Medical Aid in Dying: A Primer for Candidates

Section I: Introduction

Attention Candidates!

This brief resource is designed to provide up-to-date, reliable information about end-of-life care options for those seeking political office. 

For most candidates, expanding healthcare options for dying people is a winning issue with supermajority support from voters, as proven by numerous years of polling. 

Voters in your district are asking lawmakers to allow another end-of-life care option — medical aid in dying — and listening to their concerns is the first step to honoring their requests and winning your election. Along with containing detailed polling data and other resources, this guide will provide you important information to discuss medical aid in dying on the campaign trail

You will quickly find that medical aid in dying is not a traditionally partisan issue. The idea that terminally ill individuals should have the option to peacefully end their suffering in the face of certain, near-term death resonates with large majorities of voters across all political parties. Americans value privacy and freedom from government intrusion, especially concerning their healthcare decisions at the end of life. 

This is fundamentally a role-of-government discussion. Government’s role is to protect me from you and you from me. It is not to protect me from myself.
– Senator Chas Vincent (R-Montana)

Medical aid in dying first emerged on the national stage in 1994 when Oregon voters passed the Death With Dignity Act ballot initiative. The U.S. Supreme Court upheld the law in 1997, leading to the enactment of similar laws in a total of 10 jurisdictions across the country. Medical aid in dying laws were passed by ballot initiative in Washington (2008) and Colorado (2016); and through the legislature in Vermont (2013), California (2015), the District of Columbia (2017), Hawai‘i (2018), New Jersey (2019), and Maine (2019). The Montana Supreme Court authorized medical aid in dying (2009) in response to a lawsuit filed by Compassion & Choices on behalf of a terminally ill Montana truck driver, Bob Baxter.

As a candidate who supports medical aid-in-dying legislation, you are in good company. In 2018 and 2019, a total of 350 lawmakers sponsored or co-sponsored legislation in at least 21 legislatures, in every region of the country, including the Bible Belt, the Midwest and both coasts.

Since 2019, medical aid in dying has received unprecedented (and overwhelmingly positive) media attention across the country, including extensive state and local print and broadcast coverage. In states where medical aid-in-dying laws are being considered, newspaper editorial boards consistently endorse the legislation, including The Frederick [MD] News Post, The [La Plata] Maryland Independent, The Calvert [MD] Recorder, The [Northampton, MA] Daily Hampshire Gazette, The Berkshire [MA] Eagle, The North Jersey Record, Burlington County [NJ] Times, The Press of Atlantic City [NJ], [Middletown, NY] Times Herald-Record and The [Harrisburg, PA] Patriot-News.

Major national outlets have also editorialized in support of medical aid in dying, including The [Newark] Star-Ledger/NJ.com and The Washington Post.

The clear trend toward more states adopting aid-in-dying laws has been covered by state policy outlets, such as Pew Stateline News, as well as mainstream news outlets such as USA Today and The New York Times.

We hope your campaign joins popular opinion and embraces end-of-life care options as an important issue that enhances your ability to connect with families and constituents. We found in the 2018 elections that voters will reward a courageous stand in favor of allowing a person dying from a painful disease the option to peacefully end their suffering on their own terms. In fact, 93% of primary medical aid-in-dying bill sponsors won their primaries, and 99% won general elections. 

It serves no one — the patient, the medical community, or society at large — to deny patients the opportunity to consider this option and whether it is right for them.
– Delegate Terry Hill, MD (D-Maryland)

Section II: Public Opinion

A Winning Issue

Whether you are a candidate running for office or a voter trying to understand the news, few things are as confounding — and beguiling — as public opinion polls about social issues. One best-practice approach is to look at how an issue polls over time from a variety of sources, across demographics, and at both the national and state levels. From this perspective, medical aid in dying clearly commands long-term, bipartisan majority support among American voters nationwide. 

Majority support for medical aid in dying has been broadly reliable across a range of differently worded questions and demographics.

In May 2020, an annual Gallup poll showed that 74% of U.S. residents agree that: “When a person has a disease that cannot be cured … doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it.” Majority support included every demographic group measured in the survey, including men: 75%, women: 73%, whites: 77%,  people of color: 65%, age 18-34: 77%, age 35-54: 79%, age 55+: 68%, college graduates: 79%, some college education: 70%, high school graduates or less education: 71%,  Republicans: 69%, independents: 72%, Democrats: 85%, conservatives: 57%, moderates: 80% and liberals: 87%. To find out more, visit: CompassionAndChoices.org/resource/polling-medical-aid-dying/ 

A 2016 LifeWay Research online survey found that two-thirds of Americans (67%) agree that: “When a person is facing a painful terminal disease, it is morally acceptable to ask for a physician’s aid in taking his or her own life.” Majority support included most faith groups, including Christians (59%), Catholics (70%), Protestants (53%), those of other religions (70%) and those who identified as non-religious (84%).

