State Lawmakers wrapped up their session without voting on the Medical Aid in Dying Act, which would allow terminally ill adults to ask their doctors for life-ending medication. It's been floating around chambers for a couple of years. But with a new democratic majority in the senate, chances appeared better for passage.
The legislation generated plenty of discussion surrounding end of life issues, and about the ethical dilemmas posed by this complicated and emotionally charged topic.
Some of us have witnessed a family member or friend with cancer or other painful disease live out their final weeks or months in discomfort, and probably wondered if their suffering could have ended sooner. Medically assisted death has been gaining support…ten states and the District of Columbia now allow it. Dr. Kim Overby is a clinical ethicist and Professor of the Practice at Cornell University.
“A couple things are factoring in here. One, is that Americans tend to prioritize autonomy or the right to determination, and have control and independence.”
And the other, she says, is most Americans don’t like to think about death, talk about it, or plan for it.
“And, when they do, they often express fear about untreated symptoms, particularly pain, and this loss of control at the end of life. I think aid in dying laws are maybe falsely juxtaposed as a peaceful death to what is perceived as being a frightening experience of dying, attached to machines, having little say or control.”
New York’s proposed legislation would give terminally ill patients, under very specific circumstances, the option to seek a doctor willing to help end their lives. This can present an ethical dilemma. Dr. Mary Ann Millar is president of the Onondaga County Medical Society and a practicing gynecologist.
“There are doctors in the community that feel that doctors are healers, and we have our patient’s best interest at heart, obviously. They feel this would go against being a healer to help someone end their life. On the other hand, equally passionately, there are physicians around the country that help patients with transitioning into death, and they also feel passionate about that they are alleviating pain and helping people to transition into that next stage.”
Millar says the county and state medical societies have long been opposed to medical aid in dying. Dr. Overby at Cornell says it conflicts with the goals of medicine.
“The traditions of this profession are to emphasize care and comfort, and that physicians really should not participate in intentionally ending a person’s life. I think a lot of physicians and health care professionals feel this would fundamentally change the nature of the patient-clinician relationship, and ultimately undermine patient trust.”
Overby says there’s also the concern that legislation would undermine the public health efforts to prevent suicide. She says states with aid in dying laws have seen an increase in “unintentional” suicides because some see it as a rational way to deal with suffering. Dr. Millar with the medical society says the legislation should not be seen as an alternative to hospice, for example.
“We don’t want anyone to have to suffer at the end of their life. So, we want adequate pain control, both emotionally and physically. One thing that the medical society is looking into now are educational opportunities is residency for our physicians and physicians who are practicing so physicians are aware of all the options for their patients."
Dr. Overby with Cornell says medical aid in dying is so complex, with its almost unlimited number of circumstances that it’s very difficult to properly address with legislation.
“One of the major concerns for both clinicians and individuals is there may be some decisions opting for this practice that may not have been made had the person had access to other supports. For example, concern about untreated or inadequately treated depression or other mental health issues. There is variability in access to mental health, hospice, palliative care, and social support services."
The medical society’s Dr. Millar says any measure would also have include safeguards against potential abuse by doctors and patients.
“Even though the medical society does oppose this legislation, it doesn’t mean that we don’t want to be at the table. We want to help the legislators, we want to read the bills and help them to make it as good as it possibly can be so that there aren’t abuses, and that only patients who are really at the end of their life get this kind of care," she said.
"One of the good things about this discussion is it’s focusing more on the end of life care that we have now, and how can we make it better.”