New Jersey is poised to enact a law known as “Aid in Dying” which would allow terminally ill individuals who have less than six months to live to obtain medication they could take themselves to induce death.
But a handful of Republican lawmakers are concerned the law goes too far. Some are now pushing Gov. Phil Murphy for changes in the legislation, which he promised to sign after it passed both the state Assembly and Senate, on Monday. Another legislator said he will seek to ramp up the penalties for those who abuse the future law.
Democratic Assemblyman John Burzichelli, who has led the effort to pass the measure, said these issues have largely been addressed in changes to the bill text over the years. Supporters of the plan went further, calling the efforts to make further changes a cynical attempt by opponents to delay the law’s implementation, something that could prolong suffering for some individuals.
The bill has been under discussion for six years. “None of these discussions are new,” said Burzichelli (Gloucester), who compares the matter to abortion, suggesting it should be an available option, but not something anyone is forced to use. “We’ve studied this from every angle that you can study it from.”
The legislation is modeled in part on an Oregon law enacted 20 years ago, which has since been replicated in seven other states. It would enable physicians to prescribe a deadly cocktail of medication to patients in certain extreme situations; they must have a six-month prognosis, confirmed by two doctors, and go through a multi-step process to request the prescription. Patients would need to be able to take the drugs themselves; prescribers could decline to participate in the program; and anyone seeking to coerce a patient would face criminal prosecution.
Opponents’ main objections
Opponents of the concept — including some physicians and religious organizations —worry that the measure creates a conflict with a doctor’s sworn oath to save lives. Other fear it would encourage suicide or could be abused by family members seeking to ease their own caregiving responsibilities; a number of individuals with disabilities also opposed the measure on these grounds.
On Wednesday, Assembly members Christopher DePhillips (R-Bergen) and Serena DiMaso (R-Monmouth) sent a letter to the Democratic governor urging him to either veto the proposal outright or use his power to force the Legislature to revise the bill to include additional patient protections. These include requiring physicians to oversee the patient’s use of the deadly medication.
“There have to be extraordinary safeguards in place if we do something like this,” DePhillips said. “This bill is so impersonal and so disconnected from what doctors should be doing for patients,” he added.
A few hours later, Assemblyman Robert Auth (R-Bergen) announced he would introduce separate legislation to require a prison sentence of 25 years to life for anyone convicted of using an aid-in-dying law to intentionally harm patients; supporters of the measure say there is no evidence this has happened in other states that permit this practice. “These acts are tantamount to murder and should incur a penalty of a crime of the first degree,” Auth said.
On Monday, all the Republicans voted against the bill, which passed the Assembly with 41 “yes” votes — the minimum required — and 33 opposed; six members did not vote. While the issue split largely along party lines, religious beliefs also appeared to play a role, and at least half a dozen Democrats joined their Republican colleagues in voting against it.
Poll found majority of NJ residents were in support
But Burzichelli said that other members would have voted to support the plan, if needed; it also passed the Senate with a minimum of 21 “yes” votes; there were 16 “no” votes. A Rutgers-Eagleton poll conducted in 2015 showed more than 60 percent of state residents support the concept.
Shortly after Monday’s vote, Murphy made the unusual move of announcing his plan to sign the bill into law, calling it the “right thing to do” for terminally ill patients. “This measure is about dignity. Senator (Nicholas) Scutari (D-Union, the lead sponsor in his house) and Assemblyman Burzichelli should be commended for sponsoring this bill that will make us a more dignified and empathetic state,” Murphy said. His office declined on Thursday to address the Republicans’ suggestions for changes.
In addition to requiring a physician to be present, DePhillips and DiMaso want any law to require that patients undergo a psychological evaluation to rule out depression and they want language in the measure allowing prescribers to formally opt out of the program. They also requested changes to ensure insurance companies would not deny emergency care to individuals who had been prescribed the life-ending cocktail, and for hospice facilities to require an additional medical consultation for patients who are seeking this option.
“We feel strongly that these requirements will help ensure the lives of vulnerable residents are valued and protected,” the lawmakers wrote to Murphy.
Advocates for the bill questioned how well the Republicans had studied the measure. As approved, the legislation does call for a mental health consultation if prescribers have any concerns about a patient’s intentions and would permit the patient to have a physician — or family member — with them when they take the drugs, if they chose. Denial of care is already illegal, they note, and requiring a hospice provider to get involved would conflict with a patient’s desire to act on their own.
‘Cynical attempt’ to undermine the law
Corinne Carey, a regional campaign director with Compassion & Choices, a nonprofit that has led efforts to expand aid-in-dying legislation and other patients’ rights measures across the country, said the bill, as drafted, is “solid and sufficiently protective of patients’ safety and autonomy.” It includes “over a dozen important safeguards” and has been carefully vetted over the years, she said.
“The letter is a cynical attempt by lawmakers who would never have voted for the Medical Aid in Dying for the Terminally Ill Act to undermine the law, prevent terminally ill patients from using it, and put them in danger of suffering a needlessly painful death,” Carey added. (Carey was one of five experts who participated in an NJ Spotlight roundtable on end-of-life care, held last week.)
DePhillips conceded that he would much prefer Murphy to veto the proposal outright, but a conditional veto — requiring certain changes — would return it to lawmakers for another vote. Some of his discomfort with the matter is driven by his own experience with his father, who was given a cancer diagnosis and a six-week prognosis, only to live for another five years.
“Doctors don’t even want to give these opinions,” he said. “Often times they are at best an educated guess. That’s the problem with this thing: The entire bill rises and falls on these opinions.”