After nearly two decades of public debate and years of detailed polling data, it is clear that a broad majority of American voters support legislation to authorize medical aid in dying. It is not a fad; it is a growing long-term trend. Americans as a whole increasingly view medical aid in dying as a personal decision and an issue of individual autonomy that our laws should honor. 

Many voters are demanding authorization of medical aid in dying, and lawmakers are noticing. With widespread public support for end-of-life autonomy, more state legislators will respond to their constituents’ preferences and cast their support for this compassionate end-of-life care option. 

Section III: Language Matters

How to Talk About Medical Aid in Dying

As a political candidate, you know how important it is to have an elevator pitch to get your point across quickly. In some cases, you may have the opportunity to delve deeper into an issue. It’s normal for people to ask questions about an issue, and your thoughtful answers will help solidify their support. Here you will find facts to help answer common questions about medical aid in dying. Make a mental note of the language to ensure objective representation. 

Elevator pitch: Medical aid in dying allows a terminally ill person with six months or less to live to say to their doctor, if there is no hope for a cure and my suffering becomes unbearable, I’d like the option of taking medication that will allow me to die peacefully on my own terms.

Medical Support

Many leading national professional medical associations support medical aid in dying because it empowers physicians to respect their patients’ wishes for end-of-life care. The American Public Health Association, the American Academy of Family Physicians, the American Medical Women’s Association, the American Academy of Neurology and the American Medical Student Association have amended their policy stances on medical aid in dying to neutral or supportive. Also, a Medscape survey of U.S. physicians in December 2018 found that a majority (58%) of doctors now support medical aid in dying.

On June 11, 2019, a new policy position recommended by the Ethical and Judicial Affairs (CEJA) Council (CEJA 2-A-19 Report) was adopted by the American Medical Association. For the first time, the AMA affirmed that physicians can provide medical aid in dying “according to the dictates of their conscience without violating their professional obligations.” 

In the past few years, many state medical societies have shifted their official medical aid-in-dying policy stances to neutral or supportive. This group includes the Connecticut State Medical Society, Delaware Section of the American College of Obstetricians and Gynecologists, New Mexico Medical Society and the Hawai‘i Society of Clinical Oncology (HSCO). In 2018, the HSCO stated in its resolution that “HSCO is committed to protecting its members’ freedom to decide whether to participate in medical aid in dying according to their own values and beliefs. This decision should be between the physician and their patient.” 

The “S” Word

Medical aid in dying is not assisted suicide. It is critical to accurately describe this medical option that dying people can access to peacefully end their suffering. Dying people who consider using medical aid in dying find the suggestion that they are committing suicide deeply offensive, stigmatizing and inaccurate. Many of them have publicly expressed that the term is hurtful and derogatory to them and their loved ones. Many medical groups agree, reject the pejorative term “assisted suicide” and have adopted the term “medical aid in dying.”

The American Association of Suicidology (AAS), comprised of respected researchers and mental health professionals, is a nationally recognized organization that promotes prevention of suicide through research, public awareness programs, education and training In 2017, AAS wrote a position paper stating that “The AAS recognized that the practice of physician aid in dying … is distinct from the behavior that has traditionally and ordinarily described as ‘suicide,’ the tragic event our organization works so hard to prevent.”

The assisted suicide statutes in many states are not intended to prohibit medical aid in dying, because most of them were passed long before medical aid in dying was even a concept. They are designed to stop people from helping mentally unbalanced, despondent people kill themselves. Suicide occurs when an individual chooses death over life. Neither the statute nor the term “assisted suicide” accurately applies to terminally ill people who want to live, but given their imminent death, decide to die peacefully. State laws authorizing medical aid in dying clearly state they do not authorize assisted suicide.

To learn more visit:

compassionandchoices.org/about-us/medical-aid-dying-not-assisted-suicide/

Faith

Medical aid in dying isn’t about playing God or trying to control nature; it’s about honoring a dying person’s decision to peacefully end their pain and suffering. Notable religious leaders support medical aid in dying because they believe God doesn’t want people to suffer; their support for end-of-life care options is rooted in their faith and not in conflict with it.

Archbishop Desmond Tutu expounded: “I have been fortunate to spend my life working for dignity for the living. Now I wish to apply my mind to the issue of dignity for the dying. I revere the sanctity of life — but not at any cost … People should die a decent death. For me, that means having had the conversations with those I have crossed with in life and being at peace. It means being able to say goodbye to loved ones — if possible, at home.” 

Similarly, retired Episcopal Bishop Gene Robinson reasoned: “There is nothing innately good about allowing ‘nature’ to take its course in a prolonged and painful journey to an inevitable death. It doesn’t make you a better person because you endured the indignity and trauma of it. You don’t get extra stars for it … Shouldn’t the right to end one’s life also be provided for those [terminally ill people] who would choose it?” 

Remember, an inclusive approach is always best. Our country is built on respect for religious diversity. We should respect and honor differing opinions and beliefs when discussing end-of-life care options. 

