A Victory in Hawaii

Yesterday, with the signature of Governor David Ice on the Our Care, Our Choice Act, the Aloha State became the 8th US jurisdiction to authorize Medical Aid in Dying.   After years of starts and stops, hopeful moves forward, followed by crushing disappointments, the voices of reason and compassion prevailed over fear and demagoguery.  And how quickly it came to pass in 2018.  A Hawaii House committee passed a bill on February 28, by a vote 4-1, and then the full House on March 6 overwhelmingly 39-12.  The jurisdictional Senate cCommittee passed the bill unanimously, followed by the full Senate 23-2.  Before signing the bill on April 5, Governor Ige stated

“Mentally competent, terminally ill people who are in pain and who are suffering should be even the choice to end their lives with grace, dignity and peace.”

A more complete description of the path that Hawaii’s Our Care, Our Choice Act took before enactment is provided here by Death with Dignity.org.

 

 

Orange County Dems Endorse MAID

At the annual Democratic Party convention of the Orange County Democrats, a resolution calling for enactment of MAID in North Carolina introduced by DRNC Executive Director Edmund Tiryakian, who is also a precinct chairman, was unanimously approved.  In past years, when a similar resolution was proposed, there were several opponents who made their case.  Yesterday, there was no opposition and several delegates spoke of their own very personal End of Life experiences with loved ones in emphasizing the need for this law.  The resolution will next be sent to the District Convention and if approved to the State party convention.OCDP2018

DRNC announces major conference on MAID: May 9, 2018 in Charlotte

DRNC is sponsoring an important conference on the future of MAID in NC.  Our  keynote speakers are Barbara Mancini, whose harrowing tale of being arrested in PA while trying to help her bedridden dying father shocked audiences when she was interviewed on 60 Minutes, and Atty Kathryn Tucker, the nation’s premier litigator of MAID cases. This conference, to be held at Center City on the downtown Charlotte campus of UNC-C, will bring together experts who will lay out the difficulties and challenges in trying to get North Carolina to joint the nation’s 6 other jurisdictions which have seen the wisdom of enacting legislation allowing a terminally ill, competent adult to get a prescription filled from a participating doctor which can be taken then at a time and place of his/her choosing, rather than dying in the cold and antiseptic environment of a hospital or nursing home.

Admission is free but the best seats are limited so please register early by calling (919) 452-9092 or (704) 775-2052.  Donations to the cause are greatly appreciated to help us cover the costs of the conference.

When Words Matter

A recent NPR radio summary of an angry protest in Belgium over a controversial euthanasia incident likely disturbed any number of unwitting US listeners.  The broadcast explained that a Belgian doctor had just resigned in anger and disgust from the country’s euthanasia commission after a dementia patient who never specifically asked to die was euthanized at the family’s request.  Understandably a number of other Belgian doctors were asking for an inquiry into the circumstances and whether protocols were followed.

What would have confused and upset US listeners was the radio announcer’s assimilation of Belgium’s “physician-assisted suicide” laws with the existence in several states in America of nominally similar, or at least similarly-sounding laws.  The implication was that people living in Oregon, Washington, California, Colorado, Vermont, the District of Columbia and any other jurisdiction so foolhardy as to go Belgium’s route could find themselves euthanized against their wishes!!!

And yet nothing could be further from reality.  The NPR broadcast did quite a disservice to those in America who have made clear that in no state is euthanasia legal or even seriously contemplated.  Unlike the situation in Belgium (and the Netherlands and Canada as examples), in the US only self-administration of an Aid-in-Dying drug is authorized in those few jurisdictions which have legalized Death with Dignity laws.  A doctor in California or Oregon who administers a lethal drug to a willing patient is still guilty of murder and could be prosecuted as such.

Belgian (and European) cultural attitudes towards End of Life are vastly different than those in America.  Patients in those countries overwhelmingly ask their doctors to administer lethal doses when they are confronting a terminal, incurable and intolerable illness.  In America, where self-reliance is a touchstone, we do not want to empower doctors to have that power.

