Medical Aid in dying

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What are your thoughts on death with dignity legislation? How has it impacted your job?

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I am caring for a triple negative Stage 4 breast cancer patient who had such a negative, physical reaction to chemo that she just said "I'm done." and refused any further treatment. She was just diagnosed in January 2023 during an annual mammogram. (The first thing she asked me in February is "Can you help me? I don't want to be here anymore.")

Two weeks ago, Vermont opened their borders and their Death with Dignity protocols to NY and other out-of-state residents. My client must travel to VT for three evaluations and would typically take the medication in VT when she is ready - a fourth visit. (We live one hour from the VT border...) She is not allowed to bring the medication to NY for consumption.

So, there are travel logistics and practical issues to determine. She has already found and met with a physician (via Zoom) who is willing to take her as a client. She is now talking about modifying her will, ensuring she has a green burial, etc.

Of bigger issue is the psychological impact of the "impossible" suddenly becoming "possible". (NY's death with dignity bill is languishing at the state capitol.) I can see much impact on her care - both in terms of her having to travel while bed-ridden; needing to meet medical competency testing norms while under an increasing amount of morphine; dealing with the reality that she now has the challenge/opportunity and control of timing her death.

Also, many people rely on the local hospice organization to provide medication and some supplies to hospice patients. What impact will this have on their services??? Will they cooperate with patients wishing to leave the state for death with dignity? Will they pull services, medication and supplies from those patients?

Of concern to me is: The state of my licensure (New York) does not have a Death with Dignity law that protects healthcare givers. If I travel with my client to VT (which she wants me to do) - am I placing myself and my license in jeopardy by violating the NY Practice Act even though it is legal  where the action takes place (in Vermont)?

This is something I will need to consult with a competent authority about.

 

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We have MAID in California. Information dissemination is the biggest issue. People might want it, but don't realize there is a process that takes about 4 weeks. Two doctors, psych eval, then med processing. Most here use an online pharmacy once scripts written by doctor. Some will say, okay now I want it, then are too weak to do all the steps by themselves. Maybe once it is has been available for more time and more people know people that have done it, they will understand there needs to be a plan. It is not a spontaneous decision for a 'legislated' reason. 

 

 

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SunDazed said:

Maybe once it is has been available for more time and more people know people that have done it,...

 

 

Wow. I had no idea that CA had this option...! Thanks for sharing that! I just asked my daughter (in San Diego) if she'd ever heard of it - and she said "no"...

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Specializes in School Nursing.

I am an advocate for death with dignity legislation. Virginia doesn't have any such laws, but I hope that will change in the future. I believe that we have the right to choose how we live, why can't we choose how we die? I know that I certainly don't want to die in agonizing pain, have no quality of life. There is a wonderful documentary called "How to Die In Oregon". It was absolutely an enlightening film, and very informative. I suggest it to anyone who is an advocate to see how the system there works. 

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I have watched that documentary twice (at least). It is very well done, has high production values and truly seems to sensitively explore this deep topic. I also highly recommend it...

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Specializes in Mental Health, Gerontology, Palliative.

We have assisted dying legislation (NZ)

- patient has to raise the subject, under no circumstances is the health practitioner allowed to mention it. 

- there are two independent assessments and a third competency if anyone feels it is needed. 

- The process can be stopped at any time. 

- It does not occur in a hospice. We had a patient who was in god awful pain despite being on a butt ton of medications with only minimal effect decided to go this route, on the day was transported back home where the SENZ doctor administered the medications

We are happy to use medication and medical science to extend life yet seem to think that it is somehow bad to use medical science to reduce a patients suffering and (at the patients request) help bring about an end to their suffering

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Specializes in Hospice/Palliative Care.

I support MAID 100%. It is legal in the state I practice in. It hasn't impacted my job in any way. If anything, most agencies are so paranoid about it, preventing practitioners to be in the room when the patient takes the medications, but the reality is that prohibiting practitioners to be present sends a certain message to the patient and loved ones.

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This is the stuff I worry about, and that's just for starters. Read this to the end. The road to hell is paved with good intentions....

