Medical Aid-in-Dying 4348 Waialae Avenue #927 Honolulu, HI 96816 800 247 7421 phone CompassionAndChoices.org What Is Medical Aid in Dying? Medical aid in dying is a safe and trusted medical practice in which a terminally ill, mentally capable adult with a prognosis of six months or less to live may request from his or her doctor a prescription for medication which they can choose to self-ingest to bring about a peaceful death. Prior to providing a prescription for such medication, doctors must confirm that the person is fully informed and provide the person with information about additional endof-life options, including comfort care, hospice and pain control. Where Is Medical Aid in Dying Authorized? Medical aid in dying is currently authorized in six states, either through statute or court decision: Oregon (1994, ballot initiative) 1 Washington (2008, ballot initiative) 2 Montana (2009, state Supreme Court decision) 3 Vermont (2013, legislation) 4 California (2015, legislation) 5 Colorado (2016, ballot initiative) 6 1 http://public.health.oregon.gov/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/ors.aspx. 2 Washington Death With Dignity Act. Complete Chapter 70.245 RCW, Complete Chapter. Enacted November 4, 2008. Available from http://apps.leg.wa.gov/rcw/default.aspx?cite=70.245. 3 Montana Supreme Court Ruling, Available from: https://www.compassionandchoices.org/wpcontent/uploads/2017/01/montana-supreme-court-opinion.pdf 4 Vermont Patient Choice and Control at the End of Life Act. Act 039, Chapter 113. Enacted May 2013. Available from http://www.leg.state.vt.us/docs/2014/acts/act039.pdf. 5 California End of Life Option Act. SB-128 End of Life. Enacted October 2015. Available from http://leginfo.legislature.ca.gov/faces/billnavclient.xhtml?bill_id=201520160sb128&search_keywords= 6 Colorado End of Life Options Act, Proposition 106, Passed November 8, 2016, Pending implementation. Retrieved from: http://coendoflifeoptions.org./wp-content/uploads/2016/06/full-text-of-measure.pdf
The District of Columbia also voted to pass similar legislation in 2016, which is now under Congressional review. Additional laws are being considered in more than 20 states. Medical Aid in Dying is a Safe and Trusted Practice Medical aid in dying is a safe and trusted medical practice because the eligibility requirements ensure that only a mentally capable, terminally ill adult with a prognosis of six months or less are able to request and obtain from his or her doctor a prescription for medication which they can choose to self-ingest to bring about a peaceful death. The prestigious and peer-reviewed Journal of Palliative Medicine published clinical criteria for medical aid in dying which physicians use to ensure that the practice meets the highest standards of medical care. 7 The states that authorized medical aid in dying through legislation modeled their bills after Oregon s Death With Dignity Act. 8 Each state s regulatory and procedural requirements are slightly different, but all the legislation includes the following provisions, among others: The person must be fully informed of all their options The person must request the prescription from a physician and be free from undue influence or coercion The person must be able to take and ingest the medication by themselves Wills, contracts, insurance and annuity policies are not affected by a person choosing medical aid in dying Medical aid in dying is not considered suicide or assisted suicide How Well Has Medical Aid in Dying Worked in the States That Have Authorized It? In the more than 30 combined years of medical aid in dying in the authorized states, there has not been a single instance of documented abuse. Almost two decades of rigorously observed and documented experience in Oregon shows us the law has worked as intended, with none of the problems opponents had predicted. 7 Orentlicher, D., Pope, T.M., Rich, B.A. (2015) Clinical Criteria for Physician Aid in Dying. Journal of Palliative Medicine. 18(x): 1-4. 8 http://public.health.oregon.gov/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/ors.asp x.
In Oregon: End-of-life care has improved overall since the law s implementation, in large part due to the dialogue the Death With Dignity Act encourages between people and their doctors. 9 Hospice use is high and referrals are up, 10 as is other use of palliative care. Some hospice programs in Oregon reported a 20 percent increase in referrals since the medical aid in dying was authorized. 11 In-hospital death rates are the lowest in the nation and at-home death rates are the highest in the nation, and violent suicide among hospice patients has virtually disappeared. 12 Medical Aid in Dying Improves Care at the End of Life Medical aid in dying is one option on the palliative-care spectrum that has shown a number of benefits. Doctors report that a patient s questions about medical aid in dying prompt deeper conversations about their end-of-life care options, including hospice, pain management and emotional support in addition to medical aid in dying. Several research studies in Oregon and Washington along with multiple national surveys show the availability of medical aid in dying has positive outcomes for end-oflife care. A study of hospice nurses and social workers in Oregon reported that symptoms of pain, depression, anxiety, and fear of the process of dying were more noticeable in hospice patients who did not request aid-in-dying medication, 13 which shows a strong palliative care benefit for having an aid-in-dying prescription on hand. Where Does Hawaiʻi Stand on Medical Aid in Dying? The Governor s Blue Ribbon Panel on Living & Dying with Dignity, Final Report, June 1998, recommended changing existing laws, rules and practices to give wider choices in end-of-life decisions, including medical aid in dying. Numerous polls from multiple sources, both nationally and at the state level, demonstrate that the American public consistently supports medical aid in dying. A 2016 Lifeway Research 9 Variation of Hospice Use Patterns at the End of Life. Journal of Palliative Medicine. 18(9), 778. 10 Variation of Hospice Use Patterns at the End of Life. Journal of Palliative Medicine. 18(9), 775. 11 Lee, M,A, & Tolle, S.W. (1996) Oregon s assisted suicide vote: The silver lining. Annals of Internal Medicine. 124(2), 267-269. 12 Variation of Hospice Use Patterns at the End of Life. Journal of Palliative Medicine. 18(9), 775. 13 Ganzini, L., T.A. Harvath, A Jackson, et al. (2002) Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicide. The New England Journal of Medicine.. 347 (8): 585
