MAD, now legal in six states and the District of Columbia, is currently available to roughly 20 percent of the U.S. population and is under consideration in 20 other state legislatures. According to a 2015 survey of New York residents, 77 percent favor MAD for mentally competent terminally ill patients.
Those who do not endorse MAD, for whatever reason, need not choose it for themselves. However, denying it to others, for whatever reason, is no longer justifiable.
Robert A. Milch, M.D., is medical director emeritus at the Center for Hospice and Palliative Care.