Physician-Assisted ‘Aid in Dying’ Up for Debate Again in NJ

Lilo H. Stainton | October 5, 2016 | Health Care
Doctors, others raise concerns that helping terminal patients end lives violates their role as healers

suicide pills
If the ‘Aid in Dying’ bill is approved by the Legislature, New Jersey would be the sixth state to permit terminally ill patients to buy a lethal dose of prescription drugs to take their lives — and end their suffering.

But the controversial measure continues to raise ethical issues for many physicians who say the practice is “fundamentally incompatible” with their role as healers.

The ‘Aid in Dying’ bill gives capable adults with six months or less to live the ability to end their lives in a private, dignified way of their own design. The measure seeks to ensure both the patient and the prescribing physician only participate voluntarily, and it provides legal and other protections for doctors and others involved in the process.

While polls show that more than two-thirds of Americans support the concept, Garden State lawmakers have struggled for nearly four years to legalize the process. Although it never reached his desk, Gov. Christie has said in the past he would not support the measure.

But supporters said interest in this option continues to grow. On Thursday, the proposal (A-2451) is up for a vote in the Assembly appropriations committee, chaired by its longtime champion, the deputy speaker, Assemblyman John Burzichelli (D-Gloucester). A Senate version, led by Sen. Nick Scutari (D-Bergen) awaits a hearing, but gained a powerful sponsor, since Senate President Steve Sweeney (D-Gloucester) has also pledged his support.

“People’s opinions tend to evolve as they tune in and take time to think about things,” Burzichelli said Tuesday. “I think it’s a worthy public discussion to continue.”

Nationwide, five states currently allow medical aid in dying — Oregon, Washington, Montana, Vermont, and California, according to the Compassion & Choices campaign, which assists patients and advocates of such laws. (All states but Montana expressly prohibit the process from being called “assisted suicide” or “mercy killing,” which can be offensive to those involved.) Officials in Minnesota and Washington, D.C., are now considering similar laws.

In Oregon, where the program was established nearly a decade ago, a growing number of residents have taken advantage of the law and obtained a deadly prescription, but at least one in four don’t take the drugs. According to the latest report, 218 patients were issued these pharmaceutical cocktails last year and 132 took action; in 2010 some 97 people got prescriptions and 65 took them; in 2005 the figures were 65 and 38, respectively.

“We can get a lot of guidance from Oregon,” Burzichelli said. The fact that many of those who are issued these drugs eventually choose other options, like hospice, is important, he said. “These conversations around (end-of-life) care have ramped up significantly.”

For fatally ill individuals, faced with painful suffering, the choices are limited and often ugly, Burzichelli said. The bill seeks to give them a more human option, he said, and clarify the process for patients and providers, and to ensure that they make these decisions on their own, without the influence of family members or colleagues.

As drafted, the proposal requires patients to make two verbal requests to their doctor — at least 15 days apart — as well as a written request, which can be submitted simultaneously. The physician must wait at least 48 hours after the last request to issue a prescription. Patients can also articulate these wishes in advance, using a specific format that requires two witnesses.

The measure as now written places a number of responsibilities on the attending physician who is willing to write the prescription. The doctor is required to confirm the patient is terminally ill — defined here as in the final stage of an irreversible illness or condition that experts believe will kill them within six months — fully capable of making such a decision, and a resident of the state.

[related]In addition, the bill calls for providers to inform patient of the risks associated with the deadly prescription and refer them to hospice care or for psychiatric help, if appropriate. If mental healthcare is required, that provider must sign off before the original doctor can offer any drugs.

Finally, the plan insists physicians talk to patients about informing their next of kin about their plans, but requires them to follow through with a prescription even if the individual declines to consult with family members. It also calls on doctors to discuss with patients the best time, place, and circumstances to ingest the medicine, and discourage against its use in public places.

While some healthcare advocates have supported the concept, by and large physicians, hospice and palliative-care operators, and religious groups have opposed it. In testimony prepared for this week’s hearing, the Medical Society of New Jersey states: “Simply put, physicians should not be asked to cause or facilitate death in this manner.”

Like their colleagues nationwide, Garden State doctors believe terminally ill patients need support, comfort, quality care, and good communication, MSNJ said. Asking them to aid with death is “fundamentally incompatible with the physician’s role as healer” and would cause other risks to society, the group said.

Specifically, physicians are concerned that the proposal, as drafted, doesn’t define what drugs are to be used and fails to ensure the patient would be safe if taking these medications, MSNJ notes. If not administered in a proper facility, the process could go wrong, leaving the patient to suffer — and it’s not clear how authorities would be notified a death had occurred. In addition, it fails to provide proper controls for the lethal drugs, either before they are administered or for any left over after a patient dies.

If the goal is to ensure patients have control over their end-of-life care, other mechanisms already exist to protect these wishes, MSNJ explained. While neither permits patients to actively hasten their own death, advanced directives and Practitioner Orders for Life Sustaining Treatments (POLST) allow individuals to dictate their opposition to the use of artificial methods to keep them alive and interest in treatments that reduce pain and suffering.