By Deborah Jeanne Sergeant
Medical professionals assisting patients in ending their lives sounds paradoxical. But groups such as Death With Dignity based in Portland, Ore. 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 patients must have six months or fewer left to live and must be capable of requesting the 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, 88th New York State Assembly District and chair on the Assembly Committee on Health, 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 may receive hospice care 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
“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.”
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.
For now, Paulin is working on persuading her colleagues and hopes to push full force for the bill when back in session in January.
Samuel Gorovitz, Ph.D. has served by gubernatorial appointment on the New York State Task Force on Life and the Law since 1988. He is a professor with SU’s Philosophy Department. He thinks the bill has a good chance of passing.
“A lot of people would choose to never end their own lives but don’t believe that other people should be denied that option under the sort of circumstances,” he said.
He described in the bill in New York as “very carefully crafted,” such as its provisions that no healthcare provider is obligated to participate and that it’s only allowable if all conditions have been met.
The concept of physicians “doing no harm” such as outlined in the Hippocratic Oath seems to contradict the idea of helping patients die.
“It’s not at all clear that a patient is harmed by being allowed to end a life which is more negative than positive,” Gorovitz said. “Indeed, many would argue that forcing someone to stay alive under some circumstances is perpetuating harm. Allowing people under specific circumstances to ending a life they wish to do so is not violating the ‘do no harm.’ It’s in the view of many people honoring it.”
He believes that many people want medical aid in dying (MAID) and that many people favor reproductive freedom.
“It’s a small minority of people who oppose making this available,” Gorovitz said.
He does not view MAID as a proverbial “slippery slope” into euthanasia.
“The empirical evidence relates that this is simply not true,” he said. “In fact, many people who have secured the right to end their own lives as they see fit, having secured it are greatly relieved by knowing they can do it as they choose, and then they don’t choose it. It empowers them with an affirmation of control in them rather than others.”
He believes that someone with a terminal disease that could linger indefinitely should have MAID as an option rather than eliminating the family’s resources.
“We’d never want to see pressure on someone to accelerate the ending of life because someone else wants access to the money,” he said. “On the other hand, it does make sense I’d never want my own life prolonged thwarting my desire to leave a bequest to the philanthropies I support and my grandchildren.”
The only drawbacks he can find to Paulin’s legislation is that it’s not liberal enough, noting that someone who has experienced a stroke may be completely lucid, but unable to speak. That person would not qualify.
“It is a very cautious, carefully crafted and quite conservative and safe piece of legislation,” Gorovitz added.
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.”