A majority disagrees
There are so many pronouncements to take issue with in Sally White’s March 19 Adirondack Daily Enterprise letter to the editor that it is hard to know which is the most important to start with. The article reads as if it is not the patient but doctors, family members and an uncaring society that is making the choice for medical aid in dying, and when the patient does make the choice, it is due to fear of being abandoned. She further suggests that end-of-life legislation is more about societies saving money.
The one statement she makes that I do agree with is that we need more home care and nursing home services, but that hardly addresses the needs for physician-assisted end-of-life services.
Why are these passionate letters appearing now? As both Rev. Jeff Black and Dr. Sally White have indicated, a New York Assembly bill, A.4321 is in the legislature. This legislation would allow a mentally capable adult with a prognosis of six months or less to live to request an end-of-life prescription from their physician. The patient must make the request verbally and in writing. Two doctors must confirm the prognosis and that the patient is mentally capable of making medical decisions. Either doctor can request a psychological exam if concerned for the patient’s mental capacity. The patient must be able to ingest the medication on their own. Opponents often insist in calling this “suicide.” It is important to recognize, these are people who do not want to die; they are dying. They are not choosing dying; they are choosing a different way to die.
Polls consistently show that a strong majority of respondents across all demographic groups support assisted end-of-life legislation, whatever gender, age group, education, political affiliation or color, including those who attend church regularly. The results of a 2020 Gallup Poll further found that such legislation was supported by 70% of Catholics, 59% of Christians and 53% of Protestants. One in five Americans now has access to this end-of-life option, variously described as death with dignity, medical aid in dying, patient choice, control at the end of life and, in Hawaii, “Our Care, Our Life.” Proponents hope to be able to join Oregon, Washington, Montana, Vermont, California, Colorado, Washington, D.C., Hawaii and New Jersey in providing terminally ill patients this option. Ten other states have medical aid in dying legislation pending. Twenty other states have active volunteer groups advocating for legislation. Oregon has had this option available for more than 20 years, passed by ballot initiative in 1994. In all of that time in any of the states in which such legislation exists, there has been no substantiated evidence of abuse.
Dr. White titled her letter: “It’s not medical aid. It’s patient abandonment.” Far from dying abandoned, in all of the states in which medical aid in dying has been enacted, enrollment in hospice services has increased. It goes hand in hand with hospice care. Data from an August 2020 report from the National Hospice and Palliative Care Organization shows that New York is second only to Alaska in the lowest use of hospice services prior to death due to terminal illness.
Dr. White talked about the availability of relief from “intractable pain.” What is intractable pain?
From a number of medical sources I have learned that it is pain that cannot be controlled with standard medical care. It increases levels of stress and inflammation in the body and interferes with sleep, which increases inability to think and make decisions. The editor of the journal Practical Pain Management, reviewing the laws and regulations using the term “intractable pain,” wrote: “Pain that is excruciating, constant, incurable and of such severity that it dominates virtually every conscious moment, produces mental and physical debilitation, and produces a desire to commit suicide for the purpose of stopping the pain.” Additionally, due to the opioid crisis, government officials are calling for a crackdown on the use of prescription opioids for medical reasons. Although many states have intractable pain laws, physicians may be unwilling to risk violation of opioid laws. Opioid medication sufficient to relieve such pain often leaves the patient in a near or full comatose state that denies any interaction with loved ones or ability to make their needs and wishes known.
Whose are the voices we should be listening to about intractable pain or other experiences in the course of terminal illness? How about the patients and their family members? Compassion & Choices New York has a campaign program called “60 Reasons to Support New York’s Medical Aid in Dying Act.” Stories of patients, family members, physicians, oncology nurses and clergy are posted each day the legislature is scheduled to be in session. So far about 29 stories have been posted, including the stories of former New York Republican Assemblywoman Janet Duprey and Nancy Murphy of Vermontville, whose sister had a peaceful and celebratory death with family members and friends under Vermont’s End of Life legislation. These are stories that portray the actual experiences of patients, family members and caregivers. You owe yourselves the opportunity to read or hear those stories, which are posted on the Compassion & Choices New York web page. Compassion & Choices has additional abundant resources that provide full information about the campaign to pass this com medical aid in dying legislation.
I support compassionate, ethical commitment to a patient’s autonomy and do not believe that any group has the right to deny others the choice of medical aid in dying.
Phyllis Magnus lives in Saranac Lake.