Allow modern medicine to relieve agonizing end-of-life experiences

December 25, 2017

The following op-ed appeared in the Hill on December 25, 2017:

In early November, doctors in Europe used gene therapy to save the life of a boy who had a genetic disease that had destroyed most of his skin. Fortunately, we as a society regularly benefit from the miracles of modern medicine — that is, until we are about to die. Then our laws and medicine unnecessarily fail us.

In 44 states, society says to dying people and their families, “I understand you have used medicine for decades to extend your life; however, no matter how much you suffer you may not use medicine to peacefully die.”

This palliative care option, known as medical aid in dying, allows mentally capable, terminally ill adults with six months or fewer to live to request a prescription medication they may decide to take to die gently in their sleep if suffering becomes unbearable. Sure, we allow people access to other forms of palliative care. Yet those cannot alleviate every patient’s agony. Sadly, our approach to death has not kept up with our progress in medicine, and as a result people suffer needlessly.

Furthermore, the U.S. House of Representatives recently passed an appropriations bill (H.R. 3354) that included an amendment to repeal D.C.’s Death with Dignity Act.

In addition, some House members have introduced a concurrent resolution opposing medical aid in dying nationwide and in particular in the currently authorized jurisdictions including CaliforniaColoradoMontanaOregonVermont and Washington, as well as the District of Columbia.

Why are some members of Congress and state legislators trying to deny Americans this peaceful end-of-life care option?

Personal religious objectionsMisinformationIrrational fear of change. These are the conclusions that I have reached after reading extensively, testifying before state lawmakers and debating opponents on the topic of medical aid in dying. The arguments against this humane medical option often are based on objections raised by some religious leaders, despite polling showing most people of faith support medical aid in dying. Below is the typical line of questioning and assertions by opponents whose concerns stem from misinformation and irrational fear of change.

Won’t legalizing medical aid in dying result in greedy relatives offing vulnerable people to get at an inheritance?

No. Coercing somebody to use medical aid in dying is a felony punishable by criminal prosecution. Furthermore, the laws in authorized states include strict eligibility requirements and more than a dozen regulations to protect the patient.

The dying person must be terminally ill and mentally able to make an informed healthcare decision with a prognosis of six months or fewer to live.

Two doctors must confirm the eligibility requirements and that no coercion exists; the person must make the request at least twice verbally and also in writing; multiple witnesses must confirm that the patient isn’t being coerced; and the patient must be able to take the medication themselves. This is why the combined 40 years of experience with medical aid in dying across seven jurisdictions includes not a single instance of misuse.

How can you say that there has never been an instance of misuse?

The evidence from Oregon and other authorized states confirms that the more than a dozen steps it takes for a dying person to obtain a prescription effectively protects the patient from misuse of this option. In fact, Disability Rights Oregon, whose mission is “to promote and defend the rights of individuals with disabilities,” testified last year that it has never received a single complaint about the Oregon Death with Dignity Act.

While the practice benefits many, as studies confirm that merely knowing the option exists brings about peace of mind for dying patients, the evidence also shows that very few people will choose to use the law. In 20 years since the law took effect in Oregon in 1997, fewer than 1,800 prescriptions have been written. Fear of misuse is completely unfounded.

How can we as lawmakers authorize a practice that is going to result in even one person dying before their time?

We have now entered the territory of irrational fear of change. In states where medical aid in dying is not authorized, people are actually more vulnerable to coercion and abuse because there are no safeguards to protect the patient.

But dying people do often kill themselves with guns, jumping from balconies and other violent means when they are desperate and lack medical options. The status quo causes many premature deaths because people use violent, readily available means rather than risk unbearable suffering. When people know they hold the means to prevent their worst nightmare of suffering, they endure more than they thought they could.

That’s why every year more than one-third of Oregonians who obtain aid-in-dying medication never ingest itWith their fears put to rest, they die naturally, usually at home with hospice care. Authorizing medical aid in dying more often prolongs lives than shortens them.

But if we authorize this practice isn’t it only a matter of time until the law will be expanded to include other less-desirable practices?

We have now officially reached irrational fear. First, the law has been practiced in Oregon for 20 years without any misuse. In addition, we as a society cannot refuse to enact good public policy over a fear of unknown laws that some future body of legislators might pass.

A lawmaker’s job is to evaluate and vote on the legislation before them and decide whether there is a public policy benefit to the law. The evidence is conclusive that medical aid in dying is good public policy. In addition to the benefits to the dying person and their family, evidence also shows that these laws have likely contributed to improvements in care, including better conversations between doctors and patients about end-of-life options, increased hospice use, and decreased hospice misuse.

It’s hypocritical to use medication to extend life but then deprive dying patients of that same tool to help shorten a painful dying process. It’s time we allow the miracles of modern medicine to relieve an agonizing end-of-life experience — if that is what the patient would like. Not a single additional person will die as a result of the law, but fewer people will needlessly suffer.

Kim Callinan is the chief program officer for Compassion & Choices, an organization devoted to patient-driven end-of-life options and care.

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