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offlabel said:

This is the stuff I worry about, and that's just for starters. Read this to the end. The road to hell is paved with good intentions....

Thank you for the link. When I first started reading I hoped that no one would confuse the philosophical term of liberal with liberal democrats in American politics. It is definitely more the libertarian ideology in American politics today, than democrat.

I can't respond fully because I need to digest all of this. But my initial thoughts...

MAID (medical aid in dying) in California is not euthanasia. The person has to consent and seek providers, and meet guidelines. It is confusing that MAID term is used in Canada and seems to include euthanasia? Though not the kind where someone says "if I am ever to this point..." It seems more like a couple of providers and maybe an ethics person can make the determination with or without the informed consent of the person's quality of life warranting the continuation of life? That is like when they legally sterilized people in the US up until the 1970's for being 'unfit'. Never mind the prison doctor's who may still be sterilizing women they deem unfit for motherhood.

I am not surprised this came from Mill's wife. She lived in a time when women did not vote, and if wealthy and educated were probably mostly in arranged marriages for the financial benefit of the family of both parties. Of course she wanted to make choices about her life and lifestyle. Context people!

David Brooks, the author, must have a very rich life filled with connections and relationships. I live thousands of miles from most of my family. I have no kids. New to my community just before Covid, it has been a challenge to become integrated into the community even though I have a service based career.

I see so many patients in hospice who have no one. I am in some land of black sheep, who do not naturally band together in their blackish sheepishness. And maybe I am a black sheep for throwing off the coat I was given by my parents?  Sometimes it is amazing the created families that exist. Sometimes it is so sad that there is no one else, just conserved to have a representative who tries to be their best champion. 

I believe in life. I have born witness to suffering near the 'natural' end of life. I believe people can have different ideas of quality of life. Yes the example in the story changed when what she thought life would be was different when she got there. For my mom, never reading and comprehending what she read, ever again... was enough to lose her fight for life. She didn't use anything like MAID. She just gave into her struggle. Dad on the other hand would have been like his mother. If she woke up at all, bed bound and frail, that was enough to make it a good day.

I do believe we should have a choice. It will never be black and white. And if we could fix loneliness in the world today, we might be able to figure this all out. In a community racked with homeless, houseless, addiction, and isolation.... it is a luxury to think about the various types of liberalism presented.

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Specializes in Mental Health, Gerontology, Palliative.
offlabel said:

This is the stuff I worry about, and that's just for starters. Read this to the end. The road to hell is paved with good intentions....

In the same vein. I had a patient who had terminal cancer, was  dying just slowly. This person applied to the assisted dying scheme and was declined because their life expectancy was still over 6 months. 

I've had colleages who felt that the scheme should  have been relaxed for this person. IMO the reason it wasnt was because of peoples concerns of a slippery slope and if the criteria is relaxed for one person it will be relaxed for all people and situations. 

In New Zealand there were 807 applications for an assisted death 328 of those went through to the end and had an assisted death. I get that this is a polarising subject I think that stats are important.,

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Tenebrae said:

In the same vein. I had a patient who had terminal cancer, was  dying just slowly. This person applied to the assisted dying scheme and was declined because their life expectancy was still over 6 months. 

I've had colleages who felt that the scheme should  have been relaxed for this person. IMO the reason it wasnt was because of peoples concerns of a slippery slope and if the criteria is relaxed for one person it will be relaxed for all people and situations. 

In New Zealand there were 807 applications for an assisted death 328 of those went through to the end and had an assisted death. I get that this is a polarising subject I think that stats are important.,

After one year, 40% of applicants were permitted to use the medical system to end their lives in NZ. Canada's system has grown by about 30% per year since 2016. The trend is pretty demonstrable and as MAID becomes more and more accepted, the duty to die will become more and more a reality for many, many people that could be treated by competent pain practitioners and mental health professionals. There is a big difference, IMHO, between the medical/nursing establishment being used to directly and intentionally end a life and someone dying secondarily from analgesia not intended to directly cause death.  I'm afraid the genie is out of the bottle.

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