Just parsing the emotional and moral challenges raised by physician-assisted suicide is a daunting task. For the terminally ill, it’s an opportunity to decide for themselves when they have suffered enough. But others argue that it can be used as a lethal weapon against the indigent, when treatment becomes “prohibitively” expensive. Doctors must wrestle with their Hippocratic Oath, which tasks them to “do no harm” — often balancing it against the needs and distress of patients. And some in the healing professions feel that death with dignity can be better achieved through other means.
As New Jersey ponders a bill that would legalize physician-assisted suicide, these questions become increasingly urgent.
Battle lines are already being drawn. The Medical Society of New Jersey opposes the bill, citing its support for alternative treatments for the end of patients’ lives, as well as the potential implications for medical ethics. The New Jersey Hospice and Palliative Care Organization is also against the measure, arguing that hospices provide appropriate care that could be better utilized than it is currently.
But the bill has also drawn support from healthcare professionals, many of whom cite their professional and personal experiences for backing the measure. And some national healthcare groups allow doctors to aid patients’ deaths, including the American Public Health Association, whose members range from social workers and nutritionists to doctors and nurses who design and implement public-health policies.
According to the bill, two different doctors must approve the decision. This includes determining that the patient is mentally competent to make the choice to die. The patients would be required to have a prognosis of fewer than six months to live and would administer the lethal dose of a doctor-prescribed medication themselves.
Medical Society of New Jersey senior manager for legislative affairs Mishael Azam said patients can already express their wishes about the end of their lives through advance directives or the practitioner’s orders for life-sustaining treatment (POLST). Advance directives allow patients to state how they wish to be treated when they reach a state of permanent unconsciousness, while the POLST lists a series of options for situations, such as when to remove a feeding tube, that have the force of a doctor’s order.
“We do believe that New Jersey citizens already have dignified end-of-life options,” Azam said.
She said patients could still have a sense that their autonomy is protected and provided for by using the existing forms.
“We think that dignity comes with advanced planning,” Azam said.
Dr. Joseph Fennelly, chairman of the society’s bioethics committee, said that New Jersey differs from the states that have approved assisted suicide, which include Oregon, Vermont, and Washington, in that it faces a greater shortage of primary-care doctors and psychiatrists who would have to take the time to determine if a patient is mentally competent to decide to die.
Fennelly also questioned whether giving individuals the choice to have physician-assisted suicide would benefit the broader society, as well as the medical profession, which has traditionally opposed harming patients as part of its ethical code.
“It’s a vocation and to protect that vocation … my plea is to take the time to let these things play out before we do it too impulsively,” Fennelly said of passing the bill.
But retired oncology nurse Janet Colbert, who is terminally ill with a rare liver cancer, said her 30-year career of working with dying patients has led her to feel that physician-assisted suicide is a necessary option for her and other patients.
“I have been at the bedsides of many, many terminally ill patients and there are good deaths and there are bad deaths at the end,” Colbert said, adding: “I personally would want the choice to be able to get prescription drugs to end my life sooner if I felt I needed to.”
Colbert said she would feel greater assurance if she knew after being told that no further treatment could improve her condition that her death could come quickly rather than lingering on for months. She noted that her health has allowed her to live far beyond her original prognosis, including giving her the chance to attend her son’s wedding.
“We lived our life and now we should have choices how we end it,” Colbert said. She added that until the bill is enacted, no one could guarantee that patients won’t live prolonged and painful deaths.
Colbert, 68, retired when she was diagnosed with the cancer in March 2013.
Jessica Grennan, national field and political director for Compassionate Choices — a national organization supporting the bill — said the organization supports offering hospice and life-sustaining treatments to patients, alongside the option of assisted deaths.
“It’s about choices,” Grennan said.
Opponents focused on different potential scenarios that could present problems if the bill is enacted.
Sister Patricia Codey, president of the Catholic HealthCare Partnership of New Jersey, which includes the state’s Catholic hospitals, expressed concern about the long-term implications of the law for low-income patients.
“If life-sustaining treatment is expensive, would a person be directed toward physician-assisted suicide if legal?” Codey said. “Do we as a state want to say we’ll pay for you to die but not for you to live?”
Codey urged the state to promote hospice and other end-of-life care as an alternative to the bill.
“The compassionate choice is to continue to provide and expand end-of-life care that considers the whole person — the mind, the body, and the spirit,” she said.
But Colbert said providing public support for healthcare for low-income residents is a separate issue from giving patients the ability to choose physician-assisted deaths.
“They should be getting the same healthcare that anybody gets,” Colbert said, adding that “end-of-life issues should be a top priority on everybody’s list.”
Colbert also responded to a point that Codey raised — that surveys show that lower-income people are less interested in physician-assisted death. “That’s because it’s a taboo subject” Colbert said. “That’s the whole thing — to get it out there, talk about it with people so everybody knows your wishes, so your doctor knows your wishes. And if your doctor doesn’t listen to you, you make them listen, or you find another doctor.”
Azam raised a separate concern related to the practical aspects of administering the lethal dose of medication. While the law provides for the patient administering the medication him or herself, Azam noted that this administration might not be successful.
“If that self administration doesn’t work, doesn’t the doctor then have to step in?” Azam asked. “Do they have to save the life or end the life?”
Azam added that the same dilemma would affect family members who are with patients in their homes, adding that those who “finish the job” for those who are unsuccessful in administering the lethal dose would be breaking the law.
The Assembly version of the bill, A-2270, which is known as the Aid in Dying for the Terminally Ill Act, was passed by the Assembly in a 41-31 vote last month.
The Senate Health, Human Services and Senior Citizens Committee heard testimony on the Senate version of the bill, S-382 or the New Jersey Death with Dignity Act, yesterday but didn’t vote on it. The committee will hold at least one more hearing on the bill, committee chairman Sen. Joseph F. Vitale (D-Middlesex) said.