Medical assistance in dying: States debate right-to-die laws

A spring morning in Albany, New York, a group of people gathered at the Capitol to share harrowing stories of grief and suffering. They lit candles and read aloud the names of 22 people who lost their lives while waiting for their cause to be heard: the right to die “with dignity”.

Outside and in the same room, a small group of defenders emerged. They held signs and stood strong with their own message for lawmakers to hear: “Not dead yet.”

New York is one of several states where lawmakers have introduced bills to legalize physician-assisted dying, which allows doctors to prescribe life-threatening drugs to terminally ill, mentally capable patients with a six-month prognosis. or less to live – if they ask. It is currently legal in 10 states and Washington, D.C.

Proponents say these laws allow people to end their lives on their own terms, without the drug-resistant physical and emotional suffering that often accompanies terminal illnesses. Opponents argue it is a policy with little or no oversight that can lead to coercion of carers – and even the outright abuse of terminally ill people.

“Your Death, Your Choice”: The Case for Physician-Assisted Dying

Susan Rahn (photo courtesy of Compassion and Choices)

Susan Rahn of Rochester, New York, was diagnosed with stage 4 metastatic breast cancer in 2013. Doctors told her there was no cure and the median lifespan of her disease was d about 18 months, she said.

“At the time, my son was 14,” Rahn said in an interview with FOX television stations. “I was really terrified of not just leaving my son, but having him keep memories of my death. I didn’t want to do that.”

About a year later, Rahn learned about physician-assisted dying through Brittany Maynard, who was 29 when she was diagnosed with brain cancer and told her he would six months left to live.

After months of research, Maynard concluded there was no treatment to save her life – and due to the aggressiveness of the tumor, it would likely be a sudden death.

“Brittany said, ‘I’m not gonna die like this,'” Maynard’s husband, Dan Diaz, told FOX TV stations.

Maynard and Diaz packed up and moved from California in Oregon, one of four US states where medical assistance in dying was legal at the time. A few months later, Maynard shared her story on Youtube. More than 12 million views later, she has unknowingly become the face of the death with dignity movement.

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Brittany Maynard and Dan Diaz (Photo courtesy of Dan Diaz and TheBrittanyFund.org)

“It wasn’t his intention,” Diaz said. “She wanted lawmakers to hear her message…so that no one ever has to do what we did and leave your house with less than six months to live.”

Maynard took her own life on November 1, 2014. She died in her husband’s arms.

Rahn has yet to face this reality. She defied doctors’ prognoses with specialist treatment, but “at some point my treatment is going to fail and it will continue to run through my body until I have no treatments left”.

“I was really, really lucky,” Rahn continued. “It’s really unusual…I kind of live my life in six-month increments.”

According to data compiled by Compassion and Choices, the leading advocacy group for physician-assisted dying, in the more than 20 years since it has been permitted across the United States, 5,171 people have taken a prescription to end their sufferings. In Oregonthe first state in the nation to legalize it, 3,280 people have received lethal prescriptions since 1997. Of those, 2,159 took them as of December 2021.

Proponents argue that a third of people who get the prescription never ingest the pills and that less than 1% of people who die in each state use the law each year. The majority of terminally ill people who have used medical assistance in dying – more than 86% according to Compassion and Choices – received palliative care services at the time of their death.

Diaz said in most cases, hospice and palliative care can keep dying patients at least somewhat comfortable. But “it’s not 100%”, he said, and “the case of Brittany was one of them”.

“We can only do it once,” Diaz said. “We live this crazy life, this roller coaster, and we die once. Do I want my death to be filled with aches and pains that even morphine can’t relieve?”

“More harm than good”: the case against doctor-assisted suicide

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Aaron Baier, Executive Director of the Hudson Valley Center for Independent Living (photo credit: Julie Farrar)

If someone is diagnosed with cancer, but refuses chemotherapy, should a doctor help them die? Should people with mental illness anorexia nervosa be able to end their life with a prescription?

It’s questions like these that fuel opposition to physician-assisted dying, or what some opponents call “assisted suicide.”

“They give broad immunities to doctors and others involved,” said Diane Coleman, a disability advocate who founded the organization Not Dead Yet in 1996 to oppose physician-assisted suicide. “The only real data is reported by the prescribing physician; there is no meaningful monitoring.”

