Medical aid in dying respects a patient’s rights

BOSTON, MA–January 23, 2009– harvards med school relationship wtih pharmaceutical companies The Elizabeth Whitefield End of Life Options Act would provide dying patients who find their suffering unbearable the choice of hastening an inevitable death. Under certain conditions, their providers would be able to write a prescription for medication that would end their lives peacefully. This is not a question of life versus death. All of these patients would be close to death. The question is simply the manner of an imminent death.

Good palliative care can provide adequate relief for the great majority of dying patients, but not all. Most pain can be treated, but other symptoms are harder to deal with — profound weakness, loss of control of bodily functions, shortness of breath, nausea — and the drugs to treat these symptoms often produce unacceptable side effects. Even worse for many dying patients is the existential suffering. They know their condition will worsen day by day until their deaths, that their course is inexorably downhill, and they find it meaningless to soldier on.

If the act passes, Gov. Michelle Lujan Grisham has said she will sign it. That would make New Mexico the ninth jurisdiction in the United States to have approved this form of aid in dying.

Oregon, which implemented its Death with Dignity Act 20 years ago, has had the most experience. Over that time, medical aid in dying has accounted for only 1 in 250 deaths (0.4 percent) in the state. The great majority of these patients were suffering from metastatic cancer. Almost all were already enrolled in hospice care at the time of their decision.

The principal reasons they gave for choosing aid in dying were the loss of autonomy and dignity, and the inability to engage in activities that made their lives meaningful. Pain was relatively low on the list. There have been no documented instances of abuse since the Oregon law was implemented. No law works perfectly, but this one seems to come about as close as possible. (Detailed information is available on the Oregon Health Authority, Division of Public Health website.)

For many years, the medical establishment opposed aid in dying because, according to the American Medical Association, it is “fundamentally incompatible with the physician’s role as healer.” That is changing. Much of organized medicine now seems to recognize that when healing is no longer possible, the physician’s role must shift from curing to relieving suffering in accord with the patient’s wishes.

In states with medical aid in dying, as well as some others, the state medical societies have withdrawn their opposition. The New Mexico Medical Society has now adopted a position of neutrality.

There is also some inconsistency to physicians’ opposition, because they don’t (and legally, can’t) object to withdrawing life-sustaining treatment if that is what the patient wishes. For example, a patient can ask to have a mechanical ventilator removed or decline further dialysis for kidney failure, because they want an earlier, more peaceful death. Medical aid in dying is analogous. It should simply be one more option for desperately ill patients, a part of good and sensitive medical care as a last resort.

Why should anyone — the state, the medical profession, or anyone else — presume to tell someone else how much suffering they must endure at the end of their lives? Medical aid in dying for patients facing imminent death and whose suffering can’t be relieved is both compassionate and respectful of a patient’s right to self-determination.

Dr. Marcia Angell is a semi-retired physician who has lived part-time in Santa Fe for the past five years and plans to live here permanently. Her primary home is in Boston, where she served as editor-in-chief of the New England Journal of Medicine and taught medical ethics at Harvard Medical School.

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