Opponents of MAID use Belgium as the stalking horse for their slippery slope arguments.  However, they have used that argument for almost 20 years and no US state has even proposed to allow euthanasia, which is the administration by a third party of a lethal dose to a wiling patient, sometimes called mercy killing.  The two regimes, in Europe and America, are vastly different and the truth, which opponents consistently ignore, is never will the twain meet.

It is regrettable that the NPR broadcast of a tragic, but exceptional, event in Belgium, was so inarticulate as to cast confusion on a far safer, far more voluntary and far more foolproof approach in the US.

http://abcnews.go.com/Health/wireStory/death-dementia-patient-stirs-belgium-euthanasia-fears-53136682

MAID moves forward in Alaska, a Red State

On January 31, 2018 to the surprise and delight of many, an Alaska House Health Committee approved 5-2 a measure to enact MAID in Alaska, HB 54.

While several other states have seen the wisdom of allowing terminally ill individuals to request medication from their physicians which would mercifully end futile suffering at a time and place of their choosing, few typically GOP-leaning states have advanced the cause.  Alaska may be the first one, if the bill survives a full vote of the House and Senate and signature by Governor Bill Walker, currently registered as an Independent.  (The last time Alaska voted Republican in a Presidential race was in 1964 for Lyndon Johnson over Barry Goldwater.

While Montana, also a Red State, allows MAID, it was due to a decision by the Montana Supreme Court, and not through legislative enactment.  Colorado, a purple state, approved MAID through voter referendum.   The other states where MAID is authorized, OR, CA, WA, VT and DC, are reliably blue.

MAID is an issue which by its very nature transcends partisanship, as cancer, stroke and other terminal diseases are color-blind.  But the perception is that MAID is somehow a “liberal” concept, as it upsets medical orthodoxy.  The truth is that many Republicans who situate themselves on the libertarian spectrum of GOP politics are favorably inclined.

Success in Alaska would go a long way to dispelling the unfortunate assumption that only in Democratic-leaning states, can MAID legislation pass.

This is the essence of Dying Right NC’s mission– to work with both Republicans and Democrats in Raleigh to make NC the first Southern, Bible-Belt state to pass the legislation.

Alaska House Health & Social Services Committee Approves Medical Aid-in-Dying Legislation

When It’s a Matter of Days, Not Months

One of the more confounding reasons cited by opponents of MAID is the notion, that the timeline called for under the statutory enactments that two doctors believe the applicant is likely to pass within six months due to a terminal condition, is at best an unreliable, if not impossible guesstimate.  However, the statistics belie that incredulity, as the overwhelming number of individuals who are given six months by the best estimates of modern medicine do in fact unfortunately die more or less as predicted.

However, MAID is not just a recourse for those who do not want to spend half a year suffering, agonizing, bedridden, and deprived of life’s blessings.  Sometimes, it is the difference between a nightmarish last few days or hours and a peaceful, serene and even uplifting end.

Two recent articles highlight this notion.  In a recent New York Times op-ed by Karen Brown dated Jan 6, 2018 chronicling the sufferings of her father at the very end when hospice, otherwise such a stellar and indispensable addition to the End of Life options, failed leaving her in a mad scramble to get adequate pain medication.  We all need a fail-safe mechanism and having the ability to control one’s final destiny can indeed be the only thing separating us from a gentle passing or a horror show of terminal agony.  Who would want the last memories one leaves with loved ones to be of utter agony and screams.  Who would want their loved one to pass under such horrid circumstances.

https://www.nytimes.com/2018/01/06/opinion/sunday/hospice-good-death.html

Another recent example of when MAID can provide solace over a mere few days instead of months was brought to light by the tragic story of a 6-year old boy scratched by a rabid bat who was misdiagnosed until the rabies had spread into his system irreversibly and of course fatally.  If a human contracts the rabies virus and is not promptly treated, the disease will inevitably result in an excruciating death.  While MAID, where allowed by state law, is only accessible to adults, one can well imagine any number of situations where a human has but a few days at best to live and they will be nothing but delirium, agony and hell on earth.  For the patient and his/her family, MAID is a means to avoid an undesirable end in favor of a chance to pass peacefully.