Protecting vulnerable populations 

There is simply no evidence or data to support any claim that medical aid-in-dying laws are subject to abuse. In fact, Bob Joondeph, Executive Director or Disability Rights Oregon (DRO), stated in February 2019, “DRO has never to my knowledge received a complaint that a person with disabilities was coerced or being coerced to make use of the Act.” To be clear, there is not a single substantiated case of abuse or coercion, nor any civil or criminal charges filed related to the practice. Since the implementation of Oregon’s Death With Dignity Act in late 1997, the Oregon Health Authority has collected comprehensive data about the implementation of the Death With Dignity Act. Each of the states and jurisdictions to pass medical aid-in-dying legislation since have followed suit by collecting and publishing similar reports on an annual basis. Oregon’s 22 annual reports, as well as additional resources and information about Oregon’s experience with medical aid in dying are available here. 

Both data and research indicate that the Oregon law works as intended, with no evidence of harm to vulnerable populations.

Many disability rights advocates support medical aid in dying. James Jackson, Executive Director of Disability Rights New Mexico, stated in his testimony before the New Mexico House Health & Human Services Committee that: “One of the, probably most fundamental rights that we support as an agency is the right to make your own decisions whenever you’re competent to do so. And that leads us to stand here in support of this bill [the Elizabeth Whitefield End of Life Options Act] …”

The late famed physicist Stephen Hawking summarized it succinctly. “We should not take away the freedom of the individual to choose to die,” he concluded in a BBC-TV interview. “I believe one should have control of one’s life, including its ending.”

Respecting the wishes of others

Medical aid-in-dying legislation is about providing all healthcare options to people at the end of their life and respecting their individual autonomy. Many people support medical aid in dying without knowing whether they would use it themselves because they feel it is right to honor the wishes of others.

How each of us spends the end of our lives is a deeply personal decision, and that decision should remain with the individual as a matter of personal freedom and liberty, without criminalizing those who help to honor our wishes and ease our suffering. This law will honor that freedom with appropriate protections to prevent any abuse.
– Senator Lois Wolk (D-California)

Section IV: How the Law Works 

FAQ: The Medical Practice of Aid in Dying

While you should focus on the heart of the matter when discussing this issue on the campaign trail — honoring and respecting a dying person’s decision to peacefully end their unbearable pain and suffering — understanding the medical realities are important for your credibility. Sometimes people who don’t understand how medical aid in dying works fill in the blanks on their own and confuse the practice with euthanasia or assisted suicide. For those people, setting the record straight solidifies support.

Who is eligible for medical aid in dying?

To receive a medical aid-in-dying prescription from a doctor, people must be over 18, have six months or less to live, be of sound mind, and they must take the medicine themselves (self-ingest).

What if people change their minds?

Across all jurisdictions where medical aid in dying is authorized, state reports show that between 1/4 and 1/3 of all of those who receive a prescription for medical aid-in-dying medication do not take the medication in the end. For many individuals who request medical aid in dying, just obtaining the medication provides them with peace of mind because they know they can peacefully end their pain and suffering, should it become unbearable.

How do people obtain and use medical aid-in-dying medication?

A terminally ill person must ask their doctor to prescribe aid-in-dying medication multiple times; generally two oral requests directly to the patient’s physician and one written request. The attending physician and a consulting physician must confirm the person has a medical prognosis of six months or less, is mentally capable of making their own decisions, is making the request voluntarily, and can self-ingest the medication. In addition, two witnesses must confirm the person is making the request voluntarily. Pharmacies either prepare the medication to be mixed into a liquid — water is the best, most effective option — or people open or dispense capsules to mix into a liquid. Usually, the dying person takes anti-nausea medication an hour prior to drinking the aid-in-dying medication. The aid-in-dying medication prescribed depends on the person and the prescribing doctor, but it often consists of a fast-acting barbiturate that causes a person to fall asleep into unconsciousness, and death usually follows quickly. It takes an average of five minutes for the person to become unconscious and 25 minutes to peacefully pass away. If you want to see a real life demonstration of how medical aid in dying works, watch this TV documentary about terminally ill Seattle, WA resident Bob Fuller using this end-of-life care option: www.youtube.com/watch?v=aOG6i2Mfu7E&t=2397

How well has medical aid in dying worked in the 10 jurisdictions where it is authorized?

Medical aid in dying is authorized in 10 jurisdictions nationwide: Oregon, Washington, Montana, Vermont, California, Colorado, the District of Columbia, Hawai‘i, New Jersey and Maine. There has never been a single legally documented instance of reported abuse. In Oregon, end-of-life care has measurably improved overall since the law’s implementation, in large part due to the dialogue the law encourages between dying people and their doctors. For instance, hospice referrals are up, as is the use of palliative care. Oregon now has the lowest rates of in-hospital deaths and the highest rates of at-home deaths in the nation, and violent suicide among hospice patients is virtually non-existent today. Almost two decades of rigorously observed and documented experience show us that the law has worked as intended, with none of the problems opponents had predicted.

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