End-of-Life Choices Form Pushed as Alternative to Assisted-Suicide Bill

Doctors’ group wants program in which patients list choices beforehand to be given time before Legislature votes on controversial proposal

Debra Dunn, a registered nurse at East Orange General Hospital, spoke in favor of an assisted-suicide bill. She talked about the pain her husband endured last year in a four-month battle with a fatal cancer.
As state legislators wrestle with whether to approve a bill allowing physician-assisted suicide, the state’s largest doctors’ group is touting a new form guiding end-of-life medical decisions as an alternative.

The Medical Society of New Jersey said yesterday that the Practitioner’s Orders for Life Sustaining Treatment (POLST) form should be given more time to be adopted by doctors, hospitals and nursing homes before the Legislature considers assisted-suicide bill.

While the medical society has long opposed assisted suicide, representatives yesterday emphasized that the options available to patients through the POLST were a better alternative than what is spelled out in a proposed bill.

Legislative action regarding end-of-life decisions is occurring more quickly than the medical society would prefer.

After the Assembly Health and Senior Services Committee yesterday released the Aid in Dying for the Terminally Ill Act, A-2270 and S-382, sponsor Assemblyman John J. Burzichelli (D-Cumberland, Gloucester and Salem) said he believes that the full Assembly will vote on the measure and that it will advance in the Senate as well.

That would be a step further than the bill advanced in the last legislative session, when it was released by the committee but never saw a full Assembly vote or Senate action.

But Burzichelli added that with Gov. Chris Christie opposed to the bill, he sees the action this year as part of a long-term push to change state law.

Oregon, Vermont and Washington are the only three states that have legalized assisted suicide, although Montana courts have said doctors can cite the consent of patients to defend themselves against assisted-suicide charges.

Supporters of the bill argue that it’s needed to reduce patients’ pain and give people more control over how they die.

“We want to see this improvement in end-of-life care in New Jersey by providing terminally ill, mentally competent adults … and the people that they love … the opportunity to have a peaceful end of life, during a period of time in which their bodies and their souls are often ravaged,” said Mickey MacIntyre, chief program officer for Compassion & Choices, the largest organization supporting the bill.

But opponents argue that advances in pain treatment and palliative care give terminally ill patients the opportunity to die naturally without feeling excessive pain. Palliative care is a form of healthcare focused on managing patients’ symptoms, such as reducing pain and anxiety, rather than focusing on treating the underlying causes.

The POLST form, introduced in February 2013, is an order from the patient’s healthcare practitioner that must be followed by other providers, including paramedics. The form provides more specific information than advance directives, which often only name individuals authorized to make decisions if a patient becomes incapacitated.

“It’s so new that we’re not giving it a chance to be fully adopted,” said medical society CEO Larry Downs. “It’s going to take a few years.”

Downs added that his organization promotes the use of POLST among doctors.

“I think it will get there,” Downs said of widespread adoption of the form. “Let’s give that process a chance to work.”

State Health Commissioner Mary E. O’Dowd has made use of POLST and informed discussion of end-of-life healthcare decision-making a priority. She’s visited seven hospitals to discuss POLST, ordered creation of a new state website that deals with end-of-life care, and worked with the New Jersey Hospital Association on the issue.

The POLST lets outline their goals for care while listing their preferences for medical interventions, artificially administered fluids, and nutrition and cardiopulmonary resuscitation. For example, a patient can state that minimizing pain is his or her top goal, or that living as long as possible is their foremost concern.

The options available to patients at the end-of-life are much greater than in the past, opponents of the assisted-suicide argued.

“Let us work together to take advantage of the great advances in medicine and technology to provide better end-of-life care and improved pain management, to minimize and alleviate suffering — that should be our goal,” said Marie Tasy, New Jersey Right to Life executive director.

Most of the bill’s opponents were disabled people and their advocates, who said that allowing assisted suicide would pressure the healthcare system to reduce the amount of care available to terminally ill and disabled residents.

Healthcare providers are divided on the bill. While the medical society opposes the measure, the New Jersey Psychological Association and the state chapter of the National Association of Social Workers support it.

Bill supporters said they have seen loved ones face terrible deaths despite access to pain medication.

Debra Dunn, a registered nurse at East Orange General Hospital, recalled the pain her husband went through last year in the four months between when he received a cancer diagnosis and his death.

“We had many meds from hospice — he received morphine whenever he wanted, and that was not enough, it only took away the edge of the pain,” Dunn said.

Dunn said that even knowing that he had a choice of receiving assistance in his death “would have given him comfort and a sense of control.”

She said her husband said he wanted to die three times, and once asked their daughter after he woke from a nap if he was dead yet.

“Sadly, there was nothing we could do but watch him suffer,” she said. “His final months were nothing but torture.”

Burzichelli said he was open to “fine-tuning” the bill based on concerns raised by opponents. He changed its name from the Death with Dignity Act, adding that he didn’t want anyone to infer that any particular choice about death was more dignified.

Committee Chairman Herb Conaway Jr. (D-Burlington), a primary-care doctor, said he was confident that Burzichelli would address opponents’ concerns while maintaining that “people have the right of self-determination, really from the beginning of their life to the end of it.”

The committee released the bill on an 8-4 vote, with all Democrats supporting it and all Republicans opposed.

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