All seem to agree it is a worthy goal to ease the suffering of patients with deadly diseases who are reaching the end of their lives.
But there remain sharp divisions in New Jersey among healthcare providers, patient advocates and individuals with disabilities and their supporters over the role doctors should play in enabling those with terminal illness to take their own life.
State lawmakers took up the hot-button issue on Thursday. A Senate committee heard a proposal that would make New Jersey the eighth jurisdiction in the country to allow physicians to prescribe lethal doses of medication to patients of sound mind who had six months or less to live.
After an hour of passionate but closely timed testimony, the Senate health committee advanced the Aid in Dying for the Terminally Ill Act in a vote that split along personal, not political lines.
The legislation would require patients who met certain requirements to make multiple requests for the medication — including one request in writing, confirmed by two witnesses — and to obtain a second opinion. Patients should be able to administer the medicine themselves. The measure would protect the prescribing doctor from civil and criminal liability connected with the patient’s death.
Supporters: greater dignity, less suffering
Supporters insist the bill would allow patients on their deathbed new choices and an option for greater dignity and less suffering in their final days. They said data from other states suggest nearly a third of those who obtain the prescriptions do not follow through, and that there have been no reports of the program being abused to end people’s lives without their consent.
“The prescription that people are asking for is, quite simply, peace of mind,” said Kim Callinan, a New Jersey native and the CEO of Compassion and Choices, which is advocating for such laws nationwide. “This practice protects patients while giving them some level of compassion and comfort.”
Opponents, however — including a number of physician and religious groups — worry that “aid-in-dying” bills conflict with doctors’ mandate to save patients and that it diminishes the value of life in general. They call the measure “assisted suicide” and question whether it could lead to a rise in other self-inflicted deaths, points quickly challenged by supporters of the legislation.
And individuals with disabilities and their advocates, including Disability Rights NJ, are concerned such a law could be abused by caregivers who no longer want the burden or cost of caring for dependents with serious needs. The bill spells out criminal penalties for those who misuse the medications and stresses it does not authorize euthanasia or mercy killing, but opponents suggest that is little comfort.
Opponents: no real safeguards
“There is no way to assure the safeguards will be observed,” said Dawn Parkot, leader of the Climb Organization, a nonprofit advocate for disabled life issues, who spoke with the help of an electronic device. “Someone else can put the pills in the patient’s mouth. Someone else could put the drug in a feeding tube or feeding bag.”
Oregon was the first state to pass such a law, its Death With Dignity Act in 1997. The concept has since spread to a number of other western states, plus Massachusetts, Vermont and the District of Columbia. The U.S. Supreme Court has left the matter up to the states, according to a recent CNN report. Many of the laws make clear that while a physician may prescribe lethal medication under certain circumstances, they cannot take part in administering the drug.
In New Jersey, the controversial proposal dates to 2012; it has passed the full Assembly several times but was given little hope of becoming law under former Gov. Chris Christie, who opposed the concept. Gov. Phil Murphy, a Democrat, has not taken a position on the issue, but has supported many causes that failed to advance under his Republican predecessor.
The measure (S-1072) — sponsored by Sens. Nicholas Scutari (D-Union) and Richard Codey (D-Essex) — now heads to the full state Senate. An Assembly committee approved a companion measure late last year, with an amendment that required the patient designate someone to dispose of any unused medication, but must also clear that house before the governor could take any action.
Ensuring patient can change mind
As drafted, the measure contains language designed to give patients an opportunity to change their minds along the way. (Callinan, with Compassionate Choices, said that in other states many patients start but do not complete the process.) One thing the bill does not specify is what medications could be considered by prescribers.
Under the proposal, prescribers would be required to outline all the risks involved and discuss alternatives; if they suspect the patient is depressed or has psychiatric disorders, they must refer the individual to a psychiatrist, who must then sign off on any lethal medication. They must also encourage patients to inform their next of kin of their decision.
Despite any momentum on the legislation, significant disagreement remains in New Jersey on the role such laws can play in easing suffering. And the testimony on Thursday provided lawmakers divergent views not just on the bill, but on the underlying philosophical questions that inform the debate.
For example, what is suicide? Does the term apply when a terminally ill patient makes an informed decision to end a life that is already severely limited in terms of time and quality? Opponents of the bill said “yes,” but supporters of the measure insist otherwise.
‘…not the same as suicide’
“This is not the same as suicide,” said attorney Nona Balaban, who teaches bioethics at Monmouth University. “Suicide involves premature death. This is not premature.”
But the New Jersey Catholic Conference’s Pat Brannigan saw it differently. “We shouldn’t endorse suicide on any level,” he said, suggesting the law would send a “mixed message” to the public.
Balaban drew a distinction, however, noting that individuals who are suicidal are usually treated as though their judgment is impaired, and are urged to consider counseling or treatment. Terminally ill patients are in a different category, she said.
That’s not how the issue appears to Kristen Hanson, an advocate for the Patients Rights Action Fund, which opposes such laws. Her late husband became deeply depressed when fighting terminal brain cancer, she said, and might well have taken a deadly dose if it had been available. But he ended up living years longer than doctors originally anticipated, allowing him to enjoy the growth of one child and to father a second son.
“We saw how dangerous it was firsthand,” Hanson said.