https://urldefense.proofpoint.com/v2/url?u=https-3A__nypost.com_2018_01_15_6-2Dyear-2Dold-2Dboy-2Ddies-2Dof-2Drabies-2Dafter-2Dtouching-2Dbat_-3Futm-5Fcampaign-3Diosapp-26utm-5Fsource-3Dmail-5Fapp&d=DwIFaQ&c=JRU6Crajf79kKcplUJFHFfpcQ9GkS9xWLut8YRTooJY&r=NYWwqIRExyA_HyHOOJ4_UO1wQ8blO4sf1W23jTb8mNw&m=6iPYzRGx717fwvWD_33UtzCQ1d9MZGiHMT9Ua90DL_U&s=N-uBEI78ANsz-T4fgZVxkrlcH2KtLVhg6p296_IyLaQ&e=

 

We all know death is part of the human condition.  And we all know we all have a limited lease on life.  There will be times when death is a “maybe” in the near future, as when we go in for life-threatening surgery.  There will be times when death is more likely than not, when a soldier undertake a “suicide” mission at war.  And there are times when death is a near imminent certainty.  For those last few instances, MAID is a far better End of Life option than suffering pointlessly.

MAID is not the same as Suicide

Opponents of MAID are quick to mischaracterize the exercise as Physician Assisted Suicide.  It serves their narrative that a terminal patient seeking release from suffering, lack of autonomy, utter helplessness and futility in the face of the medically proclaimed inevitable should be viewed in the same prism as a vigorous young individual in excellent health who succumbs to a moment’s despair over a temporary setback.  Society has long held legal and ethical condemnations of suicide, enshrined in a Judeo-Christian tradition which views life as a gift from God, which only He can take back.

And yet society has evolved since those hoary days when a suicide brought such shame to a household, that a religious burial was impossible, life insurance policies were invalidated, and property of the decedent escheated to the state.  Today, it is accepted constitutional jurisprudence that an individual has a rich to terminate life saving medical treatment by pulling the plug on machinery keeping him alive.  Today, it is common practice for physicians, in concert with the patient but sometimes on her own initiative look to relieve suffering from such a potent, if not toxic, dose of morphine that death almost inevitably ensues.  These are considered routine hospital outcomes.

Slowly, experts in the filed are fighting back at the misnomer of Physician Assisted Suicide (“PAS”) as wholly inappropriate and misleading.  The American Public Health Association last year ruled that PAS should be avoided going forward in favor of the less problematic Medical Aid in Dying or Doctor Assistance in Dying.   And just this past month, the American Associate of Suicidiolgy whose mission is to study suicide in the hopes of preventing it ruled eloquently that Suicide is not the same as Physician Aid in Dying.

Their rationale follows and is worth a few moments’ study:

http://www.suicidology.org/Portals/14/docs/Press%20Release/AAS%20PAD%20Statement%20Approved%2010.30.17%20ed%2010-30-17.pdf

 

 

Debunking the Myths of Medical Aid in Dying

Among the many hoary predictions of MAID opponents is the notion that enacting Death with Dignity legislation will usher in a culture of suicide.  During the debate in the late 1990s in Oregon and Washington, one often read dire predictions that passage of the legislation would make those states suicide meccas and that soon the local medical communities would be swamped by folks availing themselves.  One prognosticator suggested that as many as 10% of all deaths in Oregon would be under the framework of the Oregon Death with Dignity Act.

Twenty years on, the data reveal outcomes vastly different.  Death with Dignity is very rarely used– in Oregon of the 25,000 annual deaths by cancer, for example, less than 200 individuals use the statute, or less than 1%.  And of course this exclude the thousands of others who die of terminal illnesses in the calculation.

The reality is that Death with Dignity is working just as its proponents suggested:  it is very rarely used, few doctors are called upon to participate, even fewer end up writing prescriptions, it has not engendered an increase in suicide among physically healthy individuals; it has increased recourse to hospice and palliative care; it has helped to take End of Life decision-making out of the closet and empowered people to exercise a modicum of autonomy when a disease is otherwise limiting outcomes.

A recent article in JAMA and UPenn Medical School make clear that Death with Dignity legislation does not lead to the nefarious consequences which its detractors predict, even today.

