What does “end-of-life options” refer to?
Not aimed at curing illness, end-of-life options focus on comfort, dignity and quality of life. These options include:
- Palliative care — pain and symptom management.
- Hospice — holistic comfort care.
- Voluntarily stopping eating and drinking (VSED) — refusing food, liquids or artificial feeding to shorten the dying process.
- Declining or stopping life-sustaining treatment — refusing medications or procedures to treat health conditions.
- Continuous deep sedation/palliative sedation — Medicating patients to reduce consciousness to relieve extreme pain and suffering, usually resulting in death.
- Medical aid in dying — A practice in which a terminally ill adult has the option to ingest medication prescribed by their doctor to end unbearable suffering and die peacefully in their sleep. This option is currently authorized in the District of Columbia and eight states: California, Colorado, Hawai‘i, Montana, New Jersey, Oregon, Vermont and Washington. On Sept. 15, Maine will become the 9th state and 10th jurisdiction to authorize it.
- Continuing current measures, even if they seem ineffective.
How does medical aid in dying work?
Medical aid in dying is the practice in which a mentally capable, terminally ill adult with less than six months to live has the option to request prescription medication from their doctor they can decide to ingest to die peacefully if their suffering becomes unbearable. Many people who get the medication do not take it, but simply having the option can relieve anxiety about needless misery at the end of their life.
Does medical aid in dying differ from euthanasia?
With medical aid in dying, the terminally ill person must take the medication themselves and, therefore, always remains in charge. In contrast, euthanasia, illegal throughout the United States, requires a third party to administer medication, commonly via an injection. It is often performed on somebody who may not have the mental capacity to give informed consent.
What’s wrong with referring to medical aid in dying as “assisted suicide”?
Factually, legally and medically speaking, it is inaccurate to equate medical aid in dying with assisted suicide. The Oregon, Washington, Vermont, California, Colorado, Hawai‘i, New Jersey, Maine and District of Columbia laws emphasize that: “Actions taken in accordance with [the Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.” This distinction is because a person who seeks medical aid in dying already has a terminal prognosis of six months or less to live. They are not choosing to die; a disease is taking their life. They are choosing not to prolong a difficult and painful dying process.
Assisting a suicide remains a felony in states where medical aid in dying is authorized. According to the American Psychological Association, medical aid in dying and suicide have “profound psychological differences.” (See Compassion & Choices’ Medical Aid in Dying Is Not Suicide fact sheet for more information.)
Suicide is often impulsive and violent, is usually done alone and caused by a mental illness, and traumatizes the person’s family and caregivers afterward. Medical aid in dying happens with family and loved ones present if preferred, is planned, is gentle, can only be used by a mentally capable person, and the family and care team grieves normally.
Where does the American public stand on medical aid in dying?
The American public consistently supports medical aid in dying by large majorities across the demographic, geographic, political and religious spectrum, including age, ethnicity, party and religious affiliation, people with disabilities, physicians, and gender identification.
Why do we need this option if people can get painkillers in a lethal dose?
It is cruel to abandon people by making them rely on “self-help” efforts at the end of life. Ingesting an unspecified amount of medication in an attempt to end an agonizing, prolonged dying process, without professional knowledge of the specific medication’s side effects or symptoms before death ensues, is never advisable. People can end up suffering even more if their efforts to die peacefully fall short. Furthermore, by criminalizing medical aid in dying, we are forcing dying patients to act in secrecy, spending their final moments alone. Nobody should have to die alone, and no family member should have to endure finding a loved one who resorted to ending their suffering in isolation when another more humane option is possible.
If someone wants to end their life, can’t they just do so with a gun or street drugs?
Violent means should not be a recommended public policy solution to a very real problem. Forcing a dying person to resort to violence or to committing a crime to end their suffering when there is a valid option that allows them to have support from their medical team, family, friends and spiritual guidance lacks compassion and an understanding of the issues. The impact of suicide, especially violent suicide, on a person’s family is extraordinarily traumatic and often evokes emotions of shame or failure from family members. Respondents to a study of Oregon hospice nurses and social workers reported family caregivers of terminally ill patients who chose to use medical aid in dying, “were more likely to find positive meaning in caring for the patient and were more prepared for and accepting of the patient’s death” than family caregivers of terminally ill patients who did not request medical aid in dying. A mental health survey of 95 Oregon families whose loved ones opted to use medical aid in dying after exhausting other palliative care options yielded similar results.
Only a small number of people access this law; why spend time on it when there are so many other pressing issues in the healthcare system?
In the states that have already authorized medical aid in dying, people report significant relief from worry about future physical and emotional pain just from knowing the option is there should they need it, regardless of whether or not they pursue it. In other words, the availability of this option significantly improves the quality of remaining life for people who are dying. Those living with terminal illness report that the availability of this option greatly lifts their mood and relieves anxiety. What’s more, multiple reports, polls and studies have concluded that medical aid in dying promotes appropriate and increased hospice use, and results in greater knowledge about palliative, end-of-life and hospice care, and better palliative care training of physicians.
Have there been any incidents of abuse?
In the more than 40 combined years of experience with medical aid in dying in states where it is authorized, there has not been a single substantiated accusation of abuse or coercion. Medical aid-in-dying laws work as intended. Terminally ill people who choose medical aid in dying are almost always under hospice care, where an interdisciplinary team that includes social workers, nurses and clergy screen them regularly to ensure they remain mentally capable and are acting voluntarily.
Furthermore, medical aid-in-dying laws make it a felony to coerce someone to request the medication or to forge a request. Under existing laws, two physicians must certify that the person’s request is informed and free of undue influence or coercion, and two witnesses who personally know the dying person have to attest that the person is making a voluntary, informed decision and without undue influence or coercion. In addition, only the dying person may self-administer the medication; administering the medication by any other person is a felony.
Won’t profit-driven health insurers and HMOs encourage medical aid in dying to save money?
A research article from the New England Journal of Medicine, co-authored by an opponent of medical aid in dying to ensure objectivity, concludes insurers have no financial incentive to pressure patients to accelerate their deaths because there are “no substantial cost savings.”
This myth is further dispelled by the fact that 90.2% of people in Oregon who choose medical aid in dying are enrolled in hospice care and not receiving expensive or intensive treatment. Hospice enjoys nearly universal insurance coverage, and hospices have charitable funds to cover those who cannot afford it. Medicare and Medicaid fully cover hospice services, with no lag or delay in payment, as with some other services. Hospice is significantly less expensive than treatments meant to extend life, which occur before a person becomes eligible for medical aid in dying. In short, consideration of medical aid in dying comes at a time when the cost of care is low, and there is no financial incentive to encourage people to choose this option.