Guest opinion: Medical aid in dying is legal, but not tested
Most people want a peaceful death. About 70 percent of us say we want to die at home, and 80 percent of chronically ill patients want to avoid intensive care. Nonetheless, only about one-fourth will die at home, surrounded by loved ones.
My father-in-law Irv died of lung cancer with chronic pain from a leg fracture that was never set properly. I’d loved him 32 years by then and knew he had always wanted to control his own death. He was home with a plentiful supply of lethal painkillers. He rarely used them.
Nearing death, he wanted to be fully present with loved ones more than he wanted pain relief. Contrary to his anticipations, he chose to live life out. But he felt stronger, “better,” because having those drugs left him in charge of his life. Irv’s death had a profound impact on me, one that led me to actively support allowing everyone the same choices Irv had.
In November 2016 Colorado voters gave terminally ill adult Coloradans a new lawful option. Approved by two-thirds of voters, Colorado’s End of Life Options Act is now in effect. It allows doctors to participate in medical aid in dying (MAID). It requires eligible patients to be mentally capable of making rational decisions and physically capable of ingesting medication unassisted.
Eligible patients must be terminally ill, with six months or less to live in the opinion of their treating physicians, and a second physician must concur. Patients must make two verbal requests for potentially lethal medication, with said requests separated by at least 15 days. Somewhere in there, they must make a written request witnessed by two adults, at least one of whom has no interest in the decision.
Strong evidence suggests that, just as for Irv, having a MAID option brings comfort to those who might use it, regardless of whether they ultimately do so. Having access to a wider range of end-of-life options also brings end-of-life better care by facilitating deeper conversations among patents, doctors and families.
However, getting MAID is not yet well established in Colorado. The law is new and untested. Health-care systems cannot prohibit doctors from discussing MAID with patients and from prescribing when medically appropriate, but no doctor must prescribe, and doing so may be technically or morally challenging for physicians not yet experienced in these matters. So, if you think you might someday request medical aid in dying, realize that your request may be as unique and difficult for your doctor and your family as for you. The sooner you begin a conversation, the more time everyone will have to explore its implications.
If you are in good health and anticipate many happy years, so much the better. Your doctor will recognize your eventual request as thoughtful rather than impulsive and your loved ones won’t be caught by surprise during difficult times.
I’ve talked about this subject with my loved ones over the years. Most were reluctant to have the discussion but, knowing how important it is to me, they always participated.
More recently, I’ve talked with three doctors. Once was during casual conversation with a nurse who was telling me about videos she had seen on this subject. The doctor happened to walk in, overheard and volunteered, “I’m all for it. No one should have to suffer needlessly.” The second was a physician friend who helped me with advice and information for my educational work. I also talked with my primary care physician about my values, and where he stands on MAID. It was not our first conversation on the subject, but the first since MAID became lawful. He remained favorable and supportive.
If you are not terminally ill, you might begin a conversation with your own doctor by saying, “Should I one day become terminally ill and want to consider medical aid in dying, can I count on you for the information I’ll need and your support for my end-of-life decisions?”
If you are terminally ill might start by asking, “Am I eligible for medical aid in dying? If yes, will you write a prescription in accordance with Colorado law if I request one? If no, will you refer me to a doctor willing to prescribe? If I’m not eligible now, when in your opinion, should I expect to be eligible?”
Medical aid in dying is an option of last resort for terminally ill adults when palliative treatment provides inadequate relief from intolerable suffering. It is a safe and trusted medical procedure to achieve a peaceful death. Terminally ill adults should always be empowered to make treatment decisions based on their personal beliefs and values, including a full range of end-of-life options. While I am currently healthy, it’s comforting to know that a wide range of options will be available when my time comes, and that my loved ones and doctors are already engaged discussing them with me. Having these conversations as soon as possible helps everyone, including doctors, come to grips with life’s inevitable final adventure.
Ron Kokish of Carbondale is a volunteer for Compassion and Choices’ Western Slopes team.