Read here

 

A few words from our M.D. Board Members

Our two Board members have recently been published arguing the logic and compassion underpinning Death with Dignity legislation, such as HB789.  Dr William Hazzard had his Letter to the Editor of the Winston Salem Journal published in early June in which he discusses the case of his sister Ra, who used the law in Oregon because of its unavailability here in NC.

Dr Hazzard’s op-ed

And Dr Haider Warraich, on the occasion of the British edition of his book Modern Death, published an excerpt in the Guardian detailing the travails of Karen Ann Quinlan who was perhaps the first public face of a terminal patient seeking redress through a compassionate death.

Dr. Warraich’s Guardian excerpt here

California’ End of Life Option Act: One Year In

On June 9, 2016 California’s version of Death with Dignity legislation (a/k/a Medical Aid in Dying), the End of Life Option Act, went into effect, following a contorted enactment over the course of several years.  Thanks in large part to the moving testimonial of 29-year-old Brittany Maynard to the legislature and to Jesuit Governor Jerry Brown, California became the 5th state (after Oregon, Washington, Vermont and Montana) to adopt a law allowing an individual to choose the time and manner of his/her death once diagnosed with a terminal illness, without the risk of criminal prosecution or civil judgment against the prescribing physician or pharmacist.

One noteworthy observation:  in its first year, California recorded 258 instances where the process was initiated.  There were 191 lethal prescriptions filled but only 111 people decided to ingest the medicine.  That suggests that as many as 42% of those who went through the application process to the extent of having the prescription filled, used the medicine not to end life, but to provide a sense of autonomy and control at a time when a disease has robbed them of almost everything which makes life worthwhile: hope and self-direction.

We shall see if California’s initial experience bears itself out going forward.  But after 20 years of data in Oregon, we can suspect this first year is not an aberration.  In Oregon, 38% of filled prescriptions under Oregon’s Death with Dignity Law are not used.  Again, individuals find comfort knowing that at hand they have a medical dosage which will quickly and painlessly accelerate the end if the pain or hopelessness becomes overwhelming.  Until that time, there is a sense of self control which in itself is a comfort.

You may wonder why this is worth contemplating.  In the 1997 companion cases of Washington v. Glucksberg, 521 US 702 (1997)  and Vacco v Quill, 521 US 793 (1997), Chief Justice Rehnquist, writing for a unanimous Supreme Court, sought to differentiate the withholding of medical treatment from the dispensing of a lethal dose of medicine.  Without the benefit of any data upon which to make an assessment, the Chief Justice wrote that a physician who withdraws care pursuant to an express patient demand “purposefully intends, or may so intend, only to respect his patients’s wishes”.  Whereas a doctor assisting suicide “must necessarily and indubitably intend primarily that the patient be made dead.”

This clearly is incorrect.  In the first instance in both cases, the doctor is merely “primarily respecting his patient’s wishes”.  Surely in both cases, the doctor would much prefer the patient be cured and healthy.  But the doctor is asked to provide a service: withholding medicine, “pulling the plug”, writing the lethal prescription.  Will the ultimate consequence be an acceleration of the inevitable death:  yes, in general.  But not all plugs pulled result in immediate death, not all withheld medicine will immediately kill the patient, and now we know, not all written lethal prescriptions will be taken.

The doctor writing a prescription under Oregon and California or any other state’s Death with Dignity laws can well anticipate that over a third, maybe 40% of his or her patients, will never take the medicine.  They will keep the medicine on their nightstand as a symbol of their last act of decision-making and destiny-determination.  At a time of hopelessness and despair, allowing a dying patient a modicum of autonomy and control might prove a liberating experience.

Justice Rehnquist pronouncement in Vacco v Quill has been proven in error.  It is important to highlight his mistake because Justice Gorsuch in his eloquent book against “Assisted Suicide” cites Justice Rehnquist approvingly.   Glucksberg and Quill are both ripe for reversal, given the evolution of the Death with Dignity movement across the country.  We now have further evidence contradicting the AMA’s refrain in opposition.

For more on the one-year mark in California Click here