Melissa Wilcox has small-cell lung cancer, a very aggressive form of lung cancer. She and her sister, Laurie Wilcox, both retired nurses, were diagnosed with terminal illnesses — and both want to be able to control when and how their lives end.
“I’ve had the rheumatoid arthritis for 30 years, so it’s invaded my lung tissue,” said Laurie. “At the end stage of my disease I do not want to suffer through air hunger in the very last days of my life.”
In April, Gov. Phil Murphy signed into law the Medical Aid in Dying for the Terminally Ill Act, which allows terminally ill patients to self-administer medication that will end their life. The law went into effect Thursday, but getting the prescription is not a simple process, explained Dr. Deborah Pasik.
“The patient has to be, first of all, a New Jersey resident and has to prove that. They have to be an adult. They have to have a terminal diagnosis,” said Pasik. “They have to be of sound mind, as deemed by the physician.”
When necessary, the attending physician can order a mental-health evaluation to prove that the patient is of sound mind. And patients have to go through a formal application process.
“That has to be requested twice with a minimum of two weeks’ separation between the two requests. They also have to request it in writing,” said Pasik. “And then this written request needs to be witnessed by two people, and the people witnessing the request cannot be the patient’s physician and cannot be anybody that stands to benefit financially.”
Starting the conversation
New Jersey is the eighth state to enact the law. Oregon passed the law 20 years ago.
“What we’ve experienced in other states and what we expect to experience in New Jersey is that there’s not this massive flood of people that start on that initial effective date,” said Matt Whitaker, director of integrated programs at Compassion and Choices, an organization that lobbied for the law in New Jersey and in other states. “It just happens to be that, starting today, those conversations can begin to take place. And we know that typically they tend to take place just within the course of a person’s care.”
In fact, Pasik says that other end-of-life options end up being chosen more as patients learn about the medical-aid-in-dying option.
“As was demonstrated in Oregon, the institution of this law resulted over the years with more and more patients using palliative services for end of life. Not necessarily medical aid-in-dying, but hospice enrollment, palliative-care enrollment has gone up,” said Pasik.
“In Oregon, there was a study that came out that showed for every one prescription that was written, 24 other people started the process, meaning they started the conversation,” said Whitaker. “For them, raising this request opened up the first honest dialogue that they had with a clinician about what their hopes were, what their fears were, what quality of life meant for them.”
And in Oregon, of all the medical-aid-in-dying prescriptions written, about one third of patients end up not even using them. Advocates say just knowing they have that option gives them the comfort they need in their last days.