Oct. 5 marked the 7th anniversary of the signing of California’s compassionate law allowing terminally ill adults to get prescription medication they can decide to take to peacefully end unbearable suffering: the End of Life Option Act. Coincidentally, Oct. 27 is the 25th anniversary of the implementation of our nation’s first medical aid-in-dying law in neighboring Oregon: the Death with Dignity Act.
So what have we learned about how these laws work?
As a hospice and palliative care specialist who prescribes medical aid in dying, I know this option is invaluable when even the best hospice and palliative care cannot provide relief from intolerable suffering. Regardless of whether a terminally ill individual takes the medication, they get great comfort from just having it if needed.
Unfortunately, medical aid-in-dying opponents recently filed a federal lawsuit challenging the constitutionality of the newly amended version of the End of Life Option Act that improves terminally ill Californians’ access to it, Senate Bill 380. Sadly, these opponents are trying to derail the real conversations our nation needs to have about the end of life.
People with six months or less to live who qualify for medical aid in dying are often facing complex serious illnesses.
Many are in hospice, just waiting for their suffering to end, because no amount of medication, comfort measures, pain, or other symptom management is going to help with the course of improving their symptoms or their disease burden until their last breath.
To better understand what medical aid in dying actually is and what it is not, let us explore it along with the other end-of-life care options in medicine available nationwide.
First, medical aid in dying is entirely voluntary—if it is not right for any given patient or doctor, they can opt-out. The main difference in all the alternative options to medical aid in dying – voluntary stopping eating and drinking (VSED), compassionate extubation, comfort care, and continuous sedation – is that in medical aid in dying, the physician writes for these medications and the patient ingests them on their own, often in their home setting. These medications do not need to be administered in the hospital or facility setting as they have to in the practice of palliative sedation or comfort care.
The intent of all these options is to ensure that the patient has a comfortable death. None of these care options will result in a patient’s living.
So why then single out medical aid in dying, if the difference is primarily giving an eligible patient who is facing death the ability to die peacefully in their own private space, surrounded by the loved ones they want in their final hours, rather than in a facility?
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Why not let dying individuals have the autonomy of deciding the date and time of their departure, knowing what they have been through as they explored everything to cure their disease?
Who are we to not allow them to at least have peace of mind during their last days on earth, because we may not believe it is the right thing for ourselves?
Our greatest ability as human beings is to feel empathy for other people. As clinicians, would asking for the acceptance of medical aid in dying as a highly regulated medical practice be unreasonable if it provided a humane end to patients eligible for it?
I personally find it going against my conscience and moral beliefs if I do not advocate for medical aid in dying to help my eligible patients secure it as an option if they should decide to pursue it. I would not want anything less for myself.
Chandana Banerjee is a hospice and palliative care physician at a cancer institute in the Los Angeles area.