Assemblymember & NY Alliance for Medical Aid in Dying Question Medical Society of State of New York “Survey”

Dying New Yorkers Suffer While Medical Society Bungles Survey on NY Doctors Opinion of Medical Aid in Dying

Apr 27, 2018 Corinne Carey New York Medical Aid in Dying Act

The lead sponsor of New York’s Medical Aid in Dying Act (S3151/A2383) and the New York Alliance for Medical Aid in Dying today called into question the methodology and lack of transparency of an admittedly “incomplete” survey of New York physicians conducted on the issue by the Medical Society of the State of New York (MSSNY). Preliminary conclusions released by MSSNY after its survey contradict the results of doctor surveys in other states and nationwide.

MSSNY’s new President, Thomas Madejski, unexpectedly disclosed preliminary conclusions from a MSSNY survey at a hearing held by the New York State Assembly Health Committee this past Monday in Albany. MSSNY was slated to review the results of the survey at its May 10 Council meeting to determine whether to reconsider its position on the issue. The second and final Assembly Health Committee hearing on the bill, sponsored by Assemblymember Amy Paulin (D-Scarsdale), is scheduled for this Thursday, May 3, in New York City.

The New York State Academy of Family Physicians has endorsed the legislation. Similar to laws in the District of Columbia and seven states, the New York legislation would give mentally capable, terminally ill adults with six months or less to live the option to request a doctor’s prescription for medication they can decide to take to die peacefully in their sleep if their suffering becomes unbearable.

Last year, when MSSNY’s House of Delegates voted to conduct a survey of physicians, then MSSNY President, Charles Rothberg, said: “The Medical Society of the State of New York unanimously passed a resolution to develop a survey to determine physician attitudes regarding medical aid in dying. MSSNY’s Bioethics Committee will assist in the development of an unbiased survey on this issue.”

Advocates applauded MSSNY for taking this step. Similar surveys conducted by medical societies in other states show a strong majority of their members support medical aid in dying, including Arizona (53%), Colorado (56% support), Maryland (54% support or neutral) and Massachusetts (60% support). Unfortunately, MSSNY’s new president, Dr. Madejski, did not live up to Dr. Rothberg’s promise of producing an unbiased survey.

This MSSNY survey of New York doctors was conducted via Survey Monkey (see survey questions posted at: bit.ly/MSSNYmaidSurveyQuestions); however, there was no process to ensure that only MSSNY members who are New York physicians completed the survey, a point Dr. Madejski conceded during his testimony, even while MSSNY has refused to publicly say how many people completed the survey, or publicly release the data.

At the hearing, Dr. Madejski testified about the survey [watch testimony just after 2:20:00 mark on hearing video: bit.ly/NYAssemblyHrgApr23 or read transcript: bit.ly/NYAssHrgTrans4-23-18]: “It was sent to our members. We are aware that there were other people who had the survey and that's part of why I'm not able to report more to you … [just before 2:20:00 mark] The survey is being analyzed. There’s some data there, but incomplete.”

Assemblymember Paulin, the lead Assembly sponsor of the Medical Aid in Dying Act, said: “I am deeply troubled by the idea that a survey that we know was accessible to people outside the membership of MSSNY and may have included results from people who aren’t even doctors was cited in the testimony we heard as lawmakers. What reassurances do we have that a survey meant to reflect the specific viewpoints of New York’s physicians wasn’t hijacked? I would like to see the results of the survey and learn more about its methodology.”

The New York Alliance for Medical Aid in Dying said: “Either release all the data or don’t talk about the data. And what exactly does Dr. Madejski mean what he says the data is incomplete? It defies logic that the MSSNY survey shows a majority of physicians oppose medical aid in dying when physician surveys both nationwide and in other states show strong support for this option to peacefully end unbearable suffering for terminally ill adults.”

A 2017 Medscape online survey showed nearly six in 10 doctors (58%) in states without medical aid-in-dying laws said they had “been in a situation where [they] wished the patient could have taken advantage of such a practice.”

Despite Madejski’s admission that data was incomplete and people other than MSSNY members may have participated in the survey, MSSNY claimed in a news release: “A large majority indicated that such a measure could have a negative impact on healthcare among racial/ethnic minorities and the physically disabled patient. Equally troubling, were physicians concerns that such a measure would have a negative impact on trust between the physician and patients.”

In fact, according to a 2007 Journal of Medical Ethics report about the 1994 Oregon Death with Dignity Act that is the model for the New York Medical Aid in Dying Act: “Rates of assisted dying in Oregon...showed no evidence of heightened risk for the elderly, women, the uninsured...people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations.” More recently, Disability Rights Oregon testified in 2016 that it: “has not received a complaint of exploitation or coercion of an individual with disabilities in the use of Oregon's Death with Dignity Act.”

Madejski also testified [just after 2:10:00 mark]: “Most physicians are deeply troubled by the potential abandonment of a patient by their physician at their time of greatest need of their physician’s skill and caring.”

Corinne Carey, New York Campaign Director for Compassion & Choices, said: “Physicians who respond to their terminally ill patients’ requests for medical aid in dying are in fact serving them in their time of greatest need. They are among the most compassionate of all doctors because they recognize this option peacefully ends intolerable suffering when no other treatment can.”

MSSNY concluded in its news release: “Based on the preliminary analysis of the survey results, it is not likely that MSSNY will change its position on this matter any time soon.” 

Laurie Leonard, Executive Director, End of Life Choices New York, said: “The idea that the Medical Society of the State of New York would do an important survey like this using an unsecured Survey Monkey link would be laughable if the potential consequences weren’t so serious. Until medical aid in dying is legalized, thousands of people will have to suffer unnecessarily at the end of their lives. Surveys using more advanced surveying techniques show that most American doctors are in favor of or neutral towards medical aid in dying, and a minority are opposed. A legitimate survey in New York would in all likelihood show similar preferences here."

Dr. Robert Milch, MD, FACS, Medical Director Emeritus of the Center for Hospice and Palliative Care in Buffalo, wrote to MSSNY: “I was profoundly disappointed by [Dr. Madejski’s] testimony. If we are to advocate for practice on the best possible evidence, I submit overwhelming documented, validated, replicated evidence indicates overwhelming support of medical aid in dying.”

Medscape has polled doctors nationally on medical aid in dying several times and in its most recent survey, 57 percent of U.S. physicians answered ‘yes’ to “Should physician-assisted suicide or physician-assisted dying be allowed for terminally ill patients?” Only 29 percent said ‘no.’ MSSNY leadership did not ask its members this question. And it is illogical to assume that New York doctors would radically differ from their national colleagues.

Peg Sandeen, Executive Director, Death with Dignity National Center, said:

“These are the very same scare tactics used in Oregon twenty years ago. Yet in two decades of flawless implementation there has never been a single case of coercion or fraud -- not one. What has happened is that hospice care improves, pain control improves and dying people have a more peaceful and dignified death. That a physician representing this state's doctors would stoop to such misguided, misinformed and made up tactics should surely be troubling to this state's lawmakers and voters. This is fear mongering clearly refuted by the facts all of the states with death-with-dignity laws have experienced.”