The American Medical Association has debated the issue for the past few years and has not changed its position: that ultimately, physician-assisted death does more harm than good.

“Six months or less is a prognosis,” said Matt Vallière, executive director of the Patients Rights Action Fund, a nonpartisan, secular organization opposed to physician-assisted suicide. “It’s a best guess from doctors, and those doctors will readily admit it’s not a hard and fast thing. They’re not very good at prognosis.”

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Matt Vallière talks to FOX TV channels

Vallière began lobbying against assisted death laws in 2012, when his home state of Massachusetts put the issue on the ballot for voters to decide. Polls leading up to the vote showed 70% approval, Vallière said, but on election day the measure fell short in a vote of 51% to 49%.

“That makes suicide a medical treatment,” he said. “It’s coded by your doctor, your insurance company. Your doctor, your pharmacist and your insurance are now involved. In some cases, your insurer will pay for this, while denying you coverage for other things.”

Lack of supervision could lead to tired and overworked caregivers giving patients medication against their will, Vallière said. He said it also allowed doctors to circumvent the requirements without consequence.

“You have to be proficient at the time of the request, not at the time of the ingestion. Not one of them requires a third party to be present at the time of the ingestion to ensure proficiency and it must be voluntary “, Valliere said.

Coleman, from Not Dead Yet, suffers from a form of muscular dystrophy and has been in a motorized wheelchair since he was 11 years old. She has been on life support for 20 years and still works full time.

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“People’s reasons for assisted suicide are disability issues – a loss of autonomy, the stress of not being able to do the same things, feeling like a burden on others. These are the kinds of concerns we understand very well,” Coleman said.

Coleman launched his organization in 1996, the same year Dr. Jack Kevorkian was acquitted of criminal charges of helping two women commit suicide in Michigan. It’s also the same year physician-assisted death went to the Supreme Court of the United States.

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American pathologist Jack Kevorkian seen in a November 2005 mugshot. (Photo by Kypros/Getty Images)

Coleman and other disability rights advocates warn that assisted dying laws can lead to unintended, life-threatening consequences that “create a change, a set of expectations in society and in a healthcare system. healthcare that already considers people like me a bit too expensive.”

“We have a lot of difficulty getting the services we need just to get up in the morning… Whatever we need is always a struggle,” she said. “The answer is to provide the supports we need, not to kill ourselves.”

Oregon Pioneers ‘Death with Dignity’

Oregon was the first state in the nation to allow physician-assisted dying after enacting the Death with Dignity Act in 1997. In March, it became the first state to eliminate residency requirements for patients seeking end-of-life care. Now, advocates say they will use the Oregon precedent to push other states to allow anyone access to assisted dying where it’s legal.

The new policy of Oregon was in response to a lawsuit filed by an Oregon doctor and Compassion and Choices, but the lawsuit focused on a specific grievance – that the doctor was unable to provide death-aid drugs to patients who he sees in neighboring Washington State. It won’t have much of an impact on people elsewhere who are looking for end-of-life medication.

Amitai Heller, senior counsel for Compassion and Choices, said people from out of state considering going to Oregon for assisted dying would have “quite a few challenges.”

“It’s extremely difficult for people who are dying to get on a plane, find a new primary care physician, establish a therapeutic relationship, manage logistics,” Heller said. “It’s extremely helpful for people to have this option, but it will only affect a small group of people who are able to travel.”

Where medical assistance in dying is legal

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Physician-assisted dying is currently legal in 10 states and Washington, DC:

  • Oregon
  • Washington
  • Montana
  • Vermont
  • California
  • Colorado
  • washington d.c.
  • Hawaii
  • New Jersey
  • Maine
  • New Mexico

Laws have been proposed in the following states, but have not been passed or enacted:

  • Nevada
  • Arizona
  • Kansas
  • North Dakota
  • Minnesota
  • Iowa
  • Indiana
  • Kentucky
  • Virginia
  • Pennsylvania
  • New York
  • Massachusetts
  • Connecticut
  • Rhode Island

In New York, where people like Rahn and Coleman are battling on opposite sides of an emotionally charged issue, the measure has been introduced multiple times since 2016. This year, the Medical Aid-in-Dying Act of New York never left the committee.

This story was reported from Seattle.