survey 14 put national support for medical aid in dying at 67%. A survey 15 of registered voters in the state conducted in November 2016 revealed that eight out of 10 Hawaiʻi voters (80%) agreed that a mentally capable adult [who] is dying of a terminal disease that cannot be cured definitely (55%) or probably (25%) should have the legal option to request prescription medicine from their doctor, and use that medication to end their suffering in their final stages of dying. A majority of Catholic respondents (82%) and those associated with the Christian Fellowship (83%) said terminally ill adults definitely or probably should have this authorized option. Hawaiʻi s Proposed Death with Dignity Act The legislation proposed in Hawaiʻi builds upon the lessons learned in Oregon, where 19 years of safe and compassionate practice allows policymakers in other states to learn about the law s implementation and the benefits it provides for those who wish to access it. The proposed Hawaii Death with Dignity Act affirms the right of mentally capable, terminally ill adults to determine their own medical treatment options as they near the end of life. Medical Aid in Dying Has Strong Support From Physicians and Professional Organizations Among U.S. physicians, support for medical aid in dying is also strong. A Medscape poll 16 of more than 7500 physicians from more than 25 specialties showed a significant increase in support for medical aid in dying from 2010. Today more than half (57%) of the doctors surveyed endorse the idea of medical aid in dying, agreeing that Physician assisted death should be allowed for terminally ill patients. In addition to Compassion & Choices, national public health and medical organizations such as the American Public Health Association, American Medical Women s Association and American Medical Student Association have adopted supportive positions on medical aid in dying at the national level. In California, the End of Life Option Act (signed into law in October 2015) was endorsed by more than 75 organizations including the American Nurses Association/California, California Psychological Association and California Primary Care Association. Most of the medical associations in authorized states currently have neutral positions on medical aid in dying including Oregon, California, Washington and Colorado. Medical aid in 14 American Views on Assisted Suicide, Lifeway Research, September, 2016. Available from: http://lifewayresearch.com/wp-content/uploads/2016/12/sept-2016-american-views-assisted-suicide.pdf 15 Hawaii Voters Express Overwhelming Support for Medical Aid in Dying Option, November 2016. Polling Summary Available from: https://drive.google.com/a/compassionandchoices.org/file/d/0b9vexfxcqxuoekf5wgw5cxbmrgc/view?usp=shar ing 16 Medscape Ethics Report 2016: Life, Death, and Pain, December 23, 2016. Available from: http://www.medscape.com/features/slideshow/ethics2016- part2#page=2
dying was vigorously debated by the Oregon Medical Association (OMA) nearly twenty years ago; at that time OMA reached a neutral position. More recently, the California Medical Association (CMA) was the first state medical association in the country to withdraw its opposition 17 to medical aid in dying in the midst of an active policy debate. To see a current list of medical and healthcare professional associations that have taken positions of support or neutrality on medical aid in dying visit the Understand the Issues page at www.compassionandchoices.org. Medical Aid in Dying is Not Euthanasia Medical aid in dying is fundamentally different from euthanasia. With medical aid in dying the terminally ill person must take the medication themselves and therefore always remains in control. Euthanasia is commonly given as a lethal injection by a third party. It is often performed on somebody who does not have a terminal diagnoses and is illegal throughout the United States. Compassion & Choices doesn t support euthanasia because someone else not the dying person chooses and acts to cause death. Medical Aid in Dying is Not Assisted Suicide Factually, legally and medically speaking, it is inaccurate to equate medical aid in dying with assisted suicide. People who consider medical aid in dying find the suggestion that they are committing suicide deeply offensive, stigmatizing and inaccurate. The Oregon, 18 Washington, 19 Vermont, 20 California 21 and Colorado 22 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 is because a person who is choosing medical aid in dying already has a terminal prognosis of six months or less to live. They are not choosing to die; the disease is taking their life. The terminally ill person who chooses medical aid in dying is simply choosing not to prolong a difficult and painful dying process. 17 California Medical Association. Excerpted from: CMA changes stance on physician aid in dying, takes neutral position on End of Life Option Act. June 2, 2015. Available at http://www.cmanet.org/news/detail/?article=cma- changes- stance- on- physician- aid- in- dying. 18 http://public.health.oregon.gov/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/ors.asp x. 19 Washington Death With Dignity Act. Complete Chapter 70.245 RCW, Complete Chapter. Enacted November 4, 2008. Available from: http://www.wsha.org/wp-content/uploads/death-with-dignity_i1000-text.pdf. 20 Vermont Patient Choice and Control at the End of Life Act. Act 039, Chapter 113. Enacted May 2013. Available from: http://www.leg.state.vt.us/docs/2014/acts/act039.pdf. 21 California End of Life Option Act. ABX2-15 End of life. Enacted October 2015. Available from: http://leginfo.legislature.ca.gov/faces/billtextclient.xhtml?bill_id=201520162ab15 22 Colorado End-of-Life Options Act, Proposition 106, Passed November 8, 2016, Pending implementation. Retrieved from: http://coendoflifeoptions.org./wp-content/uploads/2016/06/full-text-of-measure.pdf