Physician-Assisted Suicide Moves Ahead on Uncertain Path in NJ

Andrew Kitchenman | February 8, 2013 | Health Care
Death with Dignity Act could see changes before floor vote in Legislature

Claudia Dowling Burzichelli said she has struggled with a series of wrenching end-of-life situations.
New Jersey residents who are terminally ill are closer to being able to choose to end their own life with the help of a doctor.

But while a bill that would allow physician-assisted suicide with prescribed medication was released by an Assembly committee on Thursday, it faces a number of obstacles before it becomes law.

Legislators must decide whether to keep a provision in the New Jersey Death with Dignity Act (A-3328) that would require a statewide referendum on whether to approve physician-assisted suicide.

New Jersey would join Oregon and Washington as the third state to approve the measure through a ballot question. The Montana Supreme Court has allowed for judicially monitored assisted suicides.

Another major change being considered by lawmakers would require that a psychologist join a physician in evaluating a patient before approving life-ending drugs.

Even if the bill makes it through the Legislature, it faces a major hurdle in Gov. Chris Christie, who hasn’t taken a public position on the measure.

If the bill does advance, it will have survived at the center of a highly charged debate.

The personal stakes of each of the groups that have taken positions on the measure were on full display during a hearing on Thursday. Testimony focused largely on personal experiences with family members who faced terminal illnesses. It also showed a split among healthcare providers, with the state’s largest doctor’s group opposing the measure while others support it.

While bill supporters said they would attempt to incorporate suggestions from those testifying on the bill, it will be difficult to find a middle ground with opponents.

Assemblyman John J. Burzichelli (D-Cumberland, Gloucester and Salem) described the bill in a measured way, saying that it was legal “housekeeping” that raised aspects of other states’ laws for consideration in New Jersey. He said he wants to meet with all interested parties to propose amendments to improve the legislation.

“We’re early on in this,” Burzichelli said, who added that the bill “bubbled up through research” by legislative staff members.

Burzichelli said he had personally favored having the Legislature legalize the practice without a referendum, but agreed with legislative leaders to include the provision for a public vote.

“It’s a part of it as we presently stand,” Burzichelli said. “It’s designed to go to voter referendum.”

If the referendum provision survives the legislative process, the practice stands at least a fair chance of becoming law.

A Fairleigh Dickinson University poll in early December showed state voters backed physician-assisted suicide by 46 percent to 38 percent. Most of the difference stemmed from voters’ religious views, according to the poll.

However, most state residents said they hadn’t heard or read anything about the bill.

Before it goes to the ballot, it would go to the governor’s desk. Christie has sided with religious conservatives on some social issues, including abortion. But the governor hasn’t indicated his position on the assisted-suicide issue. While Burzichelli said he has had informal discussions with administration officials on the issue, he wouldn’t disclose what was said.

With the legislative fight expected to continue in coming months, the state’s medical community could play an important role. The Medical Society of New Jersey has sided with its national partner, the American Medical Association, in opposing physician-assisted suicide. National groups for women doctors and medical students have supported the practice.

Dr. Joseph Fennelly, chairman of the medical society’s bioethics committee, said that New Jersey faces different issues than Oregon or Washington. He said the state must move slowly on assisted suicide before addressing other problems, such the number of uninsured residents and the pressures that inhibit end-of-life discussions between patients and doctors.

“The best way to approach death with dignity is to assure that each and every patient receive appropriate care throughout their life,” Fennelly said.

The medical society’s chief operating officer, Mishael Azam, said several efforts are under way in the state to increase and strengthen existing end-of-life palliative programs that focus on reducing patients’ suffering.

“We just want to encourage improving palliative life, as opposed to this option,” Azam said.

The state’s hospices also oppose the measure.

The New Jersey Psychological Association supports the bill. Association member Virginia Waters said psychologists would be helpful in assessing patients’ mental health to help doctors determine who would be fit to have the option of deciding to take fatal drugs.

“It’s so important that we empower people in order to make a wise choice,” Waters said.

Burzichelli said he would consider the proposal to include psychologists in the process. He said “a significant number of our residents want the comfort of knowing they can have more control and choice when deciding what is best for them in facing their certain conclusion of their time on earth.” He emphasized that only a small number of people have chosen to end their lives using prescription drugs in the states where it is legal.

The debate over the legislation has been highly personal.

Bill supporter Claudia Dowling Burzichelli, the assemblyman’s sister-in-law, said she has struggled with a series of wrenching end-of-life situations, including her father’s suicide by gun while struggling with Parkinson’s disease and other diseases; the suicide of her husband’s friend by asphyxiation; and her mother-in-law’s struggle with terminal breast cancer.

Dowling Burzichelli was diagnosed with advanced lung cancer 18 months ago.

“It’s considered terminal. Don’t look up the statistics on the Internet – it’s depressing,” she said.

“I would hope that I would have more options than starving myself or taking my life in a violent way,” Dowling Burzichelli said. “I don’t know how I truly will feel when that time may come, but it comforts me to think there could be a process, a way to offer options that would not hurt my family.”

The assemblyman said his sister-in-law’s situation was not the driving force for his introducing the bill, and she said she first became aware of the measure after he introduced it.

The bill faces opposition from religious groups, including the New Jersey Catholic Conference.

Conference Executive Director Patrick J. Brannigan said he saw both of his parents die from prolonged illness, but that his mother benefited from hospice care, which assisted-suicide opponents support as an alternative.

Brannigan cited cases of residents who have lived for decades after being diagnosed as being terminally ill. He also said a provision of the bill that allows doctors to list the underlying terminal illness as the cause of death is disturbing.

“That statement legalizes a misstatement that borders on a fraudulent report,” Brannigan said. “The cause of death should be listed as self-administrated drugs that ended life. Why not tell the truth?”

An important supporter of the bill is Assemblyman Herb Conaway Jr. (D-Burlington), chairman of the Assembly Health and Senior Services Committee, which released the bill. Conaway said after the committee hearing that attitudes in the medical community may be evolving on the issue.

“As people become aware of an issue and think about an issue, their thoughts and feelings about it may very well change,” said Conaway, who compared it to evolving societal views of same-sex marriage.

“One of the things that so disturbs about some of the attacks we saw in the run-up to the passage of national health reform was the idea that mere discussions of end-of-life issues raised the specter of a death panel,” Conaway said. “We should all think about what we would want to do by way of self-determination.”

Conaway, a doctor, added that he may feel differently when faced with the situation, but that he currently would not take part in an assisted suicide because of the uncertainty involved in patients’ prognoses.

“I helped this bill get out of committee today, but there are a number of details that need considering,” he said, adding, “I don’t know that I would be involved in assisting a patient to end their life, but I recognize that there are physicians who will and that there are patients who will want to avail themselves of their right to self determination.”

The Senate version of the bill has been referred to the Senate Health, Human Services and Senior Citizens Committee but hasn’t been scheduled for a hearing.

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