Opponents of the end-of-life care option for terminally ill patients to gently end their suffering, medical assistance in dying, say it is unnecessary because palliative care and care palliatives are sufficient to relieve the suffering of terminally ill patients.
But while palliative care and palliative care can alleviate the suffering of most terminally ill patients, as a physician I know that some suffer from extremely painful diseases, such as ALS and brain cancer, from ovary and pancreas, who need another end-of-life care option. : medical assistance in dying.
The reality is that medical assistance in dying does not replace palliative and palliative care, it enhances and complements them. Don’t take my word for it. Let’s review the data, evidence and experience.
- Medicare palliative care use nearly doubled during the last decade. Still, studies estimate that 65 to 85 percent of patients with advanced cancer (the most common diagnosis in terminally ill people who qualify for medical assistance in dying) experience significant pain that can be attributed to the illness itself or the treatment.
- Connecticut’s medical assistance in dying legislation, SB88, specifically requires the treating physician (i.e., prescriber) to inform the claimant of all of their end-of-life care options, including comfort care. , palliative care and palliative care.
- Annual reports from nine jurisdictions that have implemented physician-assisted dying laws show that the vast majority of terminally ill people use physician-assisted dying — more than 85% — received palliative care services at the time of their death. In Oregon, where the first national medical assistance in dying law came into effect in 1997, 98% of people who used medical assistance in dying in 2021 were receiving palliative care services at the time of their death.
- A survey of physicians published in the Journal of the American Medical Association on their efforts to improve end-of-life care after the passage of Oregon’s medical assistance in dying law, showed that 30% of responding physicians had increased the number of referrals they provided for palliative care. In addition, more than three out of four responding physicians (76%) have made efforts to improve their knowledge of pain management.
- A 2015 Journal of Palliative Medicine A study found that Oregon has one of the highest rates of palliative care utilization in the nation and the lowest rate of inappropriate palliative care utilization (very short enrollment, very long enrollment or de-enrolment). The study also found that Oregon’s medical assistance in dying law may have contributed to more open conversations between physicians and patients about end-of-life care options, leading to more use. appropriate palliative care. Additionally, after the Oregon law was passed, the healthcare community focused unprecedented focus on improving care for dying patients.
A University of Pittsburgh School of Law A 2019 report confirmed that the experience in jurisdictions where physician-assisted dying is authorized “puts to rest most of the arguments advanced by opponents of authorization – or at least those that can be settled by empirical data. The most relevant data—namely, that relating to traditional and more contemporary concerns voiced by opponents of legalization—does not support and, in fact, dispel opponents’ concerns.
Medical assistance in dying is not for all terminally ill people. People who use medical assistance in dying account for less than one percent of annual deaths in jurisdictions where it is permitted.
But voters are calling for this end-of-life care option: Three in four (75%) Connecticut voters support physician-assisted dying legislation, according to the GQR survey.
Connecticut residents who testified before the public health committee in February described the progression of their own terminal illnesses and the potential for a painful and difficult death.
I urge our legislators to consider the data, evidence, experience and strong public support for this end-of-life care option and pass it this legislative session.
Terminally ill residents do not have the luxury of endless deliberation; they need the relief that this law is giving them right now. Not a single additional person will die if you allow physician-assisted death, but far fewer will suffer.
Laura Belland, MD practices palliative and palliative medicine, geriatric medicine, and internal medicine at Yale-New Haven Bridgeport Hospital.