By Deborah Jeanne Sergeant
Medical professionals assisting patients in ending their lives sounds paradoxical. But groups such as Death With Dignity based in Portland, Oregon, want to see New York join them as a state that permits lucid, terminally ill patients to request a dose of lethal medication to take when they deem it’s the right time to die.
The proposed New York law, the Medical Aid in Dying Act (A995/S2445), states that to be eligible patients must have six months or less time left to live and must be capable of requesting medication both orally and in writing, as well as administering it themselves.
“Death with Dignity laws have been proven effective at improving healthcare quality at the end of life, regardless of whether or not an individual chooses to hasten their death,” the organization’s website states. “People travel from all over the world to access New York’s doctors and hospitals. New Yorkers shouldn’t have to leave the state to receive the care they need at the end of life.”
Amy Paulin (D-Scarsdale) is the chairwoman on the NYS Assembly Committee on Health who introduced the bill on Jan. 12, 2023. She believes that the bill “provides dignity in death and throughout one’s life,” she said. “It allows someone to make a choice when they know they’re going to die anyway to determine how that death would be carried out. It helps alleviate pain.”
Terminal patients can receive hospice services when their physician has determined they have six months or less to live. They can linger in hospice for months and die without loved ones nearby, a scenario for which Paulin feels a personal connection. Her sister received treatment for cancer, including surgery, but the cancer eventually metastasized. Her doctor said she had two weeks to live.
“She could either be up, aware and able to talk and in pain or take such sufficient morphine that she’d be comatose,” Paulin said. “She altered between the two. She had no ability to determine when the death would come, yet wanted friends and family around when it did. She died during Mother’s Day with her daughter there, but not the rest of us.”
Paulin said this caused much distress for her sister, whom Paulin said repeatedly screamed, “When am I going to die?” during her last days.
“She would have had all of us there if she had this medicine,” Paulin said.
Although unsure if her sister would have taken the medication, Paulin feels certain that it could have eased her sister’s anxiety about death, “which is worth a lot when you see a loved one dying,” Paulin said.
In Paulin’s legislation, medical assistance in dying (MAID), patients must receive a mental health examination to determine if they can make the decision and sign an affidavit, witnessed by a non-relative. They would have to be capable of self-administering the medication.
“We’ve seen examples in other states that very few people take that step,” Paulin said.
“However, many avail themselves of the possibility of taking that step. When you’re dying — and cancer is what we’re mostly talking about — you lose control. This allows you to get some of that control back. People don’t want to die. People who avail themselves of this medication don’t want to die. They choose life. It’s just that cancer and disease is saying something else. That’s why most people never use the medication even after they get the prescription. If they’re in such extensive pain and they know death is imminent, they can take the control back. That’s very valuable,” she added.
Diagnoses such as ALS and dementia are not included as the medication must be self-administered by a lucid person. Slow-acting diseases restrict movement or affect the mind would not be included.
Compared with a terminal cancer patient, “Alzheimer’s presents a very different situation,” said Geoff Sugarman, national political strategist for Death with Dignity in Oregon, views medical aid in dying (MAID). “When they get to the point where this would be what they want, they wouldn’t be able to administer it. We are not advocating for expansion for dementia or Alzheimer’s, as they’d be incapable of self-advocacy.”
He said that about 25% to 33% of patients who obtain medication for assistance in dying never use it.
“It provides peace of mind so they know they can,” Sugarman said. “There are laws about proper disposal.”
Sugarman does not foresee a “slippery slope” scenario where MAID laws morph into euthanasia for people who are elderly or disabled or any push for someone who is sick to request MAID.
“This has never happened in 26 years of the existence of these laws for fraud or coercion,” he said. “It’s never happened because safeguards in these laws. You have to be terminally ill and diagnosed by two physicians and qualify.”
Currently nine US states (California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont and Washington) and Washington, DC have MAID laws and Montana does through court ruling.
Right to Die in Canada Expands
In 2016, Canada’s medical assistance in dying criteria included only people with terminal illness. Five years later, it expanded to include incurable, but not terminal illness.
In March 2024, the law will also include people whose only condition is mental illness — one of the world’s broadest allowances for MAID.
“I don’t see this coming to the US,” said Geoff Sugerman, national political strategist for Death with Dignity in Oregon. “There’s no desire for our organization to expand to mental health. There are many kinds of suffering; this is for physical suffering who are on hospice